Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory.

BACKGROUND: Intensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses' burnout during the pandemic can help to develop appropriate mitigation measures. OBJECTIVE: The objective of this study was to examine intensive care nurses' experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout. METHODS: The study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months' experience in intensive care and experienced caring for COVID-19 patients. FINDINGS: This paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category 'pandemic pervasiveness' was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout. CONCLUSION: Many issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses' burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.

Assessment of factors associated with depression and anxiety among pwMS in Saudi Arabia.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory chronic disease that is characterized by an increased prevalence of adverse mental health outcomes in patients with MS (pwMS). The main aim of this study is to investigate the factors of depression and anxiety in pwMS in the Kingdom of Saudi Arabia (KSA). MATERIALS AND METHODS: This is a cross-sectional study conducted in KSA during the period from March to June 2020. Participants were recruited from the Neuroimmunology clinics in King Fahad Medical City (KFMC) and King Saud University medical city (KSUMC)in Riyadh City, KSA. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. Fatigue Severity Scale (FSS) was used to measure fatigue in pwMS. A simple random sampling technique was utilized to select participants and the data were analyzed using SPSS v.24.0. RESULTS: A total of 529 participants participated in this study with a response rate of 53.1%. The prevalences of anxiety and depression were 35.3% and 19.7%, respectively. The findings also revealed that depression was more likely to be significantly affected by being male, low education, unemployment, physical inactivity, and fatigue but the anxiety was significantly affected by region, unemployment, short duration since last MS relapse, physical inactivity, and fatigue. CONCLUSION: Anxiety and depression are not uncommon in pwMS. Given their impact on the lives of affected patients, early detection and management of these symptoms and their associated factors are crucial.

IL-35 and IL-37 are negatively correlated with high IgE production among children with asthma in Saudi Arabia.

BACKGROUND: Asthma is one of the most prevalent inflammatory disorders among children in Saudi Arabia. OBJECTIVE: This study aimed to determine the correlation between the serum levels of vitamin D, immunoglobulin E (IgE), and cytokine (interferon-gamma (IFN-γ), interleukin (IL)-1ß, IL-4, IL-6, IL-10, IL-13, IL-35, and IL-37) in relation to the severity of disease in patients with asthma. METHODS: This case-control study was carried out at King Abdullah Specialist Children's Hospital, Saudi Arabia, and included 48 patients with asthma and 47 matched controls, aged 6-14 years. A validated questionnaire was administered to the participants, after which each patient with asthma underwent pulmonary function tests. The serum levels of vitamin D, IgE, IFN-γ, IL-1ß, IL-4, IL-6, IL-10, IL-13, IL-35, and IL-37 of each participant were also measured. RESULTS: Patients with asthma demonstrated significantly higher IgE and cytokine (IL-1ß, IL-4, IL-6, IL-10, IL-13, IL-35, and IL-37) levels compared to the control group (p value < .001). The levels of IL-1ß, IL-4, IL-10, and IL-13 were consistently positively correlated with the serum levels of IgE among patients with asthma. However, the IgE levels in patients with asthma were consistently negatively correlated with IL-35 and IL-37. CONCLUSIONS: We found significantly higher levels of eosinophils, IgE, IL-1ß, IL-4, IL-6, IL-10, IL-13, IL-35, and IL-37 in patients with asthma compared to the controls, but no relationship between vitamin D and asthma.

Molecular characterization of Trypanosoma evansi, T. vivax and T. congolense in camels (Camelus dromedarius) of KSA.

