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Aeshah AlAzmi,1,2 Omaima Ahmed,2 Hani Alhamdan,1 Hanan AlGarni,3 Rawan Mohammed Elzain,3 Rihad S AlThubaiti,3 Mohammed Aseeri,1 Adnan Al Shaikh4 1Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), Pharmaceutical Care Services Department, Clinical Pharmacy Section, Jeddah, Saudi Arabia; 2Princes Noorah Oncology Center (PNOC), Pediatric Oncology/Hematology/BMT Section, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia; 3Ibn Sina National College for Medical Studies, Pharmacy College, Jeddah, Saudi Arabia; 4Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City (KAMC), King Saud bin Abdulaziz University for Health Sciences, Department of Pediatrics, Chemistry Laboratory, Community Medicine, Jeddah, Saudi ArabiaCorrespondence: Aeshah AlAzmiKAMC 6255, Jeddah, 21423, Saudi ArabiaTel +966 122266666 Ext 22861Email Aeshah.alazmi@gmail.comAim: Drug-related problems (DRPs) “are the unwanted effects of drugs that potentially lead to a harmful outcome” thereby requiring considerable attention. Hospitalized pediatric patients, in particular, represent a population at risk of DRPs. The epidemiology of preventable DRPs among children in Saudi Arabia remains scarce, which thus poses distinct challenges to all healthcare professionals. We aim to characterize preventable DRPs among hospitalized children at KAMC-Jeddah.Methods: A prospective observational study of children (≤15 years) admitted to pediatric units (excluding cancer units) at KAMC-Jeddah over a 3-month period (May 29 to August 30, 2016) is carried out to determine the incidence of preventable DRPs and investigate the possible associated factors (gender, age, admission location, type of admission, and number of medications).Results: A total of 319 DRPs were identified among 235 patients, of which 280 DRPs (87.8%, 280/319) were deemed preventable. The majority of preventable DRPs were related to dose selection (78%, 219/280). None of the preventable DRPs were life threatening or fatal, and the majority were assessed as moderate in severity (94.3%, 264/280). There was no significant difference between DRP incidences with age mean 3.5 (P=0.389), gender mean (P=0.436), and weight mean 13.47 (P=0.323). Younger children (age ≤2years) admitted to PICU were more likely to have DRP (OR 4.44, 95% CI, 1.87 to 10.52, P=0.00001). Scheduled admissions were 2.89 times more likely to be exposed to DRP compared to transferred admissions (OR 2.8, 95% CI, 1.83 to 4.70, P=0.005). Additionally, DRP incidences increased proportionally to the number of medications.Conclusion: Our data suggest that establishing appropriate prevention strategies towards improvement and safety in medicine use among this vulnerable patient population is a high priority.Keywords: children, risk factors, drug-related problems, hospitalized pediatric patients

Abstract This research aimed to explore the effect of market orientation, marketing capability, and entrepreneurial orientation on business sustainability and corporate reputation in Small and Medium Enterprises (SMEs). It also aimed to test the mediating effect of business sustainability between the stated factors and corporate reputation. The required data was obtained from employees of various SMEs in the United Arab Emirates (UAE) through a survey method. Structural equation modeling (PLS-SEM) was used for data analysis in order to test the hypotheses and reach at conclusions. The analysis confirmed that entrepreneurial orientation and market orientation have significant effects on business sustainability and corporate reputation. It was also found that marketing capability plays a key role in affecting business sustainability and corporate reputation. Lastly, the results revealed that business sustainability mediates the relationship among the selected factors and corporate reputation. The findings contribute to the existing empirical research on this topic and suggest that SMEs’ management should emphasize on these factors in an attempt to ensure the sustainability of their businesses and strengthen their reputations.

