Nashwa Radwan

Background: The current review was conducted to determine the effectiveness of atenolol on all-cause mortality rate among Asian patients with chronic progressive diseases, mainly diabetes mellitus, primary hypertension, and coronary artery disease. Methods: We searched the COCHRANE, MEDLINE, TRIP, and EMBASE databases for published articles up to 31 March 2023. Studies that compared all-cause mortality rates among Asian patients who were on atenolol or other medications were included. Results: The review included 79603 Asian patients from three cohort studies. Out of the studied patients, 36046 were atenolol users and 43557 were non-atenolol users. The review revealed that atenolol users recorded lower all-cause mortality rates compared to non-users with a significant difference (OR= 0.57, CI= 0.44-0.75, P<0.001). The pooled estimate of the all-cause mortality rate was also lower among atenolol users (7.02%) compared to metoprolol tartrate users (13.15%) with a significant difference (OR= 0.50, CI= 0.47-0.53, p < 0.0001). Although the included studies were categorized as having a low risk of bias for most of the studied domains, significant heterogeneity was recorded across these studies (I2 =88%, P=0.001). Conclusion: This review found that atenolol when compared to a control or metoprolol tartrate, has a significant effect in reducing the all-cause mortality rate among Asian patients with chronic progressive disease.

Background: The Saudi Ministry of Health makes continual efforts to provide high-quality preventive services through a large network of primary health care (PHC) centers. Patient satisfaction is integral to measuring health outcomes and the quality of these services. Methods: We searched the Cochrane, EMBASE, and Google Scholar databases for studies investigating patient satisfaction with PHC services in Saudi Arabia in the past 10 years. The risk of bias and heterogeneity across the included studies were assessed with Newcastle Ottawa scale and I ² test, respectively. Review Manger version 5.311 was used for data analysis with the random effect model. The quality of evidence of each outcome was measured with the GRADE approach. Results: The review included 3302 Saudi residents from six observational studies conducted in different regions of Saudi Arabia. Most studies included in the review had low risk of bias regarding the studied domains. The review indicated moderate overall satisfaction with PHC services (77.00%) among participants. More than 60% of the participants (63.11% and 82.59%) were satisfied with the continuity and communication of PHC services, respectively, whereas, less than half (41.73% and 46.92%) were satisfied with the accessibility of the PHC services and the health education provided at these centers. Moreover, low satisfaction was found among older patients and those with low educational levels. Other sociodemographic factors did not determine patient satisfaction. Conclusion and Recommendations: This review indicated a moderate level of overall patient satisfaction with respect to the targeted satisfaction level for Saudi Ministry of Health 2023 PHC services of 85%. Additional efforts and continuing evaluation by health care providers will be crucial to address the weaknesses in PHC services.

Introduction: Saudi Ministry of Health (MOH) is starting to transfer the delivery of primary health care (PHC) services from solo practice to team-based care (TBC) model. It is an important to understand factors that affect the integration of this new model of care in the early stage of implementation process to ensure adequate incorporation of this new intervention into the routine work in PHC centers. Normalization process theory (NPT) is a method that helps evaluate the integration of new interventions. Therefore, this study aimed to explain the integration of TBC model in PHC services and investigate the barriers that may hinder the implementation of this model through using NPT. Methods: A cross-sectional study was conducted in PHC centers of Saudi MOH 7 months after the implementation of TBC model. A systematic random sample technique was used to select participants from all Saudi regions. A NPT questionnaire was sent online to the participants to collect data. Results: The study revealed that cognitive participation construct represented the highest score (4.06 ± 0.74) followed by coherence (3.78 ± 0.87) and reflexive monitoring (3.75 ± 0.79) constructs. Collective action construct represented the lowest integration score (3.48 ± 0.68). Gender, years of work experience, and duration of applying TBC model were not significant factors affecting the mean integration scores of the four constructs of NPT. Conclusion: The study recorded good integration scores of the included health staff to TBC model. However, the study demonstrated some barriers that may hinder the implementation progress of the model including inadequate staff training, insufficient resources, and lack of feedback reports. Other recorded barriers are the staff perception that TBC model affects the nature of their work and disrupts the working relationship. Sufficient resources, adequate staff training with close supervision, and providing them with feedback reports regularly are recommended to support and improve the implementation of the TBC model in PHC services.

