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BACKGROUND: Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus (DM) as a risk factor for SBP in liver cirrhotic patients. METHODS: Following PRISMA guidelines, fifteen studies were included, for a total of 76 815 patients. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). We represented the results as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Additionally, we pooled the hazard ratios (HR) for developing SBP in patients with DM from the included studies. RESULTS: The meta-analysis shows a significantly increased risk of SBP in cirrhotic patients with DM (HR: 1.26; 95% CI [1.05-1.51], P=.01; HR: 1.70; 95% CI [1.32-2.18], P

Objectives The use of technology has rapidly increased in the past century. Artificial intelligence (AI) and information technology (IT) are now applied in healthcare and medical education. The purpose of this study was to assess the readiness of Indonesian teaching staff and pediatric residents for AI integration into the curriculum. Methods An anonymous online survey was distributed among teaching staff and pediatric residents from 15 national universities. The questionnaire consisted of two sections: demographic information and questions regarding the use of IT and AI in child health education. Responses were collected using a 5-point Likert scale: strongly disagree, disagree, neutral, agree, and highly agree. Results A total of 728 pediatric residents and 196 teaching staff from 15 national universities participated in the survey. Over half of the respondents were familiar with the terms IT and AI. The majority agreed that IT and AI have simplified the process of learning theories and skills. All participants were in favor of sharing data to facilitate the development of AI and expressed readiness to incorporate IT and AI into their teaching tools. Conclusions The findings of our study indicate that pediatric residents and teaching staff are ready to implement AI in medical education.

Background: The coronavirus disease 2019 (COVID-19) pandemic has placed enormous pressure on different health-care systems globally. In Saudi Arabia, the COVID-19 pandemic has considerably increased the number of infected individuals and has caused a major concern among health-care professionals, including the laboratory workforce. This study aimed to measure the impact of COVID-19 workload on clinical laboratory workforce in Riyadh. Methods: This was a cross-sectional quantitative study. We distributed questionnaires via E-mail invitations and social media platforms to 252 individuals. The online survey comprised eligibility, demographic, and workload-related questions as well as the 12-item General Health Questionnaire. Results: A total of 123 respondents completed the questionnaire and fit the eligibility criteria. The data showed that the total workload burden remarkably increased the number of tasks among all laboratory workers by 30.0%. In addition, 44.7% of the laboratory personnel reported psychological distress and anxiety during the COVID-19 pandemic. Conclusions: Clinical laboratory workers reported a significant increase in workload burden during the COVID-19 pandemic. Middle age and limited years of experience were found to be risk factors for psychological distress and anxiety among the laboratory workers.

The present study aimed to measure the e-health information competencies for health science students in finding, evaluating and judging e-health information. Adapted measurement tools were used to assess the e-health information literacy. A total of 151 students accepted to participate. Few students (25) were able to locate the appropriate information using the necessary keywords and commands. Only 33.1% of the participants could distinguish between scholarly and non-scholarly sources of information. A very weak correlation was registered between the actual and the self-evaluation skill levels. Students intended to improve many health information search skills such as library database through different methods.

The purpose of this study is to understand how prepared teachers in two countries are to utilize technology effectively in a physical and virtual classroom environment. This research is a comparative study of Saudi Arabian and US preservice teachers' readiness for technology integration in their actual teaching practices. Survey methodology was used to measure both knowledge and attitudinal variables found to be important to later integration of technology into teaching among preservice teachers. The results provide updated insight into the status of US and Saudi Arabian preservice teachers' proficiencies and attitudes toward integrating technology into their teaching and implications for preservice teacher preparation. Also, the research was intended to identify critical technological, skill-based, attitudinal, and cultural factors that may weigh heavily into efforts to develop successful training programs for preservice teachers in Saudi Arabia and other developing countries. Lastly, data from this study provide some insight into teacher-student skill-gaps, meaning teachers who have fewer digital competencies than their students do, and how best to support both preservice and experienced educators as they adapt to new educational technologies and procedures. These findings were generated through use of a newly developed survey, which needs additional refinement; we encourage others to help us refine and use for other cross-cultural comparisons.

