The Impact of COVID-19 on Suicidal Behavior in King Abdulaziz Medical City in Saudi Arabia.

INTRODUCTION:  During the COVID-19 pandemic, there has been a global increase in mental health issues, including suicidal behaviors. This study focuses on assessing the impact of the pandemic on the prevalence and characteristics of suicidal behavior at King Abdulaziz Medical City in Riyadh, Saudi Arabia. METHODS: A retrospective cohort study was conducted on 580 patients from January 2017 to December 2022, focusing on those aged 18 and above referred for suicide evaluation. Data were collected via chart reviews and analyzed using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY). RESULTS: Our study reviewed 580 patient charts, with 555 (95.7%) meeting the inclusion criteria. The majority of participants were in the 18-29 age group (66.7%). We observed an increase in the number of cases undergoing suicide attempt assessment post COVID-19, with 296 incidents (53.3%) from March 2020 to December 2022 (about a year and eight months), compared to 259 incidents (46.7%) from January 2017 to March 2020 (over three years). A significant post-pandemic increase was noted in individuals with secondary education or higher (p = 0.004). No significant changes were found in other demographic variables or in the profiles of individuals with an intention to end life before and after the pandemic. CONCLUSION: The study highlights the nuanced impact of the COVID-19 pandemic on suicidal behavior in Saudi Arabia, revealing an increased demand for suicide assessments, particularly among educated individuals. However, no corresponding increase was observed in the rate of high-intent suicidal cases or other significant variables. The findings underscore the complexity of factors influencing suicidal behavior during the pandemic and the need for targeted mental health interventions. Future research, ideally supported by a national database, is essential for a comprehensive understanding of suicidal behavior in Saudi Arabia.

Farnesol prevents chlorpyrifos nephrotoxicity by modulating inflammatory mediators, Nrf2 and FXR and attenuating oxidative stress.

Chlorpyrifos (CPF) is a broad-spectrum insecticide widely employed in agricultural field for pest control. Exposure to CPF is associated with serious effects to the main organs, including kidneys. Significant evidence denotes that oxidative stress (OS) and inflammation are implicated in CPF toxicity. This study aimed to evaluate the potential of farnesol (FAR) to modulate inflammatory mediators and farnesoid-X-receptor (FXR) and Nrf2 in a rat model of CPF nephrotoxicity. CPF and FAR were orally supplemented for 28 days and blood and kidney samples were collected for investigations. CPF administration elevated blood creatinine and urea, kidney MDA and NO, and upregulated NF-κB p65, IL-1ß, TNF-α, iNOS, and caspase-3. In addition, CPF upregulated kidney Keap1, and decreased GSH, antioxidant enzymes, and Nrf2, FXR, HO-1 and NQO-1. FAR ameliorated creatinine and urea, prevented histopathological alterations, decreased MDA and NO, and enhanced antioxidants in CPF-administered rats. FAR modulated NF-κB p65, iNOS, TNF-α, IL-1ß, caspase-3, Keap1, HO-1, NQO-1, Nrf2 and FXR. In silico investigations revealed the binding affinity of FAR towards Keap1 and FXR, as well as NF-κB, caspase-3, iNOS, and HO-1. In conclusion, FAR prevents CPF-induced kidney injury by attenuating OS, inflammation, and apoptosis, effects associated with modulation of FXR, Nrf2/HO-1 signaling and antioxidants.

Eight-year epidemiological study for drug poisoning in Qassim, Saudi Arabia, 2008-2015.

Literature reported drug poisoning as a major cause for visiting emergency departments, with various rates of occurrences across countries, regions, socioeconomic status, and cultures. Therefore, this study was conducted in Qassim to describe the sociodemographic patterns of acute drug poisoning as well as the most common drugs involved. A retrospective method of data collection was used employing medical record review for drug poisoning cases that occurred in the Qassim region during the 8 years from January 2008 to December 2015. Data was collected using a standardized, validated data collection sheet. The study failed to reveal any pattern (either decreasing or increasing) in the number of poisoning cases over time. Most cases (56.2%) of drug poisoning were accidental, caused by analgesics (35%), affected children younger than 5 years of age (41.4%), and occurred via ingestion (99.2%). It can be concluded that as most poisoning cases affected children, this highlights the importance of increasing awareness and educating families about the safe handling and storage of drugs out of reach of children.

The Efficiency of Schistosoma mansoni Crude Antigens in Inhibition of Heat Shock Protein, Apoptosis, and Lysosomal Activity: An Immunohistochemical Study.

