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K9CATH is the sole cathelicidin in canines (dogs) and exhibits broad antimicrobial activity against both Gram-positive and Gram-negative bacteria. K9CATH also modulates inflammatory responses and binds to LPS. These activities depend on the secondary structure and a net-positive charge of the peptide. Peptidylarginine deiminases (PAD) convert cationic peptidyl arginine to neutral citrulline. Thus, we hypothesized that citrullination is a biologically relevant modification of the peptide that would reduce the antibacterial and LPS-binding activities of K9CATH. Recombinant PAD2 and PAD4 citrullinated K9CATH to various extents and circular dichroism spectroscopy revealed that both native and citrullinated K9CATH exhibited similar α-helical secondary structures. Notably, citrullination of K9CATH reduced its bactericidal activity, abolished its ability to permeabilize the membrane of Gram-negative bacteria and reduced the hemolytic capacity. Electron microscopy showed that citrullinated K9CATH did not cause any morphological changes of Gram-negative bacteria, whereas the native peptide caused clear alterations of membrane integrity, concordant with a rapid bactericidal effect. Finally, citrullination of K9CATH impaired its capacity to inhibit LPS-mediated release of proinflammatory molecules from mouse and canine macrophages. In conclusion, citrullination attenuates the antibacterial and the LPS-binding properties of K9CATH, demonstrating the importance of a net positive charge for antibacterial lysis of bacteria and LPS-binding effects and suggests that citrullination is a means to regulate cathelicidin activities.

An elevation in serum ferritin levels through an unknown mechanism was observed in COVID-19 infected patients. This study examined the association between patients' HLA genotype and serum ferritin level modulation and also assessed the effect of serum ferritin levels on infection severity/mortality.One hundred and thirty-six COVID-19 Saudi patients were divided into two groups according to their ferritin levels: group 1 (500 ng/mL,High serum ferritin levels were associated with a significant increase in infection severity, as 75% of ICU patients showed high levels of ferritin compared to 43% of patients with moderate symptoms,High serum ferritin levels are associated with an increase in COVID-19 severity, which may be affected by HLA polymorphism.

Introduction. Globally, human bocavirus (HBoV) has been detected in respiratory samples from patients suffering from upper and lower respiratory diseases. In Kuwait, little is known about the epidemiological and clinical characterization of the virus and genetic characterization of the virus as a respiratory pathogen is unknown. Aim. This study aims to explore the molecular epidemiology and clinical features of HBoV isolates in patients with respiratory diseases. Methodology. Retrospectively, between 2018 and 2020, 5941 respiratory samples from patients with respiratory diseases were screened for respiratory viruses using multiplex real-time PCR. Samples that were positive for HBoV were then subjected to NP1 and VP1/PV2 phylogenetic analysis. Results. HBoV was detected in 1.9 % of the patients, with a peak incidence of infection among children Conclusion. This study illustrated the predominance of the HBoV-1 genotype in patients with respiratory diseases in Kuwait with minimal genetic variability. It also highlighted the clinical features of HBoV-1 infection, verifying its role in respiratory diseases.

Arginine residues of the antimicrobial peptide LL-37 can be citrullinated by peptidyl arginine deiminases, which reduce the positive charge of the peptide. Notably, citrullinated LL-37 has not yet been detected in human samples. In addition, functional and biophysical properties of citrullinated LL-37 are not fully explored. The aim of this study was to detect citrullinated LL-37 in human bronchoalveolar lavage (BAL) fluid and to determine antibacterial and biophysical properties of citrullinated LL-37. BAL fluid was obtained from healthy human volunteers after intra-bronchial exposure to lipopolysaccharide. Synthetic peptides were used for bacterial killing assays, transmission electron microscopy, isothermal titration calorimetry, mass-spectrometry and circular dichroism. Using targeted proteomics, we were able to detect both native and citrullinated LL-37 in BAL fluid. The citrullinated peptide did not kill Escherichia coli nor lysed human red blood cells. Both peptides had similar α-helical secondary structures but citrullinated LL-37 was more stable at higher temperatures, as shown by circular dichroism. In conclusion, citrullinated LL-37 is present in the human airways and citrullination impaired bacterial killing, indicating that a net positive charge is important for antibacterial and membrane lysing effects. It is possible that citrullination serves as a homeostatic regulator of AMP-function by alteration of key functions.

Objectives: To explore preferences of the patients attending King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, in their treating physicians and to determine demographic and personal factors influencing their preferences. Methods: Through a cross sectional design, 366 patients attending KAMC were systematically selected, and were requested to a pre-designed valid questionnaire. The study conducted between November 2017 and January 2018. The Statistical Package for Social Sciences was used for statistical analysis which included independent sample t-test, ANOVA and Pearson correlation. A p-value less than 0.05 was considered significant. Results: The study showed that females were significantly more preferring to get information, careful examination and receiving attention. Older respondents were interested in nding out how serious is their problem and having enough time for talking about their condition. Higher income respondents focused on necessity of physician caring for their personal situation. Highly educated individuals were concerned about getting enough information, and patients with chronic diseases were much interested by the truth of their condition. Each dimension of the personality traits was significantly correlated with different package of preferences in their treating physician. Conclusion: Respondents’ preferences in their treating physician are significantly influenced by their demographic characteristics as well as their personality traits. It is highly recommended that physicians, generally, should be attentive listener, informative while discussion, maintaining eye contact and showing interest and empathy for adult middle-aged patient. Also, to consider other preferable features based on patients’ demographics and personalities.