Abstract Background Genetic testing for persons with a heightened likelihood of harboring a germline mutation permits early identification and appropriate management. This study aimed to identify the proportion of breast cancer (BC) patients who were offered genetic testing and the prevalence of BRCA mutations among them. Additionally, we assessed the demographic and clinical features of BC patients in the Eastern Region of Saudi Arabia. Materials and Methods Data from 2535 patients with BC were retrieved from the registry between 2017 and 2021. The data were analyzed and presented using univariate and bivariate statistics. Odds ratios and 95% confidence intervals using logistic regression analysis were computed to identify the predictors of BRCA testing. Results Patients with BC ranged in age from 18 to 103 years, and the mean age was 49.60 ± 12.14 years. BC was detected in men in 29 (1.1%) cases. Among diagnosed patients with BC, a total of 96 (3.7%) patients underwent testing for BRCA gene mutations. Of them, 36 (37.5%) patients had a BRCA gene mutation. The likelihood of undergoing BRCA testing was higher for those who were diagnosed with the condition before the age of 50, patients who were referred from private institutions, and patients with a history of previously diagnosed cancer. The likelihood of conducting BRCA testing was significantly lower among those with distant metastases. Conclusion The proportion of BRCA testing among BC patients was found to be relatively low. The development of a cost-effective, locally developed risk assessment tool that incorporates genetic counseling and testing for those with a familial predisposition to BC is imperative.

Background and Aim: Natural antioxidants are crucial for preserving and enhancing the health, survival, reproduction, and reproductive function of poultry. Phycocyanin (PC) is a natural blue food colorant with various health benefits. The aim of this study was to extract Arthrospira platensis phycocyanin (ApPC) from A. platensis using simple and economical methods and investigate the impact of phytocyanin supplementation on the performance and fatty and amino acid profiles of broiler chicks. Materials and Methods: PC was extracted from A. platensis by freezing and thawing, and optimization conditions such as pH and temperature were applied during storage periods. A total of 270 1-week-old Ross breed broiler chicks were randomly assigned to the following three treatment groups: basal diet supplemented with 0 mg of PC/kg diet (control), basal diet supplemented with 1 g PC/kg diet (T1), and basal diet supplemented with 2 g PC/kg (T2). In a completely randomized design, three cage replicates (30 birds each) were assigned to each of the three groups. The dietary effects of ApPC on growth performance (body weight gain [BWG], body weight [BW], feed intake, feed conversion ratio, serum constituents, and antioxidant indices) in broiler chickens, free amino acids, and fatty acids in muscles were evaluated. Results: Total BWG and BW increased without a significant effect on the total feed consumption. Serum levels of total proteins and albumin increased with increasing ApPC supplementation. In addition, globulin levels significantly increased. There was a significant decrease in serum total cholesterol levels among the treatments. The activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione, and total antioxidant capacity) is significantly increased. In contrast, an increase in ApPC caused a significant decrease in malondialdehyde. The content and quantity of fatty acids and amino acids in the meat of broiler chicks supplemented with PC varies. Conclusion: The addition of PC to broiler chicken diets enhances antioxidant activities, BW, BWG, and meets quality requirements.

Abstract Background Efficient resource distribution is important. Despite extensive research on response timings within ambulance services, nuances of time from unit dispatch to becoming available still need to be explored. This study aimed to identify the determinants of the duration between ambulance dispatch and readiness to respond to the next case according to the patients’ transport decisions. Methods Time from ambulance dispatch to availability (TDA) analysis according to the patients’ transport decision (Transport versus Non-Transport) was conducted using R-Studio™ for a data set of 93,712 emergency calls managed by a Middle Eastern ambulance service from January to May 2023. Log-transformed Hazard Ratios (HR) were examined across diverse parameters. A Cox regression model was utilised to determine the influence of variables on TDA. Kaplan–Meier curves discerned potential variances in the time elapsed for both cohorts based on demographics and clinical indicators. A competing risk analysis assessed the probabilities of distinct outcomes occurring. Results The median duration of elapsed TDA was 173 min for the transported patients and 73 min for those not transported. The HR unveiled Significant associations in various demographic variables. The Kaplan–Meier curves revealed variances in TDA across different nationalities and age categories. In the competing risk analysis, the ‘Not Transported’ group demonstrated a higher incidence of prolonged TDA than the ‘Transported’ group at specified time points. Conclusions Exploring TDA offers a novel perspective on ambulance services’ efficiency. Though promising, the findings necessitate further exploration across diverse settings, ensuring broader applicability. Future research should consider a comprehensive range of variables to fully harness the utility of this period as a metric for healthcare excellence.