The adverse impact of schistosomiasis on tissues is considered in generating a schistosomal vaccine. The purpose of this study was to evaluate the effectiveness of Schistosoma mansoni crude antigens as a therapeutic and prophylactic formulation in the inhibition of heat shock protein, apoptosis, and CD3/CD20 expression in a liver and spleen mouse models using the immunohistochemistry method. A total of 65 mice were divided into five groups: (i) infected untreated group (G1), (ii) therapeutic treated group (G2) with egg soluble egg antigen (SEA), and soluble worm antigen preparation (SWAP), (iii) prophylactically treated group (G3) with cercarial antigen preparation (CAP), (iv) combined treated group with three antigens (G4), and (v) control group (G5). The results we obtained showed that CAP, SEA, and SWAP antigens mitigated the deterioration and inflammation induced by infection. Apoptosis and sinusoidal injuries were significantly reduced when treated with CAP antigen before infection. After infection, using SEA and SWAP antigens may help lighten the liver's load. A high degree of activation in T and B cells in the liver and spleen is linked to this. Our findings shed light on the immunological mechanisms that contribute to the recovery from therapy and vaccination against schistosome damage.

Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia.

BACKGROUND: The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment. METHODS: This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units. RESULTS: The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported. CONCLUSIONS: To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.

The Prevalence of Multidrug-Resistant Acinetobacter baumannii and Its Vaccination Status among Healthcare Providers.

There is growing concern among healthcare providers worldwide regarding the prevalence of multidrug-resistant Acinetobacter baumannii (A. baumannii). Some of the worst hospital-acquired infections, often in intensive care units (ICUs), are caused by this bacterial pathogen. In recent years, the rise in multidrug-resistant A. baumannii has been linked to the overuse of antimicrobial drugs and the lack of adequate infection control measures. Infections caused by this bacterial pathogen are the result of prolonged hospitalization and ICU stays, and they are associated with increased morbidity and mortality. This review outlines the epidemiology, risk factors, and antimicrobial resistance associated with A. baumannii in various countries, with a special focus on the Kingdom of Saudi Arabia. In response to the growing concern regarding this drug-resistant bacteria, fundamental information about its pathology has been incorporated into the development of vaccines. Although these vaccines have been successful in animal models, their effectiveness in humans remains unproven. The review will discuss the development of A. baumannii vaccines, potential related obstacles, and efforts to find an effective strategy against this pathogen.

Diosgenin and Monohydroxy Spirostanol from Prunus amygdalus var amara Seeds as Potential Suppressors of EGFR and HER2 Tyrosine Kinases: A Computational Approach.

Cancer continues to be leading cause of death globally, with nearly 7 million deaths per year. Despite significant progress in cancer research and treatment, there remain several challenges to overcome, including drug resistance, the presence of cancer stem cells, and high interstitial fluid pressure in tumors. To tackle these challenges, targeted therapy, specifically targeting HER2 (Human Epidermal Growth Factor Receptor 2) as well as EGFR (Epidermal Growth Factor Receptor), is considered a promising approach in cancer treatment. In recent years, phytocompounds have gained recognition as a potential source of chemopreventive and chemotherapeutic agents in tumor cancer treatment. Phytocompounds are compounds derived from medicinal plants that have the potential to treat and prevent cancer. This study aimed to investigate phytocompounds from Prunus amygdalus var amara seeds as inhibitors against EGFR and HER2 enzymes using in silico methods. In this study, fourteen phytocompounds were isolated from Prunus amygdalus var amara seeds and subjected to molecular docking studies to determine their ability to bind to EGFR and HER2 enzymes. The results showed that diosgenin and monohydroxy spirostanol exhibited binding energies comparable to those of the reference drugs, tak-285, and lapatinib. Furthermore, the drug-likeness and ADMET predictions, performed using the admetSAR 2.0 web-server tool, suggested that diosgenin and monohydroxy spirostanol have similar safety and ADMET properties as the reference drugs. To get deeper insight into the structural steadiness and flexibility of the complexes formed between these compounds and theEGFR and HER2 proteins, molecular dynamics simulations were performed for 100 ns. The results showed that the hit phytocompounds did not significantly affect the stability of the EGFR and HER2 proteins and were able to form stable interactions with the catalytic binding sites of the proteins. Additionally, the MM-PBSA analysis revealed that the binding free energy estimates for diosgenin and monohydroxy spirostanol is comparable to the reference drug, lapatinib. This study provides evidence that diosgenin and monohydroxy spirostanol may have the potential to act as dual suppressors of EGFR and HER2. Additional in vivo and in vitro research are needed to certify these results and assess their efficacy and safety as cancer therapy agents. The experimental data reported and these results are in agreement.