Background: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and use of INICC Surveillance Online System (ISOS) on ventilator-associated pneumonia (VAP) rates in Saudi Arabia from September 2013 to February 2017. Methods: A multicenter, prospective, before–after surveillance study on 14,961 patients in 37 intensive care units (ICUs) of 22 hospitals. During baseline, we performed outcome surveillance of VAP applying the definitions of the CDC/NHSN. During intervention, we implemented the IMA and the ISOS, which included: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on VAP rates and consequences and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using generalized linear mixed models to estimate the effect of intervention. Results: The baseline rate of 7.84 VAPs per 1000 mechanical-ventilator (MV)-days―with 20,927 MV-days and 164 VAPs―, was reduced to 4.74 VAPs per 1000 MV-days―with 118,929 MV-days and 771 VAPs―, accounting for a 39% rate reduction (IDR 0.61; 95% CI 0.5–0.7; P 0.001). Conclusions: Implementing the IMA was associated with significant reductions in VAP rates in ICUs of Saudi Arabia. Keywords: Hospital infection, Healthcare-acquired infection, Hospital-acquired pneumonia, Nosocomial pneumonia, Limited-resource countries, Surveillance

Regional variations are found in the incidence and severity of the COVID‐19 infection. Human leukocyte antigen (HLA) polymorphism is one of the genetic factors that might have an impact on the outcome of the disease. This study explored the association between the HLA genotype and the severity of COVID‐19 among patients from South Asia. Blood samples from 95 Asians (Bangladeshis, Indians, and Pakistanis) with COVID‐19 were collected. The patients were divided according to the severity of their infection: mild (N = 64), severe (N = 31), and fatal (N = 20). DNA was extracted from all samples, and HLA genotyping was performed for both class I (A, B, and C) and class II (DRB1, DQA1, and DQB1) using the PCR‐rSSO (polymerase chain reaction–reverse sequence‐specific oligonucleotide) molecular method. The frequency of HLA‐B*51 was significantly higher among patients in the fatal group than among those in the mild infection group (15% vs. 4.7%, p = 0.027). Additionally, the frequency of HLA‐B*35 was significantly higher in the mild infection group than in the fatal group (21.1% vs. 7.5%, p = 0.050 [a borderline p‐value]). In terms of HLA class II, DRB1*13 was significantly observed in the fatal group than in the mild infection group (17.5% vs. 11.3%, p = 0.049). However, the p‐value for all alleles became insignificant after a statistical correction for the p‐values (pc = 0.216, pc = 0.4, and pc = 0.49, respectively). Compared with all published data, this study highlights that the association between the HLA system and the COVID‐19 outcome might be ethnic‐dependent. Genetic variation between populations must be examined on a wider scale to assess infection prognosis and vaccine effectiveness., Research Highlights HLA polymorphism might play a role in COVID19 infection.HLA polymorphism might be associated with COVID19 severity among South Asians.

Mutations in isocitrate dehydrogenase 1 (IDH1) and IDH2 are oncogenic drivers to a variable extent in several tumors, including gliomas, acute myeloid leukemia (AML), cholangiocarcinoma, melanoma, and thyroid carcinoma. The pathobiological effects of these mutations vary considerably, impeding the identification of common expression profiles. We performed an expression meta-analysis between IDH-mutant (IDHmut) and IDH-wild-type (IDHwt) conditions in six human and mouse isogenic disease models. The datasets included colon cancer cells, glioma cells, heart tissue, hepatoblasts, and neural stem cells. Among differentially expressed genes (DEGs), serine protease 23 (PRSS23) was upregulated in four datasets, i.e., in human colon carcinoma cells, mouse heart tissue, mouse neural stem cells, and human glioma cells. Carbonic anhydrase 2 (CA2) and prolyl 3-hydroxylase 2 (P3H2) were upregulated in three datasets, and SOX2 overlapping transcript (SOX2-OT) was downregulated in three datasets. The most significantly overrepresented protein class was termed intercellular signal molecules. An additional DEG set contained genes that were both up- and downregulated in different datasets and included oxidases and extracellular matrix structural proteins as the most significantly overrepresented protein classes. In conclusion, this meta-analysis provides a comprehensive overview of the expression effects of IDH mutations shared between different isogenic disease models. The generated dataset includes biomarkers, e.g., PRSS23 that may gain relevance for further research or clinical applications in IDHmut tumors.

HLA polymorphism is one of the genetic factors that may be associated with variations in susceptibility to COVID-19 infection. In this study, the frequency of HLA alleles among Saudi patients infected with COVID-19 was examined. The association with infection susceptibility and mortality was evaluated. This study included 135 Saudi COVID-19-infected patients (106 recovered and 29 died) who were admitted to hospitals because of their symptoms, and 135 healthy controls. HLA class I (A, B, C) and class II (DRB1, DQB1) genotyping was performed using the molecular method (PCR-rSSO). In this study, there was a significant increase in the frequency of HLA-A*01, B*56 and C*01 among infected patients compared to the control group (12.1% vs. 5.2%, p = 0.004, 3.7% vs. 0%, p = 0.006, 4.4% vs. 1.5%, p = 0.042, respectively). Moreover, there was a significant increase in the frequency of HLA-A*03 and C*06 among fatal patients compared to infected patients (13.8% vs. 5.7%, p = 0.036, 32.8% vs. 17.5%, p = 0.011, respectively). In terms of HLA class II, HLA-DRB1*04 was significantly higher in the control group compared to infected patients (27.4% vs. 16.3%, p = 0.002), while HLA-DRB1*08 was significantly higher in the infected group compared to the control (4.8% vs. 0.7%, p = 0.004). After statistical correction of the p value, A*01, B*56, DRB1*04 and DRB1*08 remained statistically significant (pc = 0.04, pc = 0.03, pc = 0.014 and pc = 0.028). This initial data suggested that individual HLA genotypes might play a role in determining susceptibility to COVID-19 infection and infection outcome. However, examining a larger sample size from different populations is required to determine a powerful association for clinical application.

