Community Knowledge about Bleeding Control in Jazan, KSA: Is There a Need for First Aid Educational Programs

The current study aimed to evaluate the first aid knowledge and general awareness of bleeding control, and their relations with different variables among the population of Jazan City, Saudi Arabia, in 2023. A cross-sectional study was conducted in Jazan City, Saudi Arabia between April 2023 and May 2023. Participants, >13 years old, living in Jazan City, were self-enrolled. Data collection was carried out by distributing a self-reported online survey questionnaire via email and social media apps. A validated, pretested online self-report questionnaire was used for data collection, with data analysis performed using (MS) Excel 2022 and SPSS version 26. A Chi-square test was used to determine the association of sociodemographic variables and Bleeding Control (BC) knowledge with, significance set at p < 0.05. A total of 250 participants completed the questionnaire, predominantly aged between 16 - 25 years, with 152 (60.8%) being male, and about 90% being Saudi citizens. Only 53 (21.2%) participated in previous first aid training concentrating on bleeding control. Only 76 (30.4%) of participants had good knowledge, while 131 (52.4%) exhibited positive attitude towards BC first aid. There were no statistically significant associations between BC knowledge and age, gender, occupation, nationality, and education. However, a significant association was observed between previous BC training and knowledge (Chi-test = 40.373, d.f = 1, p = 0.000) at p < 0.05. Conclusion: The prevalence of poor knowledge of bleeding control among community members in Jazan City was high. The findings of this study should be carefully considered by various healthcare organizations to implement educational first-aid programs and activities aimed at enhancing community awareness and knowledge of bleeding control.

Community Knowledge and Attitude about Burns First Aid (BFA) in Jazan, Saudi Arabia

Introduction and Significance: Burn injury (BI) is a considerable health issue which is responsible for around 300,000 deaths and affecting about 11 million people every year worldwide. In Saudi Arabia, the prevalence of BIs array from 112 to 518 per 100,000 per year. The appropriate awareness of performing first aid could facilitate to improve the outcomes of burns. Purpose and Objectives: To appraise the community that acknowledges burns, first aid, and associated factors among the community population in Jazan City, Saudi Arabia. The paper aims to identify limitations to encourage additional research and persuade legislators to develop improved burn-injury care recommendations and training programs. Materials and Methods: An observational-based sample survey was conducted among the people who live in Jazan City aging 13 years or more, during April 5 to May 5, 2023. Data collection was done by a validated online self-administrated questionnaire sent randomly to community members in different parts of Jazan City via social media platforms. Collected data were coded and cleaned by an excel program, and finally exported on SPSS 26.0 software. The variables were analyzed using descriptive statistics like frequencies and percentages. Also, the Chi-square test was used to investigate the relation between different variables, with a significance value of P Results: This study included 243 participants (about 62%) among them were mostly male participants (151) having a university degree. The majority of participants 75% did not take any form of BFA training in the past. This study shows that 69.9% of the participants have inadequate awareness, despite 72% having a constructive attitude towards burn first aid. Previous burn-related first aid training was significantly associated with participants’ knowledge of BFA at a p-value less than 0.05. Conclusion: This study indicates a high frequency of Jazan population having inadequate knowledge of burn first aid despite the high prevalence of a favorable attitude. There is a need to develop an effective nationwide burn prevention program and early burn first aid treatment in Saudi Arabia and promote a consistent guideline for burn first aid.

Medical care delivery at the Beijing 2008 OlympicGames

BACKGROUND： Beijing successfully hosted the 2008 Olympic Games, and the servicesincluding medical services were widely appreciated by both participants and visitors. Weretrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs,and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would beuseful for planning strategies for managing mass gatherings.METHODS： Medical encounter forms filled during the Beijing 2008 Olympic Games wereretrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation anddiagnostic categories.RESULTS： A total of 22 892 medical encounters were documented during the Beijing 2008Olympic Games. Among them, 10 549 （46.08%） involved the workforce, 3 365 （14.70%） athletes,3 019 （13.19%） spectators, 585 （2.56%） members of the media, 1 065 （4.65%） VIPs, and 4 309（18.82%） others. Of the 22 892 cases, physical injury accounted for 27.90% （6 386）, respiratorydisease 18.21% （4 169）, and heat-related illnesses 2.68% （615）.CONCLUSIONS： Preparations of the medical service for the Beijing 2008 Olympic Gameswere made for 7 years, and the service provided has been praised worldwide. This study providesvaluable information that may be useful for planning medical services for upcoming Olympic Games,including the London 2012 Olympic Games and other mass gatherings.