BACKGROUND: Trypanosoma evansi is the leading infectious Trypanosoma spp. in camels (Camelus dromedarius) present in the Kingdom of Saudi Arabia (KSA) that could lead to extensive economic losses. The present study was aimed to assess the prevalence rate of T. evansi in Taif governorate, Makkah province, KSA using parasitological and molecular evaluations, and analyze their genetic relationship targeting internal transcribed spacer 1 (ITS1) and variable surface glycoprotein (VSG) genes. For evaluation, we have used 102 blood samples of camels obtained from three different regions in Taif. RESULTS: Results show a considerable prevalence rate of trypanosomosis 2/102 (2.0%) according to Giemsa-stained buffy coat smear, and 16/102 (15.7%) according to touchdown PCR. T. evansi (n = 10/102, 9.8%) was the main infectious species found in camels then T. vivax (n = 3/102, 2.9%). Mixed infections were detected in three camels with T. evansi, T. vivax, and T. congolense (n = 3/102, 2.9%). Regarding gender, the results indicate that female camels (11/66, 16.7%) show higher prevalence of Trypanosoma than males (5/36, 13.9%). Sequencing and phylogenetic analyses of ITS1 and VSG showed their relationships with T. evansi in other hosts from different countries. CONCLUSIONS: In our peer knowledge, it is the first time to report a research-based prevalence of trypanosomosis in the camels of Taif governorate, Makkah province, KSA.

Physiological impacts on construction workers under extremely hot and humid weather.

PURPOSE: Construction worker health and safety is a primary concern for construction companies and researchers. Arabian Gulf region, like Saudi Arabia, has been experiencing extremely hot and humid (EHH) weather, which directly affects construction workers' health and safety. This study aims to address the problem of EHH weather conditions and their impacts on construction workers' physiological status. METHODS: This study assesses the impacts of EHH weather on construction workers' physiological status through the measurement of workers' physical body parameters (age, height, and weight); type of activities; and assigned tasks. Thirty-five multinational workers participated in the measurements, which were conducted in real construction site conditions A quantitative analysis was then applied to quantify the physiological impacts of the weather conditions. Several hypotheses were tested to identify the significant impacts of individual and working aspects on the workers' physiological responses. RESULTS AND CONCLUSION: The results provide empirical evidence that the recorded Heart Rate (HR) exceeded the acceptable physiological zones for construction workers exposed to extremely hot and humid weather conditions. Physical body parameters, work activities, and worker status significantly influence construction workers' physiological responses. This study recommends adopting a continuous monitoring approach as an early warning system under extremely hot and humid weather conditions.

Nature-Inspired Search Method and Custom Waste Object Detection and Classification Model for Smart Waste Bin.

Waste management is one of the challenges facing countries globally, leading to the need for innovative ways to design and operationalize smart waste bins for effective waste collection and management. The inability of extant waste bins to facilitate sorting of solid waste at the point of collection and the attendant impact on waste management process is the motivation for this study. The South African University of Technology (SAUoT) is used as a case study because solid waste management is an aspect where SAUoT is exerting an impact by leveraging emerging technologies. In this article, a convolutional neural network (CNN) based model called You-Only-Look-Once (YOLO) is employed as the object detection algorithm to facilitate the classification of waste according to various categories at the point of waste collection. Additionally, a nature-inspired search method is used as learning rate for the CNN model. The custom YOLO model was developed for waste object detection, trained with different weights and backbones, namely darknet53.conv.74, darknet19_448.conv.23, Yolov4.conv.137 and Yolov4-tiny.conv.29, respectively, for Yolov3, Yolov3-tiny, Yolov4 and Yolov4-tiny models. Eight (8) classes of waste and a total of 3171 waste images are used. The performance of YOLO models is considered in terms of accuracy of prediction (Average Precision-AP) and speed of prediction measured in milliseconds. A lower loss value out of a percentage shows a higher performance of prediction and a lower value on speed of prediction. The results of the experiment show that Yolov3 has better accuracy of prediction as compared with Yolov3-tiny, Yolov4 and Yolov4-tiny. Although the Yolov3-tiny is quick at predicting waste objects, the accuracy of its prediction is limited. The mean AP (%) for each trained version of YOLO models is Yolov3 (80%), Yolov4-tiny (74%), Yolov3-tiny (57%) and Yolov4 (41%). This result of mAP (%) indicates that the Yolov3 model produces the best performance results (80%). In this regard, it is useful to implement a model that ensures accurate prediction to develop a smart waste bin system at the institution. The experimental results show the combination of KSA learning rate parameter of 0.0007 and Yolov3 is identified as the accurate model for waste object detection and classification. The use of nature-inspired search methods, such as the Kestrel-based Search Algorithm (KSA), has shown future prospect in terms of learning rate parameter determination in waste object detection and classification. Consequently, it is imperative for an EdgeIoT-enabled system to be equipped with Yolov3 for waste object detection and classification, thereby facilitating effective waste collection.