Background In the past infectious diseases affected the quality of lifestyle during home confinement. The study conducted examines the influence of home confinement during the COVID-19 pandemic outbreak on lifestyle, mental wellbeing, nutritional status, and sleeping pattern. Method An online multicategorical questionnaire was distributed to collect demographic information combined with the following tools: Food Frequency Questionnaire (FFQ), International Physical Activity Questionnaire (IPAQ), WHO-5 wellbeing score, and Pittsburgh Sleep Quality Index (PSQI). A snowball non-discriminate sampling procedure was conducted to collect data from people attending or working at higher institutions from March 1, 2020 to April 24, 2020. A total of 1723 completed responses (917 males, 37.4 ±13.4 years old and 806 females 32.2 ± 11.5 years old) were collected. Results The female participants had significantly lower mental health scores than males (53.9% vs. 46.1%). The mental wellbeing scores were higher among participants with medium and high physical activity (PA) levels (p < 0.00). Additionally, the mental wellbeing scores were significantly improved by dietary quality and it’s sleeping score (p < 0.001). However, PA was by far the major determinant of the mental health scores. Conclusion Factors such as PA, diet, and sleeping patterns were associated with mental wellbeing during the COVID-19 confinement among Arab participants.

Background Colistin is a polypeptide antibiotic drug that targets lipopolysaccharides in the outer membrane of Gram-negative bacteria. Inactivation of the mgrB-gene is a common mechanism behind colistin-resistance in Klebsiella pneumoniae (Kpn). Since colistin is a cyclic polypeptide, it may exhibit cross-resistance with the antimicrobial peptide LL-37, and with other innate effector mechanisms, but previous results are inconclusive. Objective To study potential cross-resistance between colistin and LL-37, as well as with other innate effector mechanisms, and to compare virulence of colistin-resistant and susceptible Kpn strains. Materials/methods Carbapenemase-producing Kpn from Oman (n = 17) were subjected to antimicrobial susceptibility testing and whole genome sequencing. Susceptibility to colistin and LL-37 was studied. The surface charge was determined by zeta-potential measurements and the morphology of treated bacteria was analyzed with electron microscopy. Bacterial survival was assessed in human whole blood and serum, as well as in a zebrafish infection-model. Results Genome-analysis revealed insertion-sequences in the mgrB gene, as a cause of colistin resistance in 8/17 isolates. Colistin-resistant (Col-R) isolates were found to be more resistant to LL-37 compared to colistin-susceptible (Col-S) isolates, but only at concentrations ≥50 μg/ml. There was no significant difference in surface charge between the isolates. The morphological changes were similar in both Col-R and Col-S isolates after exposure to LL-37. Finally, no survival difference between the Col-R and Col-S isolates was observed in whole blood or serum, or in zebrafish embryos. Conclusion Cross-resistance between colistin and LL-37 was observed at elevated concentrations of LL-37. However, Col-R and Col-S isolates exhibited similar survival in serum and whole blood, and in a zebrafish infection-model, suggesting that cross-resistance most likely play a limited role during physiological conditions. However, it cannot be ruled out that the observed cross-resistance could be relevant in conditions where LL-37 levels reach high concentrations, such as during infection or inflammation.

Respiratory syncytial virus (RSV) is the most frequently identified viral agent in infants, children, and elderly people with acute respiratory tract infections (ARTIs). This study is the only one of its kind in Kuwait, and its purpose was to investigate the genetic variability of the G protein gene in RSV strains prevalent in Kuwait. Respiratory samples were collected from patients with ARTIs in various hospitals in Kuwait and subjected to reverse transcription PCR (RT-PCR) amplifying a fragment of the G gene of RSV. A total of 305 samples were collected between January and mid-December 2016, and 77 (25.2%) were positive for RSV. Group A viruses were predominant over group B viruses; the RSV-A group was detected in 52 (67.5%) of the positive samples, while the RSV-B group was detected in 25 (32.5%) of the positive samples. Phylogenetic analysis showed that all RSV-A strains grouped into eight clusters of identical sequences of untyped strains. Twelve RSV-B strains, on the other hand, belonged to the RSV-B/BA10 genotype, while the rest were untyped. These data suggest that new and untyped strains of RSV-A group likely predominated in Kuwait and that the BA10 genotype of the RSV-B group became the dominant genotype in the 2016 season.

