The Knowledge, Attitudes, and Practices of Primary Healthcare Physicians in the Al Qassim Region, Saudi Arabia Regarding Travel Medicine: A Cross-Sectional Study

Background and objective In the age of globalization, diseases associated with travel have emerged as a focal point of public health interest. This has become particularly relevant in Saudi Arabia after the changes in tourism policy in recent years. Primary care physicians are expected to suspect diseases of importance in certain geographic areas. They should dispense pre- and post-travel advice. This study aimed to assess the knowledge, attitudes, and practices of primary care physicians in the Al Qassim region, Saudi Arabia regarding travel medicine. Methods This cross-sectional study was conducted in the Al Qassim region, Saudi Arabia between October and November 2023. We reached out to all primary care physicians in the region regardless of their gender, nationality, and years of experience. The data were collected using a self-administered questionnaire, which was designed based on the available literature and validated by experts. Results A total of 197 physicians participated in the study; 74% were male, 46% were general practitioners, and 48% had 5-10 years of experience. More than half (51%) of the participants reported a weekly patient load of 50-100, while 47% engaged with 5-10 travelers annually; 53% provided travel health advice and a quarter of primary healthcare physicians never attended travel update sessions or conferences. In the last six months, 48% and 43% of the physicians conducted pre- and post-travel consultations respectively. Approximately 49.2% demonstrated a fair knowledge of the topic. Factors associated with fair knowledge included non-Saudi nationality, age below 30 years, minimal traveler exposure, and infrequent conference attendance (p<0.05). A positive attitude was linked to being under 30 years old, having <5 years of experience, seeing <5 travelers yearly, and possessing a fair knowledge of the topic (p<0.05). Conclusions Overall, about half of the physicians in the Al Qassim region engage with travelers and demonstrate good attitudes and practices toward travel medicine. Opening Saudi borders to tourism necessitates the inclusion of travel medicine in continuing medical education programs to prepare primary care physicians to care for travelers more efficiently.

A Systematic Review of the Causes, Consequences, and Solutions of Emergency Department Overcrowding in Saudi Arabia

This study aims to investigate and address the issue of emergency department (ED) overcrowding, a significant problem worldwide. The study seeks to understand the impacts of ED overcrowding on emergency medical healthcare services and patient outcomes. This systematic review follows the PRISMA flow diagram and the guidelines of the Cochrane Handbook. We systematically reviewed the causes and solutions of emergency department overcrowding. We went through Google Scholar, the National Center for Biotechnology Information, the British Medical Journal, Science Direct, Ovid, Cochrane, the Saudi Journal of Emergency Medicine, Medline, and PubMed as databases. Our criteria were articles done in Saudi Arabia from 2012 to 2022. One hundred and ninety-six (196) research papers were extracted; only 28 articles met our paper inclusion-exclusion criteria. The result of these papers regarding causes, consequences, and solutions was that non-urgent and returned visits lacked knowledge of PHC, triad, and telemedicine services. Prolonged LOS is due to slow bed turnover, laboratory and consultation time, and physical response to the final decision resulting in burnout staff, wrong diagnoses, and management plans. The crowding issues can be resolved by awareness, PHC access, triad systems, and technological and telemedicine services. High demand for emergency treatment should not be a hindrance to quality treatment. Physical, technological, and strategic measures should be put in place to fight the crowding problem in EDs in Saudi Arabia, as it may cause adverse effects such as transmission of diseases and death of patients.

Three years versus four years Saudi Board Family Medicine program: Graduates' academic performance, perceptions, burnout, and satisfaction with professional life

Background

The specialty of family medicine, established in Saudi Arabia in the 1980s, has rapidly progressed in healthcare settings and is increasingly utilized by the population as well as recent MBBS graduates. Universally, there is ambiguity in the duration, curriculum, and assessment methods used in family medicine specialization programs.

Methodology

A cross-sectional study was conducted among 183 fresh graduates from a 3-year and 4-year residency program. Data were collected using electronic forms, which were subsequently transferred to Microsoft Excel. Following appropriate coding, the data were transferred to SPSS for analysis. The dataset was then cleaned, and statistical tests, such as Chi-square and independent t-tests, were used to draw inferences.