X-linked hypophosphatemic rickets (XLH), the most prevalent form of inherited hypophosphatemic rickets, is caused by loss-of-function mutations in the gene encoding phosphate-regulating endopeptidase homolog, X-linked (PHEX). This case series presents 14 cases of XLH from Gulf Cooperation Council (GCC) countries. The patients’ medical history, biochemical and radiological investigative findings, as well as treatment responses and side effects from both conventional and burosumab therapy, are described. Cases were aged 2–40 years at diagnosis. There were two male cases and 12 female cases. All cases were treated with conventional therapy which resulted in a lack of improvement in or worsening of the clinical signs and symptoms of rickets or biochemical parameters. Side effects of conventional therapy included nausea, diarrhea, abdominal pain, nephrocalcinosis, and hyperparathyroidism, which affected the patients’ quality of life and adherence to treatment. In the 10 patients treated with burosumab, there was a marked improvement in the biochemical markers of rickets, with a mean increase in serum phosphate of +0.56 mmol/L and tubular maximum phosphate reabsorption (TmP) to glomerular filtration rate (GFR) ratio (TmP/GFR) of +0.39 mmol/L at 12 months compared to baseline. Furthermore, a mean decrease in serum alkaline phosphatase (ALP) of −80.80 IU/L and parathyroid hormone (PTH) of −63.61 pmol/L at 12 months compared to baseline was observed in these patients. Additionally, patients treated with burosumab reported reduced pain, muscle weakness, and fatigue as well as the ability to lead more physically active lives with no significant side effects of treatment.

Background: Burnout syndrome (BOS) is a syndrome characterised by high emotional exhaustion with depersonalisation and low professional accomplishment associated with the workplace. It is well known that working in the healthcare industry significantly increases stress and psychological fatigue rates. Objective: To explore the prevalence of BOS and its associated factors among healthcare professionals in Saudi Arabia. Methods: In this cross-sectional study, 385 healthcare professionals out of 809,533 were randomly surveyed. The questionnaire had three components: sociodemographic data, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool to assess BOS, and questions about personal, work-related and health status information. Results: Most of the 450 participating professionals were males and were married (66.2% and 75.8%, respectively). Precisely, 42.4% of the participants had high emotional fatigue, 42.4% experienced high depersonalisation, and 33.8% showed low personal accomplishment. Females, younger age groups, nurses, those with fewer years of experience, those with on-call duties, those with increased daily working hours, those with sleep difficulties, those who are exercising, and those experiencing high discrimination and harassment were associated with the development of burnout syndrome. Conclusion: It is essential to establish multidimensional and diversified therapies to decrease the incidence of BOS syndrome and its effect on healthcare.

In this study, using the ideas of subordination and the quantum-difference operator, we established a new subclass $ \mathcal{S} ^{\ast }\left(\delta, \sigma, q\right) $ of $ q $-starlike functions and the subclass $ \mathcal{S}_{\Sigma }^{\ast }\left(\delta, \sigma, q\right) $ of $ q $-starlike bi-univalent functions associated with the vertical strip domain. We examined sharp bounds for the first two Taylor-Maclaurin coefficients, sharp Fekete-Szegö type problems, and coefficient inequalities for the function $ h $ that belong to $ \mathcal{S}^{\ast }\left(\delta, \sigma, q\right) $, as well as sharp bounds for the inverse function $ h $ that belong to $ \mathcal{S}^{\ast }\left(\delta, \sigma, q\right) $. We also investigated some results for the class of bi-univalent functions $ \mathcal{S}_{\Sigma }^{\ast }\left(\delta, \sigma, q\right) $ and well-known corollaries were also highlighted to show connections between previous results and the findings of this paper.

Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high patient mortality. Despite recent advances in management strategies, the prognosis for poor-grade aSAH remains dismal. We present a challenging case of a patient presenting with poor-grade aSAH. A 46-year-old female presented to the emergency department after losing consciousness following a sudden headache. The examination showed a dilated left pupil and a Glasgow Coma Scale of 4. Imaging revealed a ruptured anterior communicating artery (ACoM) aneurysm, after which the patient was subsequently taken to the neuro-interventional radiology suite. We showed that carefully managing blood pressure and intracranial pressure (ICP) makes it possible to achieve a favorable outcome and reduce the risk of secondary brain injury in aSAH, regardless of patient presentation. We propose maintaining blood pressure at

Introduction: The National AIDS Program in Jordan has faced numerous challenges, including insufficient funding, limited resources, and complexities brought on by refugee influxes. The absence of a reliable HIV/AIDS surveillance system further complicates tracking and responding to the epidemic. This study aimed to evaluate the performance and functionality of the National AIDS Program and the HIV/AIDS surveillance system. Methods: A qualitative study was conducted to evaluate the National AIDS Program and the HIV/AIDS Surveillance System in Jordan. The study involved 14 key informants specialized in HIV/AIDS Surveillance Systems. Interviews were guided by an interview guide based on the Updated Centers for Disease Control and Prevention Guidelines for Evaluating Public Health Surveillance Systems. Data analysis was performed through directed content analysis. Results: The Voluntary Counseling and Testing Center in Jordan confronts multiple challenges, including poor infrastructure, limited accessibility, and inadequate facilities. Additionally, there is a lack of effective coordination between the Voluntary Counseling and Testing center and the Chest Diseases and Migrant Health Directorate, particularly regarding testing for Tuberculosis. HIV screening in Jordan is hindered by various factors, including disease sensitivity. Voluntary Counseling and Testing lacks HIV/AIDS specialists AND staff adequate training and fails to adhere to updated treatment guidelines. Persistent deficiencies in human resources, equipment, and training continue to plague the HIV/AIDS Surveillance System. Key informants expressed dissatisfaction with the data’s usefulness, citing concerns over poor data quality. The data were seldom used for prioritizing resources, identifying at-risk individuals, assessing HIV/AIDS risk factors, or evaluating prevention and control measures. Conclusion: The National AIDS Program and HIV/AIDS Surveillance System activities in Jordan are unstructured, poorly coordinated, and inefficient. Many gaps related to National AIDS Program and HIV/AIDS Surveillance System performance and data were identified. Recommendations include developing an electronic surveillance system for data collection, notification, and reporting, and building the capacities of HIV/AIDS healthcare providers in screening, diagnosis, and management.

In this article, we make use of the concepts of subordination and the q-calculus theory to analyze a new class of analytic bi-univalent functions associated to the cardioid domain. Our main focus is to derive a sharp inequality for a newly defined class of analytic and bi-univalent functions in the open unit disc U. We explore the bounds of initial coefficients, Fekete-Szegö type problems, and coefficient inequalities for newly established families. In addition, we explore some recent findings for the bi-univalent function and inverse function. Additionally, a few well-known results are mentioned to help make links between earlier and current results.