The effect of oseltamivir use in critically ill patients with COVID-19: A multicenter propensity score-matched study.

Background: Oseltamivir has been used as adjunctive therapy in the management of patients with COVID-19. However, the evidence about using oseltamivir in critically ill patients with severe COVID-19 remains scarce. This study aims to evaluate the effectiveness and safety of oseltamivir in critically ill patients with COVID-19. Methods: This multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care unit (ICU). Patients were categorized into two groups based on oseltamivir use within 48 hours of ICU admission (Oseltamivir vs. Control). The primary endpoint was viral load clearance. Results: A total of 226 patients were matched into two groups based on their propensity score. The time to COVID-19 viral load clearance was shorter in patients who received oseltamivir (11 vs. 16 days, p = 0.042; beta coefficient: -0.84, 95%CI: (-1.33, 0.34), p = 0.0009). Mechanical ventilation (MV) duration was also shorter in patients who received oseltamivir (6.5 vs. 8.5 days, p = 0.02; beta coefficient: -0.27, 95% CI: [-0.55,0.02], P = 0.06). In addition, patients who received oseltamivir had lower odds of hospital/ventilator-acquired pneumonia (OR:0.49, 95% CI:(0.283,0.861), p = 0.01). On the other hand, there were no significant differences between the groups in the 30-day and in-hospital mortality. Conclusion: Oseltamivir was associated with faster viral clearance and shorter MV duration without safety concerns in critically ill COVID-19 patients.

Evaluation of Knowledge, Attitudes, and Practices about Pharmacovigilance among Community Pharmacists in Qassim, Saudi Arabia.

BACKGROUND: Pharmacovigilance (PV) is an essential activity to detect adverse drug reactions (ADRs) and ensure patient safety. Hence, we aimed to evaluate knowledge, attitudes, and practices (KAP) regarding PV among community pharmacists in Qassim, Saudi Arabia. METHODS: A cross-sectional study was conducted by using a validated questionnaire after obtaining ethical approval from the Deanship of Scientific Research, Qassim University. The sample size was calculated based on the total number of pharmacists in the Qassim area by using Raosoft, Inc. Statistical Package for the Social Sciences version 20 was used for data entry and analysis. Ordinal logistic regression was performed to identify the predictors of KAP. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 209 community pharmacists participated in the study; 62.9% of them defined the PV correctly, and 59% of them defined ADRs correctly. However, only 17.2% knew where to report ADRs. Interestingly, the majority of participants (92.9%) reported that it is necessary to report ADRs, and 73.8% of them were willing to report ADRs. A total of 53.8% of the participants identified ADRs during their careers; however, only 21.9% reported ADRs. Barriers discourage ADR reporting; the majority of the participants (85.6%) do not know how to report ADRs. CONCLUSION: Community pharmacists who participated in the study were knowledgeable about PV, and their attitude towards reporting ADRs was highly positive. However, the number of reported ADRs was low because of the lack of knowledge on how and where to report ADRs. Continuous education and motivation about ADRs reporting and PV are warranted among community pharmacists for the rational use of medications.

Detection of ß-Lactamase Resistance and Biofilm Genes in Pseudomonas Species Isolated from Chickens.

Bacteria of the genus Pseudomonas are pathogens in both humans and animals. The most prevalent nosocomial pathogen is P. aeruginosa, particularly strains with elevated antibiotic resistance. In this study, a total of eighteen previously identified Pseudomonas species strains, were isolated from chicken. These strains were screened for biofilm formation and antibiotic resistance. In addition, we evaluated clove oil's effectiveness against Pseudomonas isolates as an antibiofilm agent. The results showed that Pseudomonas species isolates were resistant to most antibiotics tested, particularly those from the ß-lactamase family. A significant correlation (p < 0.05) between the development of multidrug-resistant isolates and biofilms is too informal. After amplifying the AmpC-plasmid-mediated genes (blaCMY, blaMIR, DHA, and FOX) and biofilm-related genes (psld, rhlA, and pelA) in most of our isolates, PCR confirmed this relationship. Clove oil has a potent antibiofilm effect against Pseudomonas isolates, and may provide a treatment for bacteria that form biofilms and are resistant to antimicrobials.

LCZ696 Protects against Diabetic Cardiomyopathy-Induced Myocardial Inflammation, ER Stress, and Apoptosis through Inhibiting AGEs/NF-κB and PERK/CHOP Signaling Pathways.

