The Effect of Genetic Variants of SLC22A2 (rs662301 and rs315978) on the response to Metformin in type 2 Saudi diabetic patients.

PURPOSE: To investigate the allelic and genotypic frequencies of the two genetic variations, NC_000006.12: g.160275887C > T (rs662301) and NC_000006.12:g.160231826 T > C (rs315978), in the SLC22A2 gene among the Saudi population. The primary goal is to elucidate potential associations with these genetic variations and the response to metformin therapy over 6 months to enhance our knowledge of the genetic basis of Type 2 Diabetes Mellitus (T2DM) and its clinical management in the Saudi population. MATERIALS/METHODS: 76 newly diagnosed T2DM patients, aged 30 to 60, of both sexes and Saudi origin, were treated with metformin monotherapy. Blood samples were collected before and after 6 months of therapy,80 healthy individuals were included as controls. Genomic DNA was extracted. Genotyping of the SLC22A2 genetic variations was performed using TaqMan® SNP Genotyping Assays. Binary logistic regression was utilized to evaluate how certain clinical parameters influence T2DM concerning the presence of SLC22A2 gene variants. RESULTS: Among these patients, 73.3 % were responders, and 26.7 % were non-responders. For these variants, no statistically significant differences in genotype or allele frequencies were observed between responders and non-responders (p = 0.375 and p = 0.384 for rs662301; p = 0.473 and p = 0.481 for rs315978, respectively). For the SLC22A2 variant rs662301, the C/C genotype was significantly associated with increased T2DM risk with age and elevated HbA1c levels. Similarly, rs315978 revealed higher T2DM susceptibility and HbA1c elevation in C/C genotype carriers, specifically with advancing age compared to individuals with C/T and T/T genotypes. CONCLUSION: The study offers insights into the genetic landscape of T2DM in Saudi Arabia. Despite the absence of significant associations with treatment response, the study suggests potential age-specific associations, this highlights the complexity of the disease. This research underscores the necessity for expanded research, considering diverse populations and genetic factors, to develop personalized treatment approaches. This study serves as a foundation for future investigations into the Saudi population, recognizing the need for a larger sample size.

Art or Artifact: Evaluating the Accuracy, Appeal, and Educational Value of AI-Generated Imagery in DALL·E 3 for Illustrating Congenital Heart Diseases.

Artificial Intelligence (AI), particularly AI-Generated Imagery, has the potential to impact medical and patient education. This research explores the use of AI-generated imagery, from text-to-images, in medical education, focusing on congenital heart diseases (CHD). Utilizing ChatGPT's DALL·E 3, the research aims to assess the accuracy and educational value of AI-created images for 20 common CHDs. In this study, we utilized DALL·E 3 to generate a comprehensive set of 110 images, comprising ten images depicting the normal human heart and five images for each of the 20 common CHDs. The generated images were evaluated by a diverse group of 33 healthcare professionals. This cohort included cardiology experts, pediatricians, non-pediatric faculty members, trainees (medical students, interns, pediatric residents), and pediatric nurses. Utilizing a structured framework, these professionals assessed each image for anatomical accuracy, the usefulness of in-picture text, its appeal to medical professionals, and the image's potential applicability in medical presentations. Each item was assessed on a Likert scale of three. The assessments produced a total of 3630 images' assessments. Most AI-generated cardiac images were rated poorly as follows: 80.8% of images were rated as anatomically incorrect or fabricated, 85.2% rated to have incorrect text labels, 78.1% rated as not usable for medical education. The nurses and medical interns were found to have a more positive perception about the AI-generated cardiac images compared to the faculty members, pediatricians, and cardiology experts. Complex congenital anomalies were found to be significantly more predicted to anatomical fabrication compared to simple cardiac anomalies. There were significant challenges identified in image generation. Based on our findings, we recommend a vigilant approach towards the use of AI-generated imagery in medical education at present, underscoring the imperative for thorough validation and the importance of collaboration across disciplines. While we advise against its immediate integration until further validations are conducted, the study advocates for future AI-models to be fine-tuned with accurate medical data, enhancing their reliability and educational utility.

Breaking the Emergency Room Cycle: The Impact of Telemedicine on Emergency Department Utilization.

