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This study presents a comprehensive genomic analysis of NDM and OXA-48-producing Klebsiella pneumoniae in the Western region of Saudi Arabia, traversed by tens of millions of Muslims from various countries annually. This significant influx of visitors invariably leads to the spread and diversity of MDR bacteria. Genome sequencing was performed using MiSeq system of 29 CPKP isolates that were NDM and OXA-48-positive isolated from nosocomial infections and demonstrated resistance to most antibiotics, including carbapenems. WGS analysis showed that 12 (41.3%) isolates co-harbored bla OXA-48, bla CTX-M-15 and bla NDM genes. Notably, 16 (55.1%) isolates were identified as high-risk clone ST14, with 50% of these isolates co-harbored bla OXA-48 , bla NDM and bla CTX-M-15 genes. All ST14 isolates were identified as capsular genotype KL2 and O1/O2v1 antigen with yersiniabactin locus ypt 14 carried by ICEKp5. The two isolates were identified as ST2096/KL64 hypervirulent K. pneumoniae (hvKp) clone harboring several virulence factors, including the regulator of the mucoid phenotype rmp A2 and aerobactin (iuc-1). Interestingly, two of the hvKp ST383/KL30 isolates were resistant to all tested antimicrobials except colistin and tigecycline, and simultaneously carried numerous ESBLs and carbapenemase genes. These isolates also harbor several virulence factors such as rmp A1, rmp A2, carried on KpVP-1, and aerobactin (iuc-1). this study provides insights into the spread and prevalence of high-risk clones of CPKP in the Western region of Saudi Arabia. The ST14 high-risk clone appears to be the predominant CPKP clone in this region, posing a significant threat to public health. This study also reports the presence of two globally disseminated hypervirulent K. pneumoniae (hvKp) clones, namely ST2096 and ST383. Therefore, it is essential to improve surveillance and implement strict infection control measures in this region, which receives a substantial number of visitors to effectively monitor and reduce the spread of high-risk clones of antimicrobial-resistant bacteria, including CPKP. [ABSTRACT FROM AUTHOR]

The use of complementary and alternative medicine (CAM) by patients with rheumatoid arthritis (RA) is highly prevalent. The relationship of these remedies with disease therapy are not fully studied. We aimed to explore the relationship between different anti-rheumatic drug therapy and CAM use in RA patients. The study used an interview-based cross-sectional survey in two major referral centres in Riyadh, Saudi Arabia. Patients were adults with confirmed RA that attended rheumatology clinics. Information on the utilization of CAM, RA duration, drug therapy, and laboratory parameters were obtained. Descriptive statistics as well as adjusted odds ratio using bivariate logistic regression were used to explore the different factors related to CAM use, including drug therapy. A total of 438 adult patients with RA were included. The mean (±SD) age of the patients was 49 (±15.0) years. The majority were women 393 (89.7%). Two hundred and ninety-two patients (66.7%) had used CAM. The CAM users who had a longer disease duration (AOR 1.041 [95% CI: 1.011, 1.073]; p = 0.008) were more likely to be female (AOR 2.068 [95% CI: 1.098, 3.896]; p = 0.024), and use methotrexate (AOR 1.918 [95% CI: 1.249, 2.946]; p = 0.003) as opposed to celecoxib (AOR 0.509 [95% CI: 0.307, 0.844]; p = 0.009) and biologic monotherapy (AOR 0.443 [95% CI: 0.224, 0.876]; p = 0.019). Other factors related to CAM were meloxicam use (AOR 2.342 [95% CI: 1.341, 4.089]; p = 0.003) and traditional therapy (AOR 2.989 [95% CI: 1.647, 5.425]; p = 0.000). The remaining factors were not significant. CAM use is prevalent in patients with RA. Understanding patients and disease related factors associated with higher use of CAM is warranted to improve RA management and provide more rational use of these remedies. [ABSTRACT FROM AUTHOR]