Results

Males (50.3%) and females (49.7%) had almost equal distribution in the study. Overall, 67.6% of respondents had passed the final exam; the pass percentage was 69.3% for the 3-year residency program and 66.4% for the 4-year program. The overall mean score for perceived achievement of SaudiMED-FM 2020 competencies was 23.06 ± 5.52 out of a total score of 30. On comparing the 3-year versus 4-year residency program, there was no statistically significant difference between perceived competency scores and professional satisfaction scores. Among the study participants, 19 (10.4%) had 'serious burnout', and 22 (12%) had 'extremely serious burnout'. Professional satisfaction was significantly associated with burnout (P = 0.006).

Conclusions

Based on the study results, there was no significant difference regarding academic performance, perceived competencies, and professional satisfaction among the graduates of the 3-year versus 4-year residency program. Approximately more than half of the graduates had suffered from burnout which was reported more by the females and those with financial issues. The majority of the respondents suggested improvements in clinical rotation and assessment methods.

Radiographers' organisational commitment and occupational stress: First Covid-19 wave

INTRODUCTION

Radiographers, like many health professionals, are in a high-risk group for succumbing to workplace demands beyond their ability to cope, particularly in the context of the COVID-19 pandemic resulting in occupational stress. Occupational stress has been linked to poor organisational commitment. Therefore, the purpose of this research was to evaluate radiographers' organisational commitment and occupational stress after the first wave of the COVID-19 pandemic.

METHODS

A mixed method approach entailed data collected from purposively sampled Australian radiographers working during the first COVID-19 wave. The quantitative phase used an online commitment questionnaire, and 21 semi-structured individual virtual interviews were conducted in the qualitative phase. Data interpretation and analysis used statistical and thematic approaches.

RESULTS

The quantitative data revealed a higher level of continuance than affective and normative commitment. Whereas the qualitative findings showed participants high levels of affective commitment to their occupation and, together with leadership support, working collectively towards a positive outcome.

CONCLUSION

Despite the variety of occupational stressors that arose during the COVID-19 crisis, Australian radiographers enjoy a high level of occupational and organisational commitment.

IMPLICATIONS FOR PRACTICE

Radiographers' organisational commitment represents their emotional and psychological attachment to their workplace, and radiographers experiencing occupational stress represent high levels of psychosomatic distress and burnout. Therefore, considering radiographers' organisational commitment and occupational stress is essential in the delivery of services, quality of patient care and radiographers well-being.

Association between levothyroxine replacement therapy and osteoporosis in Riyadh, Saudi Arabia: a matched case-control study

Hypothyroidism is a common health problem among elder women. However, conflicting results were observed regarding the association between levothyroxine treatment and osteoporosis risk. Therefore, the current study aimed to evaluate the effect of levothyroxine replacement therapy on osteoporosis risk in the Saudi population. This study was a matched case-control study conducted from June to August 2020. Data were extracted from the electronic medical records and included sociodemographic, clinical characteristics, comorbid conditions, levothyroxine replacement therapy dose, duration, concomitant therapy, and bone mineral density. Cases were matched with controls (1:1 basis) by age; the study included 256 cases and 256 controls. In the multivariate conditional logistic regression analysis, thyroxine use was independently associated with an increased likelihood of osteoporosis. Therefore levothyroxine use in elderly females was associated with an increased risk of osteoporosis, and hence, clinicians must be aware of the levothyroxine replacement therapy outcomes in postmenopausal females at risk of osteoporosis.

Pedestrian flow characteristics through different angled bends: Exploring the spatial variation of velocity

Common geometrical layouts could potentially be bottlenecks, particularly during emergency and high density situations. When pedestrians are interacting with such complex geometrical settings, the congestion effect might not be uniform over the bottleneck area. This study uses the trajectory data collected through a controlled laboratory experiment to explore the spatial variation of speeds when a group of people navigates through bends. Four turning angles, i.e., 45°, 90°, 135° and 180°, with a straight corridor and two speed levels, i.e., normal speed walking and slow running (jogging), were considered in these experiments. Results explained that the speeds are significantly different over the space within the bend for all angles (except 0°) under both speed levels. In particular, average walking speeds are significantly lower near the inner corner of the bend as compared to the outer corner. Further, such speed variations are magnified when the angle of the bend and desired speed increase. These outcomes indicate that even smaller turning angles, e.g., 45° could create bottlenecks near the inner corner of the bend, particularly when the walking speeds are high. The findings of this study could be useful in understanding the congestion and bottleneck effects associated with complex geometrical settings, and calibrating microscopic simulation tools to accurately reproduce such effects.

