Knowledge and Preparedness of Physicians in Relation to Anaphylaxis at Primary Healthcare Centers in Al-Qassim, Saudi Arabia.

Background Anaphylaxis is a significant, often fatal, systemic allergic reaction with a rapid start that may affect the respiratory and/or circulatory systems; for patients to survive, emergency management must be done properly. When anaphylaxis is confirmed or highly suspected, epinephrine should be injected intramuscularly. This study aimed to assess the preparedness of primary healthcare physicians for anaphylaxis in terms of recognition and management of this condition in Al-Qassim, Saudi Arabia. Methods This cross-sectional study was carried out among primary healthcare physicians in the Qassim region of Saudi Arabia. A self-administered questionnaire was distributed among the targeted physicians. The questionnaire comprised sociodemographic characteristics, general awareness and management of anaphylaxis, and a 10-item questionnaire to assess physicians' knowledge of anaphylaxis. Results Out of 121 primary healthcare physicians, 61.2% were male, and 47.9% were aged between 25 and 35 years. Nearly all physicians (97.5%) believed that anaphylaxis is a life-threatening situation. The overall mean knowledge score was 4.74 out of 10 points. Nearly half (48.8%) were categorized as having poor knowledge levels, 43% as moderate, and only 8.3% as having good knowledge. Being specialists/consultants and being trained in managing anaphylaxis were the factors associated with increased knowledge. Conclusion The knowledge of primary care physicians regarding anaphylaxis was deficient. However, increased knowledge of anaphylaxis was seen more frequently among consultants or specialists who attended training for managing anaphylaxis cases. A multi-center study involving a bigger sample size is needed to establish physicians' knowledge of anaphylaxis.

Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia.

Background There is a lack of local studies on vitamin D deficiency in children with cancer. This study aims to estimate the prevalence of vitamin D deficiency in the pediatric oncology population at King Abdul-Aziz Medical City (KAMC) in Jeddah, addressing knowledge gaps for improved clinical practice and future research. Methods This retrospective observational study was conducted from 2016 to 2021 at the pediatric oncology clinic in National Guard Hospital, Jeddah. The study focused on children aged 14 or younger at cancer diagnosis, data encompassed patient demographics, cancer details, and treatment information, including serum measurements of vitamin D (25(OH)D, calcium, phosphate, alkaline phosphatase). Vitamin D levels were categorized as deficient (<25 ng/ml), insufficient (25-49 ng/ml), sufficient (≥50- 125 ng/ml), or hypervitaminosis (>125 ng/ml), based on our center reference range and the validation of the assay. Results In this retrospective study of 155 pediatric oncology patients, the majority aged 0 to 10 years (78%), findings reveal a male preponderance (54.2%) and a more prevalent in patients with hematological malignancies (85%). Chemotherapy was administered to 98%, with 7% underwent radiotherapy, and 89% received steroids. Analysis of serum 25-OH vitamin D levels indicated an overall deficiency and insufficiency at diagnosis (63%) and post-therapy (43%). Age and gender had a significant influence on vitamin D levels at diagnosis, with older children and females exhibiting lower concentrations. However, these differences diminished by the end of therapy. Notably, hematological malignancy patients often presented insufficient vitamin D levels, while solid tumor patients frequently had sufficient levels. Clinical outcomes showed a high survival rate (90.7%), limited bone density assessments (18.1%), and a 14.2% prevalence of hypervitaminosis. Conclusion In summary, our study reveals that over two-thirds of pediatric oncology patients experience vitamin D deficiency and insufficiency at the time of diagnosis, particularly notable in females and older children. Notably, those with solid tumors exhibit higher baseline 25-OH vitamin D concentrations compared to counterparts with hematological malignancies. The findings underscore the importance of educating both patients and caregivers on supplementation and sun exposure to mitigate the prevalence of deficient and insufficient vitamin D levels in pediatric oncology cases.

Frequency and mutational spectrum of PIK3CA gene mutations in breast cancer patients: Largest and first report from Lebanon.