Background Telemedicine has gained prominence in healthcare, and understanding its impact on diverting non-urgent cases from the emergency room (ER) has become crucial. This study delves into the dynamic relationship between telemedicine utilization and ER visits, seeking to understand the transformative impact of telehealth on breaking the traditional ER cycle. Method To explore the awareness and utilization of telemedicine services in the broader population of Saudi Arabia, we adopted a cross-sectional design utilizing the convenience sampling method. Data collection was facilitated through a self-administered online survey comprising four sections: demographic variables, ER visits, awareness of non-urgent cases, and suggestions. The collected data were entered into IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States) for descriptive analysis. Results Among the 1140 participants, the majority were females (56.8%), with 43.2% being males. Regarding age distribution, the highest percentage fell within the 18-25 age group (46.8%). Nationality-wise, a substantial proportion identified as Saudi (95.2%). Educational backgrounds varied, with 60.7% holding a bachelor's degree. Notably, 62.6% of the visits were classified as urgent. A significant portion (66.8%) demonstrated awareness of alternative options for non-urgent care, such as outpatient clinics and telemedicine services. Specifically regarding telemedicine, 82.8% of respondents believed that video consultations and prescription refills could effectively address non-urgent conditions. Furthermore, 89.6% of participants agreed that educating patients on self-care and home remedies could help manage symptoms and deter unnecessary ER visits. Conclusions The positive reception of telemedicine, as evidenced by high satisfaction rates among participants, further reinforces its role in reshaping the landscape of healthcare delivery.

Favorable outcome of non-myeloablative allogeneic transplantation in adult patients with severe sickle cell disease: A single center experience of 200 patients.

Allogeneic hematopoietic stem cell transplant (HSCT) for adults with severe sickle cell disease (SCD) is potentially curative but not commonly utilized therapy due to complications such as graft failure (GF) and organ toxicity. Herein, we are reporting our long-term outcome data of non-myeloablative (NMA) HSCT in adults with severe SCD with emphasis on factors predicting event free survival (EFS). Adults with severe SCD undergoing NMA match-related donor allogeneic HSCT from 2015 to 2021 with at least 12 months of follow-up were included. A total of 200 patients were included with a median age of 26 years (14-43) and 56% were male. The median infused CD34 dose was 13.7 (5.07-25.8), respectively. Median absolute neutrophil count engraftment was 19 (13-39) days with 51% of patients receiving GCSF to expedite recovery. A total of 17 patients experienced GF; 3 as primary and 14 as secondary within a median time of 204 days (40-905). A 76% successfully discontinued sirolimus at the last follow-up. Median follow-up for the cohort is 29.2 (2.1-71.4) months. Estimated 3-year EFS and OS were 88.2% (81.9-92.5) and 94.6% (89.2-97.3). At multivariable analysis, minor ABC incompatibility hazard ratio (HR) 4 (1.3-12.1; 0.014) and allo-antibody against non-ABO donor antigens HR 4.3 (1.3-14.1; 0.016) were significant for EFS. No clonal evolution or myeloid malignancies were seen. This largest single-center report of NMA HSCT in adults with severe SCD further delineated its feasibility, potential toxicities, and fertility outcomes. GF remains a major impediment and appears dependent on ABO matching and non-ABO antibodies.

Antimicrobial, antioxidant, cell imaging and sensing applications of fluorescein derivatives: A review.

Fluorescein itself is a synthetic organic compound and a prominent member of the xanthene dye family. It exhibits strong fluorescence under ultraviolet (UV) or blue light excitation, making it widely used in various applications, including fluorescence microscopy, flow cytometry, immunoassays, and molecular biology techniques. One of the reasons fluorescein derivatives are highly valuable is their tunable fluorescence properties. Through chemical modifications of the fluorescein structure, different functional groups or substituents can be introduce, altering the compound's fluorescence characteristics such as emission wavelength, intensity, and photo stability. This flexibility allows for tailoring of fluorescent probes to specific experimental requirements, enhancing their utility in a range of scientific disciplines. Fluorescein derivatives also possess excellent antimicrobial and antioxidant activity. This review sheds light on the significant impact of fluorescein derivatives as biological active compounds, highlighting their potential in designing new therapeutic agents with antimicrobial properties. Additionally, their role as antioxidants is discussed. A major aspect covered in the review is the application of fluorescein derivatives as powerful cell imaging probes. Their unique fluorescent properties make them valuable tools for visualizing cellular structures and processes, opening up new possibilities for studying cellular dynamics and interactions.

Findings of a Multidisciplinary Assessment of Children Referred for Possible Neurodevelopmental Disorders: Insights from a Retrospective Chart Review Study.