Development of wide area monitoring system for smart grid application

PMU can directly measure positive sequence voltage, phase and system frequency. In this paper, the design and implementation for optimum placement of PMU in power system network (PSN) has been performed using 5 different intelligent approaches at an emulation platform. Different case studies based on IEEE 7, 14 and 30 bus system have been performed and analyzed. In the studies, PMU device is used for the measurement of voltage and current magnitude as well as its phase and its performance has been compared with measured real signals of PSN. PMU measurement gives the accurate results and reliability to PSN. But PMUs are not economical, so PSN operator needs to install a minimum number of PMU in PSN so that system should be fully observable in a real-time scenario. In this paper for optimal placement of PMU, five different intelligent methods have been analyzed for three different bus systems and obtained results are compared. For the further validation of selected PMUs for the PSN, a state estimation using WLS algorithm has been performed using conventional data and PMU data on IEEE14 and IEEE30 bus systems. The obtained results for voltage estimation error and phase estimation error with and without PMU data are compared.

Power quality disturbance analysis using data-driven EMD-SVM hybrid approach

In the modern electrical power system network (EPSN), the power quality disturbances (PSDs) are the serious issue for the power engineer to maintain the uninterrupted and reliable power supply. Generally, PQDs are generated due to non-linear loading conditions, perturb loading and other occurrences such as transient, harmonics, sag, swell and interruptions. These problems of PQDs effect the power demand mapping problem, which effect the reliability and stability of the EPSN operating condition. In this study, a novel approach for PQDs diagnosis (PQDD) is proposed, which includes real-time data generation, data pre-processing, feature extraction, feature selection, intelligent model development for PQDD. Data decomposition approach of EMD is utilized to generate the feature vector of IMFs. These features are utilized as an input variables to the intelligent classifiers. In this study, PQDD is analyzed based on SVM method and obtained results are compared with conventional AI method of LVQ-NN. The results represent the higher acceptability of the proposed approach with diagnosis accuracy of 99.98% (training phase), 93.11% (testing phase) for SVM and 92.56% (training phase) and 91.0% (testing phase) for LVQ-NN based PQDD method.

A new hybrid model combining EMD and neural network for multi-step ahead load forecasting

The electric load forecasting (ELF) is a key area of the modern power system (MPS) applications and also for the virtual power plant (VPP) analysis. The ELF is most prominent for the distinct applications of MPS and VPP such as real-time analysis of energy storage system, distributed energy resources, demand side management and electric vehicles etc. To manage the real-time challenges and map the stable power demand, in different time steps, the ELF is evaluated in yearly, monthly, weekly, daily, and hourly, etc. basis. In this study, an intelligent load predictor which is able to forecast the electric load for next month or day or hour is proposed. The proposed approach is a hybrid model combining empirical mode decomposition (EMD) and neural network (NN) for multi-step ahead load forecasting. The model performance is demonstrated by suing historical dataset collected form GEFCom2012 and GEFCom2014. For the demonstration of the performance, three case studies are analyzed into two categories. The demonstrated results represents the higher acceptability of the proposed approach with respect to the standard value of MAPE (mean absolute percent error).