The Saudi Vision 2030 emphasizes the need for health insurance in terms of both economic growth and lowering government healthcare costs. Recently, the Saudi Ministry of Health has requested the private sector to contribute more to health spending through alternative financing and delivery systems, specifically health insurance. The main purpose of this review is to systematically review the benefits and issues of the implementation approach for health insurance in Saudi Arabia. Three electronic databases were used to conduct the systematic search for articles published in 2018 or after as this is a recent review of the last 5 years articles. Articles were considered if they matched the following criteria: Saudi articles concentrating on health insurance in Saudi Arabia, with a particular emphasis on issues, problems, barriers, and challenges related to insurance in Saudi Arabia. Of the many references identified in the initial search, 13 studies were identified that met the inclusion criteria. The included studies clearly highlighted, explained the current financial methods of the healthcare system in Saudi Arabia, and evaluated Cooperative Health Insurance’s potential contribution to the healthcare system’s success in achieving the Saudi Vision 2030 goals, as well as the benefits and disadvantages of health insurance. This review exemplifies the need for implementation of health insurance in Saudi Arabia to improve economic growth, and to improve efficiency and quality of care. Many of the issues were identified in this review could be addressed by a strong healthcare infrastructure. The Council of Cooperative Health Insurance and Saudi Arabian Monetary Agency should keep monitoring medical services and collaborating toward enhancing Saudi Arabia’s health insurance.

BackgroundThe working environment of healthcare institution during pandemic puts all hospital employees at high-risk of being exposed to contagious infections. An individual’s behavior and response are largely determined by their level of knowledge, attitudes and practices (KAP) toward a disease. Therefore, the present study aimed to evaluate and assess the KAP toward COVID-19 among hospital employees working in various positions and to identify the sociodemographic determinants associated with the level of KAP.MethodsA cross-sectional survey was conducted from July 1 to July 15, 2020 in Almoosa Specialist Hospital, Alhasa, Eastern Province, Saudi Arabia in which 221 hospital employees with varied job titles participated. The data for demographics and history of COVID-19 exposure, KAP related to COVID-19 spread and prevention were collected online using a web-based platform (Survey Monkey). Student’s t-test/One-way ANOVA were used to compare total mean and standard deviation of KAP scores with demographic profiles and history of exposure.Results89.1% employees knew that COVID-19 virus is mostly transmitted from human-to-human, and 76.0% employees acknowledged droplet transmission. 64.7% employees preferred to take a sick person with unconfirmed COVID-19 to a health facility. Physicians had higher knowledge scores for COVID-19 infection and non-medical employees had the lowest scores (7.47 ± 1.23 and 6.47 ± 1.44, respectively). Nurses had the highest practice scores and non-medical employees lowest practice score (6.16 ± 0.74 and 5.37 ± 1.14, respectively). Attitude scores were similar among all the employees. All employees reported an increase in hand-washing frequency and physical contact avoidance.ConclusionThe study results revealed socio-demographic factors; level of education, nationality, and field of service are associated with COVID-19 KAP. The study highlights that there is a gap in the level of knowledge about COVID-19, especially among nonmedical employees. Targeted interventional programs need to be planned and implemented to improve COVID-19 awareness among non-medical employees.

Background Sepsis is one of the main causes of neonatal mortality. The morbidity and mortality rates due to neonatal sepsis are as high as 9-20%. Premature rupture of membranes (PROM) and preterm gestational age are among the risk factors of neonatal sepsis. Objective To evaluate for potential associations between PROM as well as preterm gestational age to neonatal sepsis by meta-analysis and systematic review. Methods A meta-analysis and systematic review were performed using literature sourced from PubMed, Cochrane, and Google Scholar according to PRISMA guidelines. We calculated the incidence of sepsis in neonates with and without PROM and premature gestational age. Journal quality was assessed according to the Newcastle-Ottawa Scale (NOS) criteria. Results From the literature search for PROM, 21 case-control studies met the inclusion criteria. Neonatal sepsis was more common in neonates who had a maternal history of PROM than in those without [OR 2.69 (95%CI 1.56 to 4.65); P

This study aimed to analyze the effect of the strategic orientation dimension on the culinary business market performance in Kendari City during the Corona Virus Disease Pandemic. The method used was descriptive quantitative with a non-probability sampling approach with purposive sampling technique. The population was culinary business actors who still survive and have been running for the business more than 2 years during the COVID-19 pandemic. The sample in this study only obtained 38 respondents. The data analysis technique in this research was path analysis using SmartPLS VS 3.0. The results showed an analysis of the strategic dimensions that have an aggressive attitude and had significant effect on market performance so that culinary business actors can improve their market performance during the COVID-19 pandemic.

