Acetylcholinesterase enzyme among cancer patients a potential diagnostic and prognostic indicator a multicenter case-control study.

Acetylcholinesterase enzyme (AChE) activity is impaired by a variety of inhibitors including organophosphorus pesticides, leading to the accumulation of acetylcholine. In this study, we aimed to determine the association between cancer and the blood level of the (AChE). This is a multicenter hospital-based case-control study conducted in the Radiation and Isotopes Center Khartoum, and Institute of Nuclear Medicine and Molecular Biology and Oncology Gezira. One hundred and fifty participants, half of them cancer patients and half cancer free were recruited. All participants were screened for demographic, environmental, occupational, and clinical characteristics. Blood for the (AChE) activity test was drawn from participants in the two groups. The mean age of the participants was 40.6 ± 14.8 years. Geographical distribution showed the Central Region of Sudan had the highest rate of cancer, followed by North State, Khartoum State, West State, and East State. The most common tumor subtype was breast cancer, followed by leukemia, colon, esophageal, and prostate cancer. Inferential analysis revealed significantly impaired (AChE) activity among cancer patients compared to controls (53.4 ± 20.3% vs. 93.8 ± 8.8, p-value 0.001). There was a significant statistical association between impaired (AChE) activity and cancer. (AChE) activity might be applied in the future as a diagnostic biomarker and therapeutic target. Further large sample and molecular studies are recommended.

Acceptance, Advocacy, and Perception of Health Care Providers on COVID-19 Vaccine: Comparing Early Stage of COVID-19 Vaccination with Latter Stage in the Eastern Region of Saudi Arabia.

Vaccination of healthcare providers has recently gained focused attention of public health officials. As HCPs have direct contact with the population, and HCPs significantly influence the population, this study aimed to compare the acceptance rate, advocacy rate, and beliefs about the COVID-19 vaccine among HCPs in two time periods. In this repeated cross-sectional study, different HCPs were assessed in two periods ten months apart, i.e., November to December 2020 and September to October 2021, which were before and after COVID-19 vaccine approval by authorities. The study was conducted in Qatif Central Hospital, Eastern Region of Saudi Arabia. There were 609 respondents: 236 participants in the first period and 373 participants in the second period. Only 13 participants did not get the COVID-19 vaccine. There was around a 40% difference in the acceptance rate between the two study periods; the latter period was higher at 94.7%. Furthermore, 24.1% was the difference between the willingness to advocate the COVID-19 vaccine for others; the first period had a lower percentage (60.1%). Overall, results of the study showed that vaccine hesitancy, as well as the willingness to advocate for the vaccine, were improved between the pre-vaccine approval period and post-vaccine approval period, showing that the efforts made by the government improved COVID-19 acceptance and advocacy among HCPs. However, vaccine hesitancy is not a new issue, and for a better understanding of HCPs' beliefs, a qualitative study is needed.

Assessment of nurses' knowledge, attitude and implementation of skin-to-skin care within the perinatal setting in Saudi Arabia: Survey study.

AIM: To evaluate knowledge, attitude and implementation of Skin-to-Skin Care (SSC) among nurses and to assess the implementation of SSC in the perinatal setting. DESIGN: A cross-sectional study design was implemented utilizing survey distributed among critical care paediatric and neonatal nurses. METHODS: The data collection form was pre-structured validated tool consisted of two main sections; socio-demographic characteristics and Likert scale of 20 items covering four main domains in; knowledge, attitude, education and implementation of SSC. RESULTS: The vast majority of the sample 91 (98%) were females with mean age and mean years of experience 33.5 ± 6.5 and 9.7 ± 6.5 years respectively. Almost half of them 45 (48.4%) work in obstetric and labor and delivery units. Correlation coefficient revealed a significant association between the total educational years of nursing degree and SSC. The results showed nurses with bachelor or master significantly more knowledgeable and skilled in implementing SSC compared to others.

Quality of Nursing Work Life among Nurses in Saudi Arabia: A Descriptive Cross-Sectional Study.

