Spectrofluorimetric determination of vitamin D in the serum of autistic and healthy children using functionalized graphene quantum dots

Vitamin D is one of the most essential nutrients for brain development, and deficiencies during pregnancy and early childhood development might be associated with autism. Regular monitoring of serum 25-hydroxyvitamin D3 level could help in early diagnosis and therapy. Analytical measurement of serum 25-hydroxyvitamin D3 level using the traditional matrix-matched calibration technique yields inaccurate results due to absence of serum matrix free from 25-hydroxyvitamin D3. The aim of this work was to develop a validated spectrofluorimetric methodology based on the standard addition approach for quantifying 25-hydroxyvitamin D3 levels in real serum samples of autistic children. The spectrofluorimetric methodology utilizes functionalized graphene quantum dots as a fluorescent probe for selective quantification of 25-hydroxyvitamin D3 level, which is based on measuring the quenching properties of 25-hydroxyvitamin D3 on a fluorescent probe. The standard addition approach exhibits a minimal matrix interference since it identically utilizes the same matrix of each study sample for creating its own calibration curve. The method was validated using the guidelines outlined in ICH M10 draft for endogenous compounds quantification. The method was successfully applied for quantifying the serum 25-hydroxyvitamin D3 levels in autistic and healthy children, and autistic children had significantly lower serum 25-hydroxyvitamin D3 levels (with a mean ± SD of 23.80 ± 17.19) when compared to healthy children (with a mean ± SD of 50.13 ± 18.74, P < 0.001). These results suggested an association between vitamin D deficiency and autism.

The Efficacy of Sodium Phytate as a Natural Chelating Agent in Reducing Elevated Calcium Levels in Nasal Mucus Among Individuals Experiencing Olfactory Dysfunction Following COVID-19: A Prospective Randomized Double-Controlled Clinical Trial

BACKGROUND

COVID-19 has been associated with olfactory disturbances in many infected patients. The increase in calcium levels in nasal secretions plays an essential role in the olfactory process with a desensitizing effect on olfactory receptor neurons and negative effects on odor transmission. Calcium chelating agents have the ability to bind calcium in nasal mucus and prevent the negative effects associated with calcium increase.

OBJECTIVES

The aim of this work is to demonstrate the intra-nasal topical application of sodium phytate, an environmentally friendly, non-harmful calcium chelating agent, to reduce the adverse effects of calcium on olfactory function and improve olfactory dysfunction according to COVID-19.

METHODS

Fifty-two patients with a previous COVID-19 and olfactory dysfunction lasting longer than 90 days were enrolled in a prospective, randomized, blinded, controlled clinical trial. Patients were divided into two equal groups: 26 patients received nasal spray containing 0.9% sodium chloride and 26 patients received nasal spray containing 1% sodium phytate. Olfactory function was measured before treatment and 1 month later using the Sniffin' Sticks test. Calcium content of nasal secretions was determined before and after treatment with an ion-selective electrode.

RESULTS

A significant improvement from anosmia to hyposmia was demonstrated after the use of sodium phytate compared with no improvement after the use of sodium chloride. In addition, a decrease in the level of calcium in nasal secretions was observed after the use of sodium phytate.

CONCLUSION

Sodium phytate has benefit role on improving the olfactory function after COVID-19.

Evaluating Adherence to Therapeutic Drug Monitoring Guidelines for Gentamicin in Neonatal Care: A Retrospective Study at the Maternity and Children's Hospital in Makkah

In this study, we assess healthcare providers' adherence to therapeutic drug monitoring (TDM) guidelines for gentamicin in neonates. Conducted at the Maternity and Children's Hospital in Makkah, Saudi Arabia, from July 2020 to July 2022, it retrospectively analyzed the compliance of healthcare workers in managing neonates treated with gentamicin. Covering 410 neonates, primarily diagnosed with respiratory distress (56%) and sepsis (32%), the study revealed that while a majority of trough and peak levels conformed to guidelines, substantial deviations were noted in cases of respiratory distress. This underlines the necessity for targeted TDM strategies, particularly in managing respiratory distress in neonates, to ensure optimal treatment efficacy and safety. The findings urge stringent compliance with TDM guidelines, emphasizing personalized approaches in neonatal gentamicin therapy for improved healthcare outcomes.

