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Stroke poses a significant health threat, affecting millions annually. Early and precise prediction is crucial to providing effective preventive healthcare interventions. This study applied an ensemble machine learning and data mining approach to enhance the effectiveness of stroke prediction. By employing the cross-industry standard process for data mining (CRISP-DM) methodology, various techniques, including random forest, ExtraTrees, XGBoost, artificial neural network (ANN), and genetic algorithm with ANN (GANN) were applied on two benchmark datasets to predict stroke based on several parameters, such as gender, age, various diseases, smoking status, BMI, HighCol, physical activity, hypertension, heart disease, lifestyle, and others. Due to dataset imbalance, Synthetic Minority Oversampling Technique (SMOTE) was applied to the datasets. Hyperparameter tuning optimized the models via grid search and randomized search cross-validation. The evaluation metrics included accuracy, precision, recall, F1-score, and area under the curve (AUC). The experimental results show that the ensemble ExtraTrees classifier achieved the highest accuracy (98.24%) and AUC (98.24%). Random forest also performed well, achieving 98.03% in both accuracy and AUC. Comparisons with state-of-the-art stroke prediction methods revealed that the proposed approach demonstrates superior performance, indicating its potential as a promising method for stroke prediction and offering substantial benefits to healthcare.

The aim of this study is to estimate the normal cross-sectional area and diameter of the stellate ganglion (SG) by ultrasound (US) in healthy adults. The study sample included 80 stellate ganglia in 40 participants (15 males, 25 females), mean age 38 years, mean height 162.5 cm, mean weight 67.8 kg, mean body mass index 25.4 kg/m2. Two radiologists separately obtained US images of the bilateral SG. Each participant was scanned 3 times bilaterally to assess for intra-observer reliability. The mean diameter of the SG was 1 mm (range: 0.1-2). The mean CSA of the bilateral SG was 1.3 mm2 (range: 0.6-3.9). The SG diameter positively correlated with age. Our study demonstrates the ability of US to image the SG and estimate its normal diameter and CSA. Knowledge of how to identify and measure the SG during ultrasound-guided procedures would be expected to decrease the risk of associated complications and help establish normal reference values., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Epilepsy is a neurological disorder affecting more than 50 million human lives of all ages, its social, physical and psychological implications is of huge concern. The current study and as a continuation of epilepsy knowledge assessment projects conducted by our research team is aimed to assess the knowledge of healthcare workers regarding epilepsy first aid in Saudi Arabia., Methods: A cross-sectional questionnaire-based study was carried out from 2020 to 2021., Results: During the study period, 272 healthcare workers were recruited; participants were males and females from different nationalities in various Saudi Arabian cities, possess diverse qualifications, and belong to several healthcare-related professions. The question, "Did you witness an epileptic seizure"? was answered as "Yes" by 42% of participants, and in response to the question "If you know that this patient struggles during seizure attacks," 58% of respondents stated that they would not call an ambulance. Moreover, the question "Put something in his/her mouth to prevent tongue biting" was incorrectly answered as "Yes" by 42% of respondents, and the question "Try to catch him/her and stop his/her movement" in order to control the attack was answered "Yes" by 21% of respondents. Furthermore, almost 90% of healthcare participants do not know how to use the Vagus Nerve Stimulation device. The mean knowledge score among participants was 23.7; sex, as well as type of higher qualification obtained, was found to be significantly associated with the score of knowledge., Conclusion: Knowledge toward epilepsy and epilepsy first aid among healthcare workers in Saudi Arabia was found fragile. Further research is appreciated to support the current findings., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objectives: Telehealth has become increasingly important in achieving universal health coverage. It offers doctors and their patients' convenience, including providing quality care at reduced costs. During the coronavirus disease (COVID)-19 pandemic, telehealth has been a vital tool for remote healthcare services. This study aimed to assess the satisfaction of adult and pediatric neurologists and neurosurgeons using telehealth, during the COVID-19 pandemic in Saudi Arabia., Methods: This study had 348 participants. It was conducted among adult and pediatric neurologists and neurosurgeons using telehealth technology at their clinics between February and June 2021. The self-administered questionnaire included sociodemographic data, behavior in using telehealth, and an assessment of satisfaction with telehealth; the SPSS Windows software version 26 was used to analyze the data., Results: The most common age group was 25-34 years (42.8%), with men dominating (68.4%). The mean satisfaction score was 25.9 (SD 3.91) out of 33 points, with 90.2% of respondents satisfied with telehealth and 9.8% dissatisfied. Working in an academic center or private hospital, being a first-time telehealth user, using messages as a telehealth method, and using telehealth daily were associated with increased satisfaction with telehealth use., Conclusion: The satisfaction of adult and pediatric neurologists and neurosurgeons with telehealth was high. Although physicians still preferred face-to-face interviews, they recognized the benefits of telehealth in strengthening the patient-provider relationship, improving productivity, and integrating into daily workflows. The satisfaction levels align with past studies, but physical examination needs should be considered. Telehealth is suitable for follow-up visits and varies across subspecialties., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Algarni, Alrashid, Aldayel, Allowaihiq, Almuqbil, Albarrak and Almobarak.)