Knowledge and Attitude toward Hemoglobinopathies in Premarital Screening Program among the General Population in the Western Region of Saudi Arabia.

The National Premarital Screening Program, which includes sickle cell disease and thalassemia, was made mandatory in 2004 by the Kingdom of Saudi Arabia (KSA), and the earlier studies have shown a poor knowledge and negative attitude toward this program in the different study groups. This study was conducted to assess the knowledge and attitudes toward premarital screening (PMS) in a randomly selected national sample of the Saudi population, 18 years and above. This was a cross-sectional study conducted in the Saudi population in the western region between July and December 2021. Valid and reliable questionnaire and data were collected from 893 participants aged ≥18 years. The χ2 test was used to ascertain if there is an association between categorical variables. Multivariate logistic regression was used to determine factors predicting satisfactory knowledge. All 893 study participants had heard about PMS with 625 (70.0%), 244 (27.3%) and 24 (2.7%) having satisfactory, fair and poor knowledge, respectively. Participants aged 26-35 years (p =0 .038), females (p < 0.001), those with higher education (p = 0.003) and employed (p = 0.004), had a better knowledge compared to other groups. Most of the participants had a positive attitude toward PMS. There is a changing trend in the knowledge and attitude toward PMS with a greater number of people wanting to go for PMS. There is also an improvement in the number of participants opting out of marriage in case of incompatibility with their future partner. However, the health education programs need to be improved regarding the hemoglobinopathies.

The evaluation of adverse drug reactions in Saudi Arabia: A retrospective observational study.

Purpose: This study aimed to assess the type, severity, seriousness, reasons, and outcomes of adverse drug reactions (ADRs) in the reports submitted to the regional spontaneous ADR database. Methods: A retrospective observational study was conducted to analyze all the Tabuk Health Affairs hospitals in Saudi Arabia submitted to SFDA from January 2020 to December 2020. The database was structured according to the Saudi ADR form's fields. The Naranjo algorithm was used to assess the causes of the ADRs (sFDA, 2022). Results: For 1 year, 2,349 ADR reports, along with 242 suspected drugs for 4,114 reactions, were submitted to SFDA. We found more males than females had ADRs (56.1% vs. 43.8%, P < 0.05).Antimicrobial drugs (26.9%), hematologic drugs (19.7%), and neuropsychiatric drugs (12.9%) were responsible for most ADRs. Most of the reactions were associated with the use of ciprofloxacin (7.7%), followed by the combination of lopinavir and ritonavir (4.1%). Two deaths resulted from salbutamol and cefazolin use. Based on the results of the Naranjo assessment of causality, cardiovascular events (9.9%) exhibited the highest score (≥9) for a causal relationship with the suspected drugs, followed by dermatological events (9.5%). Conclusions: The spontaneous report database is an important and valuable source of aftermarket authorization safety information. In our study, most drugs used as antimicrobial, cardiovascular, and hematologic therapies were associated with a higher risk of developing severe and serious events. We recommend monitoring and using medications optimally to ensure patient safety.

The prevalence of MERS-CoV among military personnel and their families: A single-center study.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a Betacoronavirus that results in a severe fatal respiratory disease; however, it is also associated with mild inapparent infections. The western part of the Kingdom of Saudi Arabia (KSA) contains the holy places where millions of Muslims gathered from all over the world, all year round, with a high probability of mass disease transmission. The aim of this study was to estimate the prevalence of MERS-CoV among military personnel and their families during the period 2014-2019, in the western part of the KSA. A total of 35,203 sputum samples collected from patients with respiratory distress were screened for the presence of MERS-CoV using real-time reverse-transcription polymerase chain reaction in the examined patients. MERS-CoV infections were detected at a very low percentage in the examined patients. Only 42 of the examined subjects (0.12%) were found positive for MERS-CoV. Most infected cases (32/42) cases were detected in 2014, and the rest of the cases were reported in 2015-2019. The cases with fatal consequences (n = 20) were only detected in 2014. It was concluded that there is a very low prevalence of MERS-CoV infections among the military personnel and their families.