Influence of increased epicardial adipose tissue volume on 1-year in-stent restenosis in patients who received coronary stent implantation

Background Epicardial adipose tissue （EAT） is significantly associated with the formation and composition of coronary atherosclerotic plaque, cardiac events and the clinical prognosis of coronary heart disease. But, whether increased EAT deposition may affect the incidence of in-stent restenosis （ISR） is currently unclear. This study used coronary computed tomography angiography （CCTA） as a mean to investigate whether increased EAT volume was associated with ISR. Methods A total of 364 patients who underwent 64-slice CCTA examination for the evaluation of suspected coronary artery disease, and subsequently underwent percutaneous coronary intervention （PCI） for the first time, and then accepted coronary angiography （CA） follow-up for ISR examination in one year, were retrospectively included in this study. EAT volume was measured by CCTA examination. CA follow-up was obtained between 9 and 15 months. ISR was defined as 〉 50% kuninal diameter narrowing of the stent segment or peri-stent segment. EAT volume was compared between patients with and without ISR and additional well-known predictors of ISR were compared. Results EAT volume was significantly increased in patients with ISR compared with those without ISR （154.5 ± 74.6 mL vs. 131.0 ± 52.2 mL, P 〈 0.001）. The relation between ISR and EAT volume remained significant after adjustment for conventional cardiovascular risk factors and angiographic parameters. Conclusions EAT volume was related with ISR and may provide additional information for future ISR.

Further understanding of an uncommon disease of combined small cell lung cancer： clinical features and prognostic factors of 114 cases

Objective： Combined small cell lung cancer （C-SCLC） is an uncommon subgroup of small cell lung cancer （SCLC） and few clinical data can be referred. Our study is to investigate the clinical features and prognostic factors of C-SCLC, as well as the role of multimodality treatment.Methods： Between January 2004 and December 2012, patients with histologically diagnosed C-SCLC were retrospectively analyzed. The survivals were evaluated with the Kaplan-Meier method. Univariate and multivariate analyses were used to evaluate potential prognostic factors.Results： One hundred and fourteen patients were enrolled, with a median age of 59 （range： 20-79） years old. The most common combined component was squamous cell carcinoma （52.6%）. Among these patients, the disease was stage I, II, III and IV in 9.6%, 19.3%, 46.5% and 24.6% of the patients, respectively. Eighty patients （70.2%） received at least two of the three modalities containing chemotherapy, radiotherapy and surgery. The median follow-up was 32.5 months. The median time of overall survival （OS） was 26.2 months. On univariate analysis, smoking （P=0.029）, Karnofsky performance score （KPS） 〈80 （P=0.000）, advanced TNM stage （P=0.000）, no surgery （P=0.010）, positive resection margin （P=0.000）, positive lymph nodes ≥4 （P=0.000）, positive lymph node ratio 〉10% （P=0.000） and non-multimodality treatment （P=0.004） were associated with poor OS. Multivariate analysis confirmed that smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉 10% were poor prognostic features. Conclusions： C-SCLC has a relatively early stage and good prognosis, which may due to the underestimated diagnosis in non-surgical patients. Multimodality therapy is recommended, especially for limited disease. Smoking, advanced TNM stage, positive resection margin and positive lymph nodes ratio 〉10% are poor prognostic factors.