Human adenovirus (HAdV) infection can result in a severe respiratory disease. The aim of this study was to identify HAdV types detected in patients hospitalized for severe respiratory illness. The study population consisted of 743 patients with severe respiratory disease admitted to four major hospitals in Kuwait between January 2013 and December 2016. Respiratory specimens were retrospectively screened for 20 respiratory viruses by real-time PCR. The HAdV hexon gene was amplified and directly sequenced, and HAdV types were identified by performing Bayesian phylogenetic analysis. HAdV DNA was detected in 27 (3.6%) patients, with peaks in November and March. Most patients were infants and young children suffering from pneumonia or acute bronchiolitis. The detected HAdV types were C1, C2, C5, B3, and B7. Clusters of HAdV C1, C2, and C5 were observed with high posterior probability. All patients infected with HAdV C5 and 50% of patients infected with HAdV C2 or B7 were admitted to the intensive care unit (ICU). Co-infection with other viruses was detected in 44.4% of patients. The most common co-infecting virus was rhinovirus (HRV). HAdV/HRV co-infection was detected in two children who presumably developed disseminated HAdV infection and died. This is the first report describing the circulation of HAdV types associated with severe outcomes in Kuwait. These findings highlight the need for a national surveillance system to monitor changes in predominant HAdV types and increased numbers of severe respiratory infections.

Introduction and importance Heterotopic mesenteric ossification is a benign bony tissue growth in the mesentery that mostly follows repetitive or severe abdominal injuries leading to reactive bone formation in the mesentery. There are only 73 cases (51 publications) identified in the literature up to the beginning of 2020. Case presentation 45-year-old Saudi male underwent multiple laparotomies to manage complicated appendicitis which ended with a diverting ileostomy and a colostomy as a mucus fistula. After 9 months, the patient was admitted to the General Surgery department in Al-Hada Armed Forces Hospital for an open ileostomy and colostomy reversal surgery where several irregular bone-like tissues of hard consistency and sharp edges with some spindle-shaped structures resembling needles were found in the mesentery of the small intestine and histopathology revealed of trabecular bone fragments confirming the diagnosis. Clinical discussion The majority of cases occur mid to late adulthood with a predilection in the male gender, and usually present with bowel obstruction or an enterocutaneous fistula. Although it has no malignant potential, it may cause severe bowel obstruction that can lead to mortality, it's a rare occurrence and, therefore, is difficult to diagnose among many common abdominal disturbances. Conclusion Here we report a rare case of heterotopic mesenteric ossification, which should be considered as one of the delayed complications of abdominal surgery or trauma. The time range of expecting the presentation of heterotopic mesenteric ossification following major abdominal trauma or surgery should be extended and continuously considered during differential diagnosis., Highlights • One of the delayed complications of abdominal surgery or trauma is Heterotopic mesenteric ossification. • Since 1983 there are only 73 cases of Heterotopic mesenteric ossification published to date. • Preoperative diagnosis of Heterotopic mesenteric ossification should be based mainly on the characteristic radiographic findings without relying on the levels of calcium or alkaline phosphatase. • The only way to reach the definitive diagnosis is through excision and histopathological analysis. • Heterotopic mesenteric ossification has no malignant potential, but it can cause severe bowel obstruction that can lead to mortality in already sick patients.

Brain magnetic resonance imaging (MRI) features of chronic hepatic encephalopathy in liver cirrhosis include diffuse cerebral atrophy symmetric high signals in the basal ganglia namely the globus pallidus bilaterally on T1 weighted images, with no corresponding high signals on the T2 weighted images

Introduction: Refractory epilepsy which is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom is common in patients with structural brain lesions including acquired disorders and genetic abnormalities. High resolution Magnetic Resonance Imaging MRI of the brain has proven its precision as a diagnostic tool for recognition of different structural lesions underlying medically intractable seizures. Objective: To recognize common MRI lesions in a series of adult patients with refractory epilepsy admitted to the epilepsy monitoring unit at Prince Sultan Military Medical City PSMMC for pre surgical evaluation for epilepsy surgery with correlation to surgical outcome and to compare our local data with the international literature. Material and methods: 245 patients (100 Males and 145 Females; 14-53 years) with refractory epilepsy were included in this retrospective analysis. They presented with partial with or without complex partial seizures 112 (46.0%), partial with secondary generalized tonic clonic seizures 76 (31.0%) or generalized seizures in 57 (23.0%) of patients. Clinical diagnosis of epilepsy and seizure classification were based on the revised criteria of the International League Against Epilepsy ILAE. Structural neuroimaging MRI brain, functional neuroimaging which include Interictal Fluorodeoxyglucose Positron Emission Computed Tomography FDG-PET, Ictal Technetium-99m hexamethyl-propylene amine oxime Single Photon Emission Computed Tomography 99 m HMPAO SPECT, Electroencephalography EEG recording, epilepsy history and neurological examination were performed. MRI brain imaging epilepsy protocol used a 1.5 or 3 Tesla MRI scanner. All patients included in this study received appropriate epilepsy surgery and post-operative seizure control was followed in the epilepsy clinic with six-month post-operative inter ictal EEG, follow up MRI brain after epilepsy surgery were performed in all patients and 50 patients had additional video-EEG recording postoperative during the follow up period. Epilepsy surgery seizure control outcome was classified according to Engel Classification system. All patients were followed for at least two years post-operatively to assess seizure control. Pre-operative MRI diagnosis was correlated with the epilepsy surgery seizure control outcome. Results: MRI detected different structural brain abnormalities in 245 (100%) patients, including temporal lobe location in 142 (58%) patients, frontal lobe location in 74 (30%) patients and parieto-occipital lobes location in 29 (12%) patients. On MRI hippocampal sclerosis HS is diagnosed in 86 (35%) patients, cerebral tumors in 74 (30%) patients and among the cerebral tumors MRI suggested the diagnosis of developmental tumors that is; glio-neural tumors in 45 out of 74 (61%) of tumor patients, malformations of cortical development MCD in 42 (17%) patients, vascular malformations in 15 (6%) patients, dual pathologies in 12 (5%) patients and remote gliotic lesions in 16 (7%) patients. The histopathological diagnosis confirmed the MRI brain diagnosis in all included patients. At 2 years of post-operative follow-up 196 (80%) patients were classified as Engel Class I, 37 (15%) patients Engel Class II, 6 (3%) patients Engel Class III and 6 (3%) patients as Class IV seizure freedom. In the class IV group two patients failed epilepsy surgery because they had high grade astrocytoma with postoperative tumor recurrence and four patients failed epilepsy surgery due to incomplete resection of epileptogenic lesions. Patients with MRI diagnosis of HS 82 out of 86 (95%) patients, low grade tumor 59 out of 74 (80%) patients and vascular malformation 12 out of 15 (80%) had best epilepsy surgery outcome. Patients with high grade tumors 2 out 3 (67%) patients and incomplete surgical resection of epileptogenic lesions 4 out of 5 (80%) patients had the worst epilepsy surgery outcome. Conclusion: This study revealed that MRI brain structural lesions were commonly associated with refractory epilepsy. Temporal lobe structural brain lesions were most common lesions in adult epilepsy patients with refractory epilepsy referred for epilepsy surgery. The presence of HS, low grade tumors and vascular malformations correlated with best surgical outcome while high grade tumors and incomplete surgical resection of the lesions correlated with worst surgical outcome. Our results were consistent with the international reported literature.

