Healthcare Providers' Experience with Saudi Arabia's 937 Virtual Medical Call Centers and Telehealth.

Introduction: This cross-sectional descriptive study evaluates the experiences and perceptions of healthcare providers (HCPs) regarding the 937 medical call center in Saudi Arabia, a key telemedicine initiative. Aim:  To assess HCP satisfaction, identify challenges, and provide recommendations for improvement. Methods: Conducted from November 20th to December 15th, 2022, the study surveyed 454 HCPs, achieving a 90.5% response rate. Results: A majority (86.8%) of respondents were satisfied with the call center, valuing its ease of use and effectiveness in healthcare delivery. However, challenges such as the accuracy of remote medical assessments, the need for clearer telehealth regulations, and concerns over management support and consultation overlaps were identified. The study also highlights the importance of ongoing support and updates, comprehensive telehealth regulations, integration of more medical specialties, and improvements in system integration and data confidentiality. Conclusion: The study underscores the need for strategic enhancements to the 937 call center to further improve healthcare accessibility and efficiency in Saudi Arabia. These enhancements are vital for aligning telehealth services with Saudi Arabia's healthcare objectives under Saudi Vision 2030.

Oral Candidal carriage and associated risk indicators among adults in Sakaka, Saudi Arabia.

BACKGROUND: Candida is a ubiquitous organism in nature which inhabits the oral cavity as part of the normal microbial flora. The oral carriage of Candida is perpetuated by several predisposing factors. METHODS: This cross-sectional study was designed to investigate the carriage rate of Candida among 104 voluntary adults at the college of medicine - Jouf University. The concentrated oral rinse technique using Sabouraud Dextrose agar medium supplemented with 0.05% Chloramphenicol was used to isolate Candida. The relative factors affecting the colonization of Candida and the concentration of each type were also determined. RESULTS: Candida species were isolated from the oral cavity of 45 (43.4%) subjects. Of these 55.6% were identifies as C. albicans as determined by the Vitek 2 compact system. Other Candida species were represented by C. glabrata (11.1%), C. krusei (11.1%), C. dubliniensis (8.9%), C. parapsilosis (6.7%), C. tropicalis (4.4%), and C. famata (2.2%). Subjects with very poor plaque status, severe gingivitis and diabetes had significantly (P = 0.001) high concentration of Candida spp. CONCLUSION: Plague, severe gingivitis, and diabetes were found to be significantly associated with higher Candida colonization.

Misdirection of regenerating motor axons after nerve injury and repair in the rat sciatic nerve model.

Misdirection of regenerating axons is one of the factors that can explain the poor results often found after nerve injury and repair. In this study, we quantified the degree of misdirection and the effect on recovery of function after different types of nerve injury and repair in the rat sciatic nerve model; crush injury, direct coaptation, and autograft repair. Sequential tracing with retrograde labeling of the peroneal nerve before and 8 weeks after nerve injury and repair was performed to quantify the accuracy of motor axon regeneration. Digital video analysis of ankle motion was used to investigate the recovery of function. In addition, serial compound action potential recordings and nerve and muscle morphometry were performed. In our study, accuracy of motor axon regeneration was found to be limited; only 71% (+/-4.9%) of the peroneal motoneurons were correctly directed 2 months after sciatic crush injury, 42% (+/-4.2%) after direct coaptation, and 25% (+/-6.6%) after autograft repair. Recovery of ankle motion was incomplete after all types of nerve injury and repair and demonstrated a disturbed balance of ankle plantar and dorsiflexion. The number of motoneurons from which axons had regenerated was not significantly different from normal. The number of myelinated axons was significantly increased distal to the site of injury. Misdirection of regenerating motor axons is a major factor in the poor recovery of nerves that innervate different muscles. The results of this study can be used as basis for developing new nerve repair techniques that may improve the accuracy of regeneration.

Two-dimensional digital video ankle motion analysis for assessment of function in the rat sciatic nerve model.