Cardiovascular diseases present a significant global health challenge that emphasizes the critical need for developing accurate and more effective detection methods. Several studies have contributed valuable insights in this field, but it is still necessary to advance the predictive models and address the gaps in the existing detection approaches. For instance, some of the previous studies have not considered the challenge of imbalanced datasets, which can lead to biased predictions, especially when the datasets include minority classes. This study's primary focus is the early detection of heart diseases, particularly myocardial infarction, using machine learning techniques. It tackles the challenge of imbalanced datasets by conducting a comprehensive literature review to identify effective strategies. Seven machine learning and deep learning classifiers, including K-Nearest Neighbors, Support Vector Machine, Logistic Regression, Convolutional Neural Network, Gradient Boost, XGBoost, and Random Forest, were deployed to enhance the accuracy of heart disease predictions. The research explores different classifiers and their performance, providing valuable insights for developing robust prediction models for myocardial infarction. The study's outcomes emphasize the effectiveness of meticulously fine-tuning an XGBoost model for cardiovascular diseases. This optimization yields remarkable results: 98.50% accuracy, 99.14% precision, 98.29% recall, and a 98.71% F1 score. Such optimization significantly enhances the model's diagnostic accuracy for heart disease.

Medical data, such as electronic health records, are a repository for a patient's medical records for use in the diagnosis of different diseases. Using medical data for individual patient care raises a number of concerns, including trustworthiness in data management, privacy, and patient data security. The introduction of visual analytics, a computing system that integrates analytics approaches with interactive visualizations, can potentially deal with information overload concerns in medical data. The practice of assessing the trustworthiness of visual analytics tools or applications using factors that affect medical data analysis is known as trustworthiness evaluation for medical data. It has a variety of major issues, such as a lack of important evaluation of medical data, the need to process much of medical data for diagnosis, the need to make trustworthy relationships clear, and the expectation that it will be automated. Decision-making strategies have been utilized in this evaluation process to avoid these concerns and intelligently and automatically analyze the trustworthiness of the visual analytics tool. The literature study found no hybrid decision support system for visual analytics tool trustworthiness in medical data diagnosis. Thus, this research develops a hybrid decision support system to assess and improve the trustworthiness of medical data for visual analytics tools using fuzzy decision systems. This study examined the trustworthiness of decision systems using visual analytics tools for medical data for the diagnosis of diseases. The hybrid multi-criteria decision-making-based decision support model, based on the analytic hierarchy process and sorting preferences by similarity to ideal solutions in a fuzzy environment, was employed in this study. The results were compared to highly correlated accuracy tests. In conclusion, we highlight the benefits of our proposed study, which includes performing a comparison analysis on the recommended models and some existing models in order to demonstrate the applicability of an optimal decision in real-world environments. In addition, we present a graphical interpretation of the proposed endeavor in order to demonstrate the coherence and effectiveness of our methodology. This research will also help medical experts select, evaluate, and rank the best visual analytics tools for medical data.

