Nearly four months have passed since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which caused the rapidly spreading Coronavirus Disease 2019 (COVID-19) ...pandemic. To date, there have been more than 2.3 million confirmed cases and more than 160,000 deaths globally caused by COVID-19. Chinese health authorities, where the virus emerged, have taken prompt strict public health measures to control and prevent the spread of the outbreak. In Saudi Arabia, unprecedented precautionary strict measures were applied to prevent virus entry to the country or to mitigate its impact when it arrives. Here, we review the response of Saudi Arabia to COVID-19 pandemic and how did the experience learned from the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic since 2012 has helped the country to be better prepared for the current COVID-19 pandemic. We also discuss the country readiness, improvement in research and development, and the unprecedented rapid precautionary measures that have been taken by the Saudi government thus far.
Operatively induced inflammation has been the focus of many studies to evaluate the most efficient responses and protocols to be used for its control. Insulin has been characterized with nonmetabolic ...properties and is used as a preoperative anti-inflammatory agent. We reviewed the published evidence in the past 10 years reporting on the use of glucose–insulin-normoglycemia therapy as a potential anti-inflammatory therapy to improve surgical outcomes about tissue trauma, with the challenges and progress attenuated so far. We also portray our experience in the use of insulin therapy on our liver resection patients as well as the significant knowledge gaps that still exist and the need for a multidisciplinary approach to bridge them.
Tumors continuously evolve to maintain growth; secondary mutations facilitate this process, resulting in high tumor heterogeneity. In this study, we compared mutations in paired primary and ...metastatic colorectal cancer tumor samples to determine whether tumor heterogeneity can predict tumor metastasis.
Somatic variations in 46 pairs of matched primary-liver metastatic tumors and 42 primary tumors without metastasis were analyzed by whole-exome sequencing. Tumor clonality was estimated from single-nucleotide and copy-number variations. The correlation between clinical parameters of patients and clonal heterogeneity in liver metastasis was evaluated.
Tumor heterogeneity across colorectal cancer samples was highly variable; however, a high degree of tumor heterogeneity was associated with a worse disease-free survival. Highly heterogeneous primary colorectal cancer was correlated with a higher rate of liver metastasis. Recurrent somatic mutations in
, and
were frequently detected in highly heterogeneous colorectal cancer. The variant allele frequency of these mutations was high, while somatic mutations in other genes such as
and
were low. The number and distribution of primary colorectal cancer subclones were preserved in metastatic tumors.
Heterogeneity of primary colorectal cancer tumors can predict the potential for liver metastasis and thus, clinical outcome of patients.
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Several global efforts are underway to develop COVID-19 vaccines, and interim analyses from phase 3 clinical testing have been announced by nine organisations: Pfizer, the Gamaleya Research Institute ...of Epidemiology and Microbiology, Moderna, AstraZeneca, Sinopharm Group, Sinovac Biotech, Johnson & Johnson, Novavax, and CanSino Biologics. The US programme known as Operation Warp Speed provided US$18 billion in funding for development of vaccines that were intended for US populations. Depending on safety and efficacy, vaccines can become available through mechanisms for emergency use, expanded access with informed consent, or full licensure. An important question is: how will these Operation Warp Speed vaccines be used for COVID-19 prevention in global health settings? We address some key questions that arise in the transition from US to global vaccine prevention efforts and from ethical and logistical issues to those that are relevant to global vaccine security, justice, equity, and diplomacy.
Saudi Arabia’s Ministry of Health (MOH) use corporate performance improvement methodologies to develop and implement performance improvement initiatives designed to continue building on the ...Ministry’s vision of transforming hospital operations and instituting a culture of quality and performance focused on the “patient first” principle. We evaluated the feasibility of setting up a performance improvement unit (PIU) within the MOH to apply the principles of Lean Six Sigma and to change management methodologies. The MOH collaborated with external consultants to implement PIU initiatives in 4 steps: PIU Setup, PIU Capability Building, High-Impact Project Implementation, and Project Sustainability and Knowledge Transfer. PIU units were setup across the 13 provinces over 90 days. The process included the promotion of knowledge sharing to strengthen the skill set of Saudi health care professionals and develop local performance improvement champions within the MOH who could lead, implement, and sustain future projects. Implementation was a challenge; though, early results from the High-Impact Project Implementation phase were encouraging. However, the sustainability of PIU interventions was poor, with performance improvement processes returning to baseline levels within 9 months. This case study shows that PIU implementation is a feasible approach for improving health care delivery in Saudi Arabia. Poor sustainability despite initial success highlights the need to further improve the engagement, incentivization, and training of team leaders and members to achieve long-term success with the program.
•SARS-CoV-2 reinfection was estimated at 0.8% over a 20-month follow-up in Saudi Arabia.•Diabetes, HIV, obesity, and working in health care were associated with reinfections.•Two vaccine doses were ...associated with 87% risk reduction of reinfection.•Delta-induced immunity may not be sufficient to prevent subsequent infections.•Previous infection and vaccination confer strong protection against severe COVID-19.
The characterization of reinfection with SARS-CoV-2 has been a subject of concern and controversy, especially with the surge of infections with highly transmissible variants worldwide.
This retrospective national study used comorbidities, vaccination status, SARS-CoV-2 variants of concern, and demographics data to profile participants who were reinfected with SARS-CoV-2, defined as having two reverse transcriptase-polymerase chain reaction-positive SARS-CoV-2 tests within at least 90 days apart. A multivariate logistic regression model assessed the risk factors associated with reinfection . Two control groups were selected: nonreinfected participants reporting a positive test (control group one) and those reporting a negative test (control group two).