Background: Quality of working life (QWL) is a multidimensional concept that describes an employee's satisfaction with several work life elements. Quality of nurse working life is considered as a stepping stone for health services improvement, as it affects job satisfaction which, in turn, affects the performance of nurses. Understanding and investigating the nurses' quality of work life in Saudi Arabia is needed for improvement actions. Objectives: This study aimed to examine the quality of nursing work life (QNWL) among nurses working in Saudi Arabia and to determine the association between demographic variables and quality of work life among nurses. Methods: It was a cross-sectional design using Brooks' quality of nursing work life survey. It was distributed among nurses over the kingdom of Saudi Arabia. Results: There were 860 nurses participating in the study. The mean total score for the participants was 174.5+/- 30.3, indicating moderate to high QNWL. The highest score achieved by the nurses was for the work world context (4.29) while the lowest score was for work design dimension (3.92). The study revealed that nationality, income, and shift duration, having a dependent person, and having family accompany the nurse as significant factors affecting the quality of work life among the nurses. Conclusion: A novel contribution of the current study was that the demographic characteristics of the participants, including nationality, income, having family accompany the nurse, having an independent child, or spouse or parents, and shift duration, tended to have a statistically significant correlation with QNWL. The comprehensive results of this study have practical implications whereby authority bodies can create regulatory plans for enhancing satisfaction and performance over the sole utilization of job satisfaction measurements and can thereby improve nurses' retention and turnover rates.

Attitudes and Practice of Health Care Providers Toward Cancer Screening: A Cross-sectional Multicenter Study, Saudi Arabia.

BACKGROUND: Screening is a cancer prevention measure for groups who are asymptomatic, and diagnosis is a medical test for groups who are symptomatic. The occupational privilege of health care providers (HCPs) is expected to play a positive role in cancer screening practices. Therefore, this study aimed to assess perceptions and personal attitudes of HCPs regarding their decision to screen for cancer in the Eastern Province of Saudi Arabia. DESIGN: A cross-sectional multicenter survey study was conducted. A well-designed and validated questionnaire was distributed to the HCPs at three tertiary hospitals in the Eastern Province of Saudi Arabia. RESULTS: Out of 900 health care providers who received the questionnaire, 372 completed it. Two-thirds, 247 (66.4%) of them were nurses and the rest were physicians and the mean age was 34.1 ± 7.1 years. Regardless of gender, profession, or age, the overall rate of belief in the importance of regular cancer screening was high; 91.4%. The number of participants who did not screen for colonoscopy was significantly higher than those who screened. The number of females in the age group of between 45 and 54 years who screened with mammography was significantly higher than non-screened. In a similar way, male HCPs above 54 years who got themselves screened for Prostate-Specific Antigen (PSA) were significantly higher than those who did not. CONCLUSIONS: Findings of the current research and existing evidence specifically for the Saudi community indicated a need to raise awareness, emphasizing the role of HCPs in motivating themselves, their families, and their patients to implement various cancer screening programs.

Overview of clinical outcome and therapeutic effectiveness of Favipiravir in patients with COVID-19 admitted to intensive care unit, Riyadh, Saudi Arabia.

BACKGROUND: Prior to the availability of the current COVID-19 vaccine, the need to control the pandemic worldwide was focused on management of the disease using previously approved antivirals, including Favipiravir which inhibits viral replication through the RNA dependent RNA polymerase enzyme. Favipiravir's efficacy against different viral infections has made it a potential treatment for COVID-19. We are aiming in this study to assess the therapeutic efficacy and safety of Favipiravir in treating critically ill patients admitted with COVID-19 to Intensive Care Units (ICUs). METHODS: This is a retrospective cohort study was conducted in five tertiary hospitals in Riyadh, Kingdom of Saudi Arabia (KSA). The studied sample was randomized from a huge pool of data collected primarily for critically ill COVID-19 patients admitted to (ICUs) during the period between April 2020 to March 2021. Two groups of patients matched 1: 1 for age and body mass index (BMI) was enrolled in the study; one group received Favipiravir and another comparison group received other antimicrobial medications, not including Favipiravir. RESULTS: A total data of 538 COVID-19 patients were analyzed, 269 (50.%) received Favipiravir and 269 (50%) the control group received different treatments. More than two-thirds 201 (74.7%) were Saudi citizens, the majority 177 (65.8%) were males and the mean age and (BMI) were; (57.23 ± 15.16) years and (31.61 ± 7.33) kg/m2 respectively. The most frequent symptoms of presentation were shortness of breath (SOB), fever, and cough, and the most frequent comorbidity was diabetes mellitus, hypertension, and ischemic heart disease. In the supplemental therapy, corticosteroid, tocilizumab and chloroquine were statistically significant (P = 0.001) when combined in the FVP group more than in the comparison group. Severe acute respiratory distress syndrome (ARDS) was more frequent among Favipiravir group, while the overall mortality rate among the Favipiravir group was not statistically significant (p-value 0.4). CONCLUSION: According to the study's results revealing FVP is not superior to other antivirals, patients who received Favipiravir presented with more severe symptoms, more comorbidities, more complications, and is not effective in controlling the cytokine storm which negatively impact the efficacy of Favipiravir. FVP therapy had no influence on ICU and hospital length of stay in comparison with the control group as well as in the overall mortality rate among the FVP group was not statistically significant. further research is needed to understand how FVP along with other treatments can improve the length of stay among COVID-19 patients admitted to the ICU.

Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis.

BACKGROUND: Currently there is no systematic review and meta-analysis of the global incidence rates of anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines in the general adult population. OBJECTIVES: To estimate the incidence rates of anaphylactic and nonanaphylactic reactions after COVID-19 vaccines and describe the demographic and clinical characteristics, triggers, presenting signs and symptoms, treatment and clinical course of confirmed cases. DESIGN: A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement was followed. METHODS: Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, and Nature) were searched from 1 December 2020 to 31 May 2021 in the English language using the following keywords alone or in combination: anaphylaxis, non-anaphylaxis, anaphylactic reaction, nonanaphylactic reaction, anaphylactic/anaphylactoid shock, hypersensitivity, allergy reaction, allergic reaction, immunology reaction, immunologic reaction, angioedema, loss of consciousness, generalized erythema, urticaria, urticarial rash, cyanosis, grunting, stridor, tachypnoea, wheezing, tachycardia, abdominal pain, diarrhea, nausea, vomiting and tryptase. We included studies in adults of all ages in all healthcare settings. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. RESULTS: Of the 1,734 papers that were identified, 26 articles were included in the systematic review (8 case report, 5 cohort, 4 case series, 2 randomized controlled trial and 1 randomized cross-sectional studies) and 14 articles (1 cohort, 2 case series, 1 randomized controlled trial and 1 randomized cross-sectional studies) were included in meta-analysis. Studies involving 26,337,421 vaccine recipients [Pfizer-BioNTech (n = 14,505,399) and Moderna (n = 11,831,488)] were analyzed. The overall pooled prevalence estimate of anaphylaxis to both vaccines was 5.0 (95% CI 2.9 to 7.2, I2 = 81%, p = < 0.0001), while the overall pooled prevalence estimate of nonanaphylactic reactions to both vaccines was 53.9 (95% CI 0.0 to 116.1, I2 = 99%, p = < 0.0001). Vaccination with Pfizer-BioNTech resulted in higher anaphylactic reactions compared to Moderna (8.0, 95% CI 0.0 to 11.3, I2 = 85% versus 2.8, 95% CI 0.0 to 5.7, I2 = 59%). However, lower incidence of nonanaphylactic reactions was associated with Pfizer-BioNTech compared to Moderna (43.9, 95% CI 0.0 to 131.9, I2 = 99% versus 63.8, 95% CI 0.0 to 151.8, I2 = 98%). The funnel plots for possible publication bias for the pooled effect sizes to determine the incidence of anaphylaxis and nonanaphylactic reactions associated with mRNA COVID-19 immunization based on mRNA vaccine type appeared asymmetrical on visual inspection, and Egger's tests confirmed asymmetry by producing p values < 0.05. Across the included studies, the most commonly identified risk factors for anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines were female sex and personal history of atopy. The key triggers to anaphylactic and nonanaphylactic reactions identified in these studies included foods, medications, stinging insects or jellyfish, contrast media, cosmetics and detergents, household products, and latex. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also found to be important. CONCLUSION: The prevalence of COVID-19 mRNA vaccine-associated anaphylaxis is very low; and nonanaphylactic reactions occur at higher rate, however, cutaneous reactions are largely self-limited. Both anaphylactic and nonanaphylactic reactions should not discourage vaccination.