Traditional methods of treating obesity have shown only limited efficacy. Intragastric balloon (BIB) is considered a new potential alternative method in the management of obesity. There is limited information in the literature about the outcome of BIB in the region of the Arabian Gulf. This study examined the efficacy and satisfaction of BIB in obese patients in Al-Amiri Hospital in Kuwait. A retrospective review of BIB in patients from October 2009 through December 2012 at Al-Amiri Hospital, Kuwait, included 179 patients. Weight loss, complications, satisfaction level, and weight gain after removal of the balloon were assessed. The weight loss was analyzed further according to different demographic groups. A total of 179 patients were included in the study. Their data were collected, and the pre-insertion and post-removal body mass index (BMI) was calculated. Before insertion of the BIB, there was a mean weight of 99.7 kg (SD 26.7); after removal, they showed a mean weight of 88.9 kg (SD 25). There was a mean weight loss of 10.9 kg (SD 8). The patients experienced a median excess weight loss of 38.5 %. There was no significant variation in the weight loss according to age, gender, and nationality. There was a satisfaction level of 44 % among the patients. Weight gain after removal was experienced by 34.7 % of patients. BIB seems to be an effective method of significant weight reduction with little complications, making it a good alternative in the management of obesity in females with lower BMI.

Campylobacter jejuni is a leading cause of foodborne bacterial gastroenteritis in human. Chickens are the reservoir host of C. jejuni, and contaminated chicken meat is an important source of human infection. Therefore, control of C. jejuni in chickens can have direct effect on human health. In this study we tested the passive immunotherapeutic efficacy of the chicken egg-yolk-derived antibodies, in the form of hyperimmunized egg yolk powder (HEYP), against 7 colonization-associated proteins of C. jejuni, namely, CadF (Campylobacter adhesion to fibronectin), FlaA (flagellar proteins), MOMP (major outer membrane protein), FlpA (fibronectin binding protein A), CmeC (Campylobacter multidrug efflux C), Peb1A (Campylobacter putative adhesion), and JlpA (Jejuni lipoprotein A). Three chicken experiments were performed. In each experiment, chickens were treated orally via feed supplemented with 10% (wt/wt) egg yolk powder. In experiment 1, chicken groups were experimentally infected with C. jejuni (10(8) cfu) followed by treatment with 5 HEYP (CadF, FlaA, MOMP, FlpA, CmeC) for 4 d either individually or as a cocktail containing equal parts of each HEYP. In experiment 2, chickens were treated for 21 d with cocktail containing equal parts of 7 HEYP before and after experimental infection with C. jejuni (10(8) cfu). In experiment 3, chickens were treated with feed containing a cocktail of 7 HEYP before and after (prophylaxis), and after (treatment) experimental infection with C. jejuni (10(5) cfu). Intestinal colonization of C. jejuni was monitored by culturing cecal samples from chickens euthanized at the end of each experiment. The results showed that there were no differences in the cecal colonization of C. jejuni between HEYP treated and nontreated control chickens, suggesting that use of HEYP at the dose and the regimens used in the current study is not efficacious in reducing C. jejuni colonization in chickens.

Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in five intensive care units (ICUs) from October 2013 to September 2015. Design: Prospective, before-after surveillance study of 3769 patients hospitalised in four adult ICUs and one paediatric ICU in five hospitals in five cities. During baseline, we performed outcome and process surveillance of CLABSI applying CDC/NHSN definitions. During intervention, we implemented IMA and ISOS, which included: (1) a bundle of infection prevention practice interventions; (2) education; (3) outcome surveillance; (4) process surveillance; (5) feedback on CLABSI rates and consequences; and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed. Results: During baseline, 4468 central line (CL) days and 31 CLABSIs were recorded, accounting for 6.9 CLABSIs per 1000 CL-days. During intervention, 12,027 CL-days and 37 CLABSIs were recorded, accounting for 3.1 CLABSIs per 1000 CL-days. The CLABSI rate was reduced by 56% (incidence-density rate, 0.44; 95% confidence interval, 0.28–0.72; P = 0.001). Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in the ICUs of Saudi Arabia.