Inflammation of the vas deferens or what known as acute vasitis is an under-reported condition that usually presents with scrotal or inguinal pain and swelling which can be misdiagnosed and treated as many other conditions. Here, we present one of the first cases to be reported in the literature with bilateral manifestation. A 28-year-old male patient presented complaining of bilateral testicular and inguinal pain associated with inguinal swelling for 3 days. Initially, the patient was being evaluated as a case of incarcerated bilateral inguinal hernia, but with the aid of radiological imaging, the patient was diagnosed correctly and the unnecessary surgical intervention was prevented.

Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was emphysematous pyelitis, which was considered the first report in the literature as far as we know.

CONTEXT: Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for preventing the risk of intubation. However, the efficiency and usage of HFNC in the case of coronavirus disease 2019 (COVID-19) among adult patients with multiple risk factors remain debatable and require more investigation. AIMS: The aim of this study was to determine the efficiency of HFNC in preventing the possible risk of intubation. SETTINGS AND DESIGN: This study was an observational cross-sectional study that was conducted at a selected hospital in Jeddah, Saudi Arabia, from July 2020 to August 2021. METHODS: The data were collected from patients' medical records through the hospital health information system. Adult COVID-19 patients who used HFNC were included, while those who used bilevel positive airway pressure or continuous positive airway pressure without any trials of HFNC and neonatal or pediatric patients were excluded. The exposure of HFNC setting which included variables such as percentages of the fraction of inspired oxygen and the duration of using HFNC were measured to find the relation with respiratory rate oxygenation (ROX) index as a measurement of patient outcome. STATISTICAL ANALYSIS USED: The data were analyzed by using the online calculator socscistatistics.com for prevalence statistics, and correlation tests of significance. Prevalence statistics were presented in mean, median, frequencies, and percentages. Statistical tests were used to measure correlations of key variables. P < 0.05 of ANOVA and t-tests was considered statistically significant. RESULTS: A total of 159 adult COVID-19 patients using HFNC were included, and most of these patients were male. The median age was 64 years. Most of patients were reported to have hypertension and diabetes mellitus. The majority (94.34%) of patients were successfully weaned from HFNC and shows effective intervention with a mean of 7.53 of ROX score. Appropriate implementation of HFNC might be a successful intervention for preventing the risk of intubation. CONCLUSIONS: According to the success rate of HFNC, which was considered a positive outcome, there might be a promising intervention for HFNC to prevent the risk of intubation and decrease the mortality rate.

