Search

Enas M Al-Khlifeh,1 Ibrahim S Alkhazi,2 Majed Abdullah Alrowaily,3 Mansoor Alghamdi,4 Malek Alrashidi,4 Ahmad S Tarawneh,5 Ibraheem M Alkhawaldeh,6 Ahmad B Hassanat5 1Department of Medical Laboratory Science, Al-Balqa Applied University, Al-salt, 19117, Jordan; 2College of Computers & Information Technology, University of Tabuk, Tabuk, 47512, Saudi Arabia; 3Department of Computer Science, College of Computer and Information Sciences, Jouf University, Sakaka, 72341, Saudi Arabia; 4Computer Science Department, Applied College, University of Tabuk, Tabuk, 71491, Saudi Arabia; 5Faculty of Information Technology, Mutah University, Al-Karak, Jordan; 6Faculty of Medicine, Mutah University, Al-Karak, JordanCorrespondence: Enas M Al-Khlifeh, Parasitology laboratory, Department of Medical Laboratory Science, Faculty of Science, Al-Balqa Applied University, Al-Salt (19117), Jordan, Tel +962795856110, Email Al-khlifeh.en@bau.edu.joBackground: The incidence of microorganisms with extended-spectrum beta-lactamase (ESBL) is on the rise, posing a significant public health concern. The current application of machine learning (ML) focuses on predicting bacterial resistance to optimize antibiotic therapy. This study employs ML to forecast the occurrence of bacteria that generate ESBL and demonstrate resistance to multiple antibiotics (MDR).Methods: Six popular ML algorithms were initially trained on antibiotic resistance test patient reports (n = 489) collected from Al-Hussein/Salt Hospital in Jordan. Trained outcome models predict ESBL and multidrug resistance profiles based on microbiological and patients’ clinical data. The results were utilized to select the optimal ML method to predict ESBL’s most associated features.Results: Escherichia coli (E. coli, 82%) was the most commonly identified microbe generating ESBL, displaying multidrug resistance. Urinary tract infections (UTIs) constituted the most frequently observed clinical diagnosis (68.7%). Classification and Regression Trees (CART) and Random Forest (RF) classifiers emerged as the most effective algorithms. The relevant features associated with the emergence of ESBL include age and different classes of antibiotics, including cefuroxime, ceftazidime, cefepime, trimethoprim/ sulfamethoxazole, ciprofloxacin, and gentamicin. Fosfomycin nitrofurantoin, piperacillin/tazobactam, along with amikacin, meropenem, and imipenem, had a pronounced inverse relationship with the ESBL class.Conclusion: CART and RF-based ML algorithms can be employed to predict the most important features of ESBL. The significance of monitoring trends in ESBL infections is emphasized to facilitate the administration of appropriate antibiotic therapy. Keywords: ESBL, machine learning, multidrug-resistant bacteria, E. coli, cefuroxime, CART and RF

Background/Aim : Since selective screening for Hepatitis B virus (HBV) in pregnant women has failed to identify a high proportion of HBV-infected mothers, pre-natal HBsAg testing of all pregnant women is now recommended. We aimed to determine the prevalence of HBV infection among pregnant women at the ante-natal clinic of a tertiary care center in Saudi Arabia and to identify the target group for postpartum immunization. Materials and Methods : A total of 755 pregnant females who attended the antenatal clinic from June 2005 to June 2006 for the first time - before 38 weeks of gestation - constituted the target of the present study. Blood samples 30-39 were drawn from all subjects and sera were tested for HBV serologic markers including Hepatitis B surface antigen, anti-HBs, and anti-HBc using ELISA technique (third generation). Results : The overall prevalence of sero-positive HBsAg among pregnant women was 1.6%. As age increased, the prevalence of sero-positive HBsAg significantly increased (χ2 = 116.43, P < 0.001), 30-39 were women aged ≥40 were five times more likely to be positive for HBsAg as compared to those < 30 years (OR = 4.78). On the other hand, women aged 40 and over were five times more likely to be susceptible to infection with hepatitis as compared to young women aged < 20 (OR = 5.15). Women susceptible to HBV infection constituted about 80% of all pregnant females. Conclusion : These findings reflect that the full impact of the Hepatitis B vaccination program that was conducted in 1989 for all Saudi children has not yet reached all pregnant women, with the majority (79.9%) being nonimmune and thus liable to HBV infection. Postpartum HB immunization should be recommended in such cases.