Knee osteoarthritis (OA) detection is an important area of research in health informatics that aims to improve the accuracy of diagnosing this debilitating condition. In this paper, we investigate the ability of DenseNet169, a deep convolutional neural network architecture, for knee osteoarthritis detection using X-ray images. We focus on the use of the DenseNet169 architecture and propose an adaptive early stopping technique that utilizes gradual cross-entropy loss estimation. The proposed approach allows for the efficient selection of the optimal number of training epochs, thus preventing overfitting. To achieve the goal of this study, the adaptive early stopping mechanism that observes the validation accuracy as a threshold was designed. Then, the gradual cross-entropy (GCE) loss estimation technique was developed and integrated to the epoch training mechanism. Both adaptive early stopping and GCE were incorporated into the DenseNet169 for the OA detection model. The performance of the model was measured using several metrics including accuracy, precision, and recall. The obtained results were compared with those obtained from the existing works. The comparison shows that the proposed model outperformed the existing solutions in terms of accuracy, precision, recall, and loss performance, which indicates that the adaptive early stopping coupled with GCE improved the ability of DenseNet169 to accurately detect knee OA.

Successful healthcare companies and illness diagnostics require data visualization. Healthcare and medical data analysis are needed to use compound information. Professionals often gather, evaluate, and monitor medical data to gauge risk, performance capability, tiredness, and adaptation to a medical diagnosis. Medical diagnosis data come from EMRs, software systems, hospital administration systems, laboratories, IoT devices, and billing and coding software. Interactive diagnosis data visualization tools enable healthcare professionals to identify trends and interpret data analytics results. Selecting the most trustworthy interactive visualization tool or application is crucial for the reliability of medical diagnosis data. Thus, this study examined the trustworthiness of interactive visualization tools for healthcare data analytics and medical diagnosis. The present study uses a scientific approach for evaluating the trustworthiness of interactive visualization tools for healthcare and medical diagnosis data and provides a novel idea and path for future healthcare experts. Our goal in this research was to make an idealness assessment of the trustworthiness impact of interactive visualization models under fuzzy conditions by using a medical fuzzy expert system based on an analytical network process and technique for ordering preference by similarity to ideal solutions. To eliminate the ambiguities that arose due to the multiple opinions of these experts and to externalize and organize information about the selection context of the interactive visualization models, the study used the proposed hybrid decision model. According to the results achieved through trustworthiness assessments of different visualization tools, BoldBI was found to be the most prioritized and trustworthy visualization tool among other alternatives. The suggested study would aid healthcare and medical professionals in interactive data visualization in identifying, selecting, prioritizing, and evaluating useful and trustworthy visualization-related characteristics, thereby leading to more accurate medical diagnosis profiles.

Background: Vitamin B12 is one of the most important B-Vitamins that the human body needs on a daily basis, the lack of which can precipitate several neurological issues., Objectives: This systematic aimed to investigate the neurological implications of Vitamin B12 deficiency and the effects when B12 levels were corrected in susceptible individuals., Methods: The databases PubMed-MEDLINE, Web of Science, Cochrane, and Scopus were all searched using pertinent keywords, reference searches, and citation searches. The terms used to access the database were "Cognition", "Dietary patterns", "Neurology", "Nutritional profile", and "Vitamin B12"., Results: Vitamin B12 was shown to noticeably improve cognition and other neurological parameters in the short term in older adults and the short-to-medium term in children; however, there was no perceived increase/improvement when the Vitamin was administered in the longer term, either alone or in conjunction with other similar nutritional interventions., Conclusion: Vitamin B12's role in the improvement of neurological functions over a long-term period remains somewhat inconclusive to date, as the majority of our selected control trials did not display much correlation between the two factors. However, Vitamin B12 did improve cognition levels in both children and older adults over a short course of administration.

