COVID-19 vaccine and non-syndromic orofacial clefts in five arab countries. A case-control study.

OBJECTIVES: Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries. MATERIALS AND METHODS: This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting. RESULTS: The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006). CONCLUSION: This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly. CLINICAL RELEVANCE: The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study's results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.

Modified Tilt-integral active disturbance rejection controller with inertia emulated direct current link for frequency control of marine microgrid.

The increasing integration of intermittent renewable sources (RSs) poses a dynamic frequency stability challenge for modern marine vessel microgrids. To address this issue, this paper proposes a novel control approach, specifically targeting frequency and tie-line power stabilization in a diverse source marine microgrid (MµG) with two intertied areas featuring renewable (wind-wave) sources. The suggested approach introduces a modified tilt-integral active disturbance rejection (TI-ADRC) controller designed to ensure effective damping of power frequency oscillations. As the control scheme depends on the optimal setting of the proposed controller, a recently developed marine predator technique (MPT) has been adopted. The performance of the proposed controller is compared with other recent controllers viz. PID, tilt-integral derivative (TID), two-degree-of-freedom (2DOF)-PID, fuzzy-PI, and ADRC to validate its superiority. To further enhance the system dynamics, a precise modeling of inertia emulated direct current (IEPDC) tie link is incorporated in microgrid system. The impact assessments, considering time delays with pre/post IEPDC link, demonstrate a substantial 57.79% and 81.53% reduction in peak frequency overshoot compared to DC link (conventional model) and AC link, respectively. The analysis of the eigen plot confirms the stability of the control system. Sensitivity assessments of the controller against ± 30% parametric variations and load fluctuations are conducted, affirming its robustness. Finally, the result from OPAL-RT confirm the practicality of the proposed method. It is asserted that the suggested controller is reliable and functions well in n the presence of diverse disruptions and parametric variations.

Assessment of non-syndromic orofacial cleft severity and associated environmental factors in Saudi Arabia: A cross-sectional study.

Objective: To evaluate the relationship between different environmental risk factors and the severity of cleft lip with/without palate (CL ± P) and cleft palate (CP) in Saudi Arabia. Methods: This was a cross-sectional national study, of government hospitals in 10 cities distributed across major regions of Saudi Arabia, from June 2020 to June 2021. All newborns with CL ± P or CP were clinically examined and evaluated for cleft phenotype severity using the LAHSHAL classification system. Various environmental factors were evaluated by interviewing parents using a validated questionnaire. The severity of CL ± P and CP was evaluated in relation to environmental factors. Results: We recruited 174 patients with non-syndromic orofacial cleft (NSOFC); 122 (70.1 %) had CL ± P and 52 (29.9 %) had CP. After adjusting the odds ratios by ordinal regression for CL ± P and logistic regression analysis for CP, environmental factors that significantly increased the severity of CL ± P were family history of NSOFC, maternal illnesses, and maternal medication use (P = 0.02, adjusted odds ratio [AOR]:2.70; P = 0.002, AOR:3.70; and P = 0.03, AOR:2.14, respectively). Folic acid supplementation in the first trimester significantly reduced the severity of CL ± P and CP (P = 0.001, AOR:0.18 and P = 0.001, AOR:0.012, respectively). Conclusion: The severity of CL ± P was affected by some maternal exposures during the 3-month pre-gestation period. Therefore, our results suggest the possibility of controlling the severity of NSOFC.

Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study.

OBJECTIVE: The coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic. DESIGN: Cohort study of infants with NSOFCs and controls matched based on recruitment site and age. SETTING: Government hospitals in Saudi Arabia between November 2020 and November 2021. MAIN OUTCOME MEASURES: Data collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage. RESULTS: Of the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P < .001) and the family histories of relatives with NSOFCs (AOR:9.73, P < .001) increased the AOR for NSOFC development. In contrast, maternal folic acid (AOR:0.56, P.010), threatened miscarriage (AOR:0.17, P = .001), fear of COVID-19 (AOR:0.83, P = .038), and suspected COVID-19 infection (AOR:0.43, P = .008) decreased the AOR for NSOFC development. CONCLUSION: Along with an established risk associated with family history of birth defects, stressful life events may be a risk factor for NSOFC development. Beyond folic acid's known benefit, it may be that higher maternal health concerns contribute to increased protective health behaviors during pregnancy. Ongoing research is needed to specify the maternal risk factors for NSOFC.