Ankle motion analysis may provide a better method to assess function in the rat sciatic nerve model than the standard method, the sciatic functional index (SFI), but it is not widely used in experiments on nerve regeneration possibly because of complicated analysis. In this study, we investigated the practical use of a two-dimensional (2D) digital video motion analysis system. Reproducibility was investigated in normal rats. Recovery of ankle motion was analyzed after sciatic, tibial, and peroneal nerve crush injury. Results were compared with scores for the SFI. Results were not significantly different from animal-to-animal and day-to-day. Interobserver variability also was small. In the analysis of recovery after separate nerve crush injuries, subtle differences in ankle plantar flexion and dorsiflexion could be detected. The method was also more sensitive than the SFI: whereas scores for the SFI had returned to normal 4 weeks after sciatic nerve crush injury, the ankle angle at mid-stance was still significantly different from that in sham-operated animals 6 weeks after the injury. 2D digital video ankle motion analysis is a practical and sensitive method to assess function in the rat sciatic nerve model.

The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures.

AIM: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon. METHODS: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery. RESULTS: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications. CONCLUSION: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

CD34+ blood cells accelerate vascularization and healing of diabetic mouse skin wounds.

Diabetes is characterized by poor circulation and impaired angiogenesis, which appear to contribute to the frequent skin lesions and poor wound healing common in diabetic patients. Therapies to improve circulation commonly improve wound healing in diabetic patients. Administration of circulating CD34+ cells, cells that can function as endothelial cell progenitors, accelerates blood flow restoration to ischemic limbs of diabetic mice. We have investigated the potential of these cells to accelerate revascularization and healing in full-thickness skin wounds of hypoinsulinemic (streptozotocin-treated) diabetic mice. Wounds were injected with human CD34+ or CD34- peripheral blood mononuclear cells or no cells, and analyzed for vascularity and healing at various times thereafter. Treatment with CD34+ enriched cells decreased wound size by 4 days after treatment, accelerated epidermal healing, and rapidly and dramatically accelerated revascularization of the wounds compared to controls. Initially increased vascularization was mediated principally by an increase in vessel diameter, but later, both an increase in vascular size and number were observed. These findings indicate that blood-derived progenitors may have therapeutic potential in the treatment of skin lesions in the setting of diabetes, and give insights into how bone marrow cells exert their effects on neovascularization.

Operational use of neem oil as an alternative anopheline larvicide. Part A: Laboratory and field efficacy.

We conducted a study to determine the laboratory and field efficacy of neem oil towards anopheline larvae. No difference in LC50 was observed between laboratory and field strains for temephos, chlorpyriphos-methyl/fenitrothion and neem oil. No difference in susceptibility was found after 3 months of application every 2 weeks. Water treated with a single application of traditional larvicides was free of larvae after 4 weeks; neem oil-treated water, however, was free after 2 weeks but not at 4 weeks. Application of chlorpyriphos-methyl/fenitrothion and neem oil every 2 weeks for 7 rounds resulted in dramatic reduction in larval density with no statistically significant differences. An adult survey after larviciding also showed no significant difference. The efficacy of crude neem oil appears to be below that of conventional larvicides.

Operational use of neem oil as an alternative anopheline larvicide. Part B: Environmental impact and toxicological potential.

This study was conducted to investigate the preliminary environmental and mammalian toxicology of neem oil, temephos and chlorpyriphos-methyl/fenitrothion. Culex pipiens, Daphnia magna and Gambusia affinis were used to study environmental impact. A high level of toxicity was observed, with slight differences between organisms. The emulsifiers individually also displayed toxicity towards the tested organisms. Up to 90 days daily oral crude neem oil treatment (5 g/kg body weight) of laboratory mice did not cause any significant changes in weekly body weight gain, nor in serum liver damage indicators, direct bilirubin or total bilirubin. Blood parameters of treated mice up to 90 days were not statistically different from those of control mice. Neem oil could be used as an environmentally friendly alternative to the traditional chemical anopheline larvicides.