Exploring the role of copper and zinc in chronic otitis media: A novel spectrofluorometric method for precise determination and association study

Chronic otitis media is a common condition characterized by fluid accumulation in the middle ear, leading to a perforated eardrum and persistent middle ear drainage. Despite its impact on global health, the role of heavy metals, particularly copper and zinc, in its development and progression remains understudied. Herein, a spectrofluorometric method was developed for the precise determination of copper and zinc in human plasma samples and investigate their association with chronic otitis media. The method involves the use of the fluorescent probe 6,7-dihydroxy-4-phenylcoumarin to selectively quantify copper through fluorescence quenching and zinc through fluorescence enhancement with a remarked bathochromic shift. The method was validated and exhibited good linearity over a concentration range of 100-3000 ng/mL for copper and 200-5000 ng/mL for zinc. Application of the method to healthy volunteers and patients with chronic otitis media revealed significantly decreased copper and zinc levels in patients with chronic otitis media compared to the healthy individuals. These findings shed light on the involvement of copper and zinc in the pathogenesis of chronic otitis media and open avenues for additional treatment approaches.

Novel spectrofluorometric method utilizing functionalized carbon quantum dots for determining histamine levels in nasal secretions: Implications for allergic rhinitis

Histamine plays a crucial role in regulating various physiological functions and is significantly involved in the development of allergic rhinitis. Accurately measuring histamine levels in nasal secretions can serve as a specific indicator for studying mast cell activation and diagnosing allergic reactions. However, the controversy surrounding histamine levels in nasal secretions during allergenic stimulation suggests potential inaccuracies and imprecision in the analytical methods used, as well as the presence of substances that may interfere with the determination of histamine. In this study, a sensitive and selective spectrofluorometric method was developed using carbon quantum dots (CQDs) derived from beetroot slices, which are non-toxic and eco-friendly materials. These CQDs were functionalized with histamine tetra phenyl borate to determine histamine levels in nasal secretions. Various characterization techniques were employed to confirm the successful synthesis and functionalization of the CQDs. The functionalized CQDs demonstrated enhanced fluorescence and selective interaction with histamine, leading to concentration-dependent fluorescence quenching. The developed method was successfully utilized to compare histamine levels in nasal secretions of healthy individuals and patients with allergic rhinitis. The results showed that the histamine level was significantly higher in patients with allergic rhinitis than in healthy individuals, suggesting a potential association between allergic rhinitis and histamine, (normal vs. patient: 350 ± 20 ng/mL vs. 2520 ± 37 ng/mL, p < 0.05). Furthermore, the proposed spectrofluorometric method exhibited improved linearity range, dynamic range, and detection limit compared to a previously reported spectrophotometric method.

Optimizing anterior laryngeal exposure during direct suspension laryngoscopy in adults

An analysis of the literature on laryngeal exposure during direct suspension laryngoscopy in adults summarized the resources available to improve visualization, specifically at the anterior commissure.

Application of a nucleophilic substitution reaction for spectrofluorimetric determination of aripiprazole in pharmaceutical dosage form and plasma matrix; greenness assessment

Aripiprazole is an antipsychotic medicine used to treat a variety of mental disorders, including irritability linked with autism disorder in children. Herein, a green and highly sensitive spectrofluorimetric method was developed for the determination of aripiprazole in pharmaceutical dosage form and plasma matrix. The method based on the formation of a fluorescent adduct from the nucleophilic substitution reaction of 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-chloride) with aripiprazole, which can be detected at 542 nm following excitation at 481 nm. Factors that affect the development and fluorescence sensitivity of the reaction product were investigated and optimized. The reaction yielded the most optimal fluorescence responses when it was performed using 1.5 mL of 0.2 % w/v NBD-chloride, 1.5 mL of borate buffer pH 9, heating at 80 °C for 20 min, and ethanol as a diluting solvent. The method was validated as per ICH guidelines for analytical and bioanalytical procedures. Good linearity was established between the fluorescence responses of the reaction product and aripiprazole concentrations in the range of 100-1200 ng/mL with adequate accuracy and precision results. The applied method was very sensitive and selectively determined aripiprazole in pharmaceutical and plasma matrices with no interferences. Furthermore, the compliance of the proposed method with the principles of green analytical chemistry was evaluated in comparison with the reported method using analytical eco-scale and AGREE metrics. The outputs proved that the proposed method complied more with the principles of green analytical chemistry than the reported method.

