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Concept: Fahd of Saudi Arabia

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During March-May 2014, a Middle East respiratory syndrome (MERS) outbreak occurred in Jeddah, Saudi Arabia, that included many persons who worked or received medical treatment at King Fahd General Hospital. We investigated 78 persons who had laboratory-confirmed MERS during March 2-May 10 and documented contact at this hospital. The 78 persons with MERS comprised 53 patients, 16 healthcare workers, and 9 visitors. Among the 53 patients, the most probable sites of acquisition were the emergency department (22 patients), inpatient areas (17), dialysis unit (11), and outpatient areas (3). Infection control deficiencies included limited separation of suspected MERS patients, patient crowding, and inconsistent use of infection control precautions; aggressive improvements in these deficiencies preceded a decline in cases. MERS coronavirus transmission probably was multifocal, occurring in multiple hospital settings. Continued vigilance and strict application of infection control precautions are necessary to prevent future MERS outbreaks.

Concepts: Saudi Arabia, Riyadh, United Arab Emirates, Middle East, Jordan, House of Saud, Ibn Saud of Saudi Arabia, Fahd of Saudi Arabia

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BACKGROUND: The role of vitamin D in breast cancer prevention is equivocal. Saudi Arabian women may be at greater risk of vitamin D deficiency because of a darker skin type and a greater likelihood of reduced ultraviolet B radiation exposure. Data regarding the vitamin D status of Saudi Arabian women and its relation to breast cancer risk are lacking. OBJECTIVE: The purpose of this research was to evaluate the association between circulating concentrations of 25-hydroxyvitamin D [25(OH)D] and breast cancer risk in Saudi Arabian women. DESIGN: A case-control study was conducted among 120 breast cancer cases and 120 controls. The study population was drawn from patients admitted to King Fahd Hospital in Jeddah, Saudi Arabia, from June to August 2009. Participants completed questionnaires on diet and medical history, and serum samples were collected from all women to measure circulating 25(OH)D concentrations. RESULTS: The participants had a mean age of 47.8 y and a mean body mass index (BMI; in kg/m(2)) of 30.0. Breast cancer cases had significantly lower (mean ± SD) serum concentrations of 25(OH)D (9.4 ± 6.4 ng/mL) than did controls (15.4 ± 12.3 ng/mL; P = 0.001). In comparison with those in the highest category of vitamin D status for this population (≥20 ng/mL), the adjusted ORs (95% CIs) for invasive breast cancer were 6.1 (2.4, 15.1) for women with a serum 25(OH)D concentration <10 ng/mL and 4.0 (1.6, 10.4) for women with a serum concentration of ≥10 to <20 ng/mL (P-trend = 0.0001). CONCLUSION: An inverse association exists between serum 25(OH)D concentrations and breast cancer risk in Saudi Arabian women. This trial was registered at clinicaltrials.gov as NCT01817231.

Concepts: Vitamin D, Cancer, Saudi Arabia, Arabian Peninsula, Abdullah of Saudi Arabia, House of Saud, Ibn Saud of Saudi Arabia, Fahd of Saudi Arabia

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To evaluate sleep quality and daytime sleepiness in health care professionals who are performing shift work. Methods: This cross-sectional study was conducted on 510 health care professionals at Prince Sultan Military Medical City and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia between December 2015 and April 2016. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Participants were divided into 2 groups: shift workers and non-shift workers. Results: We compared both groups regarding the effect of shift work on the total score of PSQI and ESS. We found that the PSQI global score (p less than 0.001) and the total ESS score (p=0.003) were significantly higher in shift work health care professionals.  Conclusion: Shift work among health care professionals is associated with poor sleep quality but not excessive daytime sleepiness. Health care professionals performing shift work have PSQI and ESS scores slightly higher than non-shift work health professionals.

Concepts: Health care, Saudi Arabia, Riyadh, Mecca, House of Saud, Ibn Saud of Saudi Arabia, King Saud University, Fahd of Saudi Arabia

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Vitamin D deficiency has emerged as a public health problem worldwide due to its important role in health and disease. The present work is intended to examine prevalence of vitamin D deficiency among pregnant Saudi women and related risk factors. A cross-sectional study was carried out at King Fahad Medical City in Riyadh, Saudi Arabia. Serum 25-hydroxy vitamin D (25(OH)D) was measured by enzyme-linked immunosorbent assay in 160 pregnant women during the first trimester of pregnancy. Socio-demographic, lifestyle and maternal characteristics were collected and vitamin D intake was assessed using a 24-h dietary recall. Weight and height were measured using standardized methods. Vitamin D deficiency (25(OH)D < 50 nmol/L) and insufficiency (25(OH)D = 50-74 nmol/L) were reported in 50% and 43.8% of the study sample, respectively. Median serum 25(OH)D concentration was 49.9 nmol/L. Adequate vitamin D intake (≥600 IU/day) was reported among only 8.1% of pregnant women. Age group, educational level, sun exposure frequency and daytime and daily practice of exercise were significantly associated with vitamin D status. Overall, vitamin D deficiency was common among pregnant Saudi women in Riyadh. Steps should be taken to address the current situation, including increased sunlight exposure, consumption of fatty fish, and vitamin D supplements.