Operational use of neem oil as an alternative anopheline larvicide. Part B: environmental impact and toxicological potential

This study was conducted to investigate the preliminary environmental and mammalian toxicology of neem oil, temephos and chlorpyriphos-methyl/fenitrothion. Culex pipiens, Daphnia magna and Gambusia affinis were used to study environmental impact. A high level of toxicity was observed, with slight differences between organisms. The emulsifiers individually also displayed toxicity towards the tested organisms. Up to 90 days daily oral crude neem oil treatment [5 g/kg body weight] of laboratory mice did not cause any significant changes in weekly body weight gain, nor in serum liver damage indicators, direct bilirubin or total bilirubin. Blood parameters of treated mice up to 90 days were not statistically different from those of control mice. Neem oil could be used as an environmentally friendly alternative to the traditional chemical anopheline larvicides

Operational use of neem oil as an alternative anopheline larvicide. Part A: laboratory and field efficacy

We conducted a study to determine the laboratory and field efficacy of neem oil towards anopheline larvae. No difference in LC50 was observed between laboratory and field strains for temephos, chlorpyriphos-methyl/fenitrothion and neem oil. No difference in susceptibility was found after 3 months of application every 2 weeks. Water treated with a single application of traditional larvicides was free of larvae after 4 weeks; neem oil-treated water, however, was free after 2 weeks but not at 4 weeks. Application of chlorpyriphos-methyl/fenitrothion and neem oil every 2 weeks for 7 rounds resulted in dramatic reduction in larval density with no statistically significant differences. An adult survey after larviciding also showed no significant difference. The efficacy of crude neem oil appears to be below that of conventional larvicides

Reassessment of some environmental conditions of Maawa el-Sayadeen squatter area.

Reassessment of some environmental conditions of Maawa El-Sayadeen squatter area was carried out during 2000. Due to unplanned urbanization, environmental sanitation has been ignored for several decades resulting in many health, social and economic problems. Maawa El-Sayadeen was chosen by West District officials for environmental and health upgrading in 1995, which depended mainly upon health education in addition to some engineering constructions. The environmental conditions and health status were reporded before 1995 and after 2000. The reassessment proved that, there was an increase in number of families use tap water inside the house by 29% compared with 1995 assessment. Moreover, number of families using water closets increased by 15%, also wastewater disposal throught public sewers increased by 34%. However, a decrease by 17% in dry areas surrounding the houses was recorded. Solid waste storage improved by 11% although solid waste collection sites decreased by 23%. It is concluded that, after Maawa El-Sayadeen area was exposed to a certain level of environmental upgrading, the environmental conditions of the area were some how better categorized, however, further training programs should be taken into account or stressed including increase of people awareness, and strong partnership should be developed with their non governmental organizations.

Parasitological profile of the surveyed population for malaria in an endemic area in Faiyoum Governorate, Egypt.

Egypt represents the only focus in the Mediterranean region where Plasmodium falciparum transmission still occurs. A longitudinal parasitological study has been implemented (September 1995 to December 1996) in Faiyoum, Egypt. A total of 9065 blood slides for malaria parasites were taken from all people in the study area as mass blood examination (MBE); those attending the malaria unit as passive case detection (PCD) as well as from neighborhood of the detected cases (NOD). They were stained by Giemsa stain and examined under standard conditions for positivity, parasite species and parasite density. Our results show that MBE detected 61.5% of malaria cases while 23.1% and 15.4% of the confirmed cases were detected through PCD and NOD respectively. The overall parasite rate was 5.7/1000 examined population. P. falciparum was the most predominant species (96.1%), followed by P. vivax (3.9%). The epidemiological factors causing the persistence of malaria transmission in the study area are discussed.

Bionomics of the anopheline vectors in an endemic area in Fayoum Governorate, Egypt.

A one-year longitudinal entomological study was carried out at Kafr Fazara village, Sinnuris District, Faiyoum Governorate from January to December 1996. The results revealed that three species of anophelines were found. A. sergenti was the most prevalent species followed by A. multicolor and the least prevalent one was A. pharoensis. The influence of climatic conditions on anopheline abundance was also studied. The mean monthly temperature has a significant effect on larvae abundance, while no significant correlation was found concerning relative humidity or wind speed for both larvae and adult anophelines. The transmission season of P. falciparum in Faiyoum Governorate extended to more than eight months a year which could explain the persistence of malaria up there. The bionomics of the recorded vectors were discussed.

Study on rodents infestation in Alexandria and prevalence of Trichinella spiralis infection among them.