Cyberattacks identification in IEC 61850 based substation using proximal support vector machine

Maintaining the reliable, efficient, secure and multifunctional IEC 61850 based substation is an extremely challenging task, especially in the ever-evolving cyberattacks domain. This challenge is also exacerbated with expending the modern power system (MPS) to meet the demand along with growing availability of hacking tools in the hacker community. Few of the most serious threats in the substation automation system (SAS) are DoS (Denial of Services), MS (Message Suppression) and DM (Data Manipulation) attacks, where DoS is due to flood bogus frames. In MS, hacker inject the GOOSE sequence (sqNum) and GOOSE status (stNum) number. In the DM attacks, attacker modify current measurements reported by the merging units, inject modified boolean value of circuit breaker and replay a previously valid message. In this paper, an intelligent cyberattacks identification approach in IEC 61850 based SAS using PSVM (proximal support vector machine) is proposed. The performance of the proposed approach is demonstrated using experimental dataset of recorded signatures. The obtained results of the demonstrated study shows the effectiveness and high level of acceptability for real side implementation to protect the SAS from the cyberattacks in different scenarios.

Multi-step ahead time-series wind speed forecasting for smart-grid application

In this paper, an intelligent approach for short-term wind speed forecasting (STWSF) is proposed. The STWSF models are developed to forecast the wind speed into a multi-step ahead forecasting, which is used to demonstrate the daily forecast results in One-Step-Ahead (OSA), Two-Step-Ahead (TSA), and Three-Step-Ahead (ThSA) based forecasting manner. To demonstrate the performance and results of the proposed approach, the real-site logged dataset is used for training and testing phase of the year 2015 to 2017. The STWSF is achieved recursively by utilizing the forecasted data in step-1 (OSA) as an input to generate the next forecasting data (in step-2 TSA) and the process is achieved upto level of step-3 (ThSA) forecasting. In order to results demonstration of fair adoptability of the proposed approach, different neural networks (NNs) models are developed for the same dataset, which shows that the proposed STWSF approach is outperformed and can be utilized for other locations for future applications.

Knowledge, attitude, and practice of physicians toward asthma inhaler techniques in Qassim, Saudi Arabia

Introduction: Asthma is a chronic inflammatory disease of the airways. Inflammation in airways leads to hypersensitivity and airway obstruction which is responsible for the symptoms of asthma like wheezing, dyspnea, chest tightness and cough that aggravates in the morning. The prevalence ranges from 1.1 to 9.9% in adults. Systemic therapy and inhalational therapy comprising of bronchodilators and steroids are the two major treatment options. Aims & objectives: To assess physicians' knowledge, attitude, and practise toward asthma inhaler devices and inhalation techniques, and classify physician’s attitudes as either poor or adequate. Methodology: A cross sectional study was conducted in Qassim, Saudi Arabia among healthcare providers for a duration of 6 months. Practicing physicians in the three major cities in Qassim were included in the study while non-practicing physicians and those practicing in the small cities and peripheries were excluded. Data collection was done by using a predesigned self-reported online questionnaire consisting of 22 items under 3 major sections- demography, knowledge and practice of physicians. Templates were generated in MS Excel sheet and analysis of data was done using SPSS software. Chi square test was the test of significance used and p<0.05 was considered significant. Results: Metered-dose inhaler (MDI) with a spacer (56, 62.2%) was the most preferred device among dry powder inhalers (18, 20%) and nebulization solution (16, 17.8%). Most of the physicians responded correctly that the first and foremost step in correct MDI inhalation was shaking the device (67, 74.4%). More than three-fifths (57, 63.3%) of physicians claimed to have taught the caregivers on each visit to use an inhaler. The increasing age of the physician was found to be associated with a better understanding, positive attitude and good practice. A significant difference was seen based on the nationality (p 0.003) and the speciality of the physician (p 0.012) in their understanding of inhaled corticosteroids. Conclusion: Older male physicians and a family physician rather than a general physician were found to have better knowledge and a positive attitude toward advising patients regarding inhalers.

Lifestyle changes of attendees at primary health care centers during the COVID-19 pandemic in Qassim Province, Saudi Arabia

Background:

The COVID-19 pandemic has affected many individuals in the past year through increased mortality, morbidity, and economic disturbances while also affecting individual lifestyles. Healthy lifestyle practices can reduce mortality and morbidity and improve quality of life. We aimed to identify daily lifestyle changes during the COVID-19 pandemic. To do so, we examined factors related to family, livelihood, and other associated changes.