Impact of a multidisciplinary antimicrobial stewardship program on antibiotic utilization and clinical outcomes at a tertiary hospital in Saudi Arabia: a quasi-experimental study.

BACKGROUND: This study aims to assess the impact of a multidisciplinary antimicrobial stewardship program (ASP) intervention on various metrics. METHODS: A quasi-experimental study was performed on non-ICU patients for whom a restricted antibiotic was ordered. In September 2020, a prospective audit and feedback was implemented involving infectious disease clinical pharmacists, utilization of electronic resources, and improved documentation. Outcomes included defined daily dose and days of therapy per 100-patient days (DDD/100PD and DOT/100PD) and patient clinical outcomes. RESULTS: 402 episodes were evaluated for 167 and 190 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD were lower in the post-phase than in the pre-phase (1.75 vs. 2.54 and 16.13 vs. 44.93). Antibiotic de-escalation and clinical cure rates were significantly higher in the post-phase than in the pre-phase (62% vs. 40.6% and 83.5% vs. 65.8%; P < 0.001 for both comparisons). Hospital and ICU stays were significantly shorter in the post-phase (14 vs. 22 and 3 vs. 9, respectively; P < 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post-phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). CONCLUSION: The implemented multidisciplinary ASP intervention was associated with a significant improvement in antibiotic utilization and patient clinical outcomes.

Incidence of non-syndromic orofacial cleft during the COVID-19 pandemic in Saudi Arabia.

OBJECTIVES: This is the first national study to investigate the incidence of non-syndromic oro-facial clefts (NSOFC) and Pierre-Robin-Sequence in Saudi Arabia over the Covid-19 pandemic period. METHODS: All maternity hospitals (30-hospitals) in the major regions and cities of Saudi from November 2020-to-2021 were included in the study. Patients were evaluated for cleft phenotype using the LASHAL-classification system. The incidence of NSOFC in Saudi Arabia was calculated by comparing the number of NSOFCs cases born out of all live births during the study period at the included hospitals. Clinical examination was performed and information was gathered using a validated data collection form. RESULTS: In one year, 140,380 live-infants were born at the selected hospitals. Of these, 177 were diagnosed with NSOFC giving an incidence of 1.26/1,000 live-births in Saudi Arabia and the highest incidence in Medina city (2.46/1000 live-births). The incidence of cleft lip-and-palate (0.67/1000 live-births) was higher than that of cleft-palate (0.37/1000 live-births) and cleft-lip (0.22/1000 live-births). Pierre-Robin Sequence incidence was (0.04/1000 live-births). There were 21(12.1) or 23(13.2%) of NSOFC's mothers exposed or vaccinated with Covid-19, respectively. CONCLUSION: The national incidence of NSOFC in Saudi Arabia was 1.26/1000 live births with variation between phenotypes and regions in the country. In addition, to reporting Covid-19 infection prevalence and vaccine exposure among NSOFC's mothers, this study represents the first of its type to evaluate NSOFC prevalence in Saudi Arabia on a national level.

Knowledge, Attitude, and Practices Regarding the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome Among Primary Healthcare Physicians in Saudi Arabia.