Campylobacter jejuni is one of the most important causes of foodborne gastroenteritis. Chickens are considered a reservoir host of C. jejuni, and epidemiological studies have shown that contaminated chicken meat is a primary source of human infection. The objective of this study was to produce chicken egg-yolk-derived antibody (IgY) against the five C. jejuni colonization-associated proteins or CAPs (CadF, FlaA, MOMP, FlpA, and CmeC). Recombinant C. jejuni CAPs were expressed in Escherichia coli and were purified by affinity chromatography. Specific-pathogen-free laying hens were hyperimmunized with each recombinant CAP to induce production of α-CAP-specific IgY. Egg yolks were collected from immunized and nonimmunized hens and were lyophilized to obtain egg-yolk powder (EYP) with or without α-C. jejuni CAP-specific IgY. IgY was purified from EYP, and the antibody response in serum and egg yolk was tested by indirect enzyme-linked immunosorbent assay. The α-C. jejuni CAP-specific IgY levels were significantly (p0.05) higher in both serum and EYP obtained from immunized hens as compared with the nonimmunized hens. Each α-C. jejuni CAP-specific IgY reacted with the C. jejuni cells and recombinant CAPs as detected by immunofluorescence microscopy and Western blot assays, respectively. We also show that α-CadF, α-MOMP, and α-CmeC IgY significantly reduced adherence of C. jejuni to the chicken hepatocellular carcinoma (LMH) cells, suggesting that these α-C. jejuni CAP-specific IgY may be useful as a passive immunotherapeutic to reduce C. jejuni colonization in chickens.

Acute necrotizing encephalopathy is a rare, clinically distinct entity of acute encephalopathy triggered by acute febrile diseases, mostly viral infections. It is postulated to arise from uncontrolled cytokine release during a febrile illness, and is most often seen in East Asia. We describe a rare Saudi patient of acute necrotizing encephalopathy attributable to enterovirus in a 4 years and 6 months old girl. A work-up revealed elevations in serum and cerebrospinal fluid interleukin-6 and tumor necrosis factor-α. The outcome on intravenous pulse methylprednisolone was good. This case is the first, to the best of our knowledge, of acute necrotizing encephalopathy reported from Saudi Arabia with a good outcome despite severe magnetic resonance imaging findings and delay in the steroid treatment.

Objective: To investigate the clinical, genetic, and neuroradiologic data of biotin-responsive basal ganglia disease (BBGD) and clarify the disease spectrum. Methods: We first investigated all patients attending our Division of Pediatric Neurology with a genetically proven diagnosis of BBGD between 2009 and 2011. All patients underwent a detailed medical history and clinical examination, extensive laboratory investigations including genetic tests, and brain MRI. Finally, we conducted a systematic review of the literature. Results: We enrolled 10 patients meeting the diagnostic criteria for BBGD, and analyzed the data on 14 patients from 4 previous reports. The BBGD occurred predominantly in preschool/school-aged patients in the Saudi population, but it was also observed in other ethnic groups. The typical clinical picture consisted of recurrent subacute encephalopathy leading to coma, seizures, and extrapyramidal manifestations. The brain MRI typically showed symmetric and bilateral lesions in the caudate nucleus and putamen, infra- and supratentorial brain cortex, and in the brainstem. Vasogenic edema characterized the acute crises as demonstrated by diffusion-weighted imaging/apparent diffusion coefficient MRI. Atrophy and gliosis in the affected regions were observed in patients with chronic disease. Early treatment with a combination of biotin and thiamine resulted in clinical and neuroradiologic improvement. Death and neurologic sequelae including dystonia, mental retardation, and epilepsy were observed in those who were not treated or were treated late. Conclusion: BBGD is an underdiagnosed pan-ethnic treatable condition. Clinicians caring for patients with unexplained encephalopathy and neuroimaging showing vasogenic edema in the bilateral putamen and caudate nuclei, infra- and supratentorial cortex, and brainstem should consider this disorder early in the hospital course because a therapeutic trial with biotin and thiamine can be lifesaving.

Meningiomas are the most common primary brain tumors bearing in a minority of cases an aggressive phenotype. Although meningiomas are stratified according to their histology and clinical behavior, the underlying molecular genetics predicting aggressiveness are not thoroughly understood. We performed whole transcript expression profiling in 10 grade I and four grade II meningiomas, three of which invaded the brain. Microarray expression analysis identified deleted in colorectal cancer (DCC) as a differentially expressed gene (DEG) enabling us to cluster meningiomas into DCC low expression (3 grade I and 3 grade II tumors), DCC medium expression (2 grade I and 1 grade II tumors), and DCC high expression (5 grade I tumors) groups. Comparison between the DCC low expression and DCC high expression groups resulted in 416 DEGs (p-value < 0.05; fold change > 2). The most significantly downregulated genes in the DCC low expression group comprised DCC, phosphodiesterase 1C (PDE1C), calmodulin-dependent 70kDa olfactomedin 2 (OLFM2), glutathione S-transferase mu 5 (GSTM5), phosphotyrosine interaction domain containing 1 (PID1), sema domain, transmembrane domain (TM) and cytoplasmic domain, (semaphorin) 6D (SEMA6D), and indolethylamine N-methyltransferase (INMT). The most significantly upregulated genes comprised chromosome 5 open reading frame 63 (C5orf63), homeodomain interacting protein kinase 2 (HIPK2), and basic helix-loop-helix family, member e40 (BHLHE40). Biofunctional analysis identified as predicted top upstream regulators beta-estradiol, TGFB1, Tgf beta complex, LY294002, and dexamethasone and as predicted top regulator effectors NFkB, PIK3R1, and CREBBP. The microarray expression data served also for a comparison between meningiomas from female and male patients and for a comparison between brain invasive and non-invasive meningiomas resulting in a number of significant DEGs and related biofunctions. In conclusion, based on its expression levels, DCC may constitute a valid biomarker to identify those benign meningiomas at risk for progression.