Rodents were monthly collected from the six districts of Alexandria all year round using live traps. The 1025 collected rodents were divided according to species, gender, age, and weight El-Amryia and El-Montaza were the most infested districts, while West, East, Middle and El-Gomrok Districts were the lowest infested ones. Rallus norvegicus was the highest abundant species in the city (41.9%) followed by R. rattus (37.2%), then Mus musculus (20.9%). There was no difference in abundance of rodents during summer compared with winter. Meanwhile, males represented 57.6% of the total collected rodents. Most of the collected rodents were < or = 2 months old (63.8%) or light weighed (61.6%) however, number of caught rodents became less and less as age or weight increased. Concerning El-Amryia and El-Montaza Districts where abattoirs are located, number of collected rodents from and around the abattoirs represented 70.4% of the total collected rodents compared with 29.6% collected from and around the houses of the same districts. The total prevalence of T. spiralis infection among collected rodents using digestion technique was 13.3%. El-Amryia, El-Montaza, West and El-Gomrok Districts were, in order, the only infected districts. Neither gender nor season of collection has influence on the prevalence of infection. The present study proved the role of abattoirs in the prevalence of T. spiralis infection. However, high prevalence of T. spiralis infection was detected among higher age or higher body weight groups of rodents. Sensitivity of the digestion diagnostic technique is proved compared with compressorium diagnostic technique. Nevertheless, diaphragm was the most sensitive site for detection of light infection in all studied rodents followed by thigh then tongue; expressed as number of larvae per gram tissue.

Sanitation characteristics of some food processing industries.

The present investigation was carried out to evaluate the sanitary conditions surrounding the food throughout the production stages in some food plants. Observation of the sanitary measures of the studied plants revealed that only 3 out of the 7 plants (42.9%) have acceptable sanitation that complies with the sanitary requirements specified by WHO. Personal hygiene and storage conditions were the most critical problems found in the studied plants. Laboratory examination of nasal and throat swabs and stool samples of workers was carried out to uncover the chronic carriers. Among the food handlers examined 46.3% were positive for intestinal parasites. Bacteriological examination of stool specimens revealed that 4.3% of carriers of Salmonella paratyphi and none were carriers of Vibreo species. Nasal swabs were also positive for Staph. aureus in 29.8% of all the examined swabs. Analysis of the main products of the studied plants revealed generally that the bacterial load of the products of plants having acceptable sanitary conditions was lower than that of the products of the other plants. The frozen vegetable products had a total aerobic mesophilic plate count ranging from 8.1 x 10(4) cfu/g in okra and 3.7 x 10(5) cfu/g in mixed vegetables. The total aerobic plate count of the ice cream (1 x 10(3) cfu/g) complies with specified Egyptian standards. However, the coliform count (9 x 10(1) MPN) was higher than the recommended limit. Lead and cadmium levels were also investigated in all products. The maximum detected level of lead was that of cream wafer (0.94 ppm) followed by banana wafer (0.82 ppm). The two detected levels were higher than Egyptian standards. The lead level in ice cream (0.19 ppm) was also higher than the specified standards. The relatively high levels of lead in cream wafer and ice cream may be attributed to more than one factor; the added color and the old machinery used in some production steps are the most accursed factors. On the other hand, the observed level of cadmium ranged between 0.046 ppm in raw mil and 0.3 ppm in soft cheese.

Firearm fatalities in Eastern Saudi Arabia: impact of culture and legislation.

A study of all firearm fatalities in the Eastern Province of Saudi Arabia during the 10-year period from 1985 to 1994 is presented. The overall number of cases was 71 (0.35 per 100,000 population), of which 48% were homicides, 28% were suicides, and 24% were accidental. Most victims were young male Saudis; most were shot in the chest (41%) or the head (34%). Hand guns were responsible for all suicides, 56% of homicides, and 71% of accidental deaths. The study shows some resemblance between the homicide and suicide groups with regard to the age of victim, type of weapon used, and site of entrance wound. The findings in the present study are comparable to reports from other Middle East countries, but different from those in communities with different cultural and legislative backgrounds. Our findings may support the argument that more strict firearm legislation is helpful in limiting the number of firearm fatalities in the community.

Seroepidemiological prevalence of hepatitis delta virus in eastern Saudi Arabia.

