Point prevalence survey of antibiotics use among hospitalised neonates and children in Saudi Arabia: findings and implications.

Background: Neonates and children are more susceptible to a variety of infections, leading to frequent antibiotic prescriptions. However, the inappropriate use of antibiotics leads to antibiotic resistance and higher mortality rates. Therefore, this study aimed to determine the prevalence of antibiotic use, and current antibiotic prescribing practices among neonates and children admitted in the selected hospitals of Saudi Arabia. Methods: A cross-sectional study was conducted from September to November 2023 to assess the prevalence of antibiotic use, and the current antibiotic prescribing practices across six hospitals of Saudi Arabia. Results: The study included 499 children and neonates, with 94.6% receiving antibiotic prescriptions. The most frequently prescribed antibiotic class was third-generation cephalosporin (31.5%), with ceftriaxone being the most commonly prescribed antibiotic (15%). The majority of patients were prescribed one antibiotic (81.4%), and the intravenous route (96.4%) was the primary route for administration. The majority of patients were prescribed antibiotics empirically (69.7%), and community-acquired infections (64.2%) were the most common type of infection for antibiotic prescription. Similarly, sepsis (39.2%) was the most common indication for antibiotics, and the majority of prescribed antibiotics (61.7%) belonged to the 'Watch' category as per WHO AWaRe classification. Conclusion: Our study revealed excessive antibiotic consumption in neonates and children, therefore quality improvement programmes including antimicrobial stewardship programmes are urgently needed to address ongoing issues.

The Accuracy of Cone Beam Computed Tomography Scans in Determining the Working Length in Teeth Requiring Non-surgical Endodontic Treatment: A Retrospective Clinical Study.

BACKGROUND: Endodontic treatment aims to eradicate both microbial infection and inflammatory processes within the root canal space as well as in the periapical (PA) region of the tooth. To achieve this, the canals should be cleaned, shaped, disinfected, and obturated to the proper working length. Clinically, the working length is described as the measurement from the coronal reference point to the physiological apex located at the apical foramen. In the available literature, electronic apex locators (EAL) with periapical (PA) radiographs are the most reliable and precise tools for determining the working length in routine root canal treatment. Therefore, the aim of this retrospective clinical study is to evaluate if cone beam computed tomography (CBCT) scans are reliable and accurate in measuring endodontic working length compared to standard clinical measurement methods. METHODS: Patients who fit the inclusion criteria were identified. A postgraduate endodontic resident blinded to the cone beam computed tomography scan results treated all teeth in the field of view that needed endodontic treatment. The root canal length was determined using J Morita Root ZX II apex locator (J Morita Corp., Kyoto, Japan) and periapical radiographs. The dental radiology specialist interpreted the pre-existing cone beam computed tomography (CBCT) scan images and determined the working length. Statistical comparisons of the working length measurements of EAL and CBCT were performed using paired sample t-tests after verifying normality. RESULTS: No statistically significant differences in the working lengths were found in all canals with the exception of the palatal canal only (t=2.16, p=0.034), suggesting consistent measurements between EAL and CBCT. CONCLUSION: In teeth requiring endodontic treatment, pre-existing cone beam computed tomography scan images are accurate as electronic apex locators when determining the working length. A limitation of this study is that it only includes a limited number of samples and is affected by operator variation.

Navigating nephrology: unveiling pharmacist perspectives on renal dose adjustment in Saudi Arabia - a comprehensive cross-sectional analysis.