Children with ASD have a wide spectrum of functional deficits in multiple neurodevelopmental domains. A multidisciplinary team assessment (MDT) is required to assess those deficits to help construct a multimodal intervention plan. This is a retrospective chart review of the assessment for children who were referred for an assessment of potential neurodevelopmental disorders. We reviewed 221 participants' charts from January 2019 to January 2020. The mean age of the children was 7.95 ± 3.69, while the mean age of the fathers and mothers was 37.31 ± 8.57 and 31.95 ± 6.93, respectively. Consanguinity was as high as 37.9% for the referred children with developmental delay who were first-degree related, and 13.2% of the parents were second-degree relatives. Approximately 26.6% of children had a family history of mental illness in first-degree relatives. ASD was the most commonly reported diagnosis post-assessment, and ADHD was the most common reported comorbidity at 64.3% and 88.5%, respectively. The MDT findings showed that 58% of children required moderate or higher assistance with toileting, 79.2% were unable to answer yes/no questions, and 86.8% were unable to understand "wh" questions. Only 26% of the nonverbal children had average IQ testing results, and 31% of verbal children did. In conclusion, the mean age of the children when assessed was above that recommended for early screening and intervention. An increased paternal and maternal age was noticeable. Consanguinity and a family history of mental disorders in first-degree relatives were high, attesting to a possible genetic risk.

Knowledge and attitude of children safety at home among population in Saudi Arabia.

Background: Unintentional injury to children at home is a public health problem and it is a significant cause of death and disabilities. It accounts for 40% of all child deaths. To our knowledge, there have been no similar studies done on Arabic countries that show the prevalence of home injuries among children. Aim: We aimed to assess the adults' knowledge and attitude toward child safety at home in Saudi Arabia. Methods: A cross-sectional study was conducted among 1,301 participants, during August 2017, who are older than 18 years old and have at least one child in the family. Data were collected by an online questionnaire assessing the believes, knowledge, and behavior of the participants. Analysis was carried out using IBM SPSS Software version 21, using descriptive analysis, t-test, and one-way ANOVA. Results: It was found that gender, age, marital status, employment status, and the type of accommodation played key roles in the awareness of children safety at home, the study showed that females and age group above 25, married, employees, and those who lived in flats had more awareness than the other groups, respectively. Conclusion: The majority of the population had good awareness about children's safety at home. Despite the good level of awareness, more public health education is recommended to improve the awareness and the prevention methods of these injuries.

The Effects of Empowerment on Health Care Worker Performance During the COVID-19 Pandemic in Saudi Arabia.

BACKGROUND AND OBJECTIVES: In this study, we assessed the potential impact of employee empowerment on health care workers' performance during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. In particular, we aimed to determine the empowerment practices that would have the greatest positive effect on employee performance. Understanding the relationship between performance and empowerment can help health care providers better manage worker stress during any global crisis. This understanding is crucial in guiding policies and interventions aimed at maintaining health care workers' psychological well-being and their overall performance. METHODS: This cross-sectional study evaluated the relationship between employee empowerment and performance, determining the best empowerment practices for health care leaders to utilize. Frontline health care workers (n = 100) selected using convenience and snowball sampling completed the survey between March 15 and 31, 2020. This is the period when the pandemic just started to accelerate in Saudi Arabia. We conducted Pearson's correlation analysis to assess whether there was a relationship between performance and health care workers' empowerment practice, and stepwise linear regression analysis to investigate the impact each of these empowerment practices on health care workers' performance. RESULTS: Our results indicate that health care workers' performance can be expected to increase the most through 2 empowerment practices: giving employees the discretion to change work processes and offering performance-based rewards (R2 = 0.301, P < .05). CONCLUSION: Our findings suggest that health care leaders must invest in these 2 practices to better equip frontline health care workers. During a global crisis, additional discretion granted to employees helps reduce their anxiety and burnout and hence empowers them with the flexibility to adapt to unforeseen circumstances and improve the quality of their interactions with health service recipients.

Family Medicine Research Productivity in Saudi Arabia for 15 Years: An Urgent Call for Action.

