A Retrospective Analysis of National-Scale Agricultural Development in Saudi Arabia from 1990 to 2021

Agricultural intensification has resulted in the depletion of groundwater resources in many regions of the world. A prime example is Saudi Arabia, which witnessed dramatic agricultural expansion since the 1970s. To explore the influence of policy interventions aimed to better manage water resources, accurate information on the changes in the number and acreage of center-pivot fields is required. To quantify these metrics, we apply a hybrid machine learning framework, consisting of Density-Based Spatial Clustering of Applications with Noise, Convolutional Neural Networks, and Spectral Clustering, to the annual maximum Normalized Differential Vegetation Index maps obtained from Landsat imagery collected between 1990 to 2021. When evaluated against more than 28,000 manually delineated fields, the approach demonstrated producer's accuracies ranging from 83.7% to 94.8% and user's accuracies ranging from 90.2% to 97.9%. The coefficient of determination ((Formula presented.)) between framework-delineated and manually delineated fields was higher than 0.97. Nationally, we found that most fields pre-dated 1990 (covering 8841 km (Formula presented.) in that year) and were primarily located within the central regions covering Hail, Qassim, Riyadh, and Wadi ad-Dawasir. A small decreasing trend in field acreage was observed for the period 1990–2010. However, by 2015, the acreage had increased to approximately 33,000 fields covering 9310 km (Formula presented.). While a maximum extent was achieved in 2016, recent decreases have seen levels return to pre-1990 levels. The gradual decrease between 1990 to 2010 was related to policy initiatives designed to phase-out wheat, while increases between 2010 to 2015 were linked to fodder crop expansion. There is evidence of an agricultural uptick starting in 2021, which is likely in response to global influences such as the COVID-19 pandemic or the conflict in Ukraine. Overall, this work offers the first detailed assessment of long-term agricultural development in Saudi Arabia, and provides important insights related to production metrics such as crop types, crop water consumption, and crop phenology and the overarching impacts of agricultural policy interventions. © 2023 by the authors.

Inequalities in Health Care Attention of Severely Malnourished Children in Remote and Conflicts Zones

Objectives: To analyze geographical and social inequalities in the process of health care of Moderate and Severely Malnourished Children under two years old in remote and Conflicts Zone. Method(s): An ambispective (retrospective and prospective) analysis of the geographical, social context and clinical information using mixed methods was developed. The retrospective information was extracted from clinical records of children diagnosed with moderate and severely malnourished and attended in nine remote territories and with conflict problems in Colombia during the COVID-19 pandemic era in the period of 2020 and 2021. The prospective analysis was developed with interviews to health care professionals and mothers of children attended in 2021 and 2022 and external resources of epidemiological reports. Result(s): 357 clinical records of children diagnosed with acute moderate and severely malnourished were analyzed. 89% (320/357) of the population was located in the rural area, 76% of the children belong to indigenous ethnicity and 20% to afro-descendant, followed of migrants;more than a half of families have an income minor to 125 USD per month, on the other hand more than 500 newborns per month was attend at home. In the geographical analysis conflict and lack access roads were the most common circumstances identified as barrier to access to a specialized health care and factors relates with the food insecurity and clean water access. A high rotation of health care workers was also funded in that area. Conclusion(s): The circumstances of poverty and inequities in that zones were increased after covid-19 pandemic and have a big influence in the health and nutrition status of children and their families. This situation requires new models of health care based on community surveillance and empowerment of leaders as midwives who are present in those territories. These results also highlight the need of intersectoral work in those areas. Copyright © 2022

Right ventricular strain in in COVID-19 patients: a single-center experience

BACKGROUND: Assessment of right ventricular systolic function using strain imaging analysis from two-dimensional echocardiography has been identified to have powerful predictive value. Utilization of right ventricular strain may provide additional information in the management of COVID-19 patients. OBJECTIVE: To determine and analyze the right ventricular systolic function using longitudinal strain imaging among COVID-19 patients. METHOD: This is a prospective cohort study of the right ventricular function using speckle tracking echocardiography among COVID-19 patients. The study included two dimensional (2D) echocardiographic studies among 137 adult patients with laboratory-confirmed COVID-19 from September to November 2020. Analysis of Variance (ANOVA) was used to compare more than two groups with numerical data. Pearson Correlation was utilized to determine correlation between numerical variables. RESULTS: The results showed a total of 35 patients (25.54%) to have abnormal right ventricular free wall strain. The results showed that there was a significant direct correlation between right ventricular free wall strain and the echocardiographic parameters of tricuspid annular plane systolic excursion (TAPSE) (r = 0.277;p = 0.001), S' (r = 0.166;p = 0.050), right ventricular fractional area change (r = 0.298;p < 0.0001) and left ventricular ejection fraction (LVEF) (r = 0.176;p = 0.040). There was a significant inverse correlation noted between right ventricular free wall strain and the echocardiographic parameters of the tricuspid regurgitation (r=-0.284;p = 0.001), pulmonary arterial systolic pressure (r=-0.209;p = 0.014) and left atrial size (r=-0.209;p = 0.014). There was a significant difference in the right ventricular free wall strain according to the severity of COVID-19 infection (p = 0.032). Moreover, a significant difference was also noted between right ventricular free wall strain and mortality (p = 0.0001). The mean right ventricular free wall strain of patients who died was significantly lower than those who were discharged with a mean of 18.92% and 23.59% respectively. CONCLUSION: Right ventricular free wall strain using speckle tracking echocardiography, can be used for risk stratification for patients with COVID-19. It also showed that it is has significant correlation with the severity of the disease and mortality. These findings together with other conventional echocardiographic parameters, may provide clinicians additional information in the management of these patients.