Introduction: Chronic kidney disease (CKD) is a major public health concern in Saudi Arabia. it is pertinent to mention that in the Southwestern region of Saudi Arabia. Hypertension and diabetes mellites are considered the major drivers of CKD. Research has documented worldwide the inappropriate dose adjustments in patients, ranging from 25% to 77%, of drugs requiring dose modifications. Pharmacists are pivotal members of the healthcare team, tasked with addressing issues pertaining to medications. This study aims to unveil pharmacist perspectives on renal dose adjustment in Saudi Arabia an important step in gauging their involvement in promoting healthy behaviours. Method: A cross-sectional study design was conducted from December 2023 to January 2024 among pharmacists working in diverse healthcare settings, including clinical and hospital pharmacies, retail, and community pharmacies who had direct encounters with patients diagnosed with CKD. A validated questionnaire, the Renal Dose Adjustment-13 (RDQ-13) was used for this study. For comparing the knowledge, attitude, and perception scores of pharmacists statistical tests like One-Way ANOVA, and independent t-test; while for factors influencing the knowledge, attitude, and perception scores a multivariate linear regression was performed. The statistical significance level was set at 0.05. Results: A total of 379 pharmacists completed the questionnaire, the knowledge score of pharmacists was 22.06 ± 2.81, while the attitude score was 8.56 ± 2.62 and the practice score was 5.75 ± 2.25. The findings of multivariate linear regression analysis indicated a statistically significant positive association between knowledge score and pharmacist's age while for practice score the findings revealed a statistically negative association between working setting and designation of pharmacists. Conclusion: The pharmacist in Saudi Arabia exhibited a proficient knowledge score of drug dosage adjustment pertinent to renal function while the attitude and practice score was less as compared to the knowledge score.

Relation of body mass index to long-term survival and cardiac remodelling for patients undergoing mitral valve replacement surgery.

BACKGROUND AND AIMS: Studies have demonstrated that obesity is paradoxically associated with reduced mortality following cardiac surgery. However, these studies have treated various types of cardiac surgery as a single entity. With mitral valve (MV) surgeries being the fastest-growing cardiac surgical interventions in North America, the purpose of this study was to identify the impact of body mass index (BMI) on long-term survival and cardiac remodelling of patients undergoing MV replacement (MVR). METHODS AND RESULTS: In this retrospective, single-center study, 1071 adult patients who underwent an MVR between 2004 and 2018 were stratified into five BMI groups (<20, 20-24.9, 25-29.9, 30-34.9, >35). Cox proportional hazard regression models were used to determine the association between BMI and all-cause mortality. Patients who were underweight had significantly higher all-cause mortality rates at the longest follow-up (median 8.2 years) than patients with normal weight (p = 0.01). Patients who were in the obese group had significantly higher readmission rates due to myocardial infarction (MI) at the longest follow-up (p = 0.017). Subgroup analysis revealed a significant increase in long-term all-cause mortality for female patients who were underweight. Significant changes in left atrial size, mitral valve peak and mean gradients were seen in all BMI groups. CONCLUSIONS: For patients undergoing mitral valve replacement, BMI is unrelated to operative outcomes except for patients who are underweight.

Survival probabilities and prognostic factors of pregnancy-associated breast cancer in Malaysian women.

OBJECTIVE: Pregnancy-associated breast cancer (PABC) is a rare cancer. This study aimed to determine the survival probabilities and prognostic factors in patients with PABC. METHODS: A retrospective cohort study was conducted in two tertiary care hospitals in Kota Bharu. We included all patients with breast cancer who were diagnosed by histopathology while pregnant or within 2 years post-partum from 2001 through 2020. We matched patients with PABC to non-pregnant patients with breast cancer by age and year of diagnosis. The data were analyzed using Cox proportional hazard regression. RESULTS: A total of 35 cases of PABC and 70 non-PABC controls were recruited. The 3-year, 5-year, and 10-year survival probabilities for patients with PABC were 58.6%, 47.54%, and 38.03%, respectively. The patients with PABC had a non-significant difference in survival probabilities compared with non-PABC patients. The significant prognostic factors of PABC were age (adjusted hazard ratio [aHR], 0.91; 95% confidence interval [CI], 0.86-0.96; P=0.001), advanced stage of cancer (aHR, 9.97; 95% CI, 3.96-25.2; P<0.001), and no surgery (aHR, 3.16; 95% CI, 1.01-9.85; P=0.047). Pregnancy was not found to be an independent factor in the prognosis of PABC (aHR, 0.72; 95% CI, 0.39-1.28; P=0.266). CONCLUSION: Women diagnosed with PABC had similar survival probabilities compared with non-PABC patients. Pregnancy was not an independent prognostic factor for breast cancer. This information can be useful when women with breast cancer are counseled and supported with the option of beginning treatment with pregnancy continuation.