Background: Neurological diseases frequently affect sexual activity, and the resulting sexual dysfunction can cause much distress for patients. However, despite the importance of such complaints, neurologists frequently do not ask patients about their sexual symptoms or how their neurological illness and medications are affecting their sexual health. This study aimed to identify these difficulties as well as potential obstructions to conversations for addressing sexual dysfunction in patients with neurological diseases., Methods: This cross-sectional study was performed by sending invitation letters and questionnaires to registered neurologists in Saudi Arabia. The questionnaire was constructed to determine the possibility of discussing sexual activities and function with patients with neurological diseases and the possible obstacles neurologists face in this regard. Statistical analyses were performed using the Statistical Package of Social Sciences (SPSS) program version 25, and p -values of <0.05 were considered statistically significant., Results: A total of 258 of 750 neurologists (34.4%) returned the survey, of which 252 had completed the entire survey; therefore, their responses were considered suitable for further analysis. The majority of the respondents (63.1%) seldom discussed sexuality with their patients, more than half of the participants never discussed sexuality with female patients, and patients aged 60 years or older. The most commonly reported barriers were the lack of spontaneous communication by patients regarding their sexual problems (82.1%), insufficient consultation time (60.7%), and barriers based on language/culture/religion (53.6%). The majority of the respondents (61.9%) expressed the need for training on discussing sexuality as a measure that may enhance the discussion of sexual life with patients. Most of the respondents (92.9%) considered the patients responsible for bringing up problems in their sexual functioning during a patient interview., Conclusion: Sexual dysfunction is rarely discussed with patients showing neurological diseases, particularly with female patients. This is due to the patient's inability to articulate their sexual problems freely as well as a lack of consultation time. Training on discussing sexuality may enhance the discussion of sexual life with patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Almalki, Kotb and Albarrak.)

Introduction: Acute transverse myelitis is an uncommon inflammatory, intramedullary, disorder of the spinal cord. Spastic paraplegia, impaired sphincter functions, and sensory loss, with sensory level, are the clinical manifestations of this devastating disorder. The utilization of magnetic resonant imaging (MRI) contributes to the surge in the diagnosis of more ATM cases. Although the causes of ATM are numerous, both Mycoplasma pneumoniae and Schistosoma mansoni are uncommon causes and their co-existence in the same patient has not been reported before in Saudi Arabia., Case: We report a 25-year-old ATM male patient presented with a history of sudden onset severe low back pain. Within four hours from the onset of the back pain, he became completely paraplegic with impaired functions of the bowel and urinary bladder sphincter. Furthermore, he lost all modalities of sensory functions in the lower limbs. His examination revealed spastic complete paraplegia with sensory level at T6. Clinical neurological examination revealed normal upper limbs and brain functions. The MRI of the cervico-dorsal spine showed extensive longitudinal hyperintense lesion extending from the upper cervical segments to the lower dorsal segments (extensive longitudinal transverse myelitis). A post-infectious immune-mediated predisposition was highly suspected due to the very high titers of anti-Mycoplasma pneumoniae IgM and IgG that were detected. The immunosuppressant therapy did not improve his paraplegia. A spinal cord biopsy revealed the presence of several Schistosoma mansoni ova surrounded by chronic inflammatory reactions and reactive gliosis., Conclusions: Both Mycoplasma pneumoniae and Schistosoma mansoni should be investigated in cases with extensive longitudinal ATM., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Hassan Ali Alayafi, Mubarak Alruwaili, Talal Khalid Aljumah, Ali Alshehri, Deema Alrasheed, Muhannad Faleh Alanazi, Raed AlRuwaili, Naif H Ali, Anas Mohammad Albarrak, Barakat M AlRashdi, Ahmed E Taha.)

Smart home technologies have attracted more users in recent years due to significant advancements in their underlying enabler components, such as sensors, actuators, and processors, which are spreading in various domains and have become more affordable. However, these IoT-based solutions are prone to data leakage; this privacy issue has motivated researchers to seek a secure solution to overcome this challenge. In this regard, wireless signal eavesdropping is one of the most severe threats that enables attackers to obtain residents' sensitive information. Even if the system encrypts all communications, some cyber attacks can still steal information by interpreting the contextual data related to the transmitted signals. For example, a "fingerprint and timing-based snooping (FATS)" attack is a side-channel attack (SCA) developed to infer in-home activities passively from a remote location near the targeted house. An SCA is a sort of cyber attack that extracts valuable information from smart systems without accessing the content of data packets. This paper reviews the SCAs associated with cyber-physical systems, focusing on the proposed solutions to protect the privacy of smart homes against FATS attacks in detail. Moreover, this work clarifies shortcomings and future opportunities by analyzing the existing gaps in the reviewed methods.