INTRODUCTION: Irritable bowel syndrome (IBS) presents a significant challenge in the medical field due to its complex nature as a functional gastrointestinal illness (FGID) without clear biological markers. Diagnosis often involves ruling out other potential causes, leading to frustration for patients and difficulty in effective treatment. Given its high prevalence among FGIDs, primary healthcare (PHC) physicians play a crucial role in its initial assessment and management. METHODS: This cross-sectional study surveyed 623 PHC physicians using a structured, closed-ended questionnaire. Employing a multistage sampling approach, physicians were selected from various provinces and cities in Saudi Arabia. Clusters within these cities were also sampled. RESULTS: The research revealed that a majority of physicians (n = 411, 66%) exhibited a strong awareness of the Rome IV criteria, essential for diagnosing IBS. This awareness correlated significantly with variables, such as age, nationality, marital status, specialty, classifications, and years of experience. CONCLUSION: PHC physicians in the study demonstrated a commendable level of familiarity with the Rome IV criteria for diagnosing IBS. Their knowledge was particularly robust concerning symptoms outlined in these criteria. However, there is room for improvement in their understanding, attitude, and application of the Rome IV guidelines in practice. Addressing these gaps could enhance the overall management of IBS cases by these physicians.

Reporting Diagnostic Reference Levels for Paediatric Patients Undergoing Brain Computed Tomography.

Brain computed tomography (CT) is a diagnostic imaging tool routinely used to assess all paediatric neurologic disorders and other head injuries. Despite the continuous development of paediatric CT imaging, radiation exposure remains a concern. Using diagnostic reference levels (DRLs) helps to manage the radiation dose delivered to patients, allowing one to identify an unusually high dose. In this paper, we propose DRLs for paediatric brain CT examinations in Saudi clinical practices and compare the findings with those of other reported DRL studies. Data including patient and scanning protocols were collected retrospectively from three medical cities for a total of 225 paediatric patients. DRLs were derived for four different age groupings. The resulting DRL values for the dose-length product (DLP) for the age groups of newborns (0-1 year), 1-y-old (1-5 years), 5-y-old (5-10 years) and 10-y-old (10-15 years) were 404 mGy cm, 560 mGy cm, 548 mGy cm, and 742 mGy cm, respectively. The DRLs for paediatric brain CT imaging are comparable to or slightly lower than other DRLs due to the current use of dose optimisation strategies. This study emphasises the need for an international standardisation for the use of weight group categories in DRL establishment for paediatric care in order to provide a more comparable measurement of dose quantities across different hospitals globally.

Nurses' readiness to prescribe under supervision in Saudi Arabia: A cross-sectional study.

Aim: To explore nurses' readiness to prescribe medications under supervision and identify associations between prescribing practices under supervision and demographic characteristics in Saudi Arabia. Design: A cross-sectional study. Methods: Using convenience sampling, this study used a 32-item survey to collect data on nurses prescribing medications under supervision between December 2022 and March 2023. Results: A total of 379 nurses were recruited from different regions in Saudi Arabia. Approximately 7% (n = 30) of the participants were prescribing medications independently, and 70% (n = 267) expressed their likelihood of becoming prescribers. The highest motivating factors to become prescribers were improvement of patient care (52.2%) and contribution to the multidisciplinary team (52.0%). Most participants (60%-81%) agreed that prescribing medications under supervision would improve potential outcomes at the system, nurse, and patient levels. Availability of appropriate mentors or supervisors (72.9%) was the highest rated facilitating factor, followed by support of nursing colleagues (72%). Based on demographic characteristics, findings revealed significant differences in the: a) likelihood and motivators of becoming prescribers; b) required minimum qualification, years of experience, and continuing professional education hours to become prescribers; and c) type of organizations delivering educational programs for nurse prescribing. Conclusion: Majority of nurses in Saudi Arabia favored becoming prescribers, and motivating factors were mostly relevant to optimizing patient care outcomes. Having the proper supervision was rated as the most facilitating factor for nurse prescribing. Nurses' views on potential outcomes, facilitating factors, and possible motivators varied based on nurses' demographical characteristics. Implications for the professional and/or patient care: Nurses favored prescribing under supervision to improve patient care outcomes, which is an opportunity to expand the benefits of health services, including easy access to healthcare. Impact: Results revealed that nurses support the implementation of prescribing practice under supervision. Thus, the findings may inform practice change in Saudi Arabia to allow prescribing under supervision, which was perceived to have a positive impact on patient care outcomes. Reporting Method: This study adhered to STROBE guidelines.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Quality of care provided to diabetic patients attending primary health care centers in National Guard in Makkah Region, Saudi Arabia.