الملخص: أهداف البحث: تتيح التطبيقات والبرامج الصحية الإلكترونية استخدام أجهزة الكمبيوتر والشبكات وتكنولوجيا المعلومات لتحسين جودة الرعاية الصحية وسلامة المرضى وتأمين الوصول السري إلى المعلومات الصحية وذلك يساعد الأفراد والمجتمعات من اتخاذ أفضل القرارات الصحية الممكنة. لذلك قمنا بدراسة قضايا الصراع التي تواجه مستخدمي التطبيقات والبرامج الإلكترونية للرعاية الصحية في الرياض. طرق البحث: استخدمنا في هذه الدراسة تصميما وصفيا مقطعيا لاستهداف جميع المتخصصين في الرعاية الصحية الذين يتعاملون مع التطبيقات والبرامج الإلكترونية للرعاية الصحية. قمنا بتوزيع استبيان معد لمقدمي الرعاية الصحية عبر الإنترنت. النتائج: جمعنا 169 عينة من المشاركين في الاستبيان. مثلت الإناث 78.1٪، و46.2٪ من المشاركين تتراوح أعمارهم بين 31-40 سنة. وجدنا أن 59.2٪ من المشاركين أشاروا إلى أنهم استخدموا هذه التطبيقات دائما، و33.7٪ من المشاركين استخدموها أحيانا، و7.1٪ فقط من المشاركين أشاروا إلى أنهم نادرا ما يستخدمونها أو لم يستخدموها مطلقا. اعترف 31.4٪ من المشاركين بأن هذه التطبيقات أدت إلى بعض النزاعات في العمل، وقال 50.6٪ منهم أنها تسببت في نزاع في القرار، و13.6٪ كشفوا عن صراعات أخلاقية، و35.8٪ أشاروا إلى أنواع أخرى من النزاعات. الاستنتاجات: أجريت الدراسة الحالية في مقدمي الرعاية الصحية في منطقة الرياض بالمملكة العربية السعودية ووجدنا أن استخدام التطبيقات والبرامج الإلكترونية في الرعاية الصحية واجهت بعض الصعوبات. وبالتالي يجب الاستمرار في تطوير الوضع الحالي. Abstract: Objective: Electronic healthcare applications and programmes enable the use of computers, networks, and information technology to improve healthcare quality and patient safety, and secure confidential access to health information in order to enable individuals and communities to make the best possible health decisions. We study conflicts challenging users of e-health electronic applications and programmes in Riyadh. Methods: We use a cross-sectional descriptive design to target all healthcare professionals who interact with e-health applications and programmes. Healthcare providers took a questionnaire survey online. Results: Of the 169 responses to our questionnaire, 78.1% are female, and 46.2% are aged between 31 and 40 years. As many as 59.2% always use these applications, and 33.7% use them occasionally. Only 7.10% of the participants rarely or never use them. As many as 31.4% recognized that these applications led to conflicts at the workplace. Of these, 50.6%, 13.6%, and 35.8% stated that they caused decision-related, ethical, and other types of conflicts, respectively. Conclusion: We conducted this study among healthcare providers in Riyadh, KSA, and found that the use of e-health applications and programmes encountered some difficulties.

Public Interest Summary Health systems harbor data that can be targeted by cyber attackers, allowing hackers to gain access to confidential data and information about patients. Patients may lose their lives or suffer permanent and irreversible harm as a result of unauthorized access to health care data used in treatment. To ensure patient safety, the health care sector must integrate cybersecurity into its operations. Additionally, the health care industry must collaborate to tackle cybercrime and prevent unauthorized access to patient data. With the rapid transition from paper health records to electronic health records, it is important to identify, study, and address the challenges that confront electronic health records in terms of protecting patient confidentiality. Examples of factors that may affect patient confidentiality are healthcare security software, and relationships between health professionals.

A Learning Management System (LMS) is a dynamic concept of critical thinking. This research aims to explain using LMS to develop critical thinking skills. This type of research is qualitative with a literature review. The data sources used secondary data from journals, books, and references. Data collection techniques were carried out with documentation, while data analysis was through content analysis. Learning Management System (LMS) can improve students' critical thinking skills because it will familiarize students with problem-solving and learning from problems, as well as the educators develop thinking skills. It was concluded that the Learning Management System (LMS) based discussion method could improve undergraduate students' critical thinking skills.

Background: Neonatal hyperbilirubinemia is a common clinical condition among newborns that requires early detection and medical management to avoid bilirubin toxicity. This study aimed to investigate the role of cord blood alkaline phosphatase (ALP) levels as a predictor of hyperbilirubinemia in full-term neonates. Methods: This cross-sectional study was conducted on full-term newborns within April-August 2019 in several hospitals in Medan, Indonesia. Cord blood ALP levels upon delivery and serum bilirubin levels on 72 h of life were measured. Results: Out of 147 full-term neonates, the mean cord blood ALP levels and serum bilirubin levels were obtained at 166.3±45.1 IU/l and 9.6±2.3 mg/dl, respectively. There was a significant difference in mean cord blood ALP levels at serum bilirubin levels of >10 mg/dl and ≤10 mg/dl on 72 h of life (196.8±40.7 IU/l and 146.4±37.5 IU/l, respectively; P=0.001). A positive, moderate, and significant correlation was observed between cord blood ALP levels and serum bilirubin levels on 72 h of life (r=0.429; P=0.001). The cut-off value of 163.5 IU/l was associated with 84.7% sensitivity and 77.3% specificity for predicting hyperbilirubinemia in full-term neonates. Conclusion: There was a positive correlation between cord blood ALP levels and serum bilirubin levels on 72 h of life. Therefore, cord blood ALP may be utilized as a predictor for hyperbilirubinemia in full-term neonates.