With the advancement in technology, machine learning can be applied to diagnose the mass/tumor in the brain using magnetic resonance imaging (MRI). This work proposes a novel developed transfer deep-learning model for the early diagnosis of brain tumors into their subclasses, such as pituitary, meningioma, and glioma. First, various layers of isolated convolutional-neural-network (CNN) models are built from scratch to check their performances for brain MRI images. Then, the 22-layer, binary-classification (tumor or no tumor) isolated-CNN model is re-utilized to re-adjust the neurons' weights for classifying brain MRI images into tumor subclasses using the transfer-learning concept. As a result, the developed transfer-learned model has a high accuracy of 95.75% for the MRI images of the same MRI machine. Furthermore, the developed transfer-learned model has also been tested using the brain MRI images of another machine to validate its adaptability, general capability, and reliability for real-time application in the future. The results showed that the proposed model has a high accuracy of 96.89% for an unseen brain MRI dataset. Thus, the proposed deep-learning framework can help doctors and radiologists diagnose brain tumors early.

Objective: Previous studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen's test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS)., Methods: Patients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated., Results: In total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant., Discussion: A positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Objectives: To determine the ideal number of sputum acid-fast bacilli (AFB) smears and polymerase chain reaction (PCR) required for discontinuing TB isolation among patients with suspected pulmonary TB.  Methods: This was a single-center, record-based retrospective study of all admitted patients diagnosed with culture-proven pulmonary TB between 2010 and 2018. The study was conducted at Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia, a large tertiary care center consisting of 1,200 beds. Data were obtained from our TB notification records. Patients with smear-positive TB were investigated. Only the first 3 sputum smears for AFB were included in the analysis. The  PCR results for Mycobacterium tuberculosis (MTB) were also included in the study. The incremental yield of the second and third smears was assessed.  Results: Overall, 240 patients were MTB-culture positive. A total of 126 (52.5%) patients were smear and culture positive, whereas 114 were culture positive but smear negative. Of 126 patients who were AFB smear positive, 98 (77.8%) were detected in the first specimen, 13 (10.3%) in the second specimen, and only 9 (7.1%) in the third specimen. Polymerase chain reaction for MTB was positive in 122 (96.8%) smear-positive patients. Four patients did not undergo a PCR test.  Conclusion:  A single Xpert MTB/resistance to rifampicin test detected all smear-positive patients, whereas the third smear did not significantly contribute to MTB isolation.

Background: This report highlights a rare case of simultaneous bilateral blindness due to posterior ischemic optic neuropathy. Typically, ophthalmic involvement in giant cell arteritis is monocular or sequential ischemia of the anterior portion of the optic nerve, and less frequently simultaneous., Case Presentation: An 80-year-old Saudi male came with a history of simultaneous bilateral vision loss 5 days prior to presentation. The exam showed dilated non-reactive pupils, no light perception in both eyes, and normal fundus exam. C-reactive protein and erythrocyte sedimentation rate levels were high Magnetic resonance imaging and magnetic resonance angiography of the brain showed a right posterior optic nerve lesion and absence of flow in both ophthalmic arteries respectively. A left temporal artery biopsy confirmed giant cell arteritis., Conclusion: The presentation of GCA can be atypical and patients may present with simultaneous blindness. Bilateral simultaneous PION does not exclusively occur in a post surgical setting, emphasizing the importance of decreasing the threshold of suspicion of similar cases to avoid further neurological complications.

Objectives: To assess the number of Saudi patients diagnosed with narcolepsy in 2 tertiary centers before and after the introduction of the 2009 A(H1N1)pdm09 vaccine.  Methods: We started collecting data after the first international report of an association between the A(H1N1)pdm09 vaccine and narcolepsy between January 2010 and December 2016. All patients diagnosed with narcolepsy after 2009 were included and data were collected for 7 years to account for any possible delays in the diagnosis of narcolepsy.  Results: One-hundred and seventy-three patients with narcolepsy were identified. The majority (144 patients, 83%) had symptom onset before June 2009. Only 29 patients (17%) had symptom onset after 2009. No difference in the annual number of narcolepsy cases was found  before and after 2009. Conclusion: Based on data obtained from 2 tertiary care sleep disorders center, there was no increase in the number of cases of narcolepsy among Saudis following the introduction of the influenza A(H1N1)pdm09 vaccination.