Background: Diabetes is a costly and serious health problem that is increasing markedly. The quality of care is a major issue among diabetic patients. This study aims to assess the quality of care provided to diabetic patients using the American Diabetes Association (ADA) indicators. Methods: This was a cross-sectional study conducted using a retrospective chart review. The population was adult diabetic patients (type 2) who had attended the National Guard's primary healthcare centers, Makkah region, Saudi Arabia, from January 1, 2017, to December 31, 2018. Results: We studied 400 adult diabetic patients aged 30-97 years with a mean age of 58.25 (SD = 11.9). The length of time with diabetes ranged from 1 to 42 years with a mean of 9.66 years (SD = 7.6). Among all the primary healthcare centers (PHCs), specialized polyclinic (SPC) had the highest number of patient visits. Furthermore, the SPC had the highest number of patients with complications; the primary healthcare center with the fewest complications was Iskan-Jeddah. The results show that the control of hemoglobin A1C (HbA1C) was better in 2018 than in 2017. Conclusion: There is improved and adequate care provided to patients among the assessed primary healthcare centers in the Makkah region. Nevertheless, there remains a need for interventions to maintain comprehensive data on diabetes performance. Monitoring and proper education on diabetic care to patients are suggested to achieve better control of diabetes and delay the occurrence of complications.

Physicians' Knowledge, Practices, and Perceptions of Reporting Communicable Diseases at Primary Health Care Centers in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Background Jeddah has the highest international traffic and is among the most diverse cities in Saudi Arabia. The chance of importing an emerging communicable disease is significant, particularly during the religious seasons. Therefore, timely and accurate reporting of communicable diseases at primary health care centers (PHCCs) is crucial. Objectives The main objective of this study was to assess physicians' knowledge, practices, and perceptions of reporting communicable diseases at PHCCs in Jeddah, Saudi Arabia. Methods The study was a cross-sectional study comprising 143 physicians from all PHCCs in Jeddah from October 2017 to February 2018. An electronic questionnaire was used to collect data to assess the physicians' knowledge, practices, and perceptions related to reporting communicable diseases at PHCCs. Results A total of 106 physicians participated in the study. Although only 21.7% of the physicians had received training on reporting communicable diseases, the average knowledge score for the six commonly reported diseases was 72%. More than half (58.5%) of the physicians indicated that they had reported at least one disease. However, there was no agreement on who should be responsible for reporting communicable diseases at PHCCs. Furthermore, some obstacles were perceived that could prevent disease reporting, including physicians not knowing which diseases to report (66%), not knowing how or whom to report to (54.7%), and a limited diagnostic or laboratory capacity (52.8%). Conclusions Reporting communicable diseases at PHCCs was of adequate quality. However, some obstacles must be addressed, and regular applied training must be provided. More extensive assessments are needed to improve the reporting of communicable diseases locally and nationally.

Relationship between Fixed Dental Crowns and Volatile Sulphur Compounds.