Spectrofluorometric quantitative analysis of aripiprazole based on quenching of natural derived carbon quantum dots in spiked human plasma

Autism spectrum disorder is a significant concern worldwide, particularly in Middle Eastern countries. Aripiprazole, a psychiatric medicine that works as a partial agonist at D2 receptors, is often used for autism-related behavior issues in children. Monitoring the therapy of aripiprazole could enhance the safety and effectiveness of treatment for autistic individuals. The purpose of this study was to develop a highly sensitive and environmentally friendly method for analysis of aripiprazole in plasma matrix. To achieve this, water-soluble N-carbon quantum dots were produced from a natural green precursor, guava fruit, and used in fluorescence quenching spectroscopy to determine the presence of aripiprazole. The synthesized dots were analyzed and characterized using transmission electron microscopy and Fourier transform infrared spectroscopy, and they showed a strong fluorescence emission peak at 475 nm. The proposed method was validated according to ICH M10 guidelines and was shown to be highly sensitive, allowing for nanoscale determination of aripiprazole in plasma matrix. Additionally, the method was compared to a previously reported spectrophotometric method, and it was found to be more sensitive and consistent with the principles of green analytical chemistry.

Guava-fruit based synthesis of carbon quantum dots for spectrofluorometric quantitative analysis of risperidone in spiked human plasma and pharmaceutical dosage forms

Autism is one of the most pressing issues facing the international community in recent years, particularly in Middle Eastern countries. Risperidone is a selective serotonin type 2 and dopamine type 2 receptor antagonist. It is the most administered antipsychotic medication in children with autism-related behavioral disorders. Therapeutic monitoring of risperidone may improve safety and efficacy in autistic individuals. The main objective of this work was to develop a highly sensitive green fitted method for the determination of risperidone in the plasma matrix and pharmaceutical dosage forms. Novel water-soluble N-carbon quantum dots were synthesized from guava fruit, a natural green precursor, and used for determination of risperidone based on quenching fluorescence spectroscopy phenomena. The synthesized dots were characterized by transmission electron microscopy and Fourier transform infrared spectroscopy. The synthesized N-carbon quantum dots exhibited aquantum yield of 26.12% and showed a strong emission fluorescence peak at 475 nm when excited at 380 nm. The fluorescence intensity of the N-carbon quantum dots decreased with increasing risperidone concentration, indicating that the fluorescence quenching was concentration dependent. The presented method was carefully optimized and validated according to the guidelines of ICH, and it demonstrated good linearity in a concentration range of 5-150 ng mL-1. With a LOD of 1.379 ng mL-1 and a LOQ of 4.108 ng mL-1, the technique was extremely sensitive. Due to the high sensitivity of the proposed method, it could be effectively used for the determination of risperidone in the plasma matrix. The proposed method was compared with the previously reported HPLC method in terms of sensitivity and green chemistry metrics. The proposed method proved to be more sensitive and compatible with the principles of green analytical chemistry.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a developing country

Background

The characteristics of premature infants vary from country to country rendering it challenging to apply retinopathy of prematurity (ROP) screening algorithm globally. The screening criteria for postnatal growth and ROP (G-ROP) for preterm infants are known to be beneficial, but it is not clear whether these criteria can be used universally.

Aim

The aim of this study is to validate the accuracy of the G-ROP criteria in screening preterm infants in Saudi Arabia.

Subjects and Methods

This single-center retrospective study included 300 premature infants (mean gestational age [GA], 28.72 ± 2.2 weeks; range, 21-36 weeks) at a referral center who were screened for ROP between 2015 and 2021. The inclusion criteria were the availability of data on ROP outcome and body weight up until day 40 after birth. The G-ROP 1 and G-ROP 2 models were examined for their ability and accuracy in identifying infants with any stage ROP and treatable ROP.

Results

The G-ROP 1 and G-ROP 2 models identified 233 and 255 infants for screening, respectively. The sensitivity of G-ROP 1 and G-ROP 2 for detecting treated ROP was 96.7% and 100%, respectively, and the specificity for detecting treatable ROP was 24.4% and 16.7%, respectively. Incorporation of the G-ROP 2 model, which did not miss any infant with type 1 ROP, would have reduced the number of screened infants by 15%.