The Nursee-Nurse Collaboration Behavior Scale:Development and psychometric testing

Objective:To develop and test the reliability and validity of a new instrument,the Nurse eNurse Collaboration Behavior Scale(NNCBS).Background:The importance of cooperation among nurses is widely acknowledged,but is a lack of scientific studies regarding the behaviorial interactions associated with nurse enurse relationships throughout the process of patient-centered care.Therefore,there is a great need to develop a reliable scale to measure nurseenurse collaboration behavior,which is what we have generated in this study.Methods:The 46-item Nursee-Nurse Collaboration Scale was developed using a process of item design,refinement,and testing for both reliability and validity.In 2014,the 202 nurses from the International Department of Services participated in this pilot study.Cronbach's a coefficients and testeretest reliability coefficients were calculated in order to evaluate this new scale's internal consistency and stability.Exploratory factor analysis was calculated using a principal factor method with promax rotation to evaluate the scale's validity.Results:Exploratory factor analysis yielded four factors and 23 items.The overall Cronbach's a coefficient of the scale was 0.929.The item-total correlation values were overall high,ranging from 0.427 to 0.751.For the entire scale,the r values of the testeretest reliability correlations were 0.764.Conclusion:The NNCB Scale developed in this study demonstrates acceptable reliability and validity for measuring the level of NNCB.Its implementration on a broader scale would at the very least guide and promote collaborative relationships between nurses involved in patient care.It should be noted that the scale requires further psychometric testing using a larger sample size of nurses who also represent a wider diversity of backgrounds,as well as researchers who are encouraged to improve the instrument.

Amblyopia screening for first and second-grade children in Jordan

AIM:To share the results of a national screening program for amblyopia in school children in the north of Jordan.METHODS:This is a prospective national screening study for amblyopia.The program rolls first and second-grade children(6 to 7 years old) in the north of Jordan.The eye examination included:best-corrected visual acuity,cover-uncover test,and cycloplegic retinoscopy.Monocular visual acuity was tested using an ETDRS visual acuity chart without correction.Moreover,children were tested with full cycloplegic refraction when the test criteria were met.Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines.In comparison,bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye.RESULTS:The prevalence of amblyopia for the total sample tested(n=17 203) was 2.78%(n=479).The most common cause of amblyopia was hypermetropia(64.45%),followed by previous ocular surgeries(15.1%),myopia(10.43%),strabismus(9.39%),and congenital cataract(0.63%).CONCLUSION:This is the first and only study,identifing modifiable risk factors in Jordanian children with amblyopia.In their first couple of years of elementary education,many Jordanian children are affected by amblyopia and pass unnoticed.A more governmental effort is needed into screening programs to improve vision in the Jordanian population.

Factors Affecting Treatment Interruption among TB Patients in Lagos Nigeria: Is There Any Need for Treatment Supporters?

Background: This study assessed treatment interruption of tuberculosis (TB) patients managed by treatment supporters and health care workers and other predictors of treatment interruption. Methods: A descriptive cross-sectional study was conducted. Four hundred and seventy new smear positive TB patients above 14 years of age were consecutively recruited between October 1 and December 31 2012 from 34 (23 public and 11 private) directly observed treatment short course (DOTS) facilities that offered TB treatment and microscopy services. They were followed up till treatment was completed. Logistic regression was used to assess the predictors of treatment interruption. Results: A significantly higher proportion of smokers (58.6% vs 38.3%, p = 0.030), patients supervised by treatment supporters (44.4% vs 34.7%, p = 0.032), patients not counselled before initiation of treatment (55.6% vs 38.2%, p = 0.041), patients managed at private DOTS facilities (50% vs 36.3%, p = 0.010) and TB/HIV co-infected patients (54.2% vs 38.6%, p = 0.038) had treatment interruption. Predictors of treatment interruption were supervision by treatment supporters, smoking, lack of pre-treatment counselling and TB/HIV co-infection. Conclusion: A higher proportion of patients supervised by treatment supporters had treatment interruption than those supervised by health care workers. There may be a need to review the concept of treatment supervision by treatment supporters in Lagos state Nigeria.

Outbreak of Mycoplasma pneumoniae at a military academy

In 2019, an outbreak of Mycoplasma pneumoniae(M. pneumoniae) occurred at a military academy in China. The attack rate(10.08%, 60/595) was significantly different among the units. High-intensity training and crowded environments to which cadets are exposed are the high risk factors for the outbreak of M. pneumoniae. In-time prevention and control measures effectively controlled the spread of the epidemic.