Saudi Health System and Health Security Structure: A Scope Review Study Addressing the National Need for Governing the Health Security.

Health security has gained significant attention at the national and global levels, "security" is not a simple term; instead, it is "essentially contested" - that is, it induces debates about what it means and how to use it. This study aimed to define three terms frequently used in health security discussions. These terms are national health security, Global Health Security, and public health. The research method was a scoping review performed in three stages. The first stage was electronic searching based on selection criteria among multiple sources at various time points during the year 2023. These sources included online literature searches, websites of non-governmental organizations (NGOs), and other governmental health agencies. The second stage involved determining the relevance of the selected papers to the study's objectives; the selected papers had moderate to high relevance to the study's objectives. The third stage was to evaluate the methodological quality of a study; we selected peer-reviewed published papers and websites recognized as trustworthy sources of information. The search yielded 143 articles; five met the inclusion criteria and were subjected to the definition of health security. Despite proposed definitions, agreement has yet to be reached on the content and scope of health security. Another main finding is that health security requires more state and international collaboration efforts to reach Global Health Security. To the best of our knowledge, no known government body or organization is responsible for governing health security in Saudi Arabia. However, the current study presents a definition of health security and differentiates it from the public health approach, in addition to emphasizing the importance of governing the related health sectors within each country in order to improve health security and have a positive impact on overall Global Health Security.

Surface Modification of PP and PBT Nonwoven Membranes for Enhanced Efficiency in Photocatalytic MB Dye Removal and Antibacterial Activity.

In this study, we developed highly efficient nonwoven membranes by modifying the surface of polypropylene (PP) and poly(butylene terephthalate) (PBT) through photo-grafting polymerization. The nonwoven membrane surfaces of PP and PBT were grafted with poly(ethylene glycol) diacrylate (PEGDA) in the presence of benzophenone (BP) and metal salt. We immobilized tertiary amine groups as BP synergists on commercial nonwoven membranes to improve PP and PBT surfaces. In situ Ag, Au, and Au/Ag nanoparticle formation enhances the nonwoven membrane surface. SEM, FTIR, and EDX were used to analyze the surface. We evaluated modified nonwoven membranes for photocatalytic activity by degrading methylene blue (MB) under LED and sunlight. Additionally, we also tested modified membranes for antibacterial activity against E. coli. The results indicated that the modified membranes exhibited superior efficiency in removing MB from water. The PBT showed the highest efficiency in dye removal, and bimetallic nanoparticles were more effective than monometallic. Modified membranes exposed to sunlight had higher efficiency than those exposed to LED light, with the PBT/Au/Ag membrane showing the highest dye removal at 97% within 90 min. The modified membranes showed reuse potential, with dye removal efficiency decreasing from 97% in the first cycle to 85% in the fifth cycle.

Metabolic and renal outcomes of empagliflozin in patients with type 2 diabetes mellitus attending Armed Forces Hospital in Saudi Arabia: Retrospective cohort study.

OBJECTIVES: To explore the effects of empagliflozin (25 mg) on metabolic and renal parameters in patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective observational comparative study was conducted at a military hospital in southern Saudi Arabia. All adults (aged >18 years) with T2DM who attended diabetic clinics between October 2021 to March 2022 (6 months), with or without insulin treatment, were eligible for inclusion in the study. RESULTS: Following the initiation of empagliflozin treatment, statistically significant reductions in patient weight (kg) were observed at 1, 3-5, and 6 months. In addition, low-density lipoprotein levels significantly decreased 3-5 months post-treatment initiation (p=0.011). However, serum creatinine level decreased gradually with time during the treatment with empagliflozin, from 87.45±31.78 (0.105) to 78.39±27.43 (0.033). Furthermore, after empagliflozin treatment, the urinary albumin-to-creatinine ratio significantly decreased at 3-5 and 6 months. Moreover, HbA1c levels exhibited statistically significant decreases at 3-5 months (p<0.001) and at 6 months (p<0.001) following the initiation of empagliflozin treatment. Notably, systolic and diastolic blood pressure significantly reduced 6 months after empagliflozin treatment. CONCLUSION: In the current study, empagliflozin has demonstrated efficacy in controlling blood pressure and body weight, and improving renal function, short-term dyslipidemia, and glycemic control in patients with T2DM.