Conclusion

G-ROP 2 was more sensitive than G-ROP 1 for identifying infants who required treatment and could potentially reduce the burden of ROP screening.

An in silico analysis of the impact of POLE mutations on cladribine docking

OBJECTIVE

Polymerase ε exonuclease (POLE) is an enzyme involved in DNA replication and may be an attractive therapeutic target in various cancers. Here we sought to model the impact of specific POLE mutations on protein function. Due to the lack of a crystal structure, the tertiary structures of the wild type and four common mutants were modeled using I-Tasser server.

MATERIALS AND METHODS

Molecular docking and dynamic simulation studies were performed, and the structure and function of the mutants analyzed through residue conservation analysis and protein folding energy changes.

RESULTS

All mutants of POLE gene had favorable binding affinities compared with their wild type of counterpart. The P286R variant, but not the other variants, disrupted cladribine binding to the protein. Similarly, dynamics studies revealed instability of the P286R mutant, while V411L, L424V, and L424F appeared to favor cladribine binding.

CONCLUSIONS

Since P286R is a hotspot mutation in endometrioid carcinomas, patients with this variant may not respond to cladribine. Population-based pharmacogenomics studies will be required to validate our results.

Adherence to Hormonal Therapy in Breast Cancer Patients in Saudi Arabia: A Single-Center Study

Breast cancer is one of the most common types of cancer in women. Approximately three-quarters of all breast cancer patients have estrogen and/or progesterone receptor positivity. As a result, the majority of patients receive hormonal treatment for between five and 10 years. Long-term use of hormonal therapy reduces the recurrence rate and the risk of death. In Saudi patients, adherence to hormonal therapy is not adequately assessed. The primary objective of this study is to determine the clinical outcomes associated with hormonal therapy adherence in breast cancer patients.

This is a retrospective cohort study of patients who received adjuvant hormonal therapy for hormone-receptor-positive breast cancer. Patients were included if they had received at least two prescription refills following their breast cancer diagnosis. The primary outcome measure was mortality and disease progression in relation to hormonal therapy adherence. Progression of disease is defined as local recurrence or radiographic evidence of metastatic disease. The secondary outcome measure was the study population's adherence to hormonal therapy. The proportion of days covered during hormonal therapy was used to assess adherence (PDC). PDC was calculated as the number of days in the prescription period divided by the total number of days in the prescription period. Patients are considered adherent if their PDC value is greater than 0.8. The mortality and disease progression curves were generated using the Kaplan-Meier method. The proportion of patients adhering to hormonal therapy was determined using descriptive analysis. The IRB granted approval. A total of 121 patients were included in the study from the 380 patients screened. Tamoxifen, letrozole, and anastrozole were administered to 58%, 27%, and 14% of patients, respectively. The median age was 53 years. Women who were postmenopausal constituted 52.3% of the study population. The majority of patients were in Stages II and I (56.2% and 16.53%, respectively). The majority of the tumors were Grade II (58.68 %). Adherence was not associated with disease progression (HR, 0.66; 95% CI, 0.25-1.72) or mortality (HR, 1.391; 95 percent CI, 0.33-5.82). Disease progression and mortality were not found to be significantly associated with hormonal therapy adherence in this study. A larger study is required to confirm the findings of our study.

Frequency of ocular manifestations in multiple sclerosis patients admitted in tertiary care hospital in Saudi Arabia

OBJECTIVE

Multiple Sclerosis (MS) is one of the most destructive demyelinating diseases of the nervous system, and it manifests through broad involvement of the visual system. The present study was aimed to evaluate the frequency of ocular symptoms among MS patients admitted to the Kingdom Hospital in Saudi Arabia PATIENTS AND METHODS: This is a cross-sectional study aiming at investigating the prevalence of eye disease among MS patients referred to Hawtat Sudair Hospital, Zulfi General Hospital, Majmaah General Hospital, and Kingdom Hospital in Riyadh (Saudi Arabia) from January 2020 to December 2020. The sample size was made of 100 MS patients including 50 males and 50 females, all presented with eye disorders. The data were analyzed with SPSS 25, Chi-square test, and descriptive statistics.

RESULTS

The examined patients included 100 patients with MS symptoms aged 35 years, ranging from 20 to 70 years. The results showed a considerable lack of sharpness of vision among patients (80%), and the rate of double vision was reported to be about 49% among them which was the most prevalent vision problem from the onset of the disease until the examination time.