Ameliorative Influence of Dietary Dates on Doxorubicin-Induced Cardiac Toxicity

Doxorubicin is a commonly used anticancer agent, which may cause cardiac toxicity. The present study designed to evaluate Phoenix dactylofera (dates) in doxorubicin (DXR) induced cardiac toxicity and cardiac remodeling in Wistar albino rats. The experimental rats procured, acclimatized and finally divided into five groups (n = 6). Group I served as normal controls, group II served as disease controls and groups 3, 4 & 5 served as therapeutic groups (Phoenix dactylofera 5%, 10%, and 15% respectively). Cardiac remodeling and toxicity in the rats were induced by administration of DXR (1.25 mg/kg i.p. in 16 divided doses/month). At the end of protocol, effect of Phoenix dactylofera on cardiac remodeling was evaluated by measuring parameters like haemodynamics, heart weight, anatomy, Troponin T, creatine phosphokinase (CPK), creatine phosphokinase-MB (CPK-MB), Lactate dehydrogenase (LDH), serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), calcium ion Ca2+, sodium ion Na+, potassium ion K+, intracellular enzymes like Malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT). The disease control groups showed significantly elevated (p dactylofera significantly (p 2+, Na+, K+ levels to a normal value. Further, the histological studies of the cardiac tissues demonstrated that the normal architecture of the cardiac cells was restored in the animals fed with dietary Phoenix dactylofera as compared to disease controls. The findings show that the administration of Phoenix dactylofera has the potential to prevent the toxicity induced by doxorubicin in the experimental rats.

Are Tuberculosis Patients Managed According to the National Guidelines in Lagos State Nigeria?

Setting: Private and public tuberculosis (TB) treatment centers in Lagos State, Nigeria. Objective: To compare adherence of private and public providers of directly observed treatment short course (DOTS) in the Lagos State TB control program, Nigeria (LSTBLCP) with the national TB guidelines. Design: A retrospective review of treatment cards of TB patients managed within the first and second quarter of 2012 in 34 DOTS facilities {23 public, 7 private for profit (PFP), and 4 private not for profit (PNFP)} involved in the private public mix of the LSTBLCP. Results: Of the 1896 treatment cards reviewed, 1524 (80.4%), 132 (7.0%) and 240 (12.6%) were from public, PFP and PNFP DOTS facilities, respectively. About 19%, 25% and none of the patients managed at the public, PNFP, and PFP DOTS facilities were treated in full adherence with the national guidelines respectively. A significantly higher proportion of adults and sputum smear positive TB patients were treated in full adherence with the national guidelines (p < 0.05). Treatment success was associated with full adherence with the national guidelines. Conclusion: There is a need to reorient health care providers in public and private health facilities in Lagos State Nigeria to ensure full adherence with the national TB guidelines.

Common COVID-19 should be distinguished from acute respiratory infections by other viruses during prehospital treatment

Dear Editor,The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)poses a serious threat to global health security.The disease severity of patients with symptomatic COVID-19 can be divided into mild,moderate,severe,and critical[1],and more than 80% of the patients have mild and moderate severity(common type)[2].

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Clinical significance,molecular characterization,and immune microenvironment analysis of coagulation-related genes in clear cell renal cell carcinoma

