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Salah H Elsafi,1 Saleh H Almutairi,2 Mujahid A Alsulaimani,3 Salma AlBahrani,4 Thekra N Al-Maqati,1 Wafa K Alanazi,2 Mohammed N Alanazi,2 Abdullah A Alamri,2 Majed Hamoud Alkhathami,5 Rakkad A Alshammari,5 Naif F Alharbi,5 Yaser A Al Naam1 1Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 2Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia; 3Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 4Infectious Disease Unit, Specialty Internal Medicine, King Fahhd Military Medical Complex, Dhahran Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia; 5Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia ArabiaCorrespondence: Yaser A Al Naam, Prince Sultan Military College of Health Sciences, P. O Box 33048, Dammam, 31448, Saudia Arabia, Email yaser@psmchs.edu.saBackground: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported.Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program.Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19.Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=< .001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002).Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.Keywords: antimicrobial stewardship, ASP, COVID-19, defined daily doses, DDD, antibiotic consumption, Saudi Arabia

Rawan M Maawadh,1 Thekra N Al-Maqati,1 Maryam Hamad Alenezi,2 Eman Alenezi,3 Amal Alsubaie,4 Amal Mohsen Alghamdi,5 Afrah AlSubaie,6 Mashael Mufleh Alruwaili,7 Haya Ali AlAnazi,7 Entisar Albugami,8 Naifah Ahmed Alanazi,9 Khaled Ahmed Alhmdan,10 Fahad Farhan Alshammari,11 Abeer Madkhali12 1Clinical Laboratory Science Department, Prince Sultan Military College of Health Science, Dammam, 31448, Saudi Arabia; 2Medical Admin & Excellence Allowance Committee Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 3Preventive Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 4Family Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 5Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 6Urology and Nephrology Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 7Patient Education Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 8Family Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 9Cardiac Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 10Health Informatics Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 11Laboratory Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia; 12Quality and Patient Safety Administration Department, Dammam Medical Complex, Dammam, Saudi ArabiaCorrespondence: Rawan M Maawadh, Clinical Laboratory Science Department, Prince Sultan Military College of Health Science, P.O. Box 33048, Dammam, 31448, Saudi Arabia, Email rmaawadh@psmchs.edu.saPurpose: Broad evidence points out that women workers in Saudi Arabia face a range of inequitable work practices despite continued efforts for gender equality. The study aims to assess the satisfaction of Saudi women working in the health sector among certain factors in the work environment, factors that enable them to gain opportunities and benefits and make decisions.Patients and Methods: This is a cross-sectional study, which involved the use of closed-ended surveys on 261 Saudi women working in the healthcare sector.Results: Most of the females were aged between 25 and 34 years (59%) and more than half of them worked in the governmental sector (53%). Fifty-eight percent of the females hold clinical jobs, 25% of the administrative jobs were 37% of them have more than 19 years of working experience. The finding showed a significant association between female workers in health sector satisfaction with factors related to the workplace environment, training, and development, and their involvement in decision-making.Conclusion: Most women felt empowered when they received equitable tasks and were able to reach managerial-level positions in their organizations. Establishing a positive work environment characterized by opportunities has the potential to enhance women workers’ satisfaction.Keywords: satisfaction, woman, education, training, opportunities

Background: The COVID-19 pandemic has had a significant impact globally, and understanding the relationship between inflammatory markers and disease progression is crucial for effective management. This retrospective study aimed to examine the association between various inflammatory markers, such as C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), D-dimer, ferritin, and procalcitonin (PCT), and the characteristics of disease progression and outcomes in individuals affected by COVID-19., Methods: This study collected raw data from 470 patients who tested positive for SARS-CoV-2 using RT-PCR., Results: The logistic regression analysis revealed that elevated LDH levels were associated with male gender, ICU admission, low oxygen saturation (O 2 < 93%), the need for mechanical ventilation, death, and the presence of lung infiltrates. Higher D-dimer levels were associated with older age, diabetes mellitus, cardiac disease, and low oxygen saturation. Ferritin levels were significantly associated with older age, ICU admission, low oxygen saturation, mechanical ventilation, and lung infiltrates. In contrast, CRP was only significant regarding lung infiltrates and procalcitonin levels were not significantly associated with any of the examined factors., Conclusion: This study highlights the importance of monitoring key inflammatory markers, such as LDH, D-dimer, and ferritin, as they are significantly associated with the severity of COVID-19 illness. These findings can inform clinical decision-making and guide the development of targeted interventions to improve patient outcomes.