Objective: To identify the risk factors and study the incidence, indications and complications of emergency peripartum hysterectomy (EPH). Materials and Methods: This was a retrospective case-control study. The cases consisted of all women who underwent EPH between January 1983 and January 2011. Two controls per case were randomly selected from the remaining deliveries by using a random number table. Case records were retrieved from the medical records. Results: Among 150,993 deliveries, there were 59 EPHs (cases), giving a rate of 0.390 per 1,000. Of the 59 cases, only 56 were analysed because 3 files were unavailable. These women were older (mean age 36 ± 5.7 vs. 22 ± 5.3 years, p < 0.01) and had delivered more than 1 child (p = 0.02). Thirty-seven (66%) cases had had previous caesarean sections (CSs) and the number of CSs in this group was greater than in the controls (21%, p < 0.01). More index cases had a history of atonic postpartum haemorrhage (46 vs. 4%, p < 0.001) and placenta praevia (34 vs. 4%, p < 0.01). More cases than controls were delivered by CS (73 vs. 29%; p = 0.003). The leading indications for EPH were haemorrhage due to uterine atony and placenta praevia. Independent risk factors were older age, multiparity, history of one or more CSs and placenta praevia. There were 2 maternal deaths from coagulopathy following massive obstetric haemorrhage. The main complications of EPH were febrile morbidity: 12 (21%), wound infection: 8 (14%) and bladder or ureteric injury: 8 (14%). Conclusions: CSs, especially repeat CSs in women with placenta praevia and persistent uterine atony, significantly increased the risks of peripartum hysterectomy.

A rare sex chromosome aneuploidy syndrome, 49,XXXXY syndrome is characterized by mental retardation with severe learning difficulties, craniofacial and skeletal abnormalities, hypogonadism, and congenital heart disease. The authors describe a 30-month-old boy with 49,XXXXY syndrome, global developmental delay and white matter changes in the brain magnetic resonance imaging. They reviewed the literature to delineate a specific magnetic resonance imaging pattern of 49,XXXXY syndrome.

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Objective. To investigate the awareness of children of dementia patients with regard to financial management options available to their parents. Method. Questionaire survey of the children of 74 consecutive patients referred with dementia and living on their own. Setting. Catchment area of a district general hospital with a population of 38 000 people over the age of 65. Results. The children of patients with dementia are generally poorly informed as to the legal status of their parents' financial position although all feel they require assistance and most would welcome the help of interested professionals. Conclusion. Much needs to and can be done to raise people's awareness of this problem. Means by which this may be accomplished are suggested. © 1998 John Wiley & Sons, Ltd.

Objectives: Breast cancer is the leading cause of death among Saudi females. Knowledge and awareness regarding breast cancer would improve patients' quality of life through early detection of the disease. This study aimed to measure female university students' knowledge and practice regarding breast cancer. Subjects and Methods: A cross-sectional research design was adopted in this study. A prevalidated questionnaire was developed and distributed to 900 female students using nonprobability convenience sampling technique. A total of 826 valid questionnaires were successfully obtained. Female students were met in the public areas of the females' campus. All data were analyzed using SPSS version 22 at alpha value of 0.05. Results: Majority of respondents showed low level of knowledge regarding breast cancer. The Internet was the main source of knowledge 53.5%. Moderate knowledge regarding breast cancer symptoms were observed by more than 50% of respondents. Knowledge regarding risk factors was low by majority of respondents >50%. In addition, only 28% of respondents practice breast self-examination (BSE), whereas main barrier for not practicing BSE was the lack of knowledge on how to perform BSE 57.5%. Conclusion: Students' knowledge and practice toward breast cancer was inadequate. There is a need for national campaigns for the public and university female students to improve their knowledge regarding breast cancer and encourage them for practicing BSE.

This study evaluates the outcome of unruptured ectopic pregnancies treated with single-dose intramuscular methotrexate injection. There were 77 women with unruptured non-laparoscopically diagnosed ectopic pregnancies who were prospectively followed after receiving a single dose of 50 mg/m2 intramuscular methotrexate. Diagnosis required transvaginal ultrasound and serial quantification of beta subunit of human chorionic gonadotropin (betahCG). A repeat dose was given if the weekly drop of betahCG was less than 30%. Therapy was considered successful if complete resolution of betahCG to a level below 25 IU/L was achieved without surgical intervention. Treatment in 73 (95%) cases was successful. The mean pre-treatment level of betahCG was 2592 +/- 3771 IU/L (177-15000 IU/L), the mean diameter of ectopic mass was 2.4 +/- 1.0 cm (1.7-3.5 cm). The average resolution period was 3.2 +/- 1.0 weeks (1-6 weeks) and this significantly correlated with the pre-treatment betahCG level. With strict criteria of inclusion and follow-up, single-dose intramuscular methotrexate is a successful method for the treatment of selected cases of ectopic pregnancy.