Comorbidities associated with maternal mortality from COVID-19 in Mexico

Introduction: In Mexico, there is a syndemic in pregnant women, where the epidemic of obesity and chronic diseases coexists with that of coronavirus disease 2019 (COVID-19), which has been associated with a higher risk of maternal mortality. Objective: To evaluate the association of comorbidities during pregnancy with maternal mortality from COVID-19 in Mexico. Material and methods: SISVER COVID-19 databases and epidemiological surveillance reports on maternal mortality were used. Multivariate logistic regression models were used to evaluate the association of comorbidities with maternal deaths from COVID-19. Results: A total of 29,416 pregnant women were evaluated, out of which 39 % were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2);the risk of maternal mortality was 3.24 times higher (p < 0.01) for positive in comparison with negative women. COVID-19 is the leading cause of maternal death since July 2020 and explains more than 50 % of total deaths in 2021. Chronic kidney disease (odds ratio [OR]: 4.11;p < 0.01) and diabetes (OR: 2.53;p < 0.01) were the two main comorbidities that were positively associated with maternal death from COVID-19. Conclusion: Comorbidities during pregnancy that are possibly associated with an increase in the inflammatory response and an alteration of the immune response increase the risk of maternal death from COVID-19 in Mexican pregnant women.

Is nutritional follow-up in patients living with rheumatoid arthritis better with teleconsultation-experience before and after pandemic

Background: Nutritional follow-up as part of the integral attention for patients living with rheumatoid arthritis (RA) has been limited due to the COVID-19 pandemic. It made necessary to implement a remote monitoring for the care of the patients and to evaluate the outcomes of the changes in the care model. Objectives: To identify the effects of the telemonitoring intervention within the pandemic scenario and the outcomes of the traditional face-to-face nutrition consultation. Methods: A retrospective analysis of health records and the administrative data base of the patient's follow-up, between 2019 and 2020, was developed at the arthritis specialized center of the Santa Fe de Bogotá Foundation in Bogotá, Colombia. The outcomes measured include the number of visits per year and the proportion of patients who attend their nutritional follow-up by telemonitoring in 2020 vs patients attending to face-to-face nutrition consultation. Differences in the Body Max Index (BMI) and the changes based on eating habits, defined by the quality of food consumption per day, were also measured. Results: A total of 212 patients from 2020 and 179 from 2019 were analyzed;An increase of 61.5% in the number of consultations, using nutritional telemonitoring per year, was identified in 2020 (n=412) compared to 2019 (n=255). In patients followed from 2019 to 2020, 13% (10/77) experienced an increase of more than 2 units of their BMI, while 22% (17/77) showed a decrease;in 2% of patients was not possible to evaluate their current weight;in the same way, 49% (103/212) in 2020 showed a positive change in their feeding habits compared with a 12% (21/179) in 2019. 135 new patients were recruited for nutritional telemonitoring 2020. Conclusion: Nutritional telemonitoring to follow-up patients with RA has increased considerably in terms of consultations per year and changes in the feeding habits. However, more evaluation is required for this model.

Renal dysfunction, COVID-19 infection, and mortality

Background: Critically ill patients with the SARS-CoV-2 virus (COVID-19) infection have diverse clinical manifestations including renal dysfunction which can determine their short-term outcomes. We assess if renal dysfunction on day one of hospital admission is associated with increased mortality risk of patients with severe COVID-19 infection. Methods: We conducted a retrospective review of records of patients with severe COVID-19 infection admitted to the Intensive Care Unit between March 4 and April 11, 2020. Patients were divided into two groups based on serum creatinine level on day one of hospital admission. Group 1 included patients with normal serum creatinine (SCr) 1.10 mg/dl while group 2 included patients with high SCr > 1.10 mg/dl. The primary outcome was mortality. Secondary outcomes were the need for renal replacement therapy (RRT), duration of RRT, development of adult respiratory distress syndrome (ARDS) and need for mechanical ventilation. Comparisons between groups were done using Mann-Whitney U-tests for continuous variables and chi-square tests for categorical variables. Mortality was evaluated with a Kaplan-Meier Survival Analysis. Results: A total of 47 patients were included: 27 in group 1 and 20 in group 2. Patients in group 2 compared to group 1 were older (67 vs. 56, p=0.04), more frequently African Americans (11% vs 45%, p=0.02), hypertensives (80% vs 52%, p=0.05) with chronic kidney disease (25% vs 0%, p=0.01), without significant differences sex, diabetes mellitus, smoking status or use of renin-angiotensin antagonists. 8 patients in group 2 and 3 patients in group 1 died, with significant difference in cumulative survival (Figure 1). Need for RRT (55% vs 41%, p=0.33), duration of RRT (6 vs 3 days, p=0.08), development of ARDS (85% vs 81%, p=0.75) and need for mechanical ventilation (65% vs 61%, p=0.89) were not significantly different between groups 2 and 1. Conclusions: The presence of renal dysfunction on the day of hospital admission is associated with increased hospital mortality in patients with severe COVID-19 infection.