The Trend of Antibiotic Consumption After the COVID-19 Pandemic: Approach to Future Outbreaks.

Background: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported. Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program. Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19. Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=<.001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002). Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.

Dynamic Patterns and Predominance of Respiratory Pathogens Post-COVID-19: Insights from a Two-Year Analysis.

INTRODUCTION: Respiratory tract infections (RTIs) stand out as the most frequent causes leading to visits to the emergency department and hospitalizations. This study aims to assess the types and prevalence of respiratory infections across two years following the end of the COVID-19 pandemic. METHODS: Patients presenting with an influenza-like illness (ILI) were tested using multiplex RT-PCR (QIAstat-Dx, Qiagen). The multiplexed RT- PCR test detects 21 respiratory viruses and bacteria. RESULTS: During the study period, PCR test was done on a total of 1,790 samples were tested, and 712 (40%) were positive for a total of 796 pathogens. The mean age (± SD) of the participants was 20.1 ± 28.4 years in 2022 and 21.9 ± 27.6 years in 2023. Among the detected pathogens, the most prevalent were Rhinovirus/Enterovirus 222 (12.4%), followed by RSV A&B (103 cases, 5.7%), and H1N1 Influenza (77 cases, 4.3%). Additionally,  Influenza A/B constituted 172 (9.6%) while parainfluenza constituted (58, 3.2%). SARS-CoV-2 was identified in 3.97% of the samples. Over the two-year period, the monthly pattern of the identified pathogens exhibited fluctuations in the prevalence. Furthermore, variations were observed in the detected pathogens across different age groups. CONCLUSION: In addition to adding significant knowledge to the field of respiratory viral infections, this study emphasizes the necessity of ongoing research and surveillance for the detection and characterization of respiratory viruses, particularly those with the potential for emergence. Such studies would also require setting up a strategy for genotyping and/or sequencing of viruses.

Factors Affecting the Satisfaction of Women Employees in Health Sector: A Perception Study in Saudi Arabia.

Purpose: Broad evidence points out that women workers in Saudi Arabia face a range of inequitable work practices despite continued efforts for gender equality. The study aims to assess the satisfaction of Saudi women working in the health sector among certain factors in the work environment, factors that enable them to gain opportunities and benefits and make decisions. Patients and Methods: This is a cross-sectional study, which involved the use of closed-ended surveys on 261 Saudi women working in the healthcare sector. Results: Most of the females were aged between 25 and 34 years (59%) and more than half of them worked in the governmental sector (53%). Fifty-eight percent of the females hold clinical jobs, 25% of the administrative jobs were 37% of them have more than 19 years of working experience. The finding showed a significant association between female workers in health sector satisfaction with factors related to the workplace environment, training, and development, and their involvement in decision-making. Conclusion: Most women felt empowered when they received equitable tasks and were able to reach managerial-level positions in their organizations. Establishing a positive work environment characterized by opportunities has the potential to enhance women workers' satisfaction.

The Association of Body Mass Index with COVID-19 Complications and Survival Rate at a Tertiary Hospital.

A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases (p = 0.013); end-stage renal disease (p = 0.021); and cardiovascular disease (p = 0.003) but not diabetes mellitus (p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots (p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients (p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 (p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients.

Self-reported long COVID-19 symptoms are rare among vaccinated healthcare workers.

INTRODUCTION: COVID-19 pandemic adversely affected healthcare workers (HCWs). Here, we evaluate the occurence of long-COVID-19 symtoms among HCWs. METHODS: This is a questionnaire-based study of HCWs who had COVID-19 in two medical centers in Saudi Arabia and were mostly vaccinated. RESULTS: The study included 243 HCWs with a mean age (+ SD) of 36.1 (+ 7.6) years. Of them, 223 (91.8%) had three doses of COVID-19 vaccine, 12 (4.9%) had four doses, and 5 (2.1%) had two doses. The most common symptoms at the start of the illness were cough (180, 74.1%), shortness of breath (124, 51%), muscle ache (117, 48.1%), headache (113, 46.5%), sore throat (111, 45.7%), diarrhea (109, 44.9%) and loss of taste (108, 44.4%). Symptoms lasted for< one week in 117 (48.1%),> one week and< 1 month in 89 (36.6%),> 2 months and< 3 months in 9 (3.7%), and> 3 months in 15 (6.2%). The main symptoms present> 3 months were hair loss (8, 3.3%), cough (5, 2.1%), and diarrhea (5, 2.1%). A binomial regression analysis showed no relationship between persistence of symptoms for> 3 months and other demographic or clinical symptoms characteristics. CONCLUSION: The study showed a low rate of the occurence of long-COVID> 3 months during the Omicron-wave among mostly vaccinated HCWs with no significant comorbidities. Furhter studies are needed to examine the effect of different vaccines on long-COVID-19 among HCWs.