Background: Premature birth is linked to neonatal morbidity and mortality worldwide. Neuregulin (NRG) is a trophic factor from the growth factor (GF) of a transmembrane polypeptide, encoded by four different genes, including NRG-1 which acts as an endogenous protector in fetal development. Decreased levels of NRG-1 affect several organs. The relationship between NRG-1 polymorphism and the outcome of neonatal development has been widely studied. There are no studies that have assessed NRG-1 levels and NRG-1 rs35753505 C/T polymorphism in preterm neonates, as well as its association with short-term morbidities in Indonesia. Methods: This cross-sectional study was conducted on preterm neonates with the gestational age of 32-36 weeks in Medan, North Sumatera, Indonesia, from December 2017 to December 2018. It aimed to evaluate the association of NRG-1 levels and NRG1 polymorphism with short-term morbidities. Samples were obtained from cord blood specimens. Enzyme-linked immunosorbent assay (ELISA) was used to determine NRG-1 levels, and NRG-1 polymorphism was sequenced by polymerase chain reaction (PCR). Observations in preterm neonates were made during the first 72 h to assess short-term morbidities. Results: During the study period, 48 cord blood specimens from preterm neonates were found eligible for analysis. Preterm neonates with low NRG-1 levels had a 10-times higher risk of developing short-term morbidities. The presence of CC and CT genotypes increased the risk of developing short-term morbidities 13.33 times (P=0.003) and 6.19 times (P=0.019), respectively. The presence of the C allele in subjects' genotype increased the risk of short-term morbidities 4.04 times (P=0.001), compared to those with T allele. Conclusion: As evidenced by the obtained results, preterm neonates with low NRG-1 levels had a higher risk of developing short-term morbidities. Furthermore, there was a significant association between NRG-1 rs35753505 C/T polymorphism and short-term morbidities.

Byline: Majid. Al-Thaqafy, Saleh. Alzahrani, Abdulwahab. Alghamdi, Saleh. Alselemi, Khalid. Alshebani, Bussma. Bugis, Alaa. Bugis, Ali. Al-Shareef CONTEXT: Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for [...]

Introduction: Currently, the majority of health facilities in Saudi Arabia are supplemented with the required technological infrastructure to support different formats of telehealth. There is limited evidence on the actual utilization of teledentistry among dental patients during COVID-19. Thus, the purpose of this study was to describe the utilization of teledentistry services during the pandemic among dental care seekers in Saudi Arabia. Methods: The study was a cross-sectional descriptive study through an online self-administered survey released publicly. The survey was available during March, April, and May 2021. The targeted population was dental care seekers who used any teledental services during the COVID-19 pandemic in Saudi Arabia. Results: There were 235 responses available for analysis. Among the 235 responses, 91.91% did not use any teledental services during COVID-19, while 8.09% utilized different teledental services during COVID-19. Participants who utilized teledental services during COVID-19, used the following services: dental diagnosis, dental consultations, monitoring and follow-ups of previous dental treatments, routine dental check-ups, and finally, triaging dental cases as emergency or nonemergency cases. Discussion: Saudi Arabia has a strong technological infrastructure with a highly ranked healthcare system. However, teledental services were weakly utilized by dental care seekers during COVID-19 in Saudi Arabia.