Nicotiana glauca belonging to the family Solanaceae is an exotic perinnial bushy species that recently has invaded the mountainous areas of Al-Baha region at the south-west of Saudi Arabia, causing degredation to soil and vegetation composition of those mountains. Accordingly, this plant must be either removed or exploited as a source of useful products such as medicines as it has been proven to contain many effective compounds with therapeutic properties. Thus, the current study aimd to screening N. glauca preliminary phytoconsitiuents and its anticmicrobial activity. Results showed that varying amounts of alkaloids, steroid, tannins, flavonoid, were present in the extracts of N. glauca leaves, stems and flowers. Saponins were present only in the flowers extract. However, all previuos bioactive compounds were absent in the roots except alkaloids, therefore, roots posses lesser amount of the phytoconstituents compared to the other parts of the plants. Leaves extracts inhibited the growth of E. coli (16.3 ± 0.71 mm) and also inhibited the growth of S. aureus (11.0 ± 0.23 mm), while, the flower extracts also inhibited the growth of E. coli (6.7 ± 0.65 mm), and also inhibited the growth of S. aureus (15.8 ± 0.52 mm). This result coincide with the previous results of the screening of N, glauca phytochemicals where the highest amounts found in leaves and flowers extracts. The inhibition zone of the antibiotic gentamycin (reference control) were 32 mm in S. aureus and 38 mm in E. coli. The inhibition zone of gentamycin (reference control) were 32 mm in S. aureus and 38 mm in E. coli. The minimum inhibitory concentration (MIC) of ethyl acetate was ranged (1.5–2 mg/ml). The lower MIC is an indication of high effectiveness of extract. Therefore, such bioactive property would support the idea that removing N. glauca from the mountainous areas of Al-Baha, Saudi Arabia, is not the only solution, but the plant can be exploited as a beneficial source of medicinal and economic purposes such as; antibacterial, antifungal and insecticidal, however, further comprehensive exploration is recommended to confirm such propreties. [ABSTRACT FROM AUTHOR]

The wild tree tobacco (Nicotiana glauca) is an alien species that invaded vast areas of the Southwestern region of Saudi Arabia. While, the Red Palm Weevil (RPW) (Rhynchophorus ferrugineus) is considered to be the most damaging invasive insect species of palm trees all over the kingdom of Saudi Arabia, causing major economic losses to farmers and the economy of the country. Using conventional insecticides to control harmful insects such as RPW has undesirable effects on the environment and human health. Alternatively, using biocontrol agents such as poisonous extracts from N. glauca might be a better approach in pest management and can be considered as an eco-friendly, cost-effective, and safe alternative. Therefore, the current study aimed to evaluate the larvicidal effect of N. glauca aqueous extracts against the red palm weevil larvae. The plant specimens were collected from Al-Baha region in the Southwest of Saudi Arabia. Each single test consisted of 20 larvae, and N. glauca preparations were; 1, 1.5, 2, 2.5, and 3 ml, besides the control test. Results obtained for the effect of botanical extracts; leaf, flower, stem and root against R. ferrugineus larvae for an exposure period of 24 hr. at the concentrations of 2.8, 4.2, 6.0, 7.0 and 8.0 ppm. The concentrations for N. glauca extracts reflected an LC 50 of 2.7 ppm for leave, 2.6 ppm for flower, 2.8 ppm for stem and 7.00 ppm for root. While, the same concentrations extracts reflected an LC 95 of 11 ppm for leaf, 9.6 ppm for flower, 8.9 ppm for stem and 13.00 ppm for root. These results showed that N. glauca extracts have a remarkable potentiality as insecticidal substances that can be used as an ecofriendly integrated approach for the management of R. ferrugineus. [ABSTRACT FROM AUTHOR]