The association of thrombophilia in women with severe obstetric complications.

Thrombophilia, where multiple genetic and acquired risk factors interact synergistically, are associated with thrombosis and pregnancy-related complications. Despite being studied profusely, an inconsistent association exists between thrombophilia and pregnancy complications. Between 2018 and 2020, ninety-three women with pregnancy complications were enrolled in the study. Twenty-five healthy pregnant women without pregnancy complications reported to the same hospital were also recruited as controls. Blood samples were tested for homocysteine, coagulation studies, and molecular diagnosis included FVL, PTH and MTHFR genes amplified using PCR strip assay (Vienna Lab Diagnostics, Austria). Other thrombophilia screening, including testing for AT, PC, and LA, were done by chromogenic assays (Dade Diagnostica, Munich, Germany). Homocysteine level was determined by fluorescence polarization immunoassay technology (Axsym, Abbot company, Germany). Overall, 29.03% of women with pregnancy complications had thrombophilia relative to 16% in the control group. However, the difference between the case and control groups did not reach a significant level (p=0.1175). Additionally, combined thrombophilia was more prevalent among cases (10.75%) than in the control group (4%). However, the difference did not reach statistical significance (p=0.1046). Our study demonstrated that the frequency of thrombophilia among healthy women was 16%, and among women with pregnancy-related complications, 29%. Relative to control, all measured thrombophilia markers were more frequent in women with pregnancy-related complications except for LA. Including all the studies on the Saudi population in a meta-analysis study could reveal more information about thrombophilia and pregnancy-related complications in our population.

Impact of muscle mass on blood glucose level.

OBJECTIVES: At present, diabetes is one of the leading causes of mortality across the world. It was hypothesized that muscle mass could have a significant influence on blood glucose level and this corelation if established successfully could pave way for novel treatment modalities for type 2 diabetes mellitus (T2DM). In the present study, the association between muscle mass and blood glucose level was examined in a healthy population who was not having T2DM at baseline and was undergoing a regular course of exercise. METHODS: The clinical study was performed involving 53 healthy male populations between 10 and 60 years of age. The participants were sampled in accordance with the quantitative experimental study design, using nonprobability sampling techniques. The independent variable measured among the subjects included muscle mass and blood glucose level, using bioelectrical impedance and a simple glucometer respectively. Subgroup analysis amongst different substantial parameters including body mass index (BMI), myostatin inhibitor usage, and age factor that could affect the muscle mass and glucose level correlation were also studied simultaneously. RESULTS: The study findings demonstrated a negative correlation between muscle mass and glucose utilization levels. There was a significant difference in the mean muscle mass of the participants which was 36.2453, and the mean glucose utilization level which was 15.1493%. Pearson correlation between the muscle mass and percentage of glucose utilization of the participants indicated a significant difference (since p-value <0.05) between these two studied parameters. CONCLUSIONS: The study finding suggests an inverse association of the skeletal muscle mass with blood glucose level which encourages the implication of muscle-building exercises as the preventive measure for T2DM.

The Association between Brain-Derived Neurotrophic Factor (BDNF) Protein Level and Body Mass Index.

Background and Objectives: Obesity is a major health concern worldwide. Many studies emphasize the important role of brain-derived neurotrophic factor (BDNF) in regulating appetite and body weight. We aimed to investigate the association between BDNF protein serum levels and body mass index (BMI). Materials and Methods: We conducted a cross-sectional study among 108 healthy adult participants divided into six categories depending on their body mass index (BMI). The ages of the participants ranged between 21 to 45 years. The BDNF serum level was measured using the enzyme-linked immunosorbent assay (ELISA) technique. Results: A Kruskal−Wallis test showed a significant difference in BDNF between the different BMI categories, χ2(2) = 24.201, p < 0.001. Our data also showed that BDNF levels were significantly lower in people with obesity classes II and III than those of normal weight (p < 0.05). The Spearman rank correlation test was statistically significant with negative correlations between the BMI and BDNF (r) = −0.478, (p < 0.01). Moreover, we observed a negative dose-dependent relationship pattern between BMI categories and the levels of circulating BDNF protein. Conclusions: In this study, our data support the hypothesis that low serum levels of BDNF are associated with high BMI and obesity in Saudi adults.

Molecular determination of van genes among clinical isolates of enterococci at a hospital setting.