Background: Urinary incontinence (UI) significantly affects women’s quality of life globally. Mid-urethral sling (MUS) procedures are common minimally invasive surgeries for treating stress urinary incontinence (SUI) and mixed urinary incontinence (MUI), but comparative outcome studies, especially regarding complication rates, are lacking. The purpose of this study was to assess and compare the efficacy and safety of the retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) approaches in treating SUI and MUI. The study also aimed to investigate predictive factors for intraoperative and postoperative complications. Methods: A retrospective cohort study was conducted at King Saud University Medical City from February 2016 to October 2022, involving 166 women who underwent either TVT or TOT surgeries. Data were collected on intraoperative and postoperative complications, with statistical analyses performed using chi-square tests and multivariate regression to identify significant predictors of morbidity. Results: The study included 166 patients who underwent MUS procedures, with 61% (n = 102) undergoing retropubic TVT and 39% (n = 64) undergoing TOT surgeries. The demographic characteristics were similar between the groups, with no significant differences in age (p = 0.559), body mass index (BMI) (p = 0.600), or presence of cystocele (p = 0.912). The TVT group experienced a significantly higher rate of intraoperative bladder/urethral perforation compared to the TOT group (9.8% vs. 0%, p = 0.008). Early postoperative complications, including urinary retention, were comparable between the groups (TVT: 10.8%, TOT: 12.5%, p = 0.600). Patients in the TOT group had shorter hospital stays, with 71.9% discharged within one day compared to 41.2% in the TVT group (p < 0.001). At long-term follow-up (>6 months), both groups reported high satisfaction, with 93.7% of TVT and 87.3% of TOT patients reporting good or very good comfort (p = 0.252). However, pain-free status was significantly higher in the TVT group (91.1% vs. 67.2%, p < 0.001). Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. Conclusions: Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. We recommend the formation of a national registry to track long-term outcomes and enhance procedural evidence.

Abstract Background and Aim Though emergency medical services (EMS) respond to all types of emergency calls, they do not always result in the patient being transported to the hospital. This study aimed to explore the determinants influencing emergency call‐response‐based conveyance decisions in a Middle Eastern ambulance service. Methods This retrospective quantitative analysis of 93,712 emergency calls to the Hamad Medical Corporation Ambulance Service (HMCAS) between January 1 and May 31, 2023, obtained from the HMCAS electronic system, was analyzed to determine pertinent variables. Sociodemographic, emergency dispatch‐related, clinical, and miscellaneous predictors were analyzed. Descriptive, bivariate, ridge logistic regression, and combination analyses were evaluated. Results 23.95% (N = 21,194) and 76.05% (N = 67,285) resulted in patient nontransport and transportation, respectively. Sociodemographic analysis revealed that males predominantly activated EMS resources, and 60% of males (n = 12,687) were not transported, whilst 65% of females (n = 44,053) were transported. South Asians represented a significant proportion of the transported patients (36%, n = 24,007). “Home” emerged as the primary emergency location (56%, n = 37,725). Bivariate analysis revealed significant associations across several variables, though multicollinearity was identified as a challenge. Ridge regression analysis underscored the role of certain predictors, such as missing provisional diagnoses, in transportation decisions. The upset plot shows that hypertension and diabetes mellitus were the most common combinations in both groups. Conclusions This study highlights the nuanced complexities governing conveyance decisions. By unveiling patterns such as male predominance, which reflects Qatar's expatriate population, and specific temporal EMS activity peaks, this study accentuates the importance of holistic patient assessment that transcends medical histories.

Abstract Background In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. Objectives and methods This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. Results and discussion Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). Conclusions The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care. Key messages Why is this topic important? Some studies have suggested that non-transport to hospitals following emergency calls is safe. However, it is a concerning issue for health systems. It is also considered a key performance metric for health systems. What does this review attempt to show? This review aimed to map the various factors discussed in the literature regarding the decisions not to transport patients following emergency calls in a pre-hospital setting. What are the key findings? The existing theories regarding non-transport to hospitals after the provision of emergency care in the pre-hospital setting were identified. Non-transport due to non-clinical decisions jeopardizes emergency care outcomes for paediatric and elderly patients in particular. Hence, further research is required to identify and control the factors governing these decisions. How is patient care impacted? The decisions regarding patient transport following emergency calls in a pre-hospital setting are crucial for patient outcomes. They could impact the pre-hospital emergency care outcomes as well as patient safety. They can also affect the emergency services resources’ ability to respond to other critical emergencies.

Abstract Background Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. Objectives To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. Methods For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. Results Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case–control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. Conclusion Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections–though the number of patients is small–but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1).