Sekolah Menengah Kejuruan (SMK) bertugas menyiapkan siswa untuk siap bekerja di industri. Tugas tersebut dapat tercapai jika proses pembelajarannya dilaksankan berbasis kompetensi di industri dan Kerangka Kualifikasi Nasional Indonesia (KKNI) level 2. Salah satu cara agar pembelajaran di SMK relevan dengan kompetensi di industri yaitu dengan pengembangan materi pembelajaran bersama industri. Materi pembelajaran dapat dikemas dalam bentuk modul pembelajaran. Namun, saat ini modul pembelajaran yang relevan dengan kompetensi di industry tidak banyak diSMK. Ketiadaan modul pembelajaran tersebut dapat diatasi dengan cara para guru diberikan pelatihan penyusunan modul. Pelatihan penyusunan modul pembelajaran dilakukan berdasarkan KKNI dan kompetensi industri. Indikator pencapaian kompetensi di kurikulum diperbaiki dan disempurnakan rumusannya menyesuaikan perkembangan teknologi baru di industri otomotif. Pelatihan diberikan kepada guru-guru produktif teknik kendaraan ringan otomotif dengan jumlah peserta18 orang. Produk dari kegiatan pengabdian ini adalah terlatihnya guru-guru SMK pengampu mata pelajaran produktif di Kota Surakarta dalam menyusun dan mengembangkan modul pembelajaran mata pelajaran produktif teknik kendaraan ringan otomotif yang selaras dengan KKNI level 2 dan kompetensi teknisi otomotif di industri. Dampak yang diharapkan dari kegiatan ini adalah tersusunnya modul pembelajaran oleh para guru, yang selanjutnya dapat digunakan dalam proses pembelajarannya. Dengan demikian proses pembelajaran dapat meningkat kualitasnya, sehingga kompetensi siswa akan meningkat.

Energy from fossil fuels consisting of petroleum, coal, natural gas containing raw material for energy fulfillment in Indonesia is still very central through the use of raw materials from renewable energy is still very low. In Indonesia the potential for renewable energy such as wind energy needs to be optimized. One of the uses of wind energy is through savonius wind turbine as electricity generators. Characteristics of savonius wind turbine with vertical axis rotors which gave a simple shape, and that able to control low speeds. This is in accordance with regions in Indonesi which have low average speeds. This experimental study, aims to determine the description of wind potential and determine the performance of savonius wind turbines on the coast of Demak regency on the electrical energy produced. Savonius wind turbine used is made of galvalum material in the form of an S type rotor with diameter 1.1 m and height 1.4 m, using pulley transmission system with multiplication ratio 1:6 dan using generator type PMG 200 W. This research uses the method experiment. Data collection in the form of wind speed, humidity, temperature, rotor rotation speed, voltage and electric curret is carried out at 14.30 to 17.30 Western Indonesian Time. Data Analysis in this study uses quantitative descriptive analysis. The result showed the potential of wind on the coast of Demak regency have an average wind speed of 2,02 m/s with a temperature of 31,34 0C and humidity of 76,96. And the performance of the installed wind turbine produces the highest power 3.5 watt with an electric power coefficient of 0,181 and tip speed ratio around 1,75. From these result, the potensial of wind with performance savonius turbine can generate electricity used for pond lighting in the village Berahan Kulon Kecamatan Wedung.

This study aims to determine the factors that cause the high number of children dropping out of school in Yellu Village, South Misool District, Raja Ampat Islands. This is a qualitative research with a social phenomelogy paradigm and was conducted in Yellu Village, South Misool District, Raja Ampat Islands. The number of children dropping out in Yellu Vilage was influenced by two factors. Internal factor includes lack of motivation from them in order to improve education. Some of external factors are lack of parental supporting, associating with their peers who are not in school, children who easily earn some money without going to school due to the emergence of pearl companies that requires labor and abundant marine resources to get fish and seaweed, unsupportive educational facilities, lack of supporting from local government and the private sector in order to education development.

Problem and goal. Currently, there is active transformation of educational technologies, which explains the emergence of new educational needs, a change in the principles and mechanisms of access to knowledge and the need to summarize existing and implement new approaches to the formalization and systematization of data collection and storage, taking into account characteristics specific education and information technology [2- 4; 10; 12; 15]. The article reveals the concept of digital technologies in the educational environment, presents theoretical and practical materials containing knowledge about digital technologies. Methodology. The pilot study was conducted using the mobile app “Lecture Racing”, which allows to check the level of knowledge of students, among other things. This is a unique tool for conducting tests and surveys at lectures or classes, both pre-prepared and without preprepared tests, in real time [14]. Results. The stages of development of digital technologies are considered, and the stages of the experiment on the use of digital technologies in the educational process are described. Description of the results of the methods used to identify the level of motivation and performance. Conclusion. The use of digital technologies, on the example of the mobile application “Lecture Racing”, has a positive impact on the motivation of students, academic performance, and contributes to the self-development of the teacher in an innovative educational environment.