Vancomycin-resistant enterococci (VRE) poses a formidable challenge to public health due to its inherent resistance to multiple antibiotics coupled with the ability to transfer genetic determinants to dangerous pathogens like Methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this study was to investigate the incidence of vancomycin resistance in enterococci among clinical isolates at a tertiary care military hospital in the eastern region of Saudi Arabia and to detect van genes using multiplex-PCR. Overall, 246 isolates of enterococci were collected from various clinical specimens. The isolates were identified, and antimicrobial susceptibility testing was done using the Vitek 2 system. Multiplex PCR was performed on the VRE isolates, thus identified to determine the van genes harbored. A total of 15 VRE were identified, of which 14 (93.3%) were Enterococcus faecium, and 1(6.7%) was Enterococcus casseliflavus with intrinsic vanC resistance. Of the 14 vancomycin-resistant Enterococcus faecium, 8 (57.1%) harbored vanB genes, while 6 (42.8%) harbored vanA genes. All the VRE were susceptible to linezolid and tigecycline. Our study detected a low prevalence (6.1%) of VRE among clinical isolates of enterococci and that the vanB gene predominates in such strains. Susceptibility profiles indicated that linezolid and tigecycline are still effective against these multidrug-resistant pathogens. Pus specimens yielded the highest percentage (53.3%) of isolates from which VRE was obtained, and this finding is novel among studies done in Saudi Arabia.

Effect of humidified versus nonhumidified CPAP on inflammatory response and nasopharyngeal symptoms in healthy participants.

INTRODUCTION: Continuous positive airway pressure (CPAP) may induce nasal inflammation because of mucosal compression or dryness. This study examined the impact of humidified versus nonhumidified CPAP on nasal inflammation and upper airway symptoms. METHODS: Seventeen healthy male subjects with no previous or current history of nasal symptoms were recruited. All subjects underwent 3 hours of nonhumidified CPAP at 12.5 cmH2O via nasal mask. Among the 17 studied subjects, seven returned to receive a humidified CPAP at 12.5 cmH2O via nasal mask. The nasal wash leukocyte count was assessed at baseline and after each CPAP setting. The white blood cell (WBC) count and levels of WBCs that are mononuclear cells (including lymphocytes and monocytes) were monitored. A six-point nasal score was also assessed before and after the CPAP intervention. RESULTS: The nasal wash WBC count (103/µL) and mononuclear cell level (103/µL) at baseline, on 12.5 cmH2O humidified CPAP, and on 12.5 cmH2O nonhumidified CPAP were significantly different (p = 0.016; p = 0.003). Changes in nasopharyngeal symptoms occurred in 12 of 17 subjects (70.5%) in the nonhumidified group. Participants experienced at least one nasal symptom after application of nonhumidified CPAP at 12.5 cmH2O. CONCLUSION: The present investigation suggests that humidified CPAP was not associated with early nasal inflammation and there were fewer nasopharyngeal symptoms. Further study is required to confirm the results and evaluate the impact of adding heat to the humidified CPAP system.

Comparison of microscopy, rapid immunoassay, and molecular techniques for the detection of Giardia lamblia and Cryptosporidium parvum.

Giardia lamblia and Cryptosporidium parvum are recognized as the most common protozoan infections in Saudi Arabia. Microscopic examination of stool samples, either direct or concentrated, for the recovery of G. lamblia cysts and trophozoites and C. parvum oocysts is still the most commonly used for the diagnosis of both parasites. We compared the conventional parasitological techniques of iodine-stained wet mount for G. lamblia and Kinyoun's acid-fast for C. parvum against ImmunoCard STAT® Cryptosporidium/Giardia and real-time polymerase chain reaction (PCR) detecting the 18S rRNA gene of G. lamblia and conventional PCR detecting the same gene of C. parvum at a tertiary hospital in Dhahran, Saudi Arabia. Out of 148 stool samples, 19 and 12 true positives were identified for G. lamblia and C. parvum, respectively, using a composite reference standard. In this case, true positives and negatives were considered as those with at least two positive or negative results out of the three tests. Both ImmunoCard STAT! and PCR methods were more sensitive than the microscopic tests of a single stool specimen of 85.7% (CI=62.6-96.2%) and 85.7% (CI=56.2-97.5%) for G. lamblia and C. parvum, respectively. However, specificity of microscopic tests was higher than other techniques for both parasites. Although PCR seems to be most sensitive for both G. lamblia and C. parvum, its low specificity may render its superiority over other techniques. When a single stool sample is used for detection of G. lamblia and C. parvum, better results can be obtained when coupled with serological testing. Although PCR is the most sensitive method for the detection of both G. lamblia and C. parvum, its use requires attention in relation to the increased possible false positives.