The role of self-esteem and self-efficacy in women empowerment in the Kingdom of Saudi Arabia: A cross-sectional study.

The study aimed to explore the role of self-esteem and self-efficacy in women empowerment among academic and administrative staff at Saudi universities. A cross-sectional design was carried out at 15 governmental universities. A multistage cluster sampling technique was used to select 5587 participants. Multiple linear regression was used to analyze the predictive relation. Data collection included socio-demographic variables, Rosenberg self-esteem scale, general self-efficacy scale, and women empowerment scale. The results indicated that study participants' self-esteem was equally distributed between moderate (49.8%) and high (50.2%). Also, 66.9% of the participants had high self-efficacy, and 86.8% had high total women's empowerment. Regression coefficient showed that self-esteem (B=0.521, b=0.127, t=13.785 and p <0.001) and self-efficacy (B=2.388, b=0.702, t=76.049 and p <0.001) are important predictors of the total women empowerment. However, self-efficacy was observed to be the most dominant predictor (t=76.049). The total model summary shows that 73.4% of the women empowerment level can be predicted through self-esteem and self-efficacy. The study results can be used as a base to build women empowerment programs in the Kingdom of Saudi Arabia (KSA) and help to achieve the 2030 KSA vision regarding women empowerment.

Act like a warrior to defeat medication counselling barriers: A cross sectional study.

BACKGROUND: In the previous literature, patients' perceptions of medication consultation provided by pharmacists was found to poor, depending upon various factors, which may lead to poor compliance with medication instructions and, therefore, poor health outcomes. In the Kingdom of Saudi Arabia (KSA), this specific area has been overlooked to date, so this study aims to examine patients' perceptions of medication counselling and the factors that influence their likelihood of participating in medication counselling as well as determine the predictors of patients' likelihood to take part in medication counselling delivered by pharmacists in KSA. MATERIALS AND METHODS: A cross-sectional survey was conducted involving people over 18 years of age, who had purchased or collected medicine for their own use from community and/or hospital pharmacies within the past two years and who lived in Saudi Arabia. The data were analysed using IBM SPSS Statistics version 24. Descriptive statistics were applied to each item as well as linear regression and Pearson's correlation. RESULTS: Five hundred and eleven participants (male (n = 101), female (n = 410), the majority of whom were aged 18-24-years-old) were included. Almost an equal number of participants had accessed either community (CP) (n = 228: 45%) or hospital pharmacies (HP) (n = 283: 55%) within the past two years in regards to their condition and/or medication. The perceived susceptibility construct had weak positive correlations with all of the constructs being measured (r < 0.3). Perceived barriers had a weak negative relationship with likelihood (r < 0.3), which means that, as the perceived barriers increase, the perceived benefits and future likelihood to participate in medication counselling decrease. Linear regression analysis found that age (ß = -0.06; P =˃0.05), gender (ß = 0.14; P =˃0.05), education level (ß = -0.01; P =˃0.05) and type of pharmacies accessed (ß = -0.05; P =˃0.05) were non-significant predictors of the participants' likelihood of participating in medication counselling. CONCLUSION: In order to improve the medication consultation provided by pharmacists and, therefore, enhance the patients' experience and care, it is important to understand the public's views, concerns and demands regarding medication consultation, in order to provide the proper interventions and serve as a platform for developing a plan of action for good pharmacy practice.

A genetic variant c.553G > T (rs2075291) in the apolipoprotein A5 gene is associated with altered triglycerides levels in coronary artery disease (CAD) patients with lipid lowering drug.