The objective of this study is to determine the level of attitude and perception of Saudi pharmacy students toward working in community pharmacies after graduation and to assess cultural, educational, and job related barriers and limitations that interfere with students and community pharmacy as a favorable workplace. A cross sectional questionnaire, was mailed to a random sample of 600 pharmacy students. It included questions on students' future careers, ideal environment and barriers that might face them in community pharmacy. Four hundreds and twelve (412) completed the survey (response rate was 69%). Mean age was 23 years and 51.2% of respondents were female. Our results revealed low responses toward how interested they are to work in community pharmacy. The study response showed that improvement in salary and money incomes (46%) and culture and society issue (45%) are the two main barrier to make the career in community pharmacy more attractive. Saudi pharmacy students had a negative attitudes and insufficient knowledge about community pharmacy. Pharmacy school would have an important role to fill the knowledge gap and prepare the student to work in the community pharmacy. In order to successfully "Saudization" the community pharmacy setting, efforts should be made to overcome their perceived barriers. [ABSTRACT FROM AUTHOR]

The use of complementary and alternative medicine (CAM) is unexplored among Saudi rheumatoid arthritis (RA) patients. The aim of this study was to estimate the prevalence and types of CAM used among patients with RA and factors associated with their use. A cross-sectional study was conducted at rheumatology clinics in two tertiary hospitals located in Riyadh, Saudi Arabia. The data was collected between May 2017 and February 2018. Unpaired Student's t -tests, Chi-square tests, and Pearson correlation tests were used to compare users vs nonusers. A total of 438 patients (mean age = 49, SD ± 15 years; 89.7% females) were included in this study. Sixty seven percent of included patients had used CAM for their RA. The majority of CAM users were female (92.1%). The most frequently used CAM products were vitamin D (47%), calcium (37%), honey (15%), ginger (13%), turmeric (11%), black seeds (8%), and fenugreek (8%). One hundred ninety-six (45%) patients believe that CAM is safe, and 287 (96%) patients took it because they believed that CAM had "added benefits". Statistically significant differences were found for gender, RA duration, erythrocyte sedimentation rate (ESR) level, and seropositivity between CAM users and nonusers (P = 0.019, P = 0.011, P = 0.022, and P < 0.0001, respectively). A significant correlation was found between the Erythrocyte Sedimentation Rate (ESR) level, RA duration and CAM use (r = 0.110, P = 0.022 and r = 0.121, P = 0.012, respectively). These data indicated that patients who used CAM had higher ESR level and longer disease duration than patients didn't use CAM. There is a high prevalence of CAM use among RA patients. CAM use was perceived to add benefit and patients using it had higher ESR. Larger studies are needed to assess the use of CAM and its impact on RA and its management. [ABSTRACT FROM AUTHOR]

Low-quality medicines deliver sub-optimal clinical outcomes and waste precious health resources. It is important to ensure that public funds are spent on healthcare technologies that meet national regulatory bodies such as the Saudi Food and Drug Authority (SFDA), quality standards for safety, efficacy, and quality. Medicines quality is a complicated combination of pre-market regulatory specifications, appropriate sourcing of ingredients (active pharmaceutical ingredient (API), excipients, etc.), manufacturing processes, healthcare ecosystem communications, and regular and robust pharmacovigilance practices. A recent conference in Riyadh, sponsored by King Saud University, sought to discuss these issues and develop specific policy recommendations for the Saudi 2030 Vision plan. This and other efforts will require more and more creative educational programs for physicians, pharmacists, hospitals, and patients, and, most importantly evolving regulations on quality standards and oversight by Saudi health authorities. [ABSTRACT FROM AUTHOR]