Background and Aim: This study was conducted in the Kingdom of Saudi Arabia to investigate the effects of the COVID-19 virus and the vaccine on menstrual periods. The data from this study would increase people's awareness of the impacts of the virus and its vaccines on menstrual periods and serve as a reference for further studies., Materials and Methods: The data was collected through a web link where standardized close-ended questionnaires were distributed via several social media platforms in Saudi Arabia., Results: The study included 691 respondents, with 411 women meeting the inclusion criteria. The majority of participants fell within the age range of 35-45, and 64% held at least a bachelor's degree. The Eastern region of Saudi Arabia had the highest percentage of participants, while the Northern region had the lowest. More than half of the participants were married, and 57% reported having been infected with COVID-19. The vast majority (99%) had received the COVID-19 vaccine, primarily the Pfizer/BioNTech vaccine. The study assessed the association between menstruation experience and symptoms in three situations: before infection or vaccination, after COVID-19 infection, and after vaccination. Differences were observed in the length of the menstrual cycle and flow, but no statistically significant differences were found for pelvic and back pain., Conclusions: The result of this current study suggests that COVID-19 infection and/or vaccination has several effects on the menstrual cycle which changes in menses are minimal and transient., (© Wael Nazzal et al., 2024; Published by Mary Ann Liebert, Inc.)

Introduction: Respiratory tract infections (RTIs) stand out as the most frequent causes leading to visits to the emergency department and hospitalizations. This study aims to assess the types and prevalence of respiratory infections across two years following the end of the COVID-19 pandemic., Methods: Patients presenting with an influenza-like illness (ILI) were tested using multiplex RT-PCR (QIAstat-Dx, Qiagen). The multiplexed RT- PCR test detects 21 respiratory viruses and bacteria., Results: During the study period, PCR test was done on a total of 1,790 samples were tested, and 712 (40%) were positive for a total of 796 pathogens. The mean age (± SD) of the participants was 20.1 ± 28.4 years in 2022 and 21.9 ± 27.6 years in 2023. Among the detected pathogens, the most prevalent were Rhinovirus/Enterovirus 222 (12.4%), followed by RSV A&B (103 cases, 5.7%), and H1N1 Influenza (77 cases, 4.3%). Additionally,  Influenza A/B constituted 172 (9.6%) while parainfluenza constituted (58, 3.2%). SARS-CoV-2 was identified in 3.97% of the samples. Over the two-year period, the monthly pattern of the identified pathogens exhibited fluctuations in the prevalence. Furthermore, variations were observed in the detected pathogens across different age groups., Conclusion: In addition to adding significant knowledge to the field of respiratory viral infections, this study emphasizes the necessity of ongoing research and surveillance for the detection and characterization of respiratory viruses, particularly those with the potential for emergence. Such studies would also require setting up a strategy for genotyping and/or sequencing of viruses., (© 2024. The Author(s).)

Introduction: COVID-19 pandemic adversely affected healthcare workers (HCWs). Here, we evaluate the occurence of long-COVID-19 symtoms among HCWs., Methods: This is a questionnaire-based study of HCWs who had COVID-19 in two medical centers in Saudi Arabia and were mostly vaccinated., Results: The study included 243 HCWs with a mean age (+ SD) of 36.1 (+ 7.6) years. Of them, 223 (91.8%) had three doses of COVID-19 vaccine, 12 (4.9%) had four doses, and 5 (2.1%) had two doses. The most common symptoms at the start of the illness were cough (180, 74.1%), shortness of breath (124, 51%), muscle ache (117, 48.1%), headache (113, 46.5%), sore throat (111, 45.7%), diarrhea (109, 44.9%) and loss of taste (108, 44.4%). Symptoms lasted for< one week in 117 (48.1%),> one week and< 1 month in 89 (36.6%),> 2 months and< 3 months in 9 (3.7%), and> 3 months in 15 (6.2%). The main symptoms present> 3 months were hair loss (8, 3.3%), cough (5, 2.1%), and diarrhea (5, 2.1%). A binomial regression analysis showed no relationship between persistence of symptoms for> 3 months and other demographic or clinical symptoms characteristics., Conclusion: The study showed a low rate of the occurence of long-COVID> 3 months during the Omicron-wave among mostly vaccinated HCWs with no significant comorbidities. Furhter studies are needed to examine the effect of different vaccines on long-COVID-19 among HCWs., Competing Interests: Declaration of Competing Interest All auhtors have no conflict of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases ( p = 0.013); end-stage renal disease ( p = 0.021); and cardiovascular disease ( p = 0.003) but not diabetes mellitus ( p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots ( p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients ( p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 ( p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients.