Family medicine is one of the most vital health specialties in the field of medicine. This can be attributed to the wide range of health services for all people regardless of age, gender, and diagnosis. Saudi Arabia as suggested by various studies put more of its attention at all levels to family medicine in order to produce an adequate number of family physicians and improve both the academic aspects and the services provided by family medicine in the country. Thus, a comprehensive national survey was suggested to analyze the current situation of the specialty in the country and to draw up a strategic plan to achieve the national vision for family medicine by 2020. In light of the aforementioned, this study deemed it necessary to examine family medicine research productivity in Saudi Arabia in order to recommend possible measures to increase the quality of research output related to the field. The Web of Science (WoS) bibliographic database search engine was used to retrieve and analyze data. The terms "Family Medicine" and "Saudi Arabia" were entered in the search address fields using the SAME boolean operator (i.e., Family Medicine SAME Saudi Arabia) to retrieve records that contained these two terms and were in the same address. Research articles that were published from 1 January 2004 to 31 December 2018 were included for data analysis. Publication details such as the year of publication, document type, research area, authors' affiliation, journal name, international collaborators, journal impact factor (JIF), and citation reports were all considered in the analysis. As for the result, Saudi Arabia's research productivity in the field of family medicine is very poor, with a very gradual linear increase over the last 15 years. Further, health institutions have low research productivity compared to universities and medical colleges. Finally, most of the publications were published in low- or no-impact-factor journals. Therefore, this study concludes that Saudi Arabia has had low research productivity in family medicine. It recommends that an educational research program with the supervision of Ministry of Health (MOH) be implemented among family medicine physicians featuring organizational support and well-structured communication between health and educational institutions to increase research productivity in the country.

A Comparison of Surgical Auditory Nerve Response and Speech Outcomes in Patients with Post-meningitic Deafness and Without Cochlear Osteogenesis Who Underwent Cochlear Implantation.

Objective Patients with post-meningitis deafness remain challenging candidates for cochlear implantation (CI) which can be difficult due to fibrosis or ossification of the inner ear, and their outcomes remain doubtful. We assessed the surgical and audiological outcomes of CI in patients with profound sensorineural hearing loss caused by meningitis and compared those outcomes to patients without cochlear ossification. Methods This retrospective cross-sectional study was carried out at King Fahad General Hospital, Jeddah, Saudi Arabia. Among 246 patients who underwent cochlear implantation, 13 patients with post-meningitic deafness were identified (Group 1). A matched control group, including patients with deafness due to other causes who did not have cochlea osteogenesis, was selected (Group 2). For all patients, data were collected from medical records, including surgical and audiological outcomes. Results Sclerosis of the cochlea was high in Group 1 (46.2%). There were no postoperative surgical complications in either group. Responses of the auditory nerve action potential obtained through auditory response telemetry (ART) or the neural response telemetry (NRT) were recorded. There was no significant difference between the two groups regarding the intraoperative and the postoperative ART or NRT at selected electrodes representing the entire cochlea. Likewise, no significant difference regarding the speech recognition test (SRT) was detected. Conclusions Cochlear implantation is a safe procedure without surgical complications in post-meningitis patients. Furthermore, early CI in children was associated with favorable outcomes in terms of preservation of the auditory nerve response, restoration of speech discrimination, and recognition to levels comparable to patients with deafness due to other causes. Early audiological assessment in meningitis patients is recommended to identify hearing loss and eventually to offer CI.

High blood pressure in children attending pediatric clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

BACKGROUND: High blood pressure (BP) is an important health issue on a global level. It is one of the major factors for mortality in Saudi Arabia. Furthermore, high BP is considered a significant risk for heart disease responsible for 30% of all deaths all over the world. The aim of this research was to determine the prevalence of hypertension in children attending the pediatric clinics and determine the common risk factors associated with high BP. MATERIALS AND METHODS: It was a cross-sectional study conducted among 6-15 year aged children attending the pediatric clinic at King Abdulaziz University Hospital in Jeddah; children were selected using sytematic random sampling technique. Data was collected by interviewing the parents using a structured questionnaire. SPSS was used for data entry and analysis. Computed frequency and percentages for categorical variables, and mean and standard deviations for continuous variables. Chi-square test and correlation used to determine associations, and logistic regression performed to determine factors associated with blood pressure >= 95th percentile. RESULTS: The prevalence of hypertension and prehypertension was 14.4% and 6.5%, respectively, in males, whereas, in females, it was 16.3% and 5.2%, respectively. A high prevalence observed for the 6-10 years age group as compared with the 11-15 year age group, and the difference was statistically significant (P = 0.001). A high prevalence of hypertension and prehypertension in overweight and obese group was noticed. A significant positive correlation between systolic BP and weight, height, and BMI was demonstrated. The common risk factors for hypertension in this study were the age range of 6-10 years, (odds ratio OR = 2.44), overweight and obese children (OR = 2.44), children with family history of hypertension (OR = 1.39), and children with low birth weight (OR = 1.05). CONCLUSION: These factors are considered risk factors for such a chronic disease as cardiovascular disease. Consequently, continuous BP monitoring and early identification of high BP in children are some of the greatest strategies for the prevention of chronic diseases in adulthood.