Background:Numerous studies have revealed a tight connection between tumor development and the coagulation system.However,the effects of coagulation on the prognosis and tumor microenvironment(TME)of clear cell renal cell carcinoma(ccRCC)remain poorly understood.Methods:We employed the consensus clustering method to characterize distinct molecular subtypes associated with coagulation patterns.Subsequently,we examined variations in the overall survival(OS),genomic profiles,and TME characteristics between these subtypes.To develop a prognostic coagulation-related risk score(CRRS)model,we utilized the least absolute shrinkage and selection operator Cox regression and stepwise multivariate Cox regression analyses.We also created a nomogram to aid in the clinical application of the risk score,evaluating the relationships between the CRRS and the immune microenvironment,responsiveness to immunotherapy,and targeted treatment.The clinical significance of PLAUR and its biological function in ccRCC were also further analyzed.Results:There were significant differences in clinical features,prognostic stratification,genomic variation,and TME characteristics between the two coagulation-related subtypes.We established and validated a CRRS using six coagulation-related genes that can be employed as an effective indicator of risk stratification and prognosis estimation for ccRCC patients.Significant variations in survival outcomes were observed between the high-and low-risk groups.The nomogram was proficient in predicting the 1-,3-,and 5-year OS.Additionally,the CRRS emerged as a novel tool for evaluating the clinical effectiveness of immunotherapy and targeted treatments in ccRCC.Moreover,we confirmed upregulated PLAUR expression in ccRCC samples that was significantly correlated with poor patient prognosis.PLAUR knockdown notably inhibited ccRCC cell proliferation and migration.Conclusion:Our data suggested that CRRS may be employed as a reliable predictive biomarker that can provide therapeutic benefits for immunotherapy and targeted therapy in ccRCC.

Clinical management and associated costs for moderate and severe Alzheimer’s disease in urban China: a Delphi panel study

Background:Healthcare resource utilisation for Alzheimer’s disease(AD)in China is not well understood.This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used.Methods:A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews.In the first round,9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients.In the second round,2 hospital administrators were asked about the cost of AD management and care.Results from the interviews were discussed by the experts in a Delphi panel meeting,where consensus was reached on quantitative aspects of AD management,including the rate of healthcare resource utilisation,the respective unit costs and caregiving time.Results:Interviewees reported that mild AD is under-recognised in China;most patients are diagnosed with moderate to severe AD.Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden.It was estimated that 70%moderate AD patients are independent/non-aggressive at the time of diagnosis,15%are independent/aggressive,10%are dependent/non-aggressive,and 5%are dependent/aggressive.Dependent/aggressive AD patients are more likely to be hospitalised(70–90%)than accepted in a nursing home(0–20%),while the opposite is true for dependent/non-aggressive patients(5–35%for hospitalisation vs.80%for nursing home).Independent AD patients require 1–3 hours/day of caregiver time,while dependent patients can require up to 12–15 hours/day.Experts agreed that AD complicates the management of age-related comorbidities,found in 70–80%of all AD patients,increasing the frequency and cost of hospitalisation.Conclusions:The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China.The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning,as well as to perform economic evaluations of AD therapies.

Targeting the insulin-like growth factor-1 receptor in MTAP-deficient renal cell carcinoma

Renal cell carcinoma(RCC)has emerged as a metabolic disease characterized by dysregulated expression of metabolic enzymes.Patients with metastatic RCC have an unusually poor prognosis and near-universal resistance to all current therapies.To improve RCC treatment and the survival rate of patients with RCC,there is an urgent need to reveal the mechanisms by which metabolic reprogramming regulates aberrant signaling and oncogenic progression.Through an integrated analysis of RCC metabolic pathways,we showed that methylthioadenosine phosphorylase(MTAP)and its substrate methylthioadenosine(MTA)are dysregulated in aggressive RCC.A decrease in MTAP expression was observed in RCC tissues and correlated with higher tumor grade and shorter overall survival.Genetic manipulation of MTAP demonstrated that MTAP expression inhibits the epithelial-mesenchymal transition,invasion and migration of RCC cells.Interestingly,we found a decrease in the protein methylation level with a concomitant increase in tyrosine phosphorylation after MTAP knockout.A phospho-kinase array screen identified the type 1 insulin-like growth factor-1 receptor(IGF1R)as the candidate with the highest upregulation in tyrosine phosphorylation in response to MTAP loss.We further demonstrated that IGF1R phosphorylation acts upstream of Src and STAT3 signaling in MTAP-knockout RCC cells.IGF1R suppression by a selective inhibitor of IGF1R,linsitinib,impaired the cell migration and invasion capability of MTAP-deleted cells.Surprisingly,an increase in linsitinib-mediated cytotoxicity occurred in RCC cells with MTAP deficiency.Our data suggest that IGF1R signaling is a driver pathway that contributes to the aggressive nature of MTAP-deleted RCC.