Methodology:

A cross-sectional study was conducted among attendees visiting selected primary health care centers of Qassim province. The data was collected through direct interview method, and 365 individuals participated during the study period. Data was entered in SPSS version 21.0, and necessary statistical tests were applied.

Results:

Out of 365 individuals, 27.4% were male and 72.6% were female. There was a drastic decrease in the frequency of in-person shopping (74.2%) and a steep increase in online shopping (41.4%). The mean weight increase was 4.5 (SD = 3.09) kg. Telemedicine use was 43.6%. There was a statistically significant association found between male gender and fear about COVID-19 (P = 0.019).

Conclusions:

We noticed adverse lifestyle changes in the study population during the COVID-19 pandemic. Health promotional measures and lifestyle modifications are still required to combat COVID-19.

Saturated Hydroxy Fatty Acids Exhibit a Cell Growth Inhibitory Activity and Suppress the Cytokine-Induced β-Cell Apoptosis

The field of bioactive lipids is ever expanding with discoveries of novel lipid molecules that promote human health. Adopting a lipidomic-assisted approach, two new families of previously unrecognized saturated hydroxy fatty acids (SHFAs), namely, hydroxystearic and hydroxypalmitic acids, consisting of isomers with the hydroxyl group at different positions, were identified in milk. Among the various regio-isomers synthesized, those carrying the hydroxyl at the 7- and 9-positions presented growth inhibitory activities against various human cancer cell lines, including A549, Caco-2, and SF268 cells. In addition, 7- and 9-hydroxystearic acids were able to suppress β-cell apoptosis induced by proinflammatory cytokines, increasing the possibility that they can be beneficial in countering autoimmune diseases, such as type 1 diabetes. 7-(R)-Hydroxystearic acid exhibited the highest potency both in cell growth inhibition and in suppressing β-cell death. We propose that such naturally occurring SHFAs may play a role in the promotion and protection of human health.

Utility of serum ferritin and soluble interleukin-2 receptor as markers of disease activity in childhood systemic lupus erythematosus

Objective

To assess the usefulness of serum ferritin and soluble interleukin-2 receptor (sIL-2r) levels as markers of disease activity in childhood systemic lupus erythematosus (cSLE) and their role in screen for subclinical macrophage activation syndrome (MAS).

Patients and methods

This is a cross-sectional analysis of prospectively collected data. Consecutive children who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria were enrolled between June 2015 and June 2017. All patients interviewed and assessed for disease activity using SLE disease activity index (SLEDAI). Biochemical and serological tests including markers of disease activity and MAS were measured by standard laboratory procedure.

Results

A total of 31 (25 female; 6 male) consecutive cSLE patients with a mean age of 10.6 (±3.2) years were included. The most frequent manifestations were mucocutaneous and musculoskeletal (84%) followed by hematological (64.5%) then renal involvement (58%). Twenty-two patients had active disease (SLEDAI ≥ 4), with a mean of 9.8. Mean serum ferritin and sIL-2r were 555 (±1860) and 2789 (±1299) respectively. Both correlated significantly with leucocyte, platelet count, transferrin, C3 and SLEDAI (p < 0.05). Additionally, sIL-2r had positive correlation with ANA, ds-DNA and C4. Both ferritin and sIL-2r had weak correlation with ESR, but no correlation with CRP. Twelve patients had a recent infection. However, they were comparable to patients without infection with regard to all clinical and laboratory features. Three patients had MAS proved by bone marrow aspiration.

Conclusion

Measurement of serum ferritin and sIL-2r might help in assessing disease activity of cSLE. Both might be good screening markers for MAS in cSLE. A larger prospective study is required to allow more definitive conclusions.

