Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA), is associated with high morbidity and mortality rates with rapid development of resistance. METHODS: A total of 512 MRSA isolates were procured from 6 major hospitals in Riyadh, Saudi Arabia and antibiotic susceptibilities and MICs were documented against several antibiotics and vancomycin. SPSS version 10 was used for statistical analysis. RESULTS: The prevalence of MRSA in the study hospitals ranged from 12% to 49.4%. Mean patient age was 44 years with males constituting 64.4% and females 35.6%. Approximately 41.5% of the isolates came from patients in the extreme age groups. MIC for vancomycin was in the susceptible range for all isolates ranging from 0.25 to 3 ug/ml. The overall susceptibility of MRSA to the various antibiotics tested was: fusidic acid 4.3%, sulfamethoxazole/trimethoprim 33.8%, gentamicin 39.6%, mupirocin 77.0%, gatifloxacin 78.9%, chloramphenicl 80.7%, linezolid 95.1%, quinupristin/dalfopristin 100%. Some differences were noted in the resistance of isolates among the participating hospitals reflecting antibiotic usage. On the whole, inpatient isolates (accounting for 77.5% of the isolates) were more resistant than outpatient isolates (22.5%) except for linezolid. Quinupristin-dalfopristin and linezolid are the most effective antibiotics tested against inpatient isolates while quinupristin-dalfopristin and gatifloxacin seem to be the most effective against outpatient isolates. Approximately one forth of the isolates are no longer susceptible to mupirocin used for eradication of the carrier state reflecting resistance developing after widespread use. Trends over time show a tendency towards decreased susceptibility to gatifloxacin and linezolid with increasing susceptibility to gentamicin and sulfamethoxazole/trimethoprim. CONCLUSION: Quinupristin/dalfopristin and linezolid are two valuable additions to our antimicrobial armamentarium, but resistance has already been described. To preserve their value, their use should be limited to those rare cases where they are clearly needed. Fusidic acid, the local antibiotic, gentamicin and trimethoprim/sulfamethoxazole should not be relied upon for treatment of MRSA infections, at least empirically as the percentage of susceptible isolates is very low

CONDA-PM -- A Systematic Review and Framework for Concept Drift Analysis in Process Mining

Business processes evolve over time to adapt to changing business environments. This requires continuous monitoring of business processes to gain insights into whether they conform to the intended design or deviate from it. The situation when a business process changes while being analysed is denoted as Concept Drift. Its analysis is concerned with studying how a business process changes, in terms of detecting and localising changes and studying the effects of the latter. Concept drift analysis is crucial to enable early detection and management of changes, that is, whether to promote a change to become part of an improved process, or to reject the change and make decisions to mitigate its effects. Despite its importance, there exists no comprehensive framework for analysing concept drift types, affected process perspectives, and granularity levels of a business process. This article proposes the CONcept Drift Analysis in Process Mining (CONDA-PM) framework describing phases and requirements of a concept drift analysis approach. CONDA-PM was derived from a Systematic Literature Review (SLR) of current approaches analysing concept drift. We apply the CONDA-PM framework on current approaches to concept drift analysis and evaluate their maturity. Applying CONDA-PM framework highlights areas where research is needed to complement existing efforts.Comment: 45 pages, 11 tables, 13 figure

Glycemic Control in Patients with Diabetes across Primary and Tertiary Government Health Sectors in the Emirate of Dubai, United Arab Emirates: A Five-Year Pattern

Objectives: In the UAE, the comparative prevalence of diabetes is reported as 18.98%, but there are very few studies evaluating glycemic control. Attaining the optimum glycemic control has been a global challenge over the years. However, there is a trend of global improvement with the availability of newer options of antidiabetic medications, increasing numbers of physicians, and patient awareness. Our primary aim was to assess the level of glycemic control across Dubai Health Authority points of care over the past five years. Additionally, we aimed to compare the differences in glycemic control between primary and tertiary centers, between nationalities, and type I and II diabetes. Methods: We conducted a retrospective analysis of the electronic medical records of all patients who attended primary and tertiary care centers within the Dubai Health Authority between 2012 and 2016. All patients with any type of diabetes were included in this assessment. Results: A total of 26 447 patients were included in the study; of these, 73.8% (n = 19 508) were UAE nationals while the other nationalities accounted for 26.2% (n = 6939) of patients. The overall mean glycated hemoglobin (HbA1c) levels from 2012 to 2016 was 7.76%. Patients attending primary care clinics had a mean HbA1c of 7.64% compared to 7.68% for the tertiary care cohort. Out of the total population, 37.7% achieved HbA1c < 7%. Over 40% of the patients attending primary care centers achieved HbA1c < 7% compared to 34.9% of those who attended tertiary care centers. Conclusions: Optimum glycemic target was achieved by less than 40% of patients. Glycemic control is still below the desired levels. However, there has been a trend of improvement in the last few years and we are achieving the international average targets. Further collaborative actions from clinical, educational, and strategic sectors are needed to improve our goals further