Copper II Complexes Based on Benzimidazole Ligands as a Novel Photoredox Catalysis for Free Radical Polymerization Embedded Gold and Silver Nanoparticles.

The copper II complex's novel benzimidazole Schiff base ligands were manufactured and gauged as a new photoredox catalyst/photoinitiator amalgamated with triethylamine (TEA) and iodonium salt (Iod) for the polymerization of ethylene glycol diacrylate while exposed to visible light by an LED Lamp at 405 nm with an intensity of 543 mW/cm2 at 28 °C. Gold and silver nanoparticles were obtained through the reactivity of the copper II complexes with amine/Iod salt. The size of NPs was around 1-30 nm. Lastly, the high performance of copper II complexes for photopolymerization containing nanoparticles is presented and examined. Ultimately, the photochemical mechanisms were observed using cyclic voltammetry. The preparation of the polymer nanocomposite nanoparticles in situ was photogenerated during the irradiation LED at 405 nm with an intensity of 543 mW/cm2 at 28 °C process. UV-Vis, FTIR, and TEM analyses were utilized for the determination of the generation of AuNPs and AgNPs which resided within the polymer matrix.

Light-Assisted Synthesis of Silver and Gold Nanoparticles by New Benzophenone Derivatives.

Benzophenone derivatives were evaluated as new photoinitiators in combination with triethylamine (TEA) and iodonium salt (Iod) for very rapid and efficient formation of metal nanoparticles in an organic solvent, by which silver and gold ions were reduced under light at 419 nm (photoreactor) with an irradiation intensity of 250 microwatts/cm2. The new benzophenone derivatives combined with TEA/Iod salt showed good production of metal nanoparticles (Au0 and Ag0) and a small size of nanoparticles of around 4-13 nm. The photochemical mechanisms for the production of initiating radicals were studied using cyclic voltammetry, where a negative ΔG of around -1.96 eV was obtained, which made the process favorable. The obtained results proved the formation of amine and phenyl radicals, which led to the reduction of gold III chloride or silver ions to the gold and silver NPs. The UV-vis spectroscopy technique was used as a very beneficial tool for the surface plasmon resonance band detection of metal nanoparticles. To sum up the results, we have observed that nanoparticles (NPs) were distributed differently in different photoinitiator systems and the particle size also changed by changing the system of initiation. In comparison to the system alone, not only were the nanoparticles smaller but they were also generated within a shorter period of irradiation time for the system BP\Iod\TEA. Finally, the quenching process of benzophenone fluorescence by the gold and silver nanoparticles was investigated.

Association of Hepatic Steatosis With Coronary Artery Disease by Studying the Role of Individual and Demographic Risk Factors.

Background In this study, we aimed to explore the possible association between hepatic steatosis (HS) and coronary artery disease (CAD) by calculating the patients' calcium scores and comparing clinical and laboratory parameters of patients in King Abdullah Medical City (KAMC), Makkah, Kingdom of Saudi Arabia (KSA). The role of risk factors associated with HS was also assessed. Methodology The medical records of 79 patients who underwent coronary cardiac computed tomography (CT) for calcium scoring and enhanced or non-enhanced CT scans of the abdomen and pelvis at the Department of Radiology, KAMC, Makkah, KSA, between April 2012 and April 2013 were collected and analyzed. Results The overall prevalence of HS was 32.9%. Gender, age, and body mass index were significantly associated with HS. Low-dose unenhanced CT is a promising screening test for the determination of HS. A severe grade of calcium score was significantly associated with HS, while hypertension had no significant relation with HS. Biomarkers such as blood urea nitrogen, creatinine, cholesterol, and triglycerides had a significant association with HS, while other liver function tests and lipid profile values did not have a significant association. Bilirubin was significantly higher in non-fatty liver than in fatty liver. Furthermore, higher grades of calcium score were significantly associated with fatty liver in non-hypertensive and non-diabetic patients. Conclusions CAD is closely associated with HS. Moreover, diabetes mellitus and hypertension play a critical role in the development of HS.

Metabolomic Fingerprint of Behavioral Changes in Response to Full-Spectrum Cannabis Extracts.