Introduction Hospital-acquired infections, also called nosocomial infections, are infectious diseases acquired in healthcare facilities at least 48 hours after admission and can't be present at the time of admission. Nosocomial bloodstream infection is a serious medical complication from hospitalization, and it can be potentially preventable by taking certain precautions. Aim The aim of this study is to determine the prevalence of central line-related bloodstream infections (CLABSI) with different organisms between January 2022 and February 2024 at the intensive care unit (ICU) at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Patients and methods This retrospective cross-sectional study was conducted among ICU adult patients. The data were collected from medical and infection control records. All data for intensive care patients with positive blood cultures, except for the pediatric age group, were collected. Data were tabulated and cleaned in MS Excel, and subsequent data analyses were performed in IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results Data from 21 patients were collected and analyzed. The mean age of the participants was 62.9 (SD 15.1) years. Female participants (61.9% (13)) were higher than males (38.1% (8)). All patients were inserted with a non-tunneled central venous catheter (CVC). The mortality rate was 76.2% (16). Vancomycin-resistant enterococci (VRE) was the most commonly detected organism in seven cultures (33.3%), followed by Candida species in six cultures (28.6%). Candida species were prevalent in younger patients (p=0.021) and those sensitive to medication (p=0.015). Survival analyses between age, gender, and organisms yielded insignificant results (p>0.05). Conclusion The major sources of bloodstream infection among adult ICU patients were VRE and Candida species. Mortality was common in this population, particularly among patients who were resistant to medication. Hence, strategies to reduce hospital-acquired bloodstream infections are warranted., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Prince Mohammed bin Abdulaziz Hospital Institutional Review Board issued approval NCBE-KACST, KSA: H-01-R-131. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Albudayri et al.)

Background: The Health Sector Transformation Program (HSTP) has been established as part of Saudi Vision 2030. Despite the significant progress achieved in previous years, the HSTP addresses multiple challenges. One of these challenges is that the current healthcare model prioritizes treatment over prevention. Therefore, prioritizing preventive healthcare measures is crucial., Objectives: This study aims to assess the levels of awareness and knowledge among the public health and preventive medicine physicians in Saudi Arabia towards the national healthcare transformation program., Method: In this cross-sectional study, we surveyed public health and preventive medicine physicians in Saudi Arabia. We collected data through a newly developed and validated self-administered questionnaire, which was distributed online. The survey questionnaire consisted of three sections: participants' background characteristics; measurement of public health and preventive medicine physicians' awareness of the HSTP and their confidence in their awareness; and measurement of the physicians' knowledge of the HSTP through six multiple-choice questions., Results: In this study, 307 public health and preventive medicine physicians in Saudi Arabia participated. The mean age ± SD was 33.1 ± 5.1 years, with 54.7% being public health and preventive medicine residents, 33.2% specialists, and 12.1% consultants. Most participants showed high awareness of the HSTP and its strategic objectives. Over two-thirds correctly defined HSTP, value-based healthcare, and the new Model of Care (MOC), while about 50% demonstrated inadequate knowledge regarding Accountable Care Organizations (ACOs) and the "Keep Well" system. Older physicians, consultants, and those with more years of work experience had higher knowledge scores. Regression analysis revealed that job rank significantly influenced public health and preventive medicine physicians' knowledge of the HSTP., Conclusion: This study shows that while public health and preventive medicine physicians are generally aware of HSTP's objectives, they have inadequate confidence in their knowledge, highlighting the need for better information dissemination. Awareness of the MOC is high, but gaps persist in understanding specific components like the "Keep Well" initiatives. The study also found that job rank and experience influence knowledge levels, suggesting the need for broader dissemination of the HSTP concepts., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The institutional review board (IRB) of King Fahad Medical CityKing Fahad Medical City issued approval (24-099C). Participants provided informed consent prior to their inclusion in the study, and their confidentiality was maintained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aldawsari et al.)