CONCLUSIONS

The achieved data from this study demonstrated that multiple sclerosis could cause eye diseases. Initial recognition of this syndrome provides the possibility of having an appropriate evaluation of patients to clinicians. Moreover, after the prevalence of MS, other ocular symptoms may occur consequently.

Dispensing Practices for Weight Management Products in Eastern Saudi Arabia: A Survey of Community Pharmacists

Due to changing lifestyles and socioeconomic status, obesity prevalence has been rising in Saudi Arabia, and community pharmacists often counsel patients about its management. The study aimed to evaluate practices of community pharmacists involved in dispensing products for weight control in four cities located in the eastern province of Saudi Arabia. A cross-sectional study was conducted involving community pharmacists in Dammam, Dhahran, Khobar, and Al-Ahsa, using a Likert format questionnaire. Only those who consented to participate were handed the questionnaire. A total of 100 complete responses were analyzed. The median value for packs sold per month for tea containing products Al-Diafa Slimming Tea, Jamue Tea, and Green Tea was ≥6 while the same for orlistat and apple cider vinegar were ≤4. Moreover, >50% of pharmacists mentioned that orlistat and apple cider vinegar were effective while ≥35% mentioned that metformin and Jamue tea were effective. Furthermore, ≥25% mentioned that green tea and Al-Diafa slimming tea were effective. Excluding orlistat, >50% of pharmacists did not know about adverse effects for other products. The rate of dispensing of several weight loss products was significant for participants’ background characteristics, such as time duration of consultation, gender, and age of patients, and pharmacist work experience (p < 0.05). The tea products and orlistat were the most frequently sold products, and community pharmacists appeared most knowledgeable about the effectiveness and adverse effect of orlistat. The pharmacists seemed to be aware about the effectiveness of other weight loss products; however, their knowledge about their potential adverse effects was unsatisfactory.

Comparison of MALDI-TOF mass spectrometry with phenotypic methods for identification and characterization of Staphylococcus aureus causing mastitis

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection is one of the greatest threats to both animal and human health. Our investigation was aimed to identify and differentiate between MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) recovered from mastitic milk using MALDI-TOF mass spectrometry compared with phenotypic methods and studying their susceptibility to various antibiotics. Four hundred milk samples from mastitic animals (cows, sheep, goats, and dromedary camels) were investigated. Phenotypic identification of S. aureus was made through MASTASAPH Latex test, STAPH ID 32, and Vitek 2 system. The proteomic characterization of S. aureus was done by MBT. The Kirby Bauer method was accomplished to detect the resistance of S. aureus strains to antibiotics. The results of the MASTASAPH Latex test, revealed that 54 (46%) were recognized as S. aureus. All S. aureus isolates were identified by MBT with a score of more or equal 2.00. Several peaks were identified in the mass of 4590 Da, 4863 Da, and 4938 Da for MSSA and in the mass of 2636 Da and 3009 Da for MRSA. The MSP dendrogram demonstrated that the S. aureus isolates were classified into one group with a distance level of less or equal 400. The percentage of S. aureus resistance against carbenicillin, erythromycin and kanamycin was 94.4%, 38.88%, and 33.33%, respectively. In conclusion, S. aureus bacteria are among the key triggers for mastitis in Saudi Arabia. MBT is reported to be not only the rapid tool to identify S. aureus but also able to discriminate MRSA from MSSA.

Dental anxiety, child-oral health related quality of life and self- esteem in children and adolescents: a systematic review and meta-analysis

AIM

To identify the directions, strength and associations between dental anxiety, COHRQoL and self-esteem in children and adolescents.

BASIC RESEARCH DESIGN

PRISMA guidelines were followed and the review registered (PROSPERO CRD42019140037). MEDLINE, Cochrane Library, Scopus, Science Direct, CINAHL, Joanna Briggs Institute (JBI), Grey Literature Report, and British Library EThOS using MeSH terms and keywords were searched. Three reviewers examined the abstracts of all articles, excluded duplicates and those not meeting inclusion criteria. All full-text papers were read by all reviewers. Meta-analysis association data including Pearson's or Spearman's correlation coefficient were extracted and effect sizes estimated.

