A global action agenda for turning the tide on fatty liver disease

Background and Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach and Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over 2 rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities using Qualtrics XM, indicating agreement using a 4-point Likert-scale and providing written feedback. Priorities were revised between rounds, and in R2, panelists also ranked the priorities within 6 domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2, the mean percentage of “agree” responses was 82.4%, with all individual priorities having at least a super-majority of agreement (> 66.7% “agree”). The highest-ranked action priorities included collaboration between liver specialists and primary care doctors on early diagnosis, action to address the needs of people living with multiple morbidities, and the incorporation of fatty liver disease into relevant non-communicable disease strategies and guidance. Conclusions: This consensus-driven multidisciplinary fatty liver disease action agenda developed by care providers, clinical researchers, and public health and policy experts provides a path to reduce the prevalence of fatty liver disease and improve health outcomes. To implement this agenda, concerted efforts will be needed at the global, regional, and national levels.publishedVersio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Current Knowledge, Satisfaction, and Use of E-Health Mobile Application (Seha) Among the General Population of Saudi Arabia: A Cross-Sectional Study

BACKGROUND: General population knowledge, satisfaction, and barriers to using Seha app have not been evaluated from a large-scale perspective. Therefore, this study aimed to explore current knowledge, satisfaction, and barriers of using Seha app and identify the most common mobile health application used among the general population in Saudi Arabia. METHODS: A cross-sectional online survey, consisting of 25 questions, was distributed among the general population of Saudi Arabia. Descriptive statistics were used to describe the respondents’ characteristics. Categorical variables were reported as frequencies and percentages. A chi-square (χ 2) test was conducted to assess the statistical difference between respondents’ demographic characteristics and their knowledge and use of the app. RESULTS: Overall, 5008 respondents, both Saudi (3723: 74%) and non-Saudi (1285: 26%) as well as male 2142 (43%) and female 2866 (57%), across the Kingdom of Saudi Arabia completed the online survey. A total of 2921 (58%) had heard of the Seha app, although only 1286 (25%) had used the app. Higher percentages of users were from the western region, females and those within the age group of ≥ 51 years old, 388 users (29%: P< 0.001), 804 (28%; P< 0.001) and 67 (35%; P=0.013), respectively. Consulting a doctor was the most frequently utilized service, 576 users (58%). Respondents strongly agreed 402 (41%) that Seha was easy to use, and 538 (54%) strongly agreed that they would recommend Seha to others. The most common barrier of using Seha was a lack of knowledge about the app and its benefits, at 1556 (35%). Overall, the Tawakkalna app was the most utilized mobile health application provided by MOH used 2170 (48%). CONCLUSIONS: Utilization of the Seha app is quite low due to a lack of knowledge about the app and its benefits. Thus, the MOH should promote public awareness about the app and its benefits

Prevalence of Self-Reported Food Allergies and Their Association with Other Health Conditions among Adults in Saudi Arabia

Food allergies are a potentially life-threatening health issue, and few studies have determined their prevalence throughout Saudi Arabia. The main objective of our study was to estimate the prevalence and distribution of self-reported food allergies, and explore their association with other health conditions among adults in Saudi Arabia. This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was used to obtain equal distributions of participants by age and gender across the 13 regions of Saudi Arabia. Self-reported food allergy, height, weight, health conditions, mental health status, and demographic variables were collected. Of the 6239 participants contacted, 4709 (75.48%) participants responded and completed the interview. Furthermore, 50.1% of the participants were female, with a mean age of 36.4 &plusmn; 13.5 years (18&ndash;90 years). The prevalence of food allergies was 19.7%. The most self-reported food allergies were egg, shellfish and shrimp, and peanuts, with a prevalence of 3.7%, 3.1%, and 3.0%, respectively. There was an association between the presence of food allergies and reported bariatric surgery, asthma, colon disease, and being at risk of depression. Bariatric surgery was significantly associated with lower likelihood of self-reported allergy (OR 1.69, 95% CI 1.22&ndash;2.34, p = 0.002). This study revealed, for the first time, a high prevalence of self-reported food allergies among adults in Saudi Arabia in a large nationwide sample, and food allergy association with bariatric surgery, asthma, colon disease, and being at risk of depression. This information is valuable for clinicians and policymakers, particularly in terms of food allergen labeling

Multi Component Reactions under Increased Pressure: On the Mechanism of Formation of Pyridazino[5,4,3-de][1,6]naphthyridine Derivatives by the Reaction of Malononitrile, Aldehydes and 2-Oxoglyoxalarylhydrazones in Q-Tubes

Efficient synthesis of phenanthridin-6(5H)-one derivatives 12a–n in a four-component reaction of aldehyde hydrazone, aromatic aldehydes and malononitrile in Q-Tubes is reported. The results showed that the methodology has the advantage of being a one-pot synthesis of tricyclic systems in good yields. Potential routes leading to formation of compounds 12 are discussed. The structures of the synthesized compounds could be unequivocally established via X-ray crystal structure determination and spectroscopic methods

Exploring the Impact of COVID-19 Response on Population Health in Saudi Arabia: Results from the “Sharik” Health Indicators Surveillance System during 2020