This study aims at (1) Assessing trends in maternal mortality in kuwait (2) Define strategies for prevention.Retrospective analysis of maternal deaths that occurred among, 55,979 live births at a tertiary hospital, between 1980 and 2009.There were 14 maternal deaths, and 55,979 live births, giving a maternal mortality rate of 25 per 100,000 live birth. In terms of decades maternal mortality declined from 54.8 in 1980-90 to 28.4 in 1990-2000 and continued to decline to 12.2 in 2000-2009. Thromboembolism (28.6%), Obstetric haemorrhage (21.5%) and Eclampsia (14.3%) were the leading causes of direct deaths. Cardiac disease is the most common cause of indirect deaths (14.3%) followed by H1N1 pneumonia 7.1%. Eclampsia contributed to 40% of deaths, only in the 1980s. Thromboembolism caused 28.6% of deaths, 50% of which were in the last 9 years. Indirect deaths from cardiomyopathies (66.7%) gained prominence in the 1990s. No deaths from puerperal sepsis were reported after the 1980s (14.3%).Maternal mortality rates are decreasing significantly (p0.01) at our institution over the last 29 years. Obstetric haemorrhage and thromboembolism remain important causes of maternal mortality. Substandard care was identified in 70% of Direct and 55% of indirect deaths.

KOC is having Booster stations facilities to compress the gas from LP and HP pressures to Very High Pressure and transport to KNPC plant for heavier extraction. BS-140 and BS-150 facilities are designed to dehydrate wet gas to 20.90 Lb. /MMSCF and 21.90 Lb. /MMSCF as part of COSTAIN improvements in 1999. BS-140 & 150 facilities are struggling with high glycol consumption and leading to higher operating costs for KOC. In order to provide solutions for the long standing issues like higher Glycol consumption and causing indirect impact on Operating cost of the Process facilities, Six Sigma approach selected for optimizing the Gas Dehydration unit performance in BS-140 facilities. Team conducted detailed analysis and various process reviews carried out and BS-140 TR-II selected as role model for implementing the operational parameters modifications and monitored the summer period Glycol consumption. Team selected Six Sigma process plan to achieve good results. As part of Six Sigma approach, MAIC (Measure, Analyze, Improve and control) action plan implemented to meet the objectives. After the improvements resulted 33% glycol consumption reduction (Revenue of US$ 565,049 Approx.)In normal operating scenarios without any business process operations interruption by implementing minor operational improvements.

Objective and Importance: To describe Leigh’s disease in 3 sibs of a Kuwaiti family. Case Presentation: Two brothers presented in early infancy with progressive neurological symptoms of hypotonia, delayed milestones and brisk reflexes. Investigations revealed metabolic acidosis, high serum and cerebrospinal fluid lactate. Magnetic resonance imaging (MRI) showed characteristic changes of Leigh’s disease. The 3rd brother, who was asymptomatic initially, was investigated because of his family history and was found to have similar changes. Intervention: All children developed progressive neurological deterioration and persistent metabolic lactic acidosis, which was treated with sodium bicarbonate, and the 1st patient needed renal dialysis to control the acidosis. The 2nd child was placed on vitamins and carnitine. Conclusion: The neurological deterioration was progressive in all 3 sibs, and they eventually died of respiratory failure despite ventilatory support. Since MRI changes are characteristic, MRI should be done to confirm the diagnosis.

The co-occurrence of Diogenes and Capgras syndromes, both unusual in themselves, would be expected to be rare. A MEDLINE search using the terms Diogenes, Capgras, self-neglect and domestic squalor revealed no previous reports of this combination of disorders. Both conditions are somewhat dubiously named as &#164 syndromes' when in fact they are probably no more than symptoms with different causes. Of particular interest in this case is the exacerbation of the self-neglect, characteristic of the Diogenes syndrome, by the delusional misidentification which marks the Capgras syndrome; as well as the reinforcement of the previously recognised association with frontal lobe pathology. The role of medication, though limited, is described. ( Int J Psych Clin Pract 2001; 5:75-76)

In [Palaniyappan et al’s (2009)][1] useful article, the side-effects of combination treatments neatly follow the description of each combination, but none mentions bleeding. Abnormal bleeding with selective serotonin reuptake inhibitors (SSRIs) has been studied and reviewed. One of the authors (

Bilateral coexistence of keratoconus and macular corneal dystrophy is a very rare clinical entity. Further elaboration on the possible genetic, histopathologic, pathophysiologic and biochemical correlation is required to study the nature of the condition. The authors hereby report a 21-year-old female who presented with the typical signs and topographic evidence of keratoconus in association with macular corneal dystrophy. Histopathologic evaluation from the excised corneal button after corneal transplant confirmed the diagnosis. To our knowledge, there is only one previous report in the literature linking the association of keratoconus and macular corneal dystrophy in the same eye bilaterally.

With Kingdon’s view,[1][1] which seems to say that because we haven’t found it we should not bother looking, all scientific endeavour would come to a halt. To propose that genetic research has not contributed to our ability to offer counselling is to ignore the extremely high heritabilty of

Haasen et al ([2007][1]) report highly significant findings from their trial of heroin plus methadone maintenance. A small problem is that the heroin plus methadone group were, to a large extent, self-selected, with only 2.3% failing to initiate treatment in this group v. 28.8% in the methadone only

Sir: Is it not heartening to see that well-known telepathic psychiatrist Jack Straw doing his bit for the College anti-stigmatisation campaign. So, Osama bin Laden is now officially, as far as the Foreign Office is concerned, ‘ psychotic’. Well that's all right then, we don't need bombs, just