BACKGROUND: Elevated plasma triglycerides (TGs) are widely used as a major cardiovascular risk predictor and are thought to play an important role in the progression of coronary heart disease (CHD). It has been demonstrated that lipid lowering was associated with lower mortality in patients with CHD. The present study therefore aimed to investigate the consequences of the genetic variant c.553G > T (rs2075291) in apolipoprotein A5 gene to determination of triglycerides levels in CAD patients receiving, atorvastatin, lipid lowering drug. METHODS: We here report that a recently identified genetic variant, c.553G > T in the APOA5 gene which causes a substitution of a cysteine for a glycine residue at amino acid residue 185(G185C) is also associated with increased TG levels. To investigate theses effects, a case-control study compressing 608 subjects from the same area was performed. RESULTS: TG levels in T allele patients were significantly lower than the control GT allele patient (χ2 = 2.382E2a, P-value < 0.001). Overall, patients carrying T allele showed lower levels of TG than patients carrying GG allele. The homozygous patient for the T allele presented normal cholesterol levels of 134 mg/dl, and the levels in GG patients ranged from 25 to 340 mg/dl (P-value < 0.001). In summary, we demonstrated that the presence of c.553G > T variant (rs2075291); in APOA5 gene increases human plasma TG levels. CONCLUSION: Nevertheless, T allele is found to reduce TG levels in CAD patients who are on the cholesterol medication, atorvastatin. Thus, c.553G > T variant can be considered as a significant predicator of hypertriglyceridemia. In addition, it could be used as a hallmark for the diagnosis and prognosis of CAD.

Prevalence of depression among adults with sickle cell disease in the southern region of Saudi Arabia.

OBJECTIVES: Sickle Cell Disease (SCD) as other chronic medical conditions is commonly complicated by psychiatric symptoms. Saudi SCD patients are usually originally from Eastern and Southwestern Provinces. The main objective of our study was to evaluate the prevalence of depression among adults with SCD in southern region of Saudi Arabia. We also studied the sociodemographic profiles for these individuals. METHODS: We conducted a cross-sectional study among subjects (n=78) in Armed Forces Hospital, Southern Saudi Arabia using an Arabic version of a Hamilton Rating Scale for Depression HAM-D that has received widespread use and have undergone reliability and validity testing. The data were analyzed by SPSS 22 package program. Pearson's chi-squared test is used to examine the association between the categorical outcome variables A p-value less than 0.05 was considered statistically significant. RESULTS: Most of the participants were young adults (26.4± 9.2 years), single females not working who are originally from Jizan and Mahayel Aseer, Southern Saudi Arabia. The prevalence of depressive symptoms was 85.9%. When the association between depression in SCD patients and different demographic characters was tested, no significant relation between depression and any factors was discovered. CONCLUSION: This study confirms that depression is common in adult patients with SCD as confirmed by previous studies. On the other hand, socio-demographic factors were not significant predictors of depression in SCD patients. Further research is needed to explore the magnitude and impact of this problem at the national level.

Prevalence of obesity and hypertension among University students' and their knowledge and attitude towards risk factors of Cardiovascular Disease (CVD) in Jeddah, Saudi Arabia.

OBJECTIVES: To investigate the prevalence of obesity and hypertension among University students' and their knowledge and attitude towards risk factors of cardiovascular disease (CVD) in Jeddah,: Saudi Arabia. METHODS: A total of 610 male students were selected for present cross sectional study and their blood pressure (BP) and body mass index (BMI) was determined, other data was gathered through a questionnaire, and SPSS-16 was used for analyzing data. RESULTS: Out of 610 students, 7.5% were hypertensive (systolic 2.6% and diastolic 6.3%) while the BMI of 51.6% was in the normal range, 29.8% were overweight and 10.7% were moderately obese and 7.9% were severely obese. Majority of the participants considered that smoking, increased fatty food intake, obesity, high BP, and increased LDL-cholesterol level, are the main causes of the CVD. Most of the participants agreed that one should know his BP, blood sugar, serum cholesterol and one should maintain normal body weight and should do regular exercise. They were also aware that healthy lifestyle could prevent CVD. However, majority of the participants were not practicing healthy lifestyle. CONCLUSION: A huge gap exists in the knowledge, attitude and practice regarding risk factors of CVD among the university students.

Clinical activity of FOLFIRI plus cetuximab according to extended gene mutation status by next-generation sequencing: findings from the CAPRI-GOIM trial.