Background: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. Objective: To explore the prevalence of some behavioral health risk factors, intermediate risk factors, and chronic diseases at different timepoints during 2020 using the data available from a currently used surveillance system in Saudi Arabia. Methods: This study undertook a secondary analysis of data from the Sharik Health Indicators Surveillance System (SHISS). The SHISS employs short cross-sectional phone interviews, conducted in all 13 administrative regions of Saudi Arabia on a quarterly basis. Each interview lasts approximately 4 min and is conducted by a trained data collector. The SHISS collects demographic data, as well as data on the major behavioral and intermediate chronic disease risk factors and the major chronic diseases, including diabetes, heart disease, stroke, cancer, and chronic respiratory diseases. Results: Of the 44,782 potential participants contacted in 2020, 30,134 completed the interview, with a response rate of 67.29%. Out of the total participants, 51.2% were female. The mean age was 36.5. The behavioral risk factors in this period exhibited significant changes compared to those in the first quarter (Q1) of 2020, when there were no significant restrictions on daily activities. These significant changes are related to reductions in fruit and vegetable intake (adjusted odds ratio (AOR), 0.23) and physical activity (AOR, 0.483), and a significant increase in e-cigarette use (AOR 1.531). In terms of the intermediate risk factors observed in the SHISS, significant increases in hypercholesterolemia (AOR, 1.225) and hypertension (AOR, 1.190) were observed. Finally, heart disease (AOR, 1.279) and diabetes (AOR, 1.138) displayed significant increases compared to Q1. Conclusions: This study shows some evidence of the impact of responses to COVID-19 on the health of the population in Saudi Arabia. Significant reductions in fruit and vegetable intake and physical activity, and significant increases in e-cigarette use, hypertension, and hypercholesterolemia may increase the burden of chronic diseases in Saudi Arabia in the near future. Thus, continuous monitoring of the health risk factors within the population, and early interventions, are recommended to prevent future increases in chronic diseases

Curcumin-loaded soluplus® based ternary solid dispersions with enhanced solubility, dissolution and antibacterial, antioxidant, anti-inflammatory activities

Amorphous solid dispersion (ASD) has emerged to be an outstanding strategy among multiple options available for improving solubility and consequently biological activity. Interestingly several binary SD systems continue to exhibit insufficient solubility over time. Therefore, the goal of current research was to design ternary amorphous solid dispersions (ASDs) of hydrophobic model drug curcumin (CUR) to enhance the solubility and dissolution rate in turn, presenting enhanced anti-bacterial, antioxidant and anti-inflammatory activity. For this purpose several ternary solid dispersions (TSDs) consisting of Soluplus®, Syloid® XDP 3150, Syloid® 244 and Poloxamer® 188 in combination with HPMC E5 (binary carrier) were prepared using solvent evaporation method. Both solubility and dissolution testing of prepared solid dispersion were performed to determine the increase in solubility and dissolution. Solid state investigation was carried out utilizing infrared spectroscopy, also known as Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM),Differential scanning calorimetry (DSC) and X-ray diffraction (XRD).Optimized formulations were also tested for their biological effectiveness including anti-bacterial, anti-oxidant and anti-inflammatory activity. Amid all Ternary formulations F3 entailing 20 % soluplus® remarkably improved the solubility (186 μg/ml ± 3.95) and consequently dissolution (91 % ± 3.89 %) of curcumin by 3100 and 9 fold respectively. These finding were also supported by FTIR, SEM, XRD and DSC. In-vitro antibacterial investigation of F3 also demonstrated significant improvement in antibacterial activity against both gram positive (Staphylococcus aureus, Bacillus cereus) and gram negative (Pseudomonas aeruginosa, Escherichia coli) bacteria. Among all the tested strains Staphylococcus aureus was found to be most susceptible with a zone of inhibition of 24 mm ± 2.87. Antioxidant activity of F3 was also notably enhanced (93 % ± 5.30) in contrast to CUR (69 % ± 4.79). In vitro anti-inflammatory assessment also exhibited that F3 markedly protected BSA (bovine serum albumin) from denaturation with percent BSA inhibition of 80 % ± 3.16 in comparison to CUR (49 % ± 2.91). Hence, F3 could be an effective solid dispersion system for the delivery of model hydrophobic drug curcumin

Incidence and Clinical Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with COVID-19: A Multicenter Cohort Study

Atrial fibrillation (Afib) can contribute to a significant increase in mortality and morbidity in critically ill patients. Thus, our study aims to investigate the incidence and clinical outcomes associated with the new-onset Afib in critically ill patients with COVID-19. A multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care units (ICUs) from March, 2020 to July, 2021. Patients were categorized into two groups (new-onset Afib vs control). The primary outcome was the in-hospital mortality. Other outcomes were secondary, such as mechanical ventilation (MV) duration, 30-day mortality, ICU length of stay (LOS), hospital LOS, and complications during stay. After propensity score matching (3:1 ratio), 400 patients were included in the final analysis. Patients who developed new-onset Afib had higher odds of in-hospital mortality (OR 2.76; 95% CI: 1.49-5.11, P  =   .001). However, there was no significant differences in the 30-day mortality. The MV duration, ICU LOS, and hospital LOS were longer in patients who developed new-onset Afib (beta coefficient 0.52; 95% CI: 0.28-0.77; P  < .0001,beta coefficient 0.29; 95% CI: 0.12-0.46; P  < .001, and beta coefficient 0.35; 95% CI: 0.18-0.52; P  < .0001; respectively). Moreover, the control group had significantly lower odds of major bleeding, liver injury, and respiratory failure that required MV. New-onset Afib is a common complication among critically ill patients with COVID-19 that might be associated with poor clinical outcomes; further studies are needed to confirm these findings