Background: The prevalence and the role of CYP2C19 gene mutations concerning recurrent Cardiovascular Events (CVEs) among patients treated with clopidogrel is still controversial especially among Arab people. Therefore, this review aimed to determine the frequency of CYP2C19 polymorphic alleles among the Arab population and to investigate the efficacy of clopidogrel as an antiplatelet drug among those carrying different variants of this gene. Methodology: Two authors independently searched in PubMed, Google Scholar, and EMBASE databases at any year for studies related to the role of CYP2C19 gene on the prognosis of patients with CVEs treated with clopidogrel. The review included Arab people who were genotyped to determine the frequency of CYP2C19 genotypes and alleles (the qualitative part). Concerning the quantitative part (meta-analysis), only patients who previously had CVEs and using clopidogrel as secondary prophylaxis had been included. The Newcastle Ottawa Scale for non-randomizes Studies was utilized to consider the risk of bias among included studies. We analyzed the data using odds ratio at 95% confidence interval and the quality of evidence of each outcome measure was judged using GRADE approach. Results: The current study revealed that 4% of Arabs reported in the included studies are homozygous, and 25% are heterozygous for the CYP2C19*2 allele. While 3% and 18.5% of them are homozygous and heterozygous of CYP2C19*17 alleles, respectively. A significant increased risk of recurrent CVEs by about threefold was associated with CYP2C19*2 or CYP2C19*3 allele carriers (OR = 3.32, CI = 1.94–5.67, and OR = 3.53, CI = 1.17–10.63, respectively). However, no significant increased risk among carriers of CYP2C19*17 mutation (OR = 0.80, (CI = 0.44–1.44) was documented. Conclusion: The present study revealed that Arabs carrying CYP2C19*2 and CYP2C19*3 alleles could be at increased risk of decreasing the antiplatelet efficacy of clopidogrel and an alternative drug should be prescribed for those patients to avoid recurrent CVEs. However, few available studies were included in the quantitative part of the analysis and further studies with large sample size are recommended to confirm our results.

Background: The global threat of COVID-19 caused by the SARS-CoV-2 virus has reached a high level and the outbreak has been declared as a pandemic. This disease affects different organs and systems including the central nervous system. In this study, we aimed to clarify the development of neurological complications in patients with COVID-19 and the factors associated with these conditions. Methodology: Two authors independently searched the Cochrane, Trip, EMBASE, and Google Scholar databases from January 2020 to February 2021. The literature search included studies written in English and related to neurological complications in COVID-19 patients. Then, the two authors independently determined the characteristics and risk of bias of the included studies. Finally, we analyzed the data using odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs). Results: This review involved 4401 patients with COVID-19 from six observational studies. Overall, low to moderate heterogeneity was recorded among the included studies. A high risk of bias was not detected in any of the domains studied, although there were some low risks of bias and heterogeneity. Of the included patients, 8.24% developed neurological manifestations, including delirium (84.3%), myalgia (44.8%), headache (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), anosmia (11.45), acute ischemic stroke (4.6%), cerebrovascular disease (1.78%), and intracerebral hemorrhage (0.5%). The severity of COVID-19 and the association of underlying comorbidity (predominantly hypertension) increased the risk of neurological complications among COVID-19 patients by fourfold (OR 4.30, CI 2.54–7.29 and OR 4.01, CI 1.05–15.36, respectively). Patients with heart diseases, diabetes, and dyslipidemia had a twofold higher risk of developing neurological complications (OR 2.53, CI 1.01–6.33; OR 2.31, CI 1.15–4.65; and OR 2.13, CI 1.52–3.00, respectively). Conclusion: Our analysis indicated that neurological complications were uncommon in patients with COVID-19. Age, male sex, smoking, the severity of disease, and underlying comorbidity, including hypertension, heart disease, diabetes, and dyslipidemia, were identified as significant risk factors for neurological complications in COVID-19 patients.