BACKGROUND: Treatment with antiepidermal growth factor receptor (anti-EGFR) monoclonal antibodies has been restricted to metastatic colorectal cancer (mCRC) patients with RAS wild-type tumors. Next-generation sequencing (NGS) allows the assessment in a single analysis of a large number of gene alterations and might provide important predictive and prognostic information. PATIENTS AND METHODS: In the CAPRI-GOIM trial, 340 KRAS exon 2 wild-type mCRC patients received first-line FOLFIRI plus cetuximab. Tumor samples (182/340, 53.5%) were assessed by NGS to search for mutations in 22 genes involved in colon cancer. RESULTS: Objective responses in the NGS cohort were observed in 104/182 patients [overall response rate (ORR) 57.1%; 95% confidence interval (95% CI) 52% to 66.4%] with a median progression-free survival (mPFS) of 9.8 (95% CI 8.7-11.5) months. NGS analysis was successfully completed in all 182 samples. One or more gene mutations (up to five) were detected in 124/182 (68.1%) tumors within 14/22 genes for a total of 206 mutations. KRAS exon 2 mutations were identified in 29/182 (15.9%) samples, defined as wild type by local laboratory assessment. Frequently mutated genes were: TP53 (39.6%), KRAS exons 3/4 (8.8%), NRAS exons 2/3 (7.1%), PIK3CA exons 9/20 (13.2%), BRAF (8.2%). FOLFIRI plus cetuximab treatment determined ORR of 62.0% (95% CI 55.5% to 74.6%) with mPFS of 11.1 (95% CI 9.2-12.8) months in patients with KRAS and NRAS wild-type tumors. Conversely, ORR was 46.6% (95% CI 39.9-57.5%) with mPFS of 8.9 (95% CI 7.4-9.6) months in patients with KRAS or NRAS mutations. Similarly, the subgroup of patients carrying KRAS, NRAS, BRAF, or PIK3CA mutations showed a worse outcome, although this might be due to a prognostic effect. CONCLUSIONS: This study demonstrates that NGS analysis in mCRC is feasible, reveals high level of intra and intertumor heterogeneity, and identifies patients that might benefit of FOLFIRI plus cetuximab treatment.

Factors influencing telehealth awareness, utilization, and satisfaction in KSA: A national population-based study.

Background: Telehealth involves delivering healthcare remotely through digital platforms such as telephone and video calls. Use of telehealth surged during the COVID-19 pandemic because of the need for contactless healthcare. The Saudi Ministry of Health established the "937 telephone medical consultation call center" almost 10 years ago. Objectives: The aim of this study was to examine public awareness of, utilization of, and satisfaction with the 937 call center service, and to assess associated factors. Materials and methods: This national community-based, cross-sectional study was conducted through multistage sampling with proportional allocation from 20 health directorates. Participants were selected from the general population in public places and were interviewed with a validated questionnaire. Results: Of 7951 approached individuals, 7692 agreed to participate (response rate 96.7%). Seventy-eight percent of participants were aware of the 937 service, and 56.4% had previously used the service. Most (86%) users were satisfied with the service. Long waiting times were the most frequent reason (46.6%) for dissatisfaction. In multivariable analysis, service awareness and utilization were both significantly associated with having higher education (aOR 4.03, 95%CI: 3.17-5.12 and aOR 3.42, 95%CI: 2.64-4.42, respectively). Positive impressions of telephone medical consultation services, Saudi nationality, having children, having medical insurance, and having a history of chronic disease were significantly associated with awareness of, utilization of, and satisfaction with the service. Conclusion: The study revealed high awareness of, utilization of, and satisfaction with the 937 telephone medical consultation call center, thus suggesting increased public acceptance of the service. Moreover, the study identified socio-demographic factors influencing public awareness of, utilization of, and satisfaction with telehealth. Further studies are required to increase understanding of the facilitators of, and barriers to, the use of service among various population groups.

KSA-1, a naturally-occurring Ambler class A extended-spectrum ß-lactamase from the enterobacterial species Kosakonia sacchari.