OBJECTIVES: The aim of this study was to investigate and compare the level of halitosis in patients with/without fixed crowns and in addition the influence of various crown parameters on halitosis was also explored. METHODS: In total, 96 subjects (fixed crowns = 52; no crowns = 44) participated in the study. The levels volatile sulphur compounds (VSCs) of hydrogen sulphide (H2S), methyl mercaptan (CH3SH), and dimethyl sulphide (CH3SCH3) were evaluated with breath samples using gas chromatography and used for classification as presence or absence of halitosis. The periodontal clinical parameters for all the participants as well as the crown parameters for participants with fixed crowns were also evaluated. Cross tabulation, Chi-square test, and one-way analysis of variance tests were used for the statistical analysis and comparisons. RESULTS: Breath samples revealed, 50 (52.1%) participants were suffering from halitosis. Out of VSCs, the level of CH3SCH3 (62.5%) was found to be the most prevalent. Significant correlations were observed between the presence of fixed crowns and oral halitosis (p < 0.001). Statistically significant difference in the concentration of H2S and CH3SH (p < 0.001) and no significance for CH3SCH3 (p = 0.075) between patients with/without fixed crowns was found. The presence of halitosis was more prevalent in the subjects with crown parameters (subgingival margin, over-contoured margin, open-crown margin, over-contoured and under-contoured crowns) considered clinically defective/unacceptable (p < 0.05). CONCLUSIONS: Presence of fixed dental crowns significantly contributes to the oral halitosis. Dental crowns with defects significantly impair the hygienic conditions and oral microflora resulting in high prevalence of halitosis.

The prevalence and predictors of refractive error among school children in Riyadh, Saudi Arabia.

PURPOSE: Refractive error (RE) is one of the most common ocular disorders among children worldwide. This study aimed to investigate the prevalence of RE and possible risk factors among school children in Riyadh. METHODS: This is a cross-sectional study using data collected at various schools. To achieve the aim of the study, we selected a random sample of 850 school children aged 6-15 years. The examination was based on the RESC protocol and included full visual assessment. Furthermore, a questionnaire was sent to the parents of the participants to ascertain information about lifestyle factors. We constructed a logistic regression model to evaluate the predictors of RE. RESULTS: Close to a third of the children had a RE. Of those identified as having the condition, 60% did not wear glasses (newly diagnosed). Nearly all the children (95.4%) in our sample reported using electronic devices, according to parents. No association was found between using electronic devices and having a RE (P = 0.26). Doing outdoor activities was associated with 52% lower odds of a RE (odds ratio = 1.52). CONCLUSION: We found a higher prevalence of uncorrected RE than previously reported in other Saudi studies. About 60% of children who had RE were not wearing glasses, highlighting the need for a standardized school screening program for early detection and management. Outdoor activities were associated with a lower likelihood of having a RE. These findings might support initiatives to encourage outdoor activities among school children.

Characterization of In vitro inhibitory effects of consensus short interference RNAs against non-structural 5B gene of hepatitis C virus 1a genotype.

PURPOSE: Chronic hepatitis C has infected approximately 170 million people worldwide. The novel direct-acting antivirals have proven their clinical efficacy to treat hepatitis C infection but still very expensive and beyond the financial range of most infected patients in low income and even resource replete nations. This study was conducted to establish an in vitro stable human hepatoma 7 (Huh-7) cell culture system with consistent expression of the non-structural 5B (NS5B) protein of hepatitis C virus (HCV) 1a genotype and to explore inhibitory effects of sequence-specific short interference RNA (siRNA) targeting NS5B in stable cell clones, and against viral replication in serum-inoculated Huh-7 cells. MATERIALS AND METHODS: In vitro stable Huh-7 cells with persistent expression of NS5B protein was produced under gentamycin (G418) selection. siRNAs inhibitory effects were determined by analysing NS5B expression at mRNA and protein level through reverse transcription-polymerase chain reaction (PCR), quantitative real-time PCR, and Western blot, respectively. Statistical significance of data (NS5B gene suppression) was performed using SPSS software (version 16.0, SPSS Inc.). RESULTS: siRNAs directed against NS5B gene significantly decreased NS5B expression at mRNA and protein levels in stable Huh-7 cells, and a vivid decrease in viral replication was also exhibited in serum-infected Huh-7 cells. CONCLUSIONS: Stable Huh-7 cells persistently expressing NS5B protein should be helpful for molecular pathogenesis of HCV infection and development of anti-HCV drug screening assays. The siRNA was effective against NS5B and could be considered as an adjuvant therapy along with other promising anti-HCV regimens.