This study aimed to predict the preventive effect of clopidogrel against recurrent cardiovascular events (CVEs) among the Arab population carrying different CYP2C19 mutations and to determine the frequency of polymorphic alleles and genotypes of CYP2C19 among them. The review included all the studies that reported data related to the CYP2C19 polymorphisms among Arab populations. The review included Arab CVDs patients who are categorized into carriers (cases) and non-carriers (controls) of CYP2C19 alleles and used clopidogrel as secondary prophylaxis. The patients who had recurrent CVEs or had high on-treatment platelet reactivity (HTPR) while using clopidogrel treatment were described as (events). The results showed a significantly increased risk of recurrent CVDs events by about three folds was associated with carriers of CYP2C19*2 and CYP2C19*3 mutations compared to non-carriers (OR= 3.32, CI=1.94-5.67, and OR=3.53, CI=1.17-10.63 respectively). However, no significant difference was recorded between both studied groups regarding the presence of CYP2C19*17 mutation (OR=0.80, (CI=0.44-1.44). The results also revealed that 59 (4.16%) of Arabs carrying two CYP2C19*2 alleles (homozygous), and 356 (25.12%) have one CYP2C19*2 allele and one CYP2C19*1 allele (heterozygous). Moreover, 42 (2.96%) were carrying two CYP2C19*17 alleles (homozygous), and 262 (18.49%) were carrying one CYP2C19*17 allele and one wild-type allele of CYP2C19 (heterozygous). The most common CYP2C19 genotypes reported among Arabs was the wild-type *1/*1 , of which 49.26% of them had the homozygous form of the CYP2C19*1 allele. The frequency of the CYP2C19*1 allele was 71.07%, followed by the CYP2C19*2 allele (16.73%) and CYP2C19*17 (12.21%), respectively. The CYP2C19*3 allele was detected rarely among Arabs (CYP2C19*1, *2 , and *17 alleles. The present study revealed that Arabs carrying CYP2C19*2 and CYP2C19*3 alleles may not respond to clopidogrel and may put those patients at risk of recurrent CVEs. Carriers of the CYP2C19*17 allele, on the other hand, did not show a significant role either in increasing or decreasing the antiplatelet efficacy of clopidogrel. The CYP2C19 genotypes including *1/*1, *1/*2, *1/*17, *2/*2 , and *17/*17 are commonly distributed among the Arabs.

Clopidogrel is an antiplatelet drug commonly used to prevent coagulation. This review aimed to investigate the effect of polymorphisms of G6PD, GCLC, GCLM, GSS, GST, GSR, HK and GLRX genes on clopi...

Background: Hajj is an annual religious ritual that takes place for a specific period in Makkah city. Every year, the Kingdom of Saudi Arabia hosts more than two million pilgrims from more than 160 countries around the world for Hajj. It is crucial to minimize illnesses among pilgrims. This study aimed to assess the impact of preventive measures on acute illnesses among pilgrims. Methods: A retrospective cross-sectional study was conducted during the Hajj season from August to September 2019. A random sample was extracted from electronic evaluation forms filled by professional health care workers at two airports in Saudi Arabia including pilgrims before their departure and after the end of hajj season. Results: The study included 2,479 pilgrims. The most frequently associated comorbidity was Diabetes Mellitus in 49.54%. Upper respiratory tract infection was found in 39.17% and was the most common illness reported. Comorbidities had a crude odds ratio (OR) of 2.67 with a p-value of 0.000 and an adjusted OR of 2.80 with p-value of 0.000. The pre-Hajj examination had an OR of 0.37 with a p-value 0.000 that remained significant even after adjusting age and gender. Hajj health education had a crude OR of 0.17 with a significant p-value of 0.000 and adjusted OR 0.39 with p-value 0.003. Conclusion: Based on the current observation, strict compliance with standard pre-Hajj clinical examination, health education, and the use of umbrella during Hajj seasons is recommended to reduce the impact of acute illness among pilgrims.

Comorbidities and severity of coronavirus disease 2019 patients