Numerous existing full-spectrum cannabis extract products have been used in clinical trials for the treatment of various diseases. Despite their efficacy, the clinical use of some of these full-spectrum cannabis extracts is limited by behavioral side effects such as cognitive dysfunction and impaired motor skills. To better understand what constitutes cannabis-induced behavioral effects, our objective was to identify a novel panel of blood-based metabolites that are predictive, diagnostic, and/or prognostic of behavioral effects. At 8 weeks of age, male rats were randomly assigned to groups and were gavage fed with full-spectrum cannabis extract (tetrahydrocannabinol/cannabidiol (THC/CBD) along with all other cannabis compounds, 15 mg/kg), broad-spectrum cannabis extract (CBD along with all other cannabis compounds, 15 mg/kg), or vehicle oil. Four hours after being gavage fed, behavioral assessments were determined using the open field test and the elevated plus maze. Following these assessments, serum was collected from all rats and the serum metabolites were identified and quantified by LC-MS/MS and 1H NMR spectroscopy. We found that only rats treated with full-spectrum cannabis extract exhibited behavioral changes. Compared to vehicle-treated and broad-spectrum extract-treated rats, full-spectrum extract-treated rats demonstrated higher serum concentrations of the amino acid phenylalanine and long-chain acylcarnitines, as well as lower serum concentrations of butyric acid and lysophosphatidylcholines. This unique metabolomic fingerprint in response to cannabis extract administration is linked to behavioral effects and may represent a biomarker profile of cannabis-induced behavioral changes. If validated, this work may allow a metabolomics-based decision tree that would aid in the rapid diagnosis of cannabis-induced behavioral changes including cognitive impairment.

Post-amputation pain among lower limb amputees in a tertiary care hospital in Jeddah, Saudi Arabia: A retrospective study.

OBJECTIVES: To estimate the prevalence of post- amputation pain among lower-limb amputees and its burden on their lives. METHODS: A retrospective patients record review of lower limb amputation surgeries was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2008-2019. e collected data included: patients demographics, surgical operations, chronic pain characteristics, functional impairment, and treatment. RESULTS: A total of 645 lower-limb amputations carried out on 509 patients, 104 (20.4%) patients had more than one amputation surgery carried out, and 40 (7.9%) patients having bilateral amputations. The estimated prevalence of chronic post-amputation pain among the lower-limb amputees was approximately 61.5%. Persistent postoperative neuropathic pain was the most common type of pain following amputation, followed by residual limb pain, then phantom limb pain. The most common cause of amputation was diabetes and its related complications (76%). The mean age at surgery was 57.46±12.02 years. Although diabetes was a common comorbid illness (95.6%), it had no correlation with the development of chronic post-amputation pain. However, peripheral vascular disease had a strong association (p=0.009), especially with the development of phantom limb pain (54.5%; p=0.016). The most common reason for functional impairment among the amputees was disability (52.7%), while only 6.6% said it was secondary to pain. CONCLUSION: Post-amputation pain is one of the major consequences of amputation. Pain was poorly managed among these patients. Special considerations should be obtained to manage these patients' pain and reduce their suffering.

Fluorine (19F) Nuclear Magnetic Resonance Spectroscopy For Real Time Maraviroc Analysis From Microparticulate Systems.

Real time analysis of pharmaceuticals in controlled release nano and microsystems remains a challenge. It is hypothesized that fluorine 19 nuclear magnetic resonance (19F qNMR) can be used for real time quantification and in vitro release of maraviroc (MVC). The release of maraviroc was analyzed in simulated body fluids from spray dried sodium alginate microspheres (MS) using the 19F qNMR method. Calibration produced a linearity curve in concentration range (0.42 mg/ml - 15 mg/ml), and the limits of detection and quantification values were 0.97 mg/ml and 2.93 mg/ml, respectively. The method was confirmed to be specific, accurate, precise, and robust (%RSE > 2%). MVC was successfully microencapsulated (18% w/w) as evidenced by the FT-IR spectra and SEM images. The MS had an average diameter of 2.522 ± 0.15 µm, with a zeta potential of - 61.31 ± 2.1 mV. Overall, the 19F qNMR method enabled a direct and real time quantification of MVC for an efficient drug release kinetics. This approach could be potentially used to quantify fluorinated drug potency, purity, and stability, and evaluate in vitro release kinetic from different formulations.