Coinfections with Bacteria, Fungi, and Respiratory Viruses in Patients with SARS-CoV-2: A Systematic Review and Meta-Analysis.

BACKGROUND: Coinfection with bacteria, fungi, and respiratory viruses in SARS-CoV-2 is of particular importance due to the possibility of increased morbidity and mortality. In this meta-analysis, we calculated the prevalence of such coinfections. METHODS: Electronic databases were searched from 1 December 2019 to 31 March 2021. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. RESULTS: Of the 6189 papers that were identified, 72 articles were included in the systematic review (40 case series and 32 cohort studies) and 68 articles (38 case series and 30 cohort studies) were included in the meta-analysis. Of the 31,953 SARS-CoV-2 patients included in the meta-analysis, the overall pooled proportion who had a laboratory-confirmed bacterial infection was 15.9% (95% CI 13.6-18.2, n = 1940, 49 studies, I2 = 99%, p < 0.00001), while 3.7% (95% CI 2.6-4.8, n = 177, 16 studies, I2 = 93%, p < 0.00001) had fungal infections and 6.6% (95% CI 5.5-7.6, n = 737, 44 studies, I2 = 96%, p < 0.00001) had other respiratory viruses. SARS-CoV-2 patients in the ICU had higher co-infections compared to ICU and non-ICU patients as follows: bacterial (22.2%, 95% CI 16.1-28.4, I2 = 88% versus 14.8%, 95% CI 12.4-17.3, I2 = 99%), and fungal (9.6%, 95% CI 6.8-12.4, I2 = 74% versus 2.7%, 95% CI 0.0-3.8, I2 = 95%); however, there was an identical other respiratory viral co-infection proportion between all SARS-CoV-2 patients [(ICU and non-ICU) and the ICU only] (6.6%, 95% CI 0.0-11.3, I2 = 58% versus 6.6%, 95% CI 5.5-7.7, I2 = 96%). Funnel plots for possible publication bias for the pooled effect sizes of the prevalence of coinfections was asymmetrical on visual inspection, and Egger's tests confirmed asymmetry (p values < 0.05). CONCLUSION: Bacterial co-infection is relatively high in hospitalized patients with SARS-CoV-2, with little evidence of S. aureus playing a major role. Knowledge of the prevalence and type of co-infections in SARS-CoV-2 patients may have diagnostic and management implications.

Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review.

BACKGROUND: Knowledge of infection prevention and control (IPC) procedures among healthcare workers (HCWs) is crucial for effective IPC. Compliance with IPC measures has critical implications for HCWs safety, patient protection and the care environment. AIMS: To discuss the body of available literature regarding HCWs' knowledge of IPC and highlight potential factors that may influence compliance to IPC precautions. DESIGN: A systematic review. A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis [PRISMA] statement. DATA SOURCES: Electronic databases (PubMed, CINAHL, Embase, Proquest, Wiley online library, Medline, and Nature) were searched from 1 January 2006 to 31 January 2021 in the English language using the following keywords alone or in combination: knowledge, awareness, healthcare workers, infection, compliance, comply, control, prevention, factors. 3417 papers were identified and 30 papers were included in the review. RESULTS: Overall, the level of HCW knowledge of IPC appears to be adequate, good, and/or high concerning standard precautions, hand hygiene, and care pertaining to urinary catheters. Acceptable levels of knowledge were also detected in regards to IPC measures for specific diseases including TB, MRSA, MERS-CoV, COVID-19 and Ebola. However, gaps were identified in several HCWs' knowledge concerning occupational vaccinations, the modes of transmission of infectious diseases, and the risk of infection from needle stick and sharps injuries. Several factors for noncompliance surrounding IPC guidelines are discussed, as are recommendations for improving adherence to those guidelines. CONCLUSION: Embracing a multifaceted approach towards improving IPC-intervention strategies is highly suggested. The goal being to improve compliance among HCWs with IPC measures is necessary.