The PIK3CA pathway is one of the most frequently altered pathways in human cancers, especially in breast cancer with approximately 40% of HR+/HER2- advanced breast cancer cases exhibiting mutations in the PIK3CA gene. While the mutations can occur across the entire gene, the most common are observed in exon 9 corresponding to the helical domain, and in exon 20 encompassing the kinase domain. This study constitutes the first attempt at determining the frequency and mutational spectrum in Lebanese breast cancer patients. For this purpose, DNA samples from 280 breast cancer patients from across Lebanon were screened for PIK3CA mutations using the Therascreen® PIK3CA RGQ Real-time PCR assay. In line with previous reports, 38.57% of cases were positive for at least one PIK3CA mutation, among which approximately 59% were in exon 9 and 37% in exon 20. However, PIK3CA mutations are breast cancer are heterogeneous whereby 20% of known PIK3CA mutants might not be detected by compact PCR based assays. Thus, the adoption of comprehensive Next Generation Sequencing based panels to decipher the complete clinical, molecular and immunohistochemical profile of breast cancer tumor requires further investigation.

Prevalence of Overweight and Obesity and Their Impact on Spirometry Parameters in Patients with Asthma: A Multicentre, Retrospective Study.

INTRODUCTION: Obesity is a common comorbidity in patients with asthma and has a significant impact on health and prognoses. However, the extent to which overweight and obesity impact asthma, particularly lung function, remains unclear. This study aimed to report on the prevalence of overweight and obesity and assess their impacts on spirometry parameters in asthmatic patients. METHODS: In this multicentre, retrospective study, we reviewed the demographic data and spirometry results of all adult patients with confirmed diagnoses of asthma who visited the studied hospitals' pulmonary clinics between January 2016 and October 2022. RESULTS: In total, 684 patients with confirmed diagnoses of asthma were included in the final analysis, of whom 74% were female, with a mean ± SD age of 47 ± 16 years. The prevalence of overweight and obesity among patients with asthma was 31.1% and 46.0%, respectively. There was a significant decline in spirometry results in obese patients with asthma compared with patients with healthy weights. Furthermore, body mass index (BMI) was negatively correlated with forced vital capacity (FVC) (L), forced expiratory volume in one second (FEV1), forced expiratory flow at 25-75% (FEF 25-75%) L/s and peak expiratory flow (PEF) L/s (r = -0.22, p < 0.001; r = -0.17, p < 0.001; r = -0.15, p < 0.001; r = -0.12, p < 0.01, respectively). Following adjustments for confounders, a higher BMI was independently associated with lower FVC (B -0.02 [95% CI -0.028, -0.01, p < 0.001] and lower FEV1 (B -0.01 [95% CI -0.01, -0.001, p < 0.05]. CONCLUSIONS: Overweight and obesity are highly prevalent in asthma patients, and more importantly, they can reduce lung function, characterised mainly by reduced FEV1 and FVC. These observations highlight the importance of implementing a nonpharmacological approach (i.e., weight loss) as part of the treatment plan for patients with asthma to improve lung function.

Prevalence of Dental Anomalies Among Orthodontic Patients: A Retrospective Study in Saudi Arabia.

BACKGROUND: Odontogenic anomalies encompass deviations in dental morphology, orientation, or spatial positioning within the mandibular structures. This study probed the frequency of such dental malformations among orthodontic patients receiving treatment in Riyadh City, Saudi Arabia. Furthermore, the study sought to discern variations in the manifestation of these dental anomalies related to gender and nationality. MATERIALS AND METHODS: A retrospective analysis was conducted on 384 panoramic radiographs belonging to orthodontic patients (comprising 222 males and 162 females) who sought treatment at orthodontic clinics of a privately owned university hospital in Riyadh City between 2017 and 2019. The patient records were scrutinized for various dental abnormalities, including but not limited to dilacerated teeth, supernumerary teeth, congenital absence of teeth, impactions, hyperdontia, hypodontia, taurodontism, tooth rotation, and amelogenesis imperfecta. The Chi-square test was employed to assess the correlation between the prevalence of dental anomalies and variables such as gender and nationality. A p-value of less than 0.05 was deemed statistically significant for all tests. RESULTS: Among the assessed sample size of orthodontic patients, dental impactions emerged as the most prevalent dental anomaly, affecting 246 patients (64.1%). This was followed by the occurrence of supernumerary teeth in 31 patients (8.1%), hyperdontia in 29 patients (7.6%), and congenital absence of teeth in 28 patients (7.3%). Other less frequently observed dental irregularities included dilacerated teeth in 23 patients (6%), amelogenesis imperfecta in 12 patients (3.1%), taurodontism in 12 patients (3.1%), and tooth rotations in five patients (1.3%). A statistically significant gender-based disparity was observed, with dental impactions being more prevalent among males (n=154; 69.4%) than females (n=92; 56.8%). Conversely, supernumerary teeth were more prevalent among females (n=24; 14.8%) than males (n=7; 3.2%). No significant variation in the prevalence of dental anomalies was discernible across different nationalities. CONCLUSION: Impactions and the presence of supernumerary teeth were the predominant dental anomalies detected among the studied orthodontic patient population. The prevalence of dental anomalies exhibited discernible variations based on gender but not nationality. These disparities could potentially influence orthodontic outcomes, underscoring the necessity for meticulous examination and tailored orthodontic treatment planning.