Concepts: Vitamin D, Pregnancy, Epidemiology, Saudi Arabia, Arabian Peninsula, Riyadh, ELISA, Fahd of Saudi Arabia

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Introduction The Middle East respiratory syndrome coronavirus (MERS-CoV) infection can cause transmission clusters and high mortality in hemodialysis facilities. We attempted to develop a risk-prediction model to assess the early risk of MERS-CoV infection in dialysis patients. Methods This two-center retrospective cohort study included 104 dialysis patients who were suspected of MERS-CoV infection and diagnosed with rRT-PCR between September 2012 and June 2016 at King Fahd General Hospital in Jeddah and King Abdulaziz Medical City in Riyadh. We retrieved data on demographic, clinical, and radiological findings, and laboratory indices of each patient. Findings A risk-prediction model to assess early risk for MERS-CoV in dialysis patients has been developed. Independent predictors of MERS-CoV infection were identified, including chest pain (OR = 24.194; P = 0.011), leukopenia (OR = 6.080; P = 0.049), and elevated aspartate aminotransferase (AST) (OR = 11.179; P = 0.013). The adequacy of this prediction model was good (P = 0.728), with a high predictive utility (area under curve [AUC] = 76.99%; 95% CI: 67.05% to 86.38%). The prediction of the model had optimism-corrected bootstrap resampling AUC of 71.79%. The Youden index yielded a value of 0.439 or greater as the best cut-off for high risk of MERS infection. Discussion This risk-prediction model in dialysis patients appears to depend markedly on chest pain, leukopenia, and elevated AST. The model accurately predicts the high risk of MERS-CoV infection in dialysis patients. This could be clinically useful in applying timely intervention and control measures to prevent clusters of infections in dialysis facilities or other health care settings. The predictive utility of the model warrants further validation in external samples and prospective studies.

Concepts: Cohort study, Prediction, Saudi Arabia, Riyadh, Middle East, Abdullah of Saudi Arabia, Cairo, Fahd of Saudi Arabia

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The Health Science Preparatory Program (HSPP) is a special program that aims to enhance the educational preparedness of students for participation in a health sciences career. Students spend their first university year in a combined extensive teaching program before they can be assigned to a particular health science specialty. It is thought that students enrolled in a highly competitive environment such as HSPP with a long list of potential stressors, including developmental, academic overload, language barriers and competition, are more disposed to stress and stress-related complications. This study aims to measure the level of academic stress and to determine its risk factors in students enrolled in HSPP-adapted local universities in Saudi Arabia. The study was conducted at two Saudi universities, King Saud University (KSU) and Imam Mohammad ibn Saud Islamic University (IMSU) with competition-based and non-competition-based HSPP learning models, respectively. Both universities adopt the HSPP system. The scale for assessing academic stress (SAAS) was used to assess students' perceived stress. A total of 290 students successfully completed the questionnaire (N=290), with a mean age of 18.66 years. Mean SAAS scores for KSU and IMSU students were 8.37 (SD = 4.641) and 7.97 (SD = 5.104), P=0.480, respectively. Only “satisfaction” and “associated social and health problems” have shown statistically significant correlation with university (P=0.000 and P=0.049, respectively). This study has found mean SAAS score for two local universities with competition-based versus non-competition-based HSPP learning models. Academic stress correlation with age, gender and universities was discussed, and valuable future work guidance was recommended.

Concepts: Saudi Arabia, Arabian Peninsula, Mecca, University, Abdullah of Saudi Arabia, House of Saud, Ibn Saud of Saudi Arabia, Fahd of Saudi Arabia

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To evaluate the risk factors, physician’s compliance, and implementation of the American College of Chest Physicians (ACCP) guidelines for venous thromboembolism (VTE) prophylaxis at our hospital.

Concepts: Saudi Arabia, Mecca, Gulf War, Jeddah, House of Saud, Ibn Saud of Saudi Arabia, Medina, Fahd of Saudi Arabia

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To identify predisposing factors, species distribution, antifungal susceptibility, and outcome. Methods: This study is a retrospective chart review that was conducted at a children’s hospital at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. One hundred twenty-nine children with invasive candidiasis who were admitted between January 2010 and January 2015. Results: The statistical analysis results have revealed a group of risk factors; prematurity in 37 (28.7%) of patients, low birth weight in 42 (32.6%), central venous catheter in 59 (45.7%), malignancy in 21 (16.3%), immunotherapy in 20 (15.5%), and ventilator support  in 60 (46.5%). More than 2-fold mortality rate in patients who had heart vegetation (odds ratio [OR]: 2.9) and patients who had Candida isolated from their blood were more than twice as likely to die as patients with Candida isolated from other sites (OR: 2.2). A total of 48.3% of patients on ventilator died versus 26.1% who were not on ventilator (p=0.009); and 43.8% of patients in the ICU died versus only 24.5% of patients who were not in the ICU (p=0.03). Candida parapsilosis exhibited the highest mortality rate (56.2%).  Conclusion: Candida albicans is the most common isolate among all Candida species. Gender, low birth weight, prolonged ICU stay, presence of vegetation, positive blood culture, and mechanical ventilation as a strong predictive risk factors for death in children with invasive candidiasis, a finding that could be applied as prophylactic indicator in critically ill children especially neonates.

Concepts: Epidemiology, Saudi Arabia, Riyadh, Pediatrics, Candida albicans, Candidiasis, Candida, Fahd of Saudi Arabia

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Only one study has been conducted in Saudi Arabia to assess medical students' knowledge of standard precautions (SPs) and infection control (IC). In this study, we examined knowledge of SPs and IC among clinical students attending the King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Concepts: Medicine, Saudi Arabia, Riyadh, Mecca, House of Saud, Ibn Saud of Saudi Arabia, Ha'il, Fahd of Saudi Arabia

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Unfortunately, one of the co-author affiliation was incorrect in the original publication of this article. The correct affiliation is given below: Abdulaziz Z. Alomar, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Concepts: Saudi Arabia, Riyadh, Mecca, House of Saud, Ibn Saud of Saudi Arabia, King Saud University, Fahd of Saudi Arabia, Khalid of Saudi Arabia