Background and Objectives: Obesity is a major health concern worldwide. Many studies emphasize the important role of brain-derived neurotrophic factor (BDNF) in regulating appetite and body weight. We aimed to investigate the association between BDNF protein serum levels and body mass index (BMI). Materials and Methods: We conducted a cross-sectional study among 108 healthy adult participants divided into six categories depending on their body mass index (BMI). The ages of the participants ranged between 21 to 45 years. The BDNF serum level was measured using the enzyme-linked immunosorbent assay (ELISA) technique. Results: A Kruskal−Wallis test showed a significant difference in BDNF between the different BMI categories, χ2(2) = 24.201, p < 0.001. Our data also showed that BDNF levels were significantly lower in people with obesity classes II and III than those of normal weight (p < 0.05). The Spearman rank correlation test was statistically significant with negative correlations between the BMI and BDNF (r) = −0.478, (p < 0.01). Moreover, we observed a negative dose-dependent relationship pattern between BMI categories and the levels of circulating BDNF protein. Conclusions: In this study, our data support the hypothesis that low serum levels of BDNF are associated with high BMI and obesity in Saudi adults.

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Introduction: Continuous positive airway pressure (CPAP) may induce nasal inflammation because of mucosal compression or dryness. This study examined the impact of humidified versus nonhumidified CPAP on nasal inflammation and upper airway symptoms., Methods: Seventeen healthy male subjects with no previous or current history of nasal symptoms were recruited. All subjects underwent 3 hours of nonhumidified CPAP at 12.5 cmH 2 O via nasal mask. Among the 17 studied subjects, seven returned to receive a humidified CPAP at 12.5 cmH 2 O via nasal mask. The nasal wash leukocyte count was assessed at baseline and after each CPAP setting. The white blood cell (WBC) count and levels of WBCs that are mononuclear cells (including lymphocytes and monocytes) were monitored. A six-point nasal score was also assessed before and after the CPAP intervention., Results: The nasal wash WBC count (10 3 /µL) and mononuclear cell level (10 3 /µL) at baseline, on 12.5 cmH 2 O humidified CPAP, and on 12.5 cmH 2 O nonhumidified CPAP were significantly different ( p = 0.016; p = 0.003). Changes in nasopharyngeal symptoms occurred in 12 of 17 subjects (70.5%) in the nonhumidified group. Participants experienced at least one nasal symptom after application of nonhumidified CPAP at 12.5 cmH 2 O., Conclusion: The present investigation suggests that humidified CPAP was not associated with early nasal inflammation and there were fewer nasopharyngeal symptoms. Further study is required to confirm the results and evaluate the impact of adding heat to the humidified CPAP system.

Giardia lamblia and Cryptosporidium parvum are recognized as the most common protozoan infections in Saudi Arabia. Microscopic examination of stool samples, either direct or concentrated, for the recovery of G. lamblia cysts and trophozoites and C. parvum oocysts is still the most commonly used for the diagnosis of both parasites. We compared the conventional parasitological techniques of iodine-stained wet mount for G. lamblia and Kinyoun's acid-fast for C. parvum against ImmunoCard STAT® Cryptosporidium/Giardia and real-time polymerase chain reaction (PCR) detecting the 18S rRNA gene of G. lamblia and conventional PCR detecting the same gene of C. parvum at a tertiary hospital in Dhahran, Saudi Arabia. Out of 148 stool samples, 19 and 12 true positives were identified for G. lamblia and C. parvum, respectively, using a composite reference standard. In this case, true positives and negatives were considered as those with at least two positive or negative results out of the three tests. Both ImmunoCard STAT! and PCR methods were more sensitive than the microscopic tests of a single stool specimen of 85.7% (CI=62.6-96.2%) and 85.7% (CI=56.2-97.5%) for G. lamblia and C. parvum, respectively. However, specificity of microscopic tests was higher than other techniques for both parasites. Although PCR seems to be most sensitive for both G. lamblia and C. parvum, its low specificity may render its superiority over other techniques. When a single stool sample is used for detection of G. lamblia and C. parvum, better results can be obtained when coupled with serological testing. Although PCR is the most sensitive method for the detection of both G. lamblia and C. parvum, its use requires attention in relation to the increased possible false positives.