A deep learning approach to detect blood vessels in basal cell carcinoma.

PURPOSE: Blood vessels called telangiectasia are visible in skin lesions with the aid of dermoscopy. Telangiectasia are a pivotal identifying feature of basal cell carcinoma. These vessels appear thready, serpiginous, and may also appear arborizing, that is, wide vessels branch into successively thinner vessels. Due to these intricacies, their detection is not an easy task, neither with manual annotation nor with computerized techniques. In this study, we automate the segmentation of telangiectasia in dermoscopic images with a deep learning U-Net approach. METHODS: We apply a combination of image processing techniques and a deep learning-based U-Net approach to detect telangiectasia in digital basal cell carcinoma skin cancer images. We compare loss functions and optimize the performance by using a combination loss function to manage class imbalance of skin versus vessel pixels. RESULTS: We establish a baseline method for pixel-based telangiectasia detection in skin cancer lesion images. An analysis and comparison for human observer variability in annotation is also presented. CONCLUSION: Our approach yields Jaccard score within the variation of human observers as it addresses a new aspect of the rapidly evolving field of deep learning: automatic identification of cancer-specific structures. Further application of DL techniques to detect dermoscopic structures and handle noisy labels is warranted.

Knowledge, Awareness, and Practice Related to Diabetic Foot Ulcer Among Healthcare Workers and Diabetic Patients and Their Relatives in Saudi Arabia: A Cross-Sectional Study.

Background Diabetes mellitus is a chronic progressive metabolic disorder characterized by high blood sugar affecting the whole body resulting in a significant impact on the quality of life for the patients and their families. Diabetes mellitus complications lead to morbidity, disability, and mortality and represent a serious global health issue threatening the health system worldwide and resulting in a critical economic impact for all countries, especially epidemic ones. Objective The objective of this study was to assess the level of knowledge and awareness regarding diabetic foot and related behaviour among diabetic patients and their relatives, as well as healthcare workers in Saudi Arabia. Methods A cross-sectional analytic study was conducted in 2022 on healthcare workers, diabetic patients, and their relatives above the age of 18 in Saudi Arabia by using a valid, pretested structured questionnaire. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results In this study, there was no correlation between the healthcare workers' attitude and knowledge. A total of 131 healthcare workers were involved, and a majority of them had good knowledge regarding the predisposing factors of diabetic foot ulcers, and 63 (48.1%) had good knowledge regarding diabetes foot care. On the other hand, there was poor knowledge regarding the characteristics and complications of diabetes ulcers. This study showed various attitudes among healthcare workers regarding diabetic ulcer care. For example, they prioritized the prevention of ulcers over treatment (N=67, 51.1%), the majority of healthcare workers were very keen to wound care (N=77, 58.8%), and they believed that it was their responsibility to educate their patients about reducing re-ulceration (N=86; 65.7%). However, 52 participants (39.7%) considered management of diabetic foot ulcer time-consuming, 54 (41.2%) mentioned that if they had the opportunity, they would like to avoid taking care of the diabetic wound, and 51 (38.9%) reported non-satisfaction with diabetic wound care.  One hundred diabetic patients and 117 relatives also were involved, and only 41.3% of participants (patients and relatives) had good knowledge regarding diabetes mellitus. However, our findings also revealed that 91.65% of the participants had good knowledge and a favourable attitude towards diabetes mellitus and diabetic foot care. Nevertheless, even though the participants had good knowledge regarding foot care, they had poor practice, with 56.55% scoring poor on the assessment questionnaire.  Conclusion Our study shows that most of the participants had good knowledge and attitudes but poor practices. This highlights the need for more efforts to educate the Saudi population about diabetes and its complications.