Background: Nephrotoxicity is an important adverse effect of colistin methanesulfonate (CMS) therapy. No data exist on rates and risk factors for colistin-related nephrotoxicity in Saudi Arabia (SA). We conducted a prospective cohort study to identify rates and risk factors for CMS nephrotoxicity in our patient population., Methods: We prospectively included adult patients who received ≥48 hours of intravenous CMS therapy. Pregnant patients and those on renal replacement were excluded. Patients received 9 million units (mU) loading dose followed by 3 mU 8 hourly. In renal impairment, CMS dosing was adjusted according to calculated creatinine clearance (CrCl). Nephrotoxicity was defined as per RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease). Statistical analysis was performed using SPSS version 20.0 (IBM, Armonk, New York, USA). The study was approved by the institution's Research Ethics Committee., Results: A total of 67 patients were included in the study. Mean (±standard deviation) age was 57.5 (±24.0) years, Charlson Co-morbidity Score 2.88 (±2.39), CrCl 133.60 (±92.54) mL/min and serum albumin 28.65 (±4.45) g/L. Mean CMS dose was 0.11 (±0.04) mU/kg/day and mean total CMS dose received was 101.21 (±47.37) mU. Fifty-one (76.1%) patients developed RIFLE-defined nephrotoxicity. Mean total CMS dose and duration of therapy before onset of nephrotoxicity were 66.71 (±43.45) mU and 8.70 (±6.70) days, respectively. In bivariate analysis, patients with nephrotoxicity were significantly older (P 0.013) and had lower baseline serum albumin (P 0.008). Multivariate logistic regression identified serum albumin [odds ratio (OR) 0.72; 95% confidence interval (CI) 0.57-0.93; P 0.010] and intensive care admission (OR 16.38; 95% CI 1.37-195.55; P 0.027) as independent risk factors for CMS nephrotoxicity., Conclusions: High dose intravenous CMS therapy is associated with high rates of nephrotoxicity in SA. Independent risk factors for colistin nephrotoxicity were baseline hypoalbuminemia and intensive care admission.

Objectives: To report the experience with Middle East respiratory syndrome coronavirus (MERS-CoV) infection at a single center in Saudi Arabia., Methods: Cases of laboratory-confirmed MERS-CoV occurring from October 1, 2012 to May 31, 2014 were reviewed retrospectively. Information sources included medical files, infection control outbreak investigations, and the preventive medicine database of MERS-CoV-infected patients. Data were collected on clinical and epidemiological aspects and outcomes., Results: Seventy consecutive patients were included. Patients were mostly of older age (median 62 years), male (46, 65.7%), and had healthcare acquisition of infection (39, 55.7%). Fever (43, 61.4%), dyspnea (42, 60%), and cough (38, 54.3%) were the most common symptoms. The majority developed pneumonia (63, 90%) and required intensive care (49, 70%). Infection commonly occurred in clusters. Independent risk factors for severe infection requiring intensive care included concomitant infections (odds ratio (OR) 14.13, 95% confidence interval (CI) 1.58-126.09; p=0.018) and low albumin (OR 6.31, 95% CI 1.24-31.90; p=0.026). Mortality was high (42, 60%), and age ≥65 years was associated with increased mortality (OR 4.39, 95% CI 2.13-9.05; p<0.001)., Conclusions: MERS-CoV can cause severe infection requiring intensive care and has a high mortality. Concomitant infections and low albumin were found to be predictors of severe infection, while age ≥65 years was the only predictor of increased mortality., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To review the epidemiology of invasive Candida infections in a single center in Saudi Arabia over a subsequent 10-year period., Methods: This retrospective study was carried out in a single center in Saudi Arabia over a 10-year period. Records of all patients with invasive Candida infections (ICI) over the period from January 2003 to December 2012 were reviewed. Mann-Whitney U test was used for comparison of Candida albicans (C. albicans) versus non-albicans Candida species, and fluconazole resistance versus fluconazole susceptible in relation to crude mortality at 30 days and 90 days., Results: Eight hundred positive sterile site cultures, associated with 652 ICI were identified. Median age was 52 years and 53% of patients were males. Candida albicans were the most common species (38.7%), followed by Candida tropicalis (18.9%), and Candida glabrata (C. glabrata) (16.3%). The proportion of ICI caused by C. albicans remained stable over time (p=0.07), but C. glabrata increased significantly (p<0.001). The median rate of ICI per 1,000 hospital discharges per year was 1.65, with a significant trend towards higher rates over time (p=0.01). Most isolates were susceptible to fluconazole, voriconazole, and amphotericin B. Only 66.7% of Candida krusei were susceptible to caspofungin. Overall 30-day crude mortality was 40.6%. There was no significant difference in crude mortality in association with C. albicans compared with non-albicans species, nor in association with fluconazole resistance., Conclusion: The rate of ICI increased significantly in the proportion of ICI caused by C. glabrata. Most isolates remain susceptible to caspofungin, voriconazole, and amphotericin B. The crude mortality remains high.