The present study is designed to determine the effect of LCZ696 on DCM in rats and investigate the underlying mechanism involved. Diabetes was induced by feeding rats with a high-fat diet for six weeks following a single injection of STZ (30 mg/kg). Diabetic rats were divided into three groups (n = 10). LCZ696 and valsartan treatment was started two weeks after diabetic induction and continued for eight weeks. At the end of the treatment, serum and cardiac tissues were analyzed by RT-PCR, Western blot, and ELISA kits. LCZ696 and valsartan ameliorated DCM progression by inhibiting AGEs formation at activity levels; pro-apoptotic markers (BAX/Bcl2 ratio and caspase-3) in mRNA and protein expressions, the NF-κB at mRNA; and protein levels associated with the restoration of elevated proinflammatory cytokines such as the TNF-α, IL-6, and IL-1ß at the activity level. Furthermore, LCZ696 and valsartan contribute to restoring the induction of ER stress parameters (GRP78, PERK, eIF2a, ATF4, and CHOP) at mRNA and protein levels. LCZ696 and valsartan attenuated DCM by inhibiting the myocardial inflammation, ER stress, and apoptosis through AGEs/NF-κB and PERK/CHOP signaling cascades. Collectively, the present results reveal that LCZ696 had a more protective solid effect against DCM than valsartan.

Tardive Dyskinesia Following Low-Dose Risperidone.

Tardive dyskinesia is an involuntary athetoid or choreiform movement lasting a minimum of a few weeks. It is associated with the use of neuroleptic medication for at least three months and persists beyond four to eight weeks. Tardive dyskinesia usually occurs as a result of the long-term use of dopamine receptor-blocking agents, mainly first-generation antipsychotics or a high-dose, second-generation antipsychotic. We present a case of a 28-year-old female with osteogenesis imperfecta presented later with major depressive disorder with psychotic features. She was given a low-dose second-generation antipsychotic, namely, risperidone (2 mg) for psychosis for a cumulative duration of three months. As a result, she developed extrapyramidal symptoms in the form of akathisia, axial dystonia, involuntary movement of the right hand, and smacking movement of the lips. Symptoms persisted for more than eight weeks despite discontinuing risperidone and switching to quetiapine. After the exclusion of other differential diagnoses, she was labeled as a case of tardive dyskinesia. More studies are needed to assess whether undiscovered contributing factors to tardive dyskinesia exist and to understand how second-generation antipsychotics (SGAs) contribute to the development of tardive dyskinesia.

Late Presentation of Linezolid-Induced Serotonin Syndrome After Maprotiline and Mirtazapine Therapy: A Case Report.

OBJECTIVE: This report describes a 45-year-old man who developed serotonin syndrome on day 13 of linezolid therapy. This is unusual as it typically appears within 24 hours of linezolid initiation. METHODS: The patient did not receive any serotonergic agents concurrently with linezolid; maprotiline and mirtazapine were stopped 17 days before the development of serotonin syndrome. On day 13 of linezolid administration, the patient exhibited diaphoresis, fever, confusion, agitation, disorientation, anxiety, and restlessness. His blood pressure was elevated with persistent tachycardia. He was then diagnosed with serotonin syndrome using the Hunter criteria. RESULTS: Linezolid was discontinued and supportive measures were initiated, which resulted in the complete resolution of the syndrome. CONCLUSIONS: This case report highlights that linezolid-induced serotonin syndrome can occur late in the course of therapy and the importance of the serotonergic agent washout period before the introduction of linezolid. A multidisciplinary team is important for optimal diagnosis and management of such cases.

Seasonal variations of respiratory viruses detected from children with respiratory tract infections in Riyadh, Saudi Arabia.

ARTIs have a huge impact in health systems in which 20-30% of all hospital admissions and 30-60% of practitioner visits are related to respiratory tract infections. The aim of this study is to determine the prevalence, age distribution, and seasonal variation of respiratory viruses. This study was descriptive retrospective study in which all patients 14 years of age and below who presented with signs and symptoms of ARTIs between January 2013 and December 2014 and had respiratory specimen tested by direct immunofluorescence assays for viruses identification were included in the study. During that period, a total of 4611 patients who presented with ARTIs from January 2013 to December 2014 were investigated, viruses were detected in 1115 (24%). RSV was associated with 97.4% of the total viral pathogens. Viruses were detected throughout all the two years with a peak in winter; Dec (n: 265), Jan (n: 418), Feb (n: 218), and Mar (n: 109). Viral pathogens are very important cause of ARTIs in our region. RSV was the most common virus detected with the highest detection rate in children who are two years old and below. A multi-center surveillance with more sensitive detection methods like PCR may help to provide a comprehensive understanding of virus distribution in our area, which may contribute implant an effective prevention approach for each virus.