RESULTS

Twelve papers met the inclusion criteria, 7 assessed the relationship between child dental anxiety and COHRQoL; four between COHRQoL and self-esteem and one between child dental anxiety and self-esteem. Significant relationships were found between COHRQoL and the other child-related outcomes measures. An inverse relationship was shown for dental anxiety and COHRQoL. The meta-analysis found small associations between child dental anxiety and COHRQoL and moderate associations between COHRQoL and self-esteem. High heterogeneity between COHRQoL and self-esteem was noted. The association between child dental anxiety and self-esteem was limited. No source reported associations between all three variables.

CONCLUSION

The studies were of varying quality and the degree of heterogeneity meant that only limited conclusions were possible. There is a need for high-quality evidence to underpin intervention designs to promote COHRQoL and self-esteem to reduce child dental anxiety.

Mode of bond failure between 3D-printed denture teeth and printed resin base material: effect of fabrication technique and dynamic loading. An in-vitro study

PURPOSE

To evaluate the failure load of 3D-printed denture resin material and teeth before and after dynamic loading.

MATERIALS AND METHODS

A total of 40 specimens were fabricated following ISO/TS 19736 and were divided into two equal groups. In the test group, the cylindrical base and denture teeth were 3D printed separately and then luted together. In the control group, the specimens were fabricated from conventional heat-cured polymethyl methacrylate (PMMA) and commercially available denture teeth using the compression-molding technique. Ten specimens from each group were subjected to dynamic load of 50 N for 250,000 cycles in a chewing simulator. All specimens were subjected to static load of 50 N using Instron machine with a crosshead speed of 1 mm/minute until fracture. The fractured surfaces were analyzed using field emission scanning electron microscopy. The failure loads were calculated and compared using analysis of variance (P < .05).

RESULTS

All specimens survived the loading, undergoing 250,000 cycles without fracture. The mean failure load was influenced by fabrication technique and was significantly higher for the 3D-printed test group (P = .028). 3D-printed teeth showed a mixed mode of fracture, whereas in the control group, the specimens showed cohesive fracture within the teeth.

CONCLUSION

The fabrication technique has an influence on the mode of failure between acrylic teeth and resin base material. Cohesive failure in teeth was predominant in the conventional group, suggesting possibly higher bond strength between the teeth and resin base in this group. The observed failure modes reveal that both fabrication techniques exhibited satisfactory bond strength. Chewing simulation did not significantly influence the bond strength of any of the tested groups.

The Psychological Impact of COVID-19 on Healthcare Workers in Saudi Arabia: A Year Later Into the Pandemic

Objective: The COVID-19 pandemic poses unprecedented challenges to healthcare workers worldwide. This study sought to estimate the prevalence of depression, anxiety, and stress among healthcare workers in Saudi Arabia, and to identify the factors associated with these psychological disorders. Methods: A cross-sectional questionnaire-based study was conducted from January 21 to March 2, 2021. Physicians, pharmacists, nurses, and other healthcare workers from different parts of Saudi Arabia were recruited through snowball sampling. Psychological outcomes were measured using the Depression, Anxiety, and Stress Scale (DASS-21). Pearson's chi-square test was used to explore the bivariate association between diverse characteristics and each outcome. Multiple logistic regression analyses were performed to identify factors associated with depression, anxiety, and stress. Results: A total of 501 healthcare workers completed the survey, of whom 60% were female and nearly half were pharmacists. The majority (76.25%) of respondents reported that a family member, friend, or colleague had contracted COVID-19, and more than one-third (36%) knew someone who died due to COVID-19. Overall, the estimated prevalence rates of depression, anxiety, and stress were 54.69, 60.88, and 41.92%, respectively. The multivariate analysis revealed that healthcare workers with chronic diseases, nurses, and healthcare workers from the southern region were more likely to suffer from depression and stress. Further, individuals with positive COVID-19 test results showed a greater proportion of depressive symptoms compared to others. In addition, knowing someone who died due to COVID-19 and having a chronic illness were predisposing factors for anxiety. Conclusion: After more than a year, the prevalence of depression, anxiety, and stress remains substantial among healthcare workers in Saudi Arabia. The findings can help guide efforts to mitigate the psychological impact of the pandemic.