In arid zones, the shortage of bee forage is critical and usually compels beekeepers to move their colonies in search of better forages. Identifying and mapping the spatiotemporal distribution of the bee forages over given area is important for better management of bee colonies. In this study honey bee plants in the target areas were inventoried following, ground inventory work supported with GIS applications. The study was conducted on 85 large plots of 50 × 50 m each. At each plot, data on species name, height, base diameter, crown height, crown diameter has been taken for each plant with their respective geographical positions. The data were stored, and processed using Trimble GPS supported with ArcGIS10 software program. The data were used to estimate the relative frequency, density, abundance and species diversity, species important value index and apicultural value of the species. In addition, Remotely Sensed Satellite Image of the area was obtained and processed using Hopfield Artificial Neural Network techniques. During the study, 182 species from 49 plant families were identified as bee forages of the target area. From the total number of species; shrubs, herbs and trees were accounting for 61%, 27.67%, and 11.53% respectively. Of which Ziziphus spina-christi , Acacia tortilis , Acacia origina , Acacia asak , Lavandula dentata , and Hypoestes forskaolii were the major nectar source plants of the area in their degree of importance. The average vegetation cover values of the study areas were low (<30%) with low Shannon’s species diversity indices (H′) of 0.5–1.52 for different sites. Based on the eco-climatological factors and the variations in their flowering period, these major bee forage species were found to form eight distinct spatiotemporal categories which allow beekeepers to migrate their colonies to exploit the resources at different seasons and place. The Remote Sensed Satellite Image analysis confirmed the spatial distribution of the bee forage resources as determined by the ground inventory work. An integrated approach, combining the ground inventory work with GIS and satellite image processing techniques could be an important tool for characterizing and mapping the available bee forage resources leading to their efficient and sustainable utilization. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the knee is associated with deformities of the lower limb. Tibia valga is a contributing factor to lower limb alignment in valgus knees. We evaluated 97 valgus knees and 100 varus knees. Long-leg films were taken in weight bearing with both knees in full extension. For valgus knees, 52 knees (53%) had a tibia valga deformity. Average tibia valgus deformation was 5.0°. For varus knees, there was only 1 case of tibia valga (1%), with a deformation of 2.5°. The aim of this study was to assess the prevalence of primary tibia valga in valgus and varus knees and understand how it affects our approach to total knee arthroplasty (TKA). We recommend having full-leg length films when planning for TKA in valgus knees. [ABSTRACT FROM AUTHOR]

Abstract: Based on the interfacial adsorptive character of danazol onto the hanging mercury drop electrode (HMDE), a simple and sensitive square-wave adsorptive stripping voltammetric (SW-AdSV) procedure for the electrochemical analysis of this drug in pharmaceutical formulations has been developed and validated. Cyclic and SW-AdSV voltammograms showed a single well-defined irreversible cathodic peak. Various chemical and instrumental parameters affecting the monitored electroanalytical response were investigated and optimized for the danazol determination. Under these optimized conditions the SW-AdSV peak current showed a linear dependence on drug concentration over the range 7.5×10−8–3.75×10−7 moll−1 (r =0.999) with estimated detection limit (at a S/N ratio of 3) of 5.7×10−9 moll−1 (1.78ngml−1). A mean recovery of 100.9±1.2% and relative standard deviation of 1.07% were achieved. Possible interferences by substances usually present in the pharmaceutical tablets and formulations were also evaluated. The proposed electrochemical procedure was successfully applied for the determination of danazol in pharmaceutical capsules (Danol™ 100mg) with mean recoveries of 100.48±0.87%. Results of the developed SW-AdSV method were comparable with those obtained by reported analytical procedures. [Copyright &y& Elsevier]

Blood pressure measurement and continuous control are essential for heart and blood pressure patients. Therefore, continuous blood pressure measurement from these patients is required. In this paper, a novel hybrid prediction method combining Gaussian process regression (GPR) and feature extraction stage has been proposed and then applied to the estimation of blood pressure from cuff Oscillometric waveforms (or signals). First of all, 27 features including time, chaotic, and frequency domain have been extracted from these waveforms to detect the systolic blood pressure (SBP) and diastolic blood pressure (DBP) automatically. As the second stage in the proposed method, three different GPR methods comprising Exponential GPR, Matern 5/2 GPR, and Rational Quadratic GPR, have been used to estimate the SBP and DBP values based the extracted 27 features. As the performance measures, we have used seven different metrics including MAE (mean absolute error), MSE (mean square error), RMSE (root mean square error), R2, IA (index of agreement), and MAPE (mean absolute percentage error) for evaluation of the proposed methods concerning estimation performance of SBP and DBP values from cuff Oscillometric waveforms. The obtained MAPE values for Exponential GPR, Matern 5/2 GPR, and Rational Quadratic GPR in the estimation of SBP values from cuff Oscillometric signals are 0.1136, 0.2286, and 0.1745, respectively. The obtained MAPE values for Exponential GPR, Matern 5/2 GPR and Rational Quadratic GPR in the estimation of DBP values from cuff Oscillometric signals are 0.2878, 0.4220, and 0.4150, respectively. The experimental results have demonstrated that the best-proposed hybrid model is the combination of the Exponential GPR and the feature extraction stage for the estimation of both SBP and DBP values. The proposed method could be safely used in the medical blood pressure measurement systems in the hospital and clinics. [ABSTRACT FROM AUTHOR]

