A Review of the Resistance Mechanisms for ß-Lactams, Macrolides and Fluoroquinolones among Streptococcus pneumoniae.

Streptococcus pneumoniae (S. pneumoniae) is a bacterial species often associated with the occurrence of community-acquired pneumonia (CAP). CAP refers to a specific kind of pneumonia that occurs in individuals who acquire the infection outside of a healthcare setting. It represents the leading cause of both death and morbidity on a global scale. Moreover, the declaration of S. pneumoniae as one of the 12 leading pathogens was made by the World Health Organization (WHO) in 2017. Antibiotics like ß-lactams, macrolides, and fluoroquinolones are the primary classes of antimicrobial medicines used for the treatment of S. pneumoniae infections. Nevertheless, the efficacy of these antibiotics is diminishing as a result of the establishment of resistance in S. pneumoniae against these antimicrobial agents. In 2019, the WHO declared that antibiotic resistance was among the top 10 hazards to worldwide health. It is believed that penicillin-binding protein genetic alteration causes ß-lactam antibiotic resistance. Ribosomal target site alterations and active efflux pumps cause macrolide resistance. Numerous factors, including the accumulation of mutations, enhanced efflux mechanisms, and plasmid gene acquisition, cause fluoroquinolone resistance. Furthermore, despite the advancements in pneumococcal vaccinations and artificial intelligence (AI), it is not feasible for individuals to rely on them indefinitely. The ongoing development of AI for combating antimicrobial resistance necessitates more research and development efforts. A few strategies can be performed to curb this resistance issue, including providing educational initiatives and guidelines, conducting surveillance, and establishing new antibiotics targeting another part of the bacteria. Hence, understanding the resistance mechanism of S. pneumoniae may aid researchers in developing a more efficacious antibiotic in future endeavors.

Electrocardiographic interpretation by emergency medical services professionals in Saudi Arabia: A cross sectional study.

BACKGROUND: Management of acute myocardial infarction (AMI) and cardiac arrhythmias in prehospital settings is largely determined by providers of emergency medical services (EMS) who can proficiently interpret the electrocardiography (ECG). The aim of this study was to assess the ECG competency of EMS providers in Saudi Arabia. METHODS: Between Aug and Sep 2022, we invited all EMS providers working for the Saudi Red Crescent Authority in Makkah, Riyadh, and Sharqiyah regions to complete a cross-sectional survey. The survey was used to assess the ability of EMS providers to interpret 12 ECG strips. Characteristics and ECG competency were summarized using descriptive statistics. Differences in ECG competency across paramedics with lower and higher qualifications were assessed. RESULTS: During the study period, 231 participants completed the survey, and all were included. The overall mean age was 33.4, and most participants were male (94.8%). Nearly half of the participants were paramedics with an associate degree and 46.4% were paramedics with higher degrees. The average rate of correct answers to the 12 ECG strips was 43.3% (95% CI: 35.4%, 51.3%). Atrial flutter, ventricular fibrillation, atrial fibrillation, 3rd degree heart block, and ventricular tachycardia were identified by 52.8%, 60.2%, 42.0%, 40.7%, and 49.4% of the participants, respectively. The strip with an AMI was identified by 41.1%, while a pathological Q wave and ventricular extrasystole were identified by 19.1% and 24.7%, respectively. Paramedics with higher qualifications were as 28.0%-61.0% more likely to correctly interpret the 12 ECG strips compared to those with an associate degree (p-value across all variables was ≤ 0.001). CONCLUSION: While the majority of participants in our region were unable to correctly answer the 12 ECG questionnaire, paramedics with higher qualifications were. Our study indicates that there is a need for evidenced-based ECG curricula targeting different levels of EMS professionals.

Patient Satisfaction and Its Predictors With Perioperative Anesthesia Care at Two General Hospitals in Southwestern Saudi Arabia.

Introduction  Patient satisfaction is one of the most crucial quality assessment and improvement indicators in anesthesia. Different factors reflect satisfaction such as postoperative pain, procedure duration, patient-physician relationship, inpatient services, and waiting time. A high level of satisfaction can lead to better outcomes in many ways, such as decreasing future surgeries fear and strengthening the healthcare system trust among the population. Therefore, this study aimed to evaluate the satisfaction level and its predictors with perioperative anesthesia care among patients subjected to different surgeries in two general hospitals in southwestern Saudi Arabia. Methodology  A cross-sectional study was conducted among patients admitted to different surgical specialties at two general hospitals in Al-Qunfudhah governorate in October 2022. Data were collected through interviews with postoperative patients and checking their medical data from the patient's medical reports. However, all surgical patients aged more than 18 consider as inclusion. In contrast, intensive care unit (ICU) admission, local anesthesia, refusal to participate, and cognitive and communication impairment are the exclusion. Perioperative patient satisfaction was assessed using the Leiden Perioperative Care Patient Satisfaction Questionnaire (LPPSq). Results Eighty-three of 201 patients were included in the final analysis. The overall level of patient satisfaction concerning perioperative anesthetic care was calculated to be 73.5%. Hospital setting, admission type, BMI, and smoking were statistically associated with perioperative anesthesia patient satisfaction. Additionally, the most frequently reported unpleasant anesthetic side effect was shivering, followed by postoperative pain at a frequency of 42 (50.6%) and 37 (44.6%), respectively. Conclusion A moderate level of patient satisfaction concerning perioperative anesthetic care was detected. Smoking, BMI, admission type, and hospital setting were significantly associated predictors for patients' satisfaction. In order to present a complete picture, we recommend that future research concentrate on additional elements of patient satisfaction, particularly operating room turnover and standards for discharge. Additionally, we propose a routine evaluation before patients' discharge when patients are altering and oriented. Periodic evaluation and enhancement of patient satisfaction with perioperative anesthetic care should be employed and promoted.