Health Literacy, Perceived Threat, and Posttraumatic Stress Disorder During the COVID-19 Pandemic in Saudi Arabia

Purpose

This study aimed to investigate the prevalence of and factors associated with posttraumatic stress disorder (PTSD) during the COVID-19 pandemic in Saudi Arabia.

Materials and Methods

This was a cross-sectional online survey that targeted adults over the age of 18 residing in Saudi Arabia. The data collection began June 1, 2020 and continued for four weeks. The Posttraumatic Stress Disorder Checklist-Specific, the Brief Illness Perception Questionnaire version BIP-Q5, and a 9-item health literacy measure were used.

Results

There were 1249 participants, of which 62.21% were under the age of 34. The prevalence of PTSD was 19.5% among all participants. The results showed that both the perception of threat (OR =1.17, 95% CI = 1.13−1.19) and health literacy (OR =0.97, 95% CI = 0.95−0.99) were associated with PTSD symptoms.

Conclusion

This study highlights important findings that the level of an individual’s perception of threat and health literacy is associated with symptoms of PTSD. Thus, an understanding of these constructs in the target population will enable the development of better measures designed to reduce the psychological impact of the COVID-19 pandemic.

Prevalence of post-traumatic stress disorder during the COVID-19 pandemic in Saudi Arabia

Background

The coronavirus diseases of 2019 (COVID-19) pandemic was classified as one of the worst pandemics in the 21st century. Its rapid transmission, unpredicted mortality rate, and the uncertainty surrounding its transmission method have evoked additional fear and anxiety. Nonetheless, to the best of our knowledge, no prior study has explored PTSD prevalence three months after the start of the quarantine procedures in Saudi Arabia nor has examined PTSD prevalence by three different methods.

Objective

This observational cross-sectional study aimed to identify the prevalence, severity, and influencing factors of PTSD in different regions of Saudi Arabia three months after the onset of the quarantine procedures related to the COVID-19 pandemic.

Methods

Through the month of June 2020, 1374 people (49.05% men and 50.95% women) completed a 35-item, 10-minute online. The prevalence of PTSD was measured using PCL-S (specific for COVID-19) that assesses the 17 symptoms of PTSD. Resilience was measured using 2-items Arabic version of the Connor-Davidson Resilience Scale 2 (CD-RISC 2).

Results

We calculated the prevalence by three methods, namely, PTSD cut-off score, criteria, and combined, and the prevalence was 22.63%, 24.8%, and 19.6%, respectively. Female participants showed higher prevalence than male. As well, participants who were either tested positive or suspected of having been infected with COVID-19 showed higher PTSD prevalence. Higher resilience was associated with lower PTSD prevalence.

Conclusions

This was the first study to report PTSD prevalence by three differential methods three months after the onset of the quarantine procedures related to the COVID-19 pandemic in Saudi Arabia. We observed a significant impact of the COVID-19 pandemic in the Saudi population; therefore, great attention should be performed in implementing new procedures that deal with the highlighted risk factors, especially in vulnerable groups, to overcome the psychological impact of the COVID-19 pandemic.

Melioidosis: Case reports of confirmed Burkholderia pseudomallei in Saudi Arabia

Melioidosis is an infectious disease of tropical climates. The disease is caused by the bacterium Burkholderia pseudomallei. Most cases are diagnosed in southeast Asia and northern Australia. Some imported cases diagnosed in returning tourists, soldiers, and immigrants from endemic areas. It caught much attention since the Centers for Disease Control and Prevention (CDC) designated B. pseudomallei as an agent for biological warfare and terrorism. We describe two cases of a 26-year-old Saudi woman who had fulminant sepsis soon after returning from Thailand & a 48-year-old woman with a long history of fever. B. pseudomallei was isolated from both patients blood cultures, and they had different consequences. A confirmed case of melioidosis was not reported before in Saudi Arabia.

Cost-Effectiveness of More Intensive Blood Pressure Treatment in Patients with High Risk of Cardiovascular Disease in Saudi Arabia: A Modelling Study of Meta-Analysis

OBJECTIVE

The current literature suggests that more intensive blood pressure (BP) treatment is clinically more effective than less intensive treatment in patients at high risk for cardiovascular disease (CVD). In this analysis, we evaluated the potential clinical benefit and cost-effectiveness of more intensive BP treatment in patients at high risk of developing CVD over their lifetimes.