Reasonable adjustments to provide equitable and inclusive assessment, screening and treatment of osteoporosis for adults with intellectual disabilities: a feasibility study

Background: People with intellectual disabilities are a high risk population for developing osteoporosis and fragility fractures, yet they experience barriers to accessing dual‐energy x‐ray absorptiometry (DXA) bone mineral density (BMD) screening and fracture assessment. Reasonable adjustments are a statutory requirement in the UK, but there is a paucity of evidence‐based examples to assist their identification, implementation and evaluation. Method: Thirty adults with intellectual disabilities underwent DXA BMD screening and fracture risk assessment. Reasonable adjustments were identified and implemented. Results: The presence of osteopenia or osteoporosis was detected in 23 out of 29 (79%) participants. Osteoporosis professionals report that 17 of 18 reasonable adjustments identified and implemented are both important and easy to implement. Conclusion: Adults across all levels of intellectual disabilities can complete DXA BMD screening with reasonable adjustments. Widely implementing these reasonable adjustments would contribute to reducing inequalities in health care for adults with intellectual disabilities

Evaluating Explainable Artificial Intelligence Methods Based on Feature Elimination: A Functionality-Grounded Approach

Although predictions based on machine learning are reaching unprecedented levels of accuracy, understanding the underlying mechanisms of a machine learning model is far from trivial. Therefore, explaining machine learning outcomes is gaining more interest with an increasing need to understand, trust, justify, and improve both the predictions and the prediction process. This, in turn, necessitates providing mechanisms to evaluate explainability methods as well as to measure their ability to fulfill their designated tasks. In this paper, we introduce a technique to extract the most important features from a data perspective. We propose metrics to quantify the ability of an explainability method to convey and communicate the underlying concepts available in the data. Furthermore, we evaluate the ability of an eXplainable Artificial Intelligence (XAI) method to reason about the reliance of a Machine Learning (ML) model on the extracted features. Through experiments, we further, prove that our approach enables differentiating explainability methods independent of the underlying experimental settings. The proposed metrics can be used to functionally evaluate the extent to which an explainability method is able to extract the patterns discovered by a machine learning model. Our approach provides a means to quantitatively differentiate global explainability methods in order to deepen user trust not only in the predictions generated but also in their explanations

Comparison of Endothelial Cell Loss following the Big Bubble versus the Microbubble Incision Technique during Deep Anterior Lamellar Keratoplasty in Eyes with Keratoconus

Introduction. Deep anterior lamellar keratoplasty (DALK) is now becoming an increasingly popular surgical technique in treating corneal stromal pathologies with healthy endothelium. Several advantages of DALK over penetrating keratoplasty (PKP) have been described such as maintenance of globe integrity, absence of endothelial rejection, and a low rate of chronic endothelial cell loss (ECL). ECL following PKP results in 50% cell loss after 2 years from the estimated graft endothelial cell density (ECD). Although there are several reports confirming that ECL following DALK is similar to the physiologic cell loss 2 years after surgery, few reports discussed the surgically induced ECL due to difficulty in preoperative imaging of ECD. Materials and Methods. This prospective, interventional study included 20 eyes of 20 patients, who underwent DALK surgery. 11 eyes underwent DALK using the big bubble technique, while 9 eyes underwent the microbubble technique. Postoperative evaluation was done 3 months after surgery and included best spectacle corrected visual acuity (BSCVA), keratometric readings, and refraction measured using an autokeratorefractometer (Topcon KR800, Japan) and endothelial cell density (ECD) using noncontact specular microscopy (Nidek CEM-530, Japan). Results. Regarding postoperative parameters such as postoperative logMAR visual acuity, postoperative mean K, and postoperative K max, there was no statistical difference found between both groups (P=0.754, P=0.119, and P=0.970, respectively). Regarding change in specular endothelial cell density and percent change in the specular endothelial cell density, again there was no statistical difference between both groups with P=0.057 and P=0.126, respectively (significance defined as P<0.05). Conclusion. ECD is not affected by failure of the big bubble to form and continuing DALK via the microbubble technique