Macrophage polarization is linked to Ca2+-independent phospholipase A2β-derived lipids and cross-cell signaling in mice

Phospholipases A₂ (PLA₂s) catalyze hydrolysis of the sn-2 substituent from glycerophospholipids to yield a free fatty acid (i.e., arachidonic acid), which can be metabolized to pro- or anti-inflammatory eicosanoids. Macrophages modulate inflammatory responses and are affected by Ca²⁺-independent phospholipase A₂ (PLA₂)β (iPLA₂β). Here, we assessed the link between iPLA₂β-derived lipids (iDLs) and macrophage polarization. Macrophages from WT and KO (iPLA₂β-/-) mice were classically M1 pro-inflammatory phenotype activated or alternatively M2 anti-inflammatory phenotype activated, and eicosanoid production was determined by ultra-performance LC ESI-MS/MS. As a genotypic control, we performed similar analyses on macrophages from RIP.iPLA₂β.Tg mice with selective iPLA₂β overexpression in β-cells. Compared with WT, generation of select pro-inflammatory prostaglandins (PGs) was lower in iPLA₂β^-/- , and that of a specialized pro-resolving lipid mediator (SPM), resolvin D2, was higher; both changes are consistent with the M2 phenotype. Conversely, macrophages from RIP.iPLA₂β.Tg mice exhibited an opposite landscape, one associated with the M1 phenotype: namely, increased production of pro-inflammatory eicosanoids (6-keto PGF₁α, PGE₂, leukotriene B₄) and decreased ability to generate resolvin D2. These changes were not linked with secretory PLA₂ or cytosolic PLA₂α or with leakage of the transgene. Thus, we report previously unidentified links between select iPLA₂β-derived eicosanoids, an SPM, and macrophage polarization. Importantly, our findings reveal for the first time that β-cell iPLA₂β-derived signaling can predispose macrophage responses. These findings suggest that iDLs play critical roles in macrophage polarization, and we posit that they could be targeted therapeutically to counter inflammation-based disorders.

Pattern and diagnostic evaluation of systemic autoinflammatory diseases other than familial Mediterranean fever among Arab children: a multicenter study from the Pediatric Rheumatology Arab Group (PRAG)

To define the spectrum and phenotypic characteristics of systemic autoinflammatory diseases (SAIDs) other than familial Mediterranean fever (FMF) in Arab children and to delineate diagnostic evaluation. Data retrospectively collected on patients with clinical and/or genetically proven SAIDs other than FMF at 10 tertiary Arab pediatric rheumatology clinics from 1990 to 2018. The collected data comprised the clinical findings and diagnostic evaluation including genetic testing, the provided treatment and the accrual damage related to SAIDs. A total of 144 patients (93 female) with a median age at onset of 2.5 (range 0.1-12) years were enrolled. The initial diagnosis was inaccurate in 49.3%. Consanguinity rate among parents was 74.6%. The median time-to-diagnosis for all SAIDs was 2.5 (range 0.1-10) years. There were 104 patients (72.2%) with a confirmed diagnosis and 40 patients with suspected SAIDs. Seventy-two had monogenic and 66 patients with multifactorial SAIDs while six patients had undifferentiated SAIDs. The most frequent monogenic SAIDs were LACC1 mediated monogenic disorders (n = 23) followed by CAPS (12), TRAPS (12), HIDS (12), and Majeed's syndrome (6). The most frequent multifactorial SAIDs was CRMO (34), followed by PFAPA (18), and early onset sarcoidosis (EOS) (14). Genetic analysis was performed in 69 patients; 50 patients had genetically confirmed disease. Corticosteroid used for 93 patients while biologic agents for 96 patients. Overall, growth failure was the most frequent accrual damage (36%), followed by cognitive impairment (13%). There were three deaths because of infection. This study shows a heterogenous spectrum of SAIDs with a high number of genetically confirmed monogenic diseases; notably, LACC1 associated diseases. Hopefully, this work will be the first step for a prospective registry for SAIDs in Arab countries.

Stand-alone renal SLICC criterion with full house glomerular deposits: is it enough for childhood lupus nephritis?