Background: Both everolimus and peptide receptor radionuclide therapy (PRRT) are approved as monotherapies for advanced neuroendocrine tumors (NETs). Research in animal models showed synergism between the two treatment modalities. This study evaluate the safety and efficacy of combining everolimus and PRRT for the treatment of unresectable NETs. Methods: Adult patients (≥18 years) with progressing and unresectable histologically confirmed grade 1-2 NETs of all origins were enrolled. Everolimus was started at a 5 mg daily dose and was increased after the initial three patients to 10 mg daily. Patients were treated concurrently with 177 Lu-DOTATATE at an 8-week interval, with four cycles planned. Safety was the primary endpoint, with response rate and progression-free survival (PFS) being secondary. Results: Eleven patients were enrolled. The trial was terminated early for poor accrual. The median age was 51 years (18-64), and 4 were males. The median number of cycles of 177 Lu-DOTATATE was 3, and the median cumulative dose was 300 mCi. The most frequent grade 1-2 toxicities were stomatitis (90.9%) and nausea (72.7%). Less frequent were fatigue (63.6%), anorexia, diarrhea, and skin changes (each at a 36.4% rate). Grade 3 toxicities occurred in 36% (fatigue, infection, pneumonitis, neutropenia, and stroke). No patient developed grade 4 toxicity. Treatment was stopped because of progression in three patients, and toxicity in another three patients; in addition, four patients were halted due to therapy interruption and in one patient who developed stroke. One patient achieved partial response, and nine patients had stable disease. One patient developed disease progression. At a median follow-up of 18.9 months, three patients died and one was lost to follow-up. The median PFS was 23.3 months. Conclusions: The combination of everolimus at a dose of 10 mg daily and 177 Lu-DOTATATE appears not to be feasible. A larger trial at a lower dose of everolimus is warranted.

Background: Vaccine hesitancy re-emerged as a critical public health issue during the COVID-19 pandemic., Aims: This study assessed the concerns of recovered COVID-19 patients about vaccination and the predictors of vaccine hesitancy., Methods: This was a cross-sectional study of 319 adult patients who recovered from COVID-19 in Saudi Arabia. It was conducted during 1 May to 1 October 2020 at King Abdulaziz Medical City, Riyadh. Each participant was interviewed 6-12 months post-recovery using the vaccination attitude examination scale. Data were collected on COVID-19 illness severity, sociodemographic characteristics, history of chronic disease, and post-COVID-19 vaccination. Level of vaccination concern was assessed based on the percentage mean score (PMS)., Results: Most (85.3%) of the patients who recovered from COVID-19 expressed moderate overall concern (PMS = 68.96%) about vaccination. Concern was highest for mistrust in vaccine benefits (PMS = 90.28%), followed by natural immunity preference (PMS = 81.33%) and worries about the vaccine side-effects (PMS = 60.29%). Concern over commercial profiteering was low (PMS = 43.92%). The overall PMS for concern about vaccination was significantly higher among patients aged 45+ years (t = 3.12, P = 0.002) and among those who had experienced severe COVID-19 illness (t = 1.96, P = 0.05)., Conclusion: Overall concern about vaccination was high, and specific concerns were prevalent. Patient education on how the vaccine protects against reinfection should be targeted at COVID-19 patients before being discharged from hospital., (Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Road traffic injury (RTI) is the third leading cause of death in Saudi Arabia. Using a mobile phone when driving is associated with distracted driving, which may result in RTIs. Because of limited empirical data, we investigated the association between mobile phone use and RTI in injured patients and community controls in Riyadh. Cases were patients admitted to King Abdulaziz Medical City (KAMC) between October 2016 and March 2018 due to RTIs. During admission, mobile phone use at the time of the accident was investigated. The controls were drivers observed at various locations citywide. A logistic regression model was constructed to estimate the association between mobile phone use while driving and sustaining RTIs. We included 318 cases and 1700 controls. For the cases, using a mobile phone was associated with higher severity and prevalence of disability. In addition, using a mobile phone while driving is associated with 44% higher odds of incurring a severe RTI ( p = 0.04). Mobile phone use while driving is prevalent in Riyadh and pose a significant threat of disability. In addition, the low prevalence of seatbelt use is alarming and requires significant improvement. Prevention programs may use these findings to educate the public and policymakers and to advocate for increased visibility of enforcement to reduce RTIs and improve population health., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Introduction: Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations., Methods: This is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal., Results: A total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9-3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36-0.92)., Discussion: This study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%)., Conclusion: Our study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health., (Copyright © 2018 Elsevier Ltd and National Safety Council. All rights reserved.)