Between March 2020 and December 2021, 4454 reinfected participants were identified in Saudi Arabia (0.8%, 95% confidence interval CI 0.7-0.8). The majority (67.3%) were unvaccinated (95% CI 65.9-68.7) and 0.8% (95% CI 0.6-1.1) had severe or fatal SARS-CoV-2 disease. COVID-19 vaccines were 100% effective against mortality in reinfected individuals who received at least one dose, whereas it conferred 61% (odds ratio OR 0.4, 95% CI 0.1-1.0) additional protection against severe disease after the first dose and 100% after the second dose. In the risk factor analysis, reinfection was highly associated with comorbidities, such as HIV (OR 2.5, 95% CI 1.3-5.2; P = 0.009), obesity (OR 2.3, 95% CI 1.3-3.9; P = 0.003), pregnancy (OR 3.2, 95% CI 1.4-7.4; P = 0.005), and working in health care facilities (OR 6.1, 95% CI 3.1-12.9; P <0.0001). The delta variant (B.1.617.2) was the most frequent variant of concern among the reinfected cohort.
This in-depth study of the reinfection profile identified risk factors and highlighted the associated SARS-CoV-2 variants. Results showed that naturally acquired immunity to SARS-CoV-2 through multiple reinfections together with vaccine-induced immunity provided substantial protection against severe SARS-CoV-2 disease and mortality.
The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged ...hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients’ immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in immunocompromised people are generally lacking and extrapolated from other populations. The large clinical trials leading to authorisation and approval of SARS-CoV-2 vaccines and therapeutics included very few immunocompromised participants. While experience is accumulating, studies focused on the special circumstances of immunocompromised patients are needed to inform prevention and treatment approaches.
Abbreviations: ACT-A, Access to COVID-19 Tools Accelerator; CEPI, Coalition for Epidemic Preparedness Innovations; COVAX, COVID-19 Vaccines Global Access; COVID-19, Coronavirus Disease 2019; EUL, ...emergency use listing; HIC, high-income country; LMIC, low- and middle-income country; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; SRA, stringent regulatory authority; TRIPS, Trade-Related Aspects of Intellectual Property Rights; WTO, World Trade Organization Many may not be aware of the full extent of global inequity in the rollout of Coronavirus Disease 2019 (COVID-19) vaccines in response to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. The COVAX Facility has been challenged to meet its supply commitments to LMICs due to insufficient access to doses of COVID-19 vaccines with the prerequisite WHO emergency use listing (EUL) or, under exceptional circumstances, product approval by a stringent regulatory authority (SRA) 8,9. Because of the anticipated insufficient COVID-19 vaccine supply through the COVAX Facility, the majority of nonvaccine-producing LMIC countries made the decision, early in the COVID-19 pandemic, to secure and use vaccines produced in China or Russia prior to receipt of WHO EUL or SRA approval. An international initiative to support vaccine technology transfer is needed The governments of South Africa and India have called for the waiver of intellectual property protections for patents, industrial designs, trade secrets, and regulatory data for COVID-19 vaccines and therapies. ...embark on a parallel initiative to ramp up production and distribution capacity for additional doses of vaccines.
Hajj, Umrah, and the neglected tropical diseases Almutairi, Mashal M; Alsalem, Waleed Saleh; Hassanain, Mazen ...
PLoS neglected tropical diseases,
08/2018, Letnik:
12, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Genetic distance mapping further indicates that AHFV is a subtype of KFDV, suggesting that the transmission of AHFV occurred from the Indian subcontinent, possibly through the Hajj and animal ...importation 21. ...of the increase in the pilgrims to Saudi Arabia, the risk of NTDs is magnified. ...the future plans for Umrah and Hajj expansion also include strengthening the healthcare system and constructing a national plan to deal with potential public health threats. ...during the coming years, we can continue to expect a large influx of pilgrims to Saudi Arabia, especially from countries known to be endemic for NTDs. ...there is an urgent need for development of more comprehensive surveillance programs and data collection not only during the Hajj but also around the year to account for Umrah pilgrims. In summary, mass gatherings may facilitate the emerging of NTDs just as they do other diseases of epidemic or pandemic potential. Since the Hajj and Umrah represent international gatherings, collaboration at multiple levels is required, including expanded surveillance and intensified vector management and control, increased reference laboratory diagnostic testing, and R&D for both new diagnostics and vaccines.
Surgical treatment for hepatocellular carcinoma Madkhali, Ahmad A; Fadel, Zahir T; Aljiffry, Murad M ...
Saudi journal of gastroenterology,
2015 Jan-Feb, 2015-00-00, 20150101, 2015-01-01, Letnik:
21, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Hepatocellular carcinoma (HCC) is an epithelial tumor derived from hepatocytes; it accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related ...deaths. HCC treatment is a multidisciplinary and a multimodal task, with surgery in the form of liver resection and liver transplantation (LT) representing the only potentially curative modality. However, there are variable opinions and discussions about applying these surgical options and using other supporting treatments. This article is a narrative review that includes articles published from 1984 to 2013 located by searching scientific databases such as PubMed, SCOPUS, and Elsevier, with the main keyword of hepatocellular carcinoma in addition to other keywords such as liver transplantation, liver resection, transarterial chemoembolization, portal vein embolization, bridging therapy, and downstaging. In this review, we focus mainly on the surgical treatment options offered for HCC, in order to illustrate the current relevant data available in the literature to help in applying these surgical options and to use other supporting treatment modalities when appropriate.
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