Background: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures., Materials and Methods: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed., Results: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result., Conclusions: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.

Background: Ninety confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported to the World Health Organization. We report the details of a second family cluster of MERS-CoV infections from Riyadh, Saudi Arabia., Methods: We present the clinical, laboratory and epidemiological details of 3 patients from a family cluster of MERS-CoV infections., Results: The first patient developed respiratory symptoms and fever 14 days after admission to hospital for an unrelated reason. He died 11 days later with multi-organ failure. Two of his brothers presented later to another hospital with respiratory symptoms and fever. MERS-CoV infection in the latter 2 patients was confirmed by reverse transcriptase polymerase chain reaction testing. All 3 patients had fever, cough, shortness of breath, bilateral infiltrates on chest x-ray, thrombocytopenia, lymphopenia and rises in serum creatinine kinase and alanine transaminase. No hospital or other social contacts are known to have acquired the infection. It appears that the index patient in this cluster acquired MERS-CoV infection whilst in hospital from an unrecognized mild or asymptomatic case., Conclusion: MERS-CoV acquisition from unrecognized mild or asymptomatic cases may be a more important contributor to ongoing transmission than previously appreciated., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

We describe the third confirmed case of novel coronavirus infection in a resident of the Arabian Peninsula. Our patient presented, as did 2 prior cases, with severe pneumonia and renal dysfunction requiring intensive care support including assisted ventilation. However, unlike the earlier cases, and despite underlying chronic disease and a single kidney, he survived his infection and has been discharged home. The Ministry of Health continues active surveillance for additional cases. As this case report goes to press, 2 additional confirmed cases have been identified in Riyadh, Saudi Arabia. Contact investigations are in progress. Future work will focus not only on the origin of the virus and mechanisms of transmission, but also the host factors that influence pathogenesis and prognosis.

Background: The objective of this study was to evaluate the impact of annual review of the infection control practice in all Ministry of Health hospitals in the holy city of Makkah, Saudi Arabia, during the Hajj period of four lunar Islamic years, 1423 to 1426 corresponding to 2003 to 2006., Methods: Audit of infection control service was conducted annually over a 10-day period in six community hospitals with bed capacities ranging from 140 to 557 beds. Data were collected on standardized checklists on various infection control service items during surprise visits to the medical, pediatric, surgical, and critical care units, and the kitchens. Percentage scores were calculated for audited items. The results of the audit for hospitals were confidentially sent to them within four weeks after the end of Hajj., Results: Deficiencies observed in the first audit included lack of infection control committees, infection control units, infection control educational activities, and surveillance system and shortage of staff. These deficiencies were resolved in the subsequent audits. The average (range) scores of hospitals in 11 infection control items increased from 43% (20-67%) in the first audit to 78% (61-93%) in the fourth audit., Conclusion: Regular hospital infection control audits lead to significant improvement of infection control practice. There is a need to build a rigorous infection control audit into hospitals' ongoing monitoring and reporting to the Ministry of Health and to provide these hospitals with feed back on such audits to continuously strengthen the safety standards for patients, visitors, and employees.