Double-blind evaluation and benchmarking of survival models in a multi-centre study.

Accurate modelling of time-to-event data is of particular importance for both exploratory and predictive analysis in cancer, and can have a direct impact on clinical care. This study presents a detailed double-blind evaluation of the accuracy in out-of-sample prediction of mortality from two generic non-linear models, using artificial neural networks benchmarked against a partial logistic spline, log-normal and COX regression models. A data set containing 2880 samples was shared over the Internet using a purpose-built secure environment called GEOCONDA (www.geoconda.com). The evaluation was carried out in three parts. The first was a comparison between the predicted survival estimates for each of the four survival groups defined by the TNM staging system, against the empirical estimates derived by the Kaplan-Meier method. The second approach focused on the accurate prediction of survival over time, quantified with the time dependent C index (C(td)). Finally, calibration plots were obtained over the range of follow-up and tested using a generalization of the Hosmer-Lemeshow test. All models showed satisfactory performance, with values of C(td) of about 0.7. None of the models showed a systematic tendency towards over/under estimation of the observed survival at tau=3 and 5 years. At tau=10 years, all models underestimated the observed survival, except for COX regression which returned an overestimate. The study presents a robust and unbiased benchmarking methodology using a bespoke web facility. It was concluded that powerful, recent flexible modelling algorithms show a comparative predictive performance to that of more established methods from the medical and biological literature, for the reference data set.

Activity of adefovir dipivoxil against all patterns of lamivudine-resistant hepatitis B viruses in patients.

One hundred and thirty-one post-liver transplantation patients with chronic hepatitis B and failing lamivudine therapy with detectable serum hepatitis B virus (HBV) deoxyribonucleic acid by hybridization assays or > or =1 x 10(6) copies/mL by polymerase chain reaction, and elevated alanine transaminase levels despite continuous lamivudine, were enrolled in an open-label study of adefovir dipivoxil. The B and C domains of HBV polymerase were sequenced for baseline samples to determine the presence of lamivudine resistance mutations. The results showed that 98% of the samples had tyrosine-methionine-aspartate-aspartate (YMDD) mutations, indicating a strong correlation between the above clinical definition of lamivudine treatment failure and the presence of YMDD mutations. In addition to the rtM204V/I and the rtL180M mutations, the mutation rtV173L was identified in 19% of patients. Four major patterns of lamivudine-resistant HBV were identified: rtL180M + rtM204V (60%), rtV173L + rtL180M + rtM204V (19%), rtM204I (9%) and rtL180M + rtM204I (9%). Treatment with adefovir dipivoxil showed similar antiviral efficacy in patients with lamivudine-resistant virus from all four patterns.

[Cholera in Guinea: the 1994-1995 epidemic]. / Le choléra en Guinée: l'epidémie de 1994-1995.

Since the first outbreak in 1970, cholera epidemics have occurred regularly in Guinea. Until 1994, epidemics recurred every 8 years and were confined to the capital and coastal areas. The first cases in every epidemic were observed in coastal lagoons near the Sierra Leone border. In 1994, the disease demonstrated its migratory ability as the first cases were reported in towns located in far eastern inland areas. Spread of the disease from war-torn Sierra Leone and Liberia where epidemics have also been reported cannot be ruled out. Control measures have gradually been implemented to deal with these outbreaks and a treatment facility was built at the University of Conakry in 1994. Bacteriological studies including antibiotic susceptibility tests carried out at this center showed that the offending bacteria was Vibrio cholerae El Tor of the Ogawa group. Although this strain is relatively sensitive to all antibiotics, analysis of epidemiological data revealed high mortality rates at the beginning of every outbreak probably due to delays in organizing appropriate care. A major effort is now being made to improve the response time particularly in remote inland areas.

[Mother and child sharing the same room and breast feeding]. / Internación conjunta madre-hijo y lactancia materna.

The author analyzes the existing relationship among breast feeding and socioeconomical level and degree of instruction of the mother. He also describes the causes for the interruption of breast feeding in a maternity where rooming-in existed. He stressed the importance of the motivation to the mother for breast feeding and the independence between levels of instruction and frequency of breast feeding.