Abstract Background There is a high incidence of deep vein thrombosis (DVT) among cancer patients undergoing chemotherapy. Chemotherapy-induced vascular endothelial cell activation (VECA) is characterized by increased plasma levels of von Willebrand factor (vWF) and soluble P-selectin (sP-selectin), leading to the activation of endothelial cells and signaling cascades. The biological role of a disintegrin-like and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS-13) is to control the activity of vWF and consequently the risk of thrombosis. The objective of this study was to investigate the roles of sP-selectin, vWF, and ADAMTS-13 as risk factors for the first episode of DVT in cancer patients undergoing chemotherapy. Methods This prospective cohort study was conducted at Dr. Kariadi Hospital, Indonesia, on 40 cancer patients. Prechemotherapy (baseline) and postchemotherapy sP-selectin, vWF antigen (vWF:Ag), and ADAMTS-13 plasma levels were determined with ELISAs before and 3 months after chemotherapy. The clinical characteristics of the patients, cancer type, cancer stage, chemotherapy regimen, ABO blood type, D-dimer level and Khorana risk score were also analyzed using logistic regression. Patients were observed for the possibility of developing DVT during chemotherapy. Results DVT was confirmed in 5 patients (12.5%) after a period of 3 months. In patients with DVT, sP-selectin and vWF were significantly higher while ADAMTS-13 was lower than in their counterparts. The levels of baseline vWF:Ag and ADAMTS-13, with cut-off points ≥ 2.35 IU/mL and ≤ 1.03 IU/mL, respectively, were found to independently predict the incidence of DVT. In the multivariate logistic regression analysis, the relative risk (RR) for DVT in patients with high vWF:Ag was 3.80 (95% CI 1.15–12.48, p = 0.028), and that for patients with low ADAMTS-13 was 2.67 (95% CI 1.22–23.82, p = 0.005). The vWF:Ag/ADAMTS-13 ratio and both vWF:Ag and ADAMTS-13 dynamics during treatment were also able to differentiate those with prospective DVT. However, sP-selectin and other covariates showed no statistical significance. Conclusion We found that prechemotherapy plasma levels of vWF:Ag ≥ 2.35 IU/mL and ADAMTS-13 ≤ 1.03 IU/mL are independent risk factors for DVT incidence among cancer patients.

Aisha A Towhari,1,2 Bussma A Bugis3 1Respiratory Care Department, Prince Sultan Military College of Health Sciences, Al-Dhahran, Kingdom of Saudi Arabia; 2Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia; 3Department of Public Health, College of Health Sciences, Saudi Electronic University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Aisha A Towhari Respiratory Care Department, Prince Sultan Military College of Health Sciences, Dhahran P.O. Box 946, 31932, Saudi ArabiaTel +966 13 8440000, EXT: 3603 Email Atowhari@psmchs.edu.saPurpose: Healthcare professionals are one of the most vulnerable groups subjected to verbal and physical violence daily while carrying out their duties; such violence is a worldwide concern. This study aimed to explore the awareness of a violence reporting system among healthcare providers and the impact of the new Ministry of Health (MOH) violence regulations at one of the Eastern Region hospitals in Saudi Arabia.Methods: A cross-sectional study was conducted from January to February 2020. The study included 210 healthcare providers from different specialties working in critical care units. A sample of 137 healthcare providers was selected randomly, and a self-administered questionnaire was distributed accordingly.Results: In this study, 31.4% of participants were not aware of whether they had a specific system for reporting violent incidents, while 68.6% had no training on these systems. Experiences of violence among the staff decreased from 78.6% before the MOH regulations to almost 20% after the MOH regulations.Conclusion: The majority of victims did not report incidents because there is a lack of system privacy, and the workers felt that the incidents of violence were a part of their daily jobs. In addition, this study revealed that the majority of healthcare workers did not receive training on the reporting system, which explains their lack of knowledge about the formal reporting system. Finally, the MOH initiative and penalties for controlling workplace violence have resulted in a significant drop in the prevalence of violence among healthcare workers.Keywords: Saudi Arabia, violence penalties, Ministry of Health, reporting of violence, healthcare workers