The objective of this study is to assess the usefulness of the stand-alone renal SLICC criterion in patients with childhood systemic lupus erythematosus (cSLE) and report their disease course, treatment response, and outcome. This study included children who were followed regularly in our lupus clinic with proved full house glomerular immune deposits nephritis and antinuclear (ANA), or anti-double-stranded DNA (dsDNA). They were compared with patients who diagnosed with cSLE with and without biopsy proven nephritis, based on Systemic Lupus International Collaborating (SLICC). The comparative group selected by systematic sampling from our cSLE database; the first patient was chosen randomly, and the subsequent patients chosen at intervals of three. The two groups were compared in respect to demographic data, clinical and laboratory findings, and disease course including response to treatment and outcome using urine protein/creatinine ratio, eGFR, and urine sediments. A total of 37 patients were assessed, six patients met the stand-alone renal SLICC criterion, 18 patients had cSLE with biopsy proven nephritis, and 13 cSLE patients without biopsy proven nephritis. Age of onset and time to diagnosis were comparable. However, patients with stand-alone renal criterion had significantly higher baseline serum creatinine, urine protein/creatinine ratio, and lower ANA titer (p < 0.05). Furthermore, none of the patients had other lupus manifestations. Four patients showed partial response to treatment. Two patients had renal impairment and one patient developed end-stage renal disease. Patients with full house glomerular immune deposits nephritis and ANA, or anti-dsDNA reflect a different disease spectrum with severe renal manifestations and worse outcome. Further large prospective study is required to revisit the validity of the stand-alone renal SLICC criterion in cSLE. KEY POINTS : • There is no definite diagnostic tool for SLE. Furthermore, to date there are no specific classification criteria for cSLE. • It seems that patients who met the stand-alone renal SLICC criterion might represent a distinct disease spectrum with severe renal involvement.

Combination of tacrolimus and mycophenolate mofetil in persistent proteinuria due to refractory childhood lupus nephritis

Background

Children with lupus nephritis particularly, diffuse proliferative and membranous glomerulonephritis, may necessitate potent immunosuppressive medications and occasionally combined therapy.

Objective

To report the beneficial effects of tacrolimus (TAC) in children with refractory lupus nephritis from a single tertiary pediatric rheumatology clinic.

Methods

This is a retrospective case series of children with refractory lupus nephritis treated with TAC after failure of aggressive immunosuppressive treatment. All patients were evaluated at the time of initiation of TAC and at last follow-up visit by assessing the following response parameters: cSLE Disease Activity Index (SLEDAI), urine protein/creatinine ratio, urine sediments, serum albumin, complement (C₃ and C₄), anti-double-stranded DNA (dsDNA) antibody levels, and renal function assessed by glomerular filtration rate (eGFR).

Results

Three children (two girls and one boy) with lupus nephritis and persistent nephrotic-range proteinuria failed prednisone treatment as well as sequential treatment of cyclophosphamide, mycophenolate mofetil (MMF), and rituximab. When TAC was administered along with MMF and prednisone, all patients showed improvement in response parameters, namely, SLEDAI, serum albumin, and proteinuria, and prednisone doses were significantly weaned off and discontinued in two patients. However, eGFR remained stable during the treatment period. TAC was well tolerated, and no adverse effects were observed.

Conclusion

TAC combined with MMF can be considered as an alternative therapeutic option for children with refractory lupus nephritis particularly those with persistent nephrotic-range proteinuria.

Catalase expression mediates redox regulation of autophagy and promiscuous gene expression in thymic stromal cells

T lymphocytes develop in the thymus, where mutually inductive signaling between lymphoid progenitors and thymic stromal cells (TSCs) directs progenitors along a well-characterized differentiation program. However, the biology of stromal cells comprising the lymphopoietic thymic microenvironment remains relatively under-characterized because stromal cells are rare and difficult to isolate. Using a deconvolution technique to study gene expression essentially in situ, we previously identified a deficiency in the peroxide quenching enzyme catalase (CAT) in thymic stromal cells, and found that CAT deficiency results in high reactive oxygen species (ROS) levels in this population, eventually leading to thymic atrophy in aged mice. Here, we find that when catalase deficiency is complemented by overexpression targeted to mitochondria in transgenic mice (mCAT Tg), both ROS levels and stromal function decline in young mice relative to non-transgenic littermates. TSC transcriptome analysis reveals decreased expression of tissue-restricted antigen (TRA) and autophagy pathway genes in mCat Tg mice. Analysis of autophagy flux reporter mice ubiquitously expressing the RFP-EGFP-LC3 fusion transgene also indicates diminished autophagic flux in mCAT Tg mice, particularly in TSCs. Stromal TRA expression and autophagic flux are required for self-antigen presentation, and therefore promote negative selection of potentially auto-reactive T cells. We propose that oxidative stress generated by low catalase levels in stromal cells promotes these key physiological functions in the young, steady state thymus; in contrast however, the resulting accumulated oxidative damage ultimately impairs function in the aged thymus.