Resveratrol reduces cardiac NLRP3-inflammasome activation and systemic inflammation to lessen doxorubicin-induced cardiotoxicity in juvenile mice.

Doxorubicin (DOX) is a very effective anticancer agent that is widely used in pediatric cancer patients. Nevertheless, DOX is known to have cardiotoxic effects that may progress to cardiomyopathy later in life. We have recently shown that cotreatment of resveratrol (RES) with DOX in juvenile mice attenuates late-onset hypertension-induced cardiomyopathy. However, the molecular mechanism responsible for these changes remains unknown. Herein, we show that the cardiac NLRP3 inflammasome plays a crucial role in regulating cardiac injury in a DOX -treated juvenile mouse model and the detrimental effects of hypertension in these mice later in life. We further demonstrate that RES significantly reduces systemic inflammation to contribute to the improvements observed in DOX -induced cardiac injury in young mice and late-onset hypertension-induced cardiomyopathy.

Prevalence and Parental Attitude Toward Nitrous-Oxide and Papoose-Board Use in Two Dental Referral Centers in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Parental preferences and attitudes strongly influence dentists' choices for managing children's behavior in clinics. This study aimed to assess parental attitudes toward two behavior management technique (BMTs)-nitrous oxide (N2O) sedation and/or protective passive stabilization by papoose board (PB)-before and after their children received dental treatment at two referral centers in Jeddah, Saudi Arabia. METHODS: Participants were parents of healthy children who required dental treatment under N2O and/or PB over an 18-month period. Before and after dental treatment, parents answered a questionnaire on their attitudes toward BMTs used on their children. Parents were divided into three groups: Group 1 (parents of children who received N2O), Group 2 (parents of children who received PB), and Group 3 (parents of children who received both N2O and PB). RESULTS: Out of the 132 parents who answered the questionnaire, 106 (80.3%) were in Group 1, 10 (7.6%) in Group 2, and 16 (12.1%) in Group 3. More children of parents with low monthly family incomes were in Group 3 than Group 1 compared to other family-incomes. CONCLUSION: Parental attitudes toward N2O and/or PB improved after their children experienced BMTs. The future use of PB alone with their child's sibling was parents' least preferred BMT (p = 0.001).

Combination of Revascularization and Apexification in the Treatment of an Avulsed Tooth: A Case Report.

AIM: To demonstrate an exceptional result in the treatment of an avulsed tooth that had been stored in a dry environment for over 2 hours before being replanted. BACKGROUND: Sixteen percent of all traumatic injuries to the permanent dentition are avulsions. Maxillary central and lateral incisors are most commonly affected. CASE DESCRIPTION: In this report, a 7-year-old girl sustained trauma to the upper right maxillary incisor during a bicycle accident. The tooth was avulsed and remained outside the oral cavity for more than 2 hours in a dry napkin before eventual reimplantation in the emergency room. Upon presentation to the endodontic clinic at the University of Southern California, the case was assessed, and the available treatment options discussed with the patient's parents. Revascularization using BC putty was the chosen mode of treatment. At a 6-month recall appointment, the patient presented with a sinus tract. A decision was then made to perform apexification using the mineral trioxide aggregate (MTA) as an apical filling material. To date, the tooth remains intact and functional. CONCLUSION: Although both of the described treatment modalities are acceptable and commonly used in modern endodontics, apexification of a tooth following a failed attempt of a regenerative procedure has not been described. In this case, a chronic abscess formed and the ultimate goal of revascularization was not achieved. However, the performance of the revascularization procedure was not without benefit since it allowed the tooth to develop in both length, dentinal volume, and aided in the partial closure of the apical foramen. Additional studies are needed regarding the treatment of avulsed teeth. This case study may provide a viable treatment alternative in a number of clinical situations. CLINICAL SIGNIFICANCE: The procedures described in this case report may be of clinical significance in the treatment and retention of teeth, which may otherwise be considered to have a poor prognosis and extracted.