BACKGROUND: Several bacterial species belonging to the Gammaproteobacteria possess intrinsic class A ß-lactamase genes that may represent the source of further dissemination and acquisition to other Gram-negative species. Her,e we characterized the KSA-1 class A ß-lactamase which gene was identified into the chromosome of an environmental Enterobacterales species, namely Kosakonia sacchari, recently identified also progenitor of an MCR-like colistin resistance determinant. METHODS: In-silico analysis using the GenBank database identified a class A ß-lactamase gene in the chromosome of Kosakonia sacchari SP1 (GenBank accession no. WP_065368351). The corresponding protein KSA-1 shared 63% amino-acid identity with the intrinsic CKO-1 from Citrobacter koseri and 53% with TEM-1. Using K. sacchari DSM 100203 reference strain as template, the blaKSA-1 was amplified, cloned into plasmid pUCp24 and expressed in E. coli TOP10. MICs and kinetic parameters were obtained from the purified enzyme. RESULTS: Strain K. sacchari SP1 conferred resistance to amino-, carboyx- and ureidopenicillins only. Once produced in E. coli, KSA-1 showed a typical clavulanic-acid inhibited extended-spectrum ß-lactamase (ESBL) associated to a peculiar temocillin resistance profile. Kinetic assays were performed using a purified extract of KSA-1, showed a high hydrolysis rate for benzylpenicillin and piperacillin and weakly extended-spectrum cephalosporins. Determination of inhibitory constants showed IC50 values of 2.2, 3 and 1.8 nM for clavulanic acid, tazobactam and avibactam, respectively. Analysis of sequences surrounding the blaKSA-1 gene did not reveal any mobile element that could have been involved in the acquisition of this ß-lactamase gene in that species. CONCLUSION: KSA-1 is a class A ESBL, distantly related to known ESBLs, with a high activity also temocillin. The blaKSA-1 gene can be considered as intrinsic in the species.

A comprehensive review of the biodiversity of freshwater fish species in Valleys worldwide and in the Kingdom of Saudi Arabia.

An overview of freshwater fish variety worldwide and the variables influencing trends in variation between and within river basins are given in this review. Continental freshwater ecosystems are highly diverse and species-rich, housing nearly 18,000 species of fish (=50% of all fish species) in <0.5% of the total land area and providing a negligible (<0.01%) share of the planet's water supply. Large lowland tropical river basins such as the Amazon, Congo, and Mekong basins are home to the greatest freshwater fish diversity. Freshwater species of fish depth variation at the global magnitude is correlated with the total amount and variation of aquatic habitats and the environment's equilibrium overtime during the evolution of scales. The river continuum concept states that there is a predictable shift in fish species depth, diversity of species, and functional characteristics along gradients of environment from headwater to estuary. The ongoing trade of minerals and organic matter related to nearby floodplains is a strong factor in the number and variety of riverine fishes in most parts of the world (the flood pulse concept). Without coordinated conservation efforts, freshwater fishes will suffer significant losses in abundance and diversity due to the numerous threats they currently face worldwide. However, further development, adaptation, training, and guidance are needed. New technologies based on water conservation, suitable species, and local traditions are needed. Waste materials and local feed additives can also be used. Farmers should be provided with the necessary training and information.

Women's access to healthcare services in the Jazan region of the KSA.

Objective: Our study investigated women's access to governmental healthcare in the Jazan region of the KSA. Our purpose is to provide a comprehensive analysis of the determinates of women's perceptions of their own access to healthcare, considering various demographic factors, family life, and gender role beliefs. Methods: We conducted a hierarchical regression analysis using data from a sample of 494 women. The first model included nationality, education, age, rurality, and other sociodemographic factors. The second model included the variables from the first model as well as self-ratings of physical and mental health and regular exercise. The third model included the variables from the first two models in addition to satisfaction with family life and gender role beliefs. Results: Our analysis revealed that age, nationality, employment, and having good physical and mental health, and satisfaction with family life positively predicted women's perceptions of their access to healthcare. Adherence to traditional gender roles, however, predicted less accessibility. Conclusion: Policymakers could use the outcomes of our study to enhance women's healthcare accessibility in Jazan region. The results could enhance the development and transformation of healthcare and women's health issues, particularly in understudied rural Saudi regions.

Patient satisfaction with Saudi community pharmacy services (Wasfaty System).

Introduction: The healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. Methods: This cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. Results: The sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03-1.37) and waiting time (OR: 1.23; 95% CI: 1.03-1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85-0.99). Saudi patients had lower odds of being satisfied with multiple services. Conclusions: The overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient-pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.