Micro- and Nanoparticles for Treating Cardiovascular Disease

Cardiovascular disease, including myocardial infarction (MI) and peripheral artery disease (PAD), afflicts millions of people in Unites States. Current therapies are insufficient to restore blood flow and repair the injured heart or skeletal muscle, respectively, which is subjected to ischemic damage following vessel occlusion. Micro- and nano-particles are being designed as delivery vehicles for growth factors, enzymes and/or small molecules to provide a sustained therapeutic stimulus at the injured tissue. Depending on the formulation, the particles can be injected directly into the heart or skeletal muscle, or accumulate at the site of injury following an intravenous injection. In this article we review existing particle based therapies for treating MI and PAD.

IFPA meeting 2015 workshop report IV: placenta and obesity; stem cells of the feto-maternal interface; placental immunobiology and infection

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialised topics. At the 2015 IFPA annual meeting there were 12 themed workshops, three of which are summarized in this report. These workshops related to various aspects of placental biology and collectively covered areas of obesity and the placenta, stem cells of the feto-maternal interface, and placental immunobiology and infection.

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer

The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.

Phenotypic and Functional Characterization of Mesenchymal Stem/Multipotent Stromal Cells From Decidua Parietalis of Human Term Placenta

Mesenchymal stem/multipotent stromal cells (MSCs) from the human placenta show stem cell-like properties useful for regenerative medicine. Previously, we reported that MSCs isolated from the fetal part of human term placentae have characteristics, which make them a potential candidate for regenerative medicine. In this study, we characterized MSC isolated from the maternal part of human term placenta. The MSCs were isolated from the decidua parietalis (DPMSCs) of human placenta using a digestion method and characterized by colony-forming unit assay and the expression of MSC markers by flow cytometry technique. In addition, DPMSC differentiation into the 3 mesenchymal lineages was also performed. Moreover, the gene and protein expression profiles of DPMSCs were identified by real-time polymerase chain reaction and flow cytometry techniques, respectively. Furthermore, proteins secreted by DPMSCs were detected by sandwich enzyme-linked immunosorbent assays. Finally, the proliferation and migration potentials of DPMSCs were also determined. The DPMSCs were positive for MSC markers and negative for hematopoietic and endothelial markers, as well as costimulatory molecules and HLA-DR. Functionally, DPMSCs formed colonies and differentiated into chondrocytes, osteocytes, and adipocytes. In addition, they proliferated and migrated in response to different stimuli. Finally, they expressed and secreted many biological and immunological factors with multiple functions. Here, we carry out an extensive characterization of DPMSCs of human placenta. We report that these cells express and secrete a wide range of molecules with multiple functions, and therefore, we suggest that these cells could be an attractive candidate for cell-based therapy.

Awareness, Attitudes, and Practices Related to Coronavirus Pandemic Among Public in Saudi Arabia

New cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) were reported in Gulf countries in 2014, and to date, it has reportedly infected 837 people and killed 291 globally. Awareness of an individual's knowledge and being able to predict his or her behavior is crucial when evaluating clinical preparedness for pandemics with a highly pathogenic virus. The aim of this study was to identify awareness, attitudes, and practices related to MERS-CoV among the public in Saudi Arabia. A cross-sectional study of 1147 adult subjects recruited from various shopping malls in Riyadh was conducted. All the subjects were interviewed using a questionnaire that tested their knowledge, attitudes, and use of precautionary measures in relation to the MERS-CoV pandemic. The majority of the participants showed high levels of concern and had utilized precautionary measures. After adjusting for other variables, gender was the only significant predictor of the level of concern (P < .001), while knowledge was the significant predictor of both the level of concern and precaution (P < .001). High concern translated into a higher compliance with precautionary recommendations. Frequent communication between health care providers and the public is recommended to help dispel myths about the disease and to empower the public with the information needed to help the Saudi government in containing the disease outbreak.