Invasive Candidiasis in pediatric patients at King Fahad Medical City in Central Saudi Arabia. A 5-year retrospective study.

OBJECTIVES: To identify predisposing factors, species distribution, antifungal susceptibility, and outcome. Methods: This study is a retrospective chart review that was conducted at a children's hospital at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. One hundred twenty-nine children with invasive candidiasis who were admitted between January 2010 and January 2015. Results: The statistical analysis results have revealed a group of risk factors; prematurity in 37 (28.7%) of patients, low birth weight in 42 (32.6%), central venous catheter in 59 (45.7%), malignancy in 21 (16.3%), immunotherapy in 20 (15.5%), and ventilator support  in 60 (46.5%). More than 2-fold mortality rate in patients who had heart vegetation (odds ratio [OR]: 2.9) and patients who had Candida isolated from their blood were more than twice as likely to die as patients with Candida isolated from other sites (OR: 2.2). A total of 48.3% of patients on ventilator died versus 26.1% who were not on ventilator (p=0.009); and 43.8% of patients in the ICU died versus only 24.5% of patients who were not in the ICU (p=0.03). Candida parapsilosis exhibited the highest mortality rate (56.2%).  Conclusion: Candida albicans is the most common isolate among all Candida species. Gender, low birth weight, prolonged ICU stay, presence of vegetation, positive blood culture, and mechanical ventilation as a strong predictive risk factors for death in children with invasive candidiasis, a finding that could be applied as prophylactic indicator in critically ill children especially neonates.

Depression and anxiety in patients with hematological malignancies, prevalence, and associated factors.

OBJECTIVES: To study the prevalence and associated factors of depression and anxiety in hematological cancers (HC) patients. METHODS: We conducted a cross-sectional survey in all HC patients at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between March 2014 and June 2015. We excluded patients with depression, or generalized anxiety disorder. We conducted a structured face to face interview using an internally developed and validated questionnaire (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 patient's questionnaire with all participants). RESULTS: Among 211 participants, depression was detected in 98 (46.5%) and anxiety was detected in 47 (22.3%). Thirty-eight (18.1%) had concurrent anxiety and depression. Multiple co-morbidities and tense home atmosphere were predictive for anxiety and depression. We found no association between gender, smoking, income, or being on active therapy and depression or anxiety. CONCLUSIONS: Depression and anxiety are highly prevalent in HC patients in KAMC. Health care providers should screen HC cancers for depression and anxiety; as early intervention possibly improve their disease outcome and will likely enhance their psychological wellbeing.

Acceptance and Adverse Effects of H1N1 Vaccinations Among a Cohort of National Guard Health Care Workers during the 2009 Hajj Season.

BACKGROUND: The H1N1 influenza pandemic had garnered a large amount of attention. Currently, the most effective preventive measure available is the H1N1 vaccine. We aimed to assess the willingness of our study participants to receive the H1N1 vaccination prior to the annual Hajj season. If any participant declined, we investigated the reasons for vaccine rejection. FINDINGS: We conducted a prospective cohort study of National Guard employees during the 1430 (2009) Hajj season. A survey was used as the primary method for data collection. Participants were vaccinated one to two weeks prior to their trip to Mona, and any side effects reported at the time of injection and three weeks post vaccination were recorded.There were 100 male and 26 female participants in the study. In total, 66.7% (n = 84) of the participants were health care workers (HCWs) and 33.3% (n = 42) were non-health care workers (non-HCWs). Less than half of the respondents (46.8%, n = 59) accepted the vaccination. The vaccination acceptance rate was higher among non-HCWs, at a rate of 71.4% (n = 30); HCWs only accepted at a rate of 34.5% (n = 29) (OR 1.103, 95% CI [0.488-2.496]). The most common reason for vaccine refusal was the impression that the disease was not fatal (25.4%, n = 32). Finally, all participants reported pain at the injection site and 18.3% (n = 11) reported swelling. All other side effects were reported in less than 15% of the participants. CONCLUSIONS: Despite fears of the new H1N1 vaccine, there was a reasonable rate of vaccine acceptance among our study participants. Early health education may increase the rate of acceptance of the H1N1 vaccine. Furthermore, additional research is needed on long-term adverse effects of the H1N1 vaccine.