METHODS

A Markov state-transition model was developed for the BP strategies to estimate the lifetime incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) using evidence published from a meta-analysis. The other model inputs were retrieved from previous studies. Estimated costs were collected from five hospitals in Riyadh. The model used a lifetime framework adopting Saudi payer perspective and applied a 3% annual discount rate. Sensitivity analysis was conducted using one-way and probabilistic sensitivity analysis (PSA) to evaluate the robustness and uncertainty of the estimates.

RESULTS

Treating 10,000 patients with high CVD risk with more intensive BP therapy would avert a total of 873 CV events over their remaining lifetimes as compared with a less intensive strategy. The projections showed that more intensive BP therapy would be cost-effective compared to the less intensive strategy with incremental costs per QALY of $20,358. Probabilistic sensitivity analysis suggested more intensive control would be cost-effective compared with the less intensive control of BP 87.25 % of the time.

CONCLUSION

The result of this study showed that more intensive BP treatment appears to be a cost-effective choice for patients with a high risk of CVD in Saudi Arabia when compared with a less intensive BP strategy. Thus, this finding provides strong evidence for the adoption of this strategy within the Saudi healthcare system.

The contribution of platelets in the production of cryoprecipitates for use in a fibrin glue

BACKGROUND AND OBJECTIVES

Cryoprecipitate has a wide application for use as a fibrin glue. In some situations, platelets are added to the preparation in order to enhance the fibrin glue.

MATERIALS AND METHODS

Fresh plasma was collected by apheresis from the same donor to produce 250 ml of platelet-rich plasma (PRP) or platelet-poor plasma (PPP) (n = 12 each). Cryoprecipitate was then produced following the standards of the American Association of Blood Banks and resuspended to a total volume of 8 ml, from which aliquots were removed and assayed. Clot formation was measured using the thromboelastogram.

RESULTS

The protein content of the two preparations was identical for PRP and PPP. Results for fibrinogen (PPP 475 +/- 220 mg; PRP 399 +/- 215 mg), Factor VIII (PPP 186 +/- 67 IU; PRP 175 +/- 70 IU) and von Willebrand Factor (PPP 260 +/- 104 IU; PRP 221 +/- 88 IU) were not significantly different. The concentration of platelet-derived growth factor was markedly higher (a 100-fold increase at 3778 +/- 1036 ng) when platelets were added to the plasma. There was a small, but not statistically significant, difference in the rate of clot formation (R = 2.3 for PPP and 3.8 for PRP) and clot strength (MA = 63.4 for PPP and 56.6 for PRP) between PPP and PRP cryoprecipitates when measured using the thromboelastogram.

CONCLUSIONS

Platelets do not significantly increase the concentration of the usual constituents of cryoprecipitate; however, the levels of platelet-derived growth factor are markedly enhanced. Therefore, there are advantages for using PRP to enhance the growth of new tissue.

Automated collection of blood components: their storage and transfusion

The performance of an automated device, the Gambro TRIMA, was evaluated for component production, and an in vivo assessment of the platelets was carried out. Red cell concentrates (RCCs), platelets and plasma were collected and stored according to standard blood bank procedures and evaluated for quality by in vitro measurements. Additionally, single-donor platelets (n=10) were transfused to thrombocytopenic patients after 5 days of storage. Platelet counts were measured after 1 h and the corrected count increment (CCI) was calculated. No significant changes were seen before or after procedure in donor haemoglobin, haematocrit, coagulation factors or platelet count. Return-line samples showed no increase in the level of plasma haemoglobin. Plasma haemoglobin and potassium increased following RBC storage, but there was no change in the red cell number. Platelet aggregation decreased from 52 to 11% (adenosine diphosphate) and the Kunicki morphology score dropped from 379 to 174. Little change was seen in the hypotonic shock response (69-63%) or in the percentage of CD62 expression (4.8-19.8) over time. The CCI averaged 28+/-26 x 10(3) microL(-1) in 10 patients 1 h after transfusion. The TRIMA machine collects RCCs, platelets and plasma in a variety of combinations in one session. For autologous collection, two units of RCC plus platelets can be collected at one time, reducing administrative and testing costs. The platelets have good in vivo recovery, as shown by the CCI values. An added advantage is that the TRIMA machine can be used in hospitals to generate components in times of shortage without the need for a component's laboratory.