Blood pressure measurement and prediction is an important condition for heart patients and people with heart problems and should be kept under constant control. In this study, based on the oscillometric waveform obtained from individuals using a cuff, the oscillometric waveforms are divided into three periods. These periods are; the first period from the starting point to the systolic blood pressure (SBP), the second period is between systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the third period is between diastolic blood pressure (DBP) and end of the waveform. In the dataset used, the attributes obtained from the oscillometric wave envelope were subtracted for each pulse. On the dataset, the attributes of the beat corresponding to the systolic pressure point are labeled 1, and the attributes of the beat corresponding to the diastolic pressure point are labeled with 2. Other beats are labeled with 0. In the study, the dataset was first re-labeled. Systolic beats were labeled with 1, beats before systolic point, 2 with systolic, diastolic point including diastolic point, and 3 with a diastolic point. After re-labeling, 350 measurements, 300 measurements were divided into training and 50 measurements were divided into test data subset. Classifiers were trained with 300 subsets and the classifier model was produced. With the generated model, the classification of the pulse sequences in the test data subsets was performed. In the found label series, the first 1 to 2 label was marked as the systolic pressure point and the last 2 to 3 labels as the diastolic pressure point and the corresponding cuff pressures were estimated as systolic and diastolic pressure values. By classifying these periods, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values have been estimated using three classifier algorithms including k-nearest neighbor (kNN), weighted k-nearest neighbor (WkNN), and Bagged Trees algorithms. To evaluate the performance of the prediction algorithms, four different performance metrics comprising MAE (mean absolute error), MSE (mean square error), RMSE (root mean square error), and R2 have been used. For the estimation of SBP values using the kNN algorithm, weighted kNN, and Bagged Trees, the obtained MAEs are 3.590, 3.520, and 4.499, respectively. As for the estimation of DBP values using kNN algorithm, weighted kNN and, Bagged Trees, the obtained MAEs are 11.077, 11.032, and 13.069, respectively. The obtained results demonstrated that the proposed method could be used in the blood pressure estimation as the new approach. [ABSTRACT FROM AUTHOR]

The current study investigated the impact of an individualized exercise prescription on physical function, muscle strength and QoL in patients and compare it to general exercise and to exercise at liberty. This was a prospective study comparing three groups: Individualized Exercise Prescription (IEP) group, General Exercise (GE) group and exercise at liberty or No Exercise (NE) group. A total of 22 patients were recruited for the study according to strict the inclusion and exclusion criteria. The NE group received education about keeping active, the patients GE group were given a blanket exercise prescription and lastly, the IEP group were prescribed individualized exercise program based on their pre-transplant scores. The GEG and CG groups were provided with instructions on activities and asked to keep a daily exercise record. The IEP group was divided into two groups, group A) Supervised out-patient rehab group (8 weeks) and B) Home exercise group. The preliminary results of the trial are presented. Demographic and medical characteristics of study participants are described in Table 1. The upper and lower limb scores had some differences between the groups. The EQ-5D-5L scale (Table. 2) in the IEP group showed significant differences from baseline to 6 months post-HCT. An individualized prescription plan has the propensity to positively affect the QoL of HCT patients however these results are only preliminary and the trial data is still accumulating thereby definitive conclusions cannot be made based on early results. [ABSTRACT FROM AUTHOR]