To describe hypercholesterolemia in an urban community in Saudi Arabia, total serum cholesterol (TSC) was measured in 966 apparently healthy males (475 Saudi Arabs, 351 other Arabs and 140 non-Arabs) using a portable analyzer (Boehringer Model[R]). Mean age was 35.9 years (SD+/-9.1) and mean body mass index (BMI) was 26.2 kg/m(2) (SD+/-3.4) with a mean TSC of 5.20 mmol (SD+/-1.21). Mean TSC was significantly higher among non-Arabs at 5.74 mmol/L (SD+/-1.48) than in Saudi Arabs at 4.93 mmol/L (SD+/-1.11), P<0.001 mmol/L. TSC was higher than 5.20 mmol/L in 44.3% and higher than 6.80 mmol/L in 6.9% of the population. TSC was higher than 6.80 mmol/L in 3.6% of Saudi Arabs, 8.0% in other Arabs and 15.7% in the non-Arabs. This calls for cholesterol screening of the indigenous male population for hypercholesterolemia and other coronary heart disease risk factors at every opportunity. Among expatriate males, a mass screening strategy might be appropriate. The health care system needs appropriate adjustment to deal with this growing health problem.

Deaths from hanging in the eastern province of Saudi Arabia.

An analysis of cases of hanging in the Eastern Province of Saudi Arabia over a period of five years is presented. Of 61 victims investigated there was a high incidence of suicidal hanging among expatriate males of lower socio-economic classes especially Asians, and in particular, Indians. Two distinct patterns of suicidal hanging were observed in this series. The first used a seemingly popular plastic clothes line, with complete body suspension. This produced a narrow ligature mark, commonly deep and high up in the neck, often with internal cervical injuries. In the second, soft cotton cloth was used with partial suspension of the body, which produced a broad, low, ill-defined ligature mark with facial congestion and petechial haemorrhages, but minimal or absent deep neck injuries. Classical external injuries of asphyxial death (congestion of the face and petechial haemorrhages) were more common in cases of partial suspension than in complete suspension. While the mechanism of death in the majority of cases of partial suspension was apparently due to airways or vascular obstruction, death in cases of complete suspension appeared to result from, in addition to obstruction (airways or vascular), vagal stimulation or carotid sinus pressure, or a combination of these. No fracture of the hyoid bone, thyroid cartilage or cervical vertebrae was detected in any of the victims in this series.

Influence of different means of washing and processing on removing of Actellic residue from spinach and eggplant and its in-vivo action on mice hepatic biochemical targets.

This study was carried out to investigate the effect of different washing solutions on the removal of Actellic residue from fresh and processed vegetables, namely; spinach and eggplant. Also, to identify the effect of Actellic residue on the health status of mice when fed these contaminated vegetables. The amount of insecticide residue detected using GLC indicated that, tap water, sodium hydroxide solution and potassium permanganate solution gave high percent removal. However, processing did not remove more than 45% except for grilling of eggplant which removed 88.17%. Meanwhile, changes in some hepatic biological parameters were well recognized in the groups of mice fed contaminated- unwashed either processed or unprocessed vegetables.

Effect of ischemia and reperfusion in vivo on energy metabolism of rat sciatic-tibial and caudal nerves.

Our model of severe nerve ischemia consistently results in extinction of the compound nerve and muscle action potentials (NAP; CMAP) within 30 min. Since impulse transmission may depend on nerve energy metabolism (NEM), we studied the effects of ischemia with reperfusion on sciatic-tibial nerve NEM in vivo and compared these results with NEM of this nerve in deoxygenated Ringer's solution in vitro and postmortem. Ischemia for 30 min postmortem or in deoxygenated Ringer's solution resulted in marked depletion of adenosine triphosphate (ATP) and creatine phosphate (CP) and an increase in lactate (LAC) of sciatic-tibial nerve of adult male Sprague-Dawley rats. In vivo ischemia for up to 3 h to sciatic-tibial nerve was sufficient to extinguish CMAP but not NAP and did not deplete ATP, CP, or GLU nor did it increase LAC. Ischemia sufficient to extinguish NAP resulted in reduction of energy substrates to about 50% of resting. Muscle fails to conduct impulses before nerve and in vivo reductions of energy substrates are milder than in vitro changes. These changes are explainable in terms of energy requirements and supply. These findings support an energetic basis of ischemic conduction failure.