Candida auris  is a fungal species that belongs to Ascomycetous  fungi which are generally recognized as the sac fungi or ascomycetes. 1 It is the biggest phylum of Fungi, in which over 64,000 fungal species are included. C.auris belongs to  the genus  Candida  that grows as a  yeast . 2 Genomic analysis of C.auris DNA  has revealed that it is a distinct fungal species bearing close resemblance of the phylogenetic profiles of  Candida haemulonii ,  Candida ruellia ,  C. pseudohaemulonii and  C. duobushaemulonii . 4 Its name is derived from the Latin word “ auris”   wich means “ear”,  as it was initially discovered  in the year 2009 in Japan from the ear canal of a 70-year-old woman at the Tokyo Metropolitan Geriatric Hospital. Latter in 2011 it was reported in South Korea following its  spread across Asia and Europe, and in the year 2013 it was reported in  United states. 3 Till present day it has been reported in almost thirty five  countries located in all continents, with the exception of Antarctica. 4,5 C. auris   is resistant to majority of antifungal drugs, hence establishing itself as a new example of one of the world's most obdurate health threats resulting from of infections caused by various drug resistant organisms for example Carbapenamese resistant Klebsella pneumoniae, Vancomycin resistant Enterococci (VRE) , Methicillin resistant Staphlylococcus aureus ( MRSA). 6 C. auris  can endure on the surfaces of a  healthcare setting resulting in nosocomial infections as it can spread in between patients admitted in that  healthcare facility. C. auris  can survive on a broad range of dry and moist surfaces, including plastic where the pathogen may dwell for up to fourteen days. 7    C. auris  is found  to be resistant to a broad range of disinfectants that includes various quaternary compounds and cationic surface active products.  Although the precise mode of transmission of C.auris is yet to be recognized, evidence suggests that  C. auris  spread is chiefly associated with direct or indirect contact with the contaminated surfaces located in a health care setting as well as from healthcare personnel. Persistent outbreaks have been reported accusing transmission through hand and contaminated of surfaces. 8.9 Patients who are immunocompromised or  have an extensive hospital  stay in an intensive care unit  or who had previously received antibiotic or antifungal medications are particularly more prone to be infected by C.auris . Healthcare facilities in different countries have reported that C. auris  has been causing severe disease in patients. In several patients, this yeast has also been reported to enter the bloodstream resulting in spread of infection in different parts of the body, causing life threatening  invasive infections. 10,11 As this  yeast is often resistant to most of the commonly used antifungal drugs, it leads in difficulty to treat such infected patients hence leading to an increase in morbidity and mortality rate. Fungal identification methods implied to identify yeasts in various clinical specimens, by the clinical laboratories,  frequently misidentify  C. auris   as other yeasts therefore making the diagnosis and control of this multi drug resistant pathogen an enormous challenge. Morphologically C. auris  is a budding yeast with cells that are approximately  2.5-5.0 micrometers in size and are arranged singly,  in pairs or even in groups. It grows well at a temperature of 40 degrees Celsius however  the growth slows down at 42 degrees Celsius.  C. auris  does not  form hyphae or pseudohyphae. Though, if it is grown under high-salt stress, such as on yeast extract, tryptone, and dextrose (YTD) with 10% NaCl, and depletion of heat-shock proteins (HSP), it can result in   production of  pseudohyphae like forms. 12  The appearance of C. auris  on culture medium varies depending upon the culture  media. Globally the most common media used for fungal growth   is Sabouraud’s dextrose agar, on which C. auris  will create smooth, white to cream-colored colonies. 13  Whereas on CHROM agar, C. auris  will appear in different colors  ranging from pale to dark pink. The ability of  C. auris  to build up resistance to several commonly used antifungal drugs may be a vital factor that had contributed for its high rate of mortality. 14 Antifungal susceptibility data published so far reflects that a number of  C. auris  strains demonstrate elevated minimum inhibitory concentration (MIC) for three major classes of antifungal drugs, which includes azoles, polyenes, and echinocandins.  Echinocandins were considered as the first line therapy for treating  C. auris  infection if resistance to azoles and amphotericin B is detected. However as the resistance to echinocandins has also been established, patients should undergo close follow up and microbiological culture based reassessment to detect therapeutic failure and consultation with an infectious diseases expert is recommended. Scrupulous awareness of infection prevention and control, along with strict implementation of hand hygiene for healthcare personnel and healthcare facility visitors either by  hand washing with soap and water or hand sanitizing with an alcohol-based hand rub is a vital step to control the spread of C.auris . Moreover the healthcare personnel should strictly follow the basic infection prevention and control measures that include the proper use of gowns and gloves, appropriate discarding of medical waste and sterilizing or effectively disinfecting equipment and surfaces. Health care facilities should have mounted directions to a specific ward or facility so that the visitors can follow those facility directions in order to prevent the spread of infection. Lastly the most crucial step is environmental cleaning and disinfection, healthcare cleaning products that have a sporicidal activity or  hydrogen peroxide containing solutions can contribute in an effective cleaning of  surfaces in a healthcare facilities leading to decrease in  C. auris  colony-forming unit (CFU). 15 Those patients who are colonized or with  suspected  C. auris  infection should be kept in isolation under strict contact precautions until microbiological screening and diagnostic results are obtainable. Patients who are referred from the  institutions where C. auris has been  isolated, should be screened for C.auris colonization. Suggested screening sites are axilla, groin, nose, throat, and rectal swab. Other high risk sites  include cannula or catheter entry sites, wounds and endotracheal secretions. After a  patient is discharged from a  healthcare facility, environmental decontamination  procedures with Chlorine-based detergents, ultraviolet light, and hydrogen peroxide vapor demonstrated  have shown to be effective in environmental decontamination. 16 In order to restrain transmission it is also recommended that central and peripheral line catheter , urinary catheter, and tracheostomy sites should be strictly monitored and incase of any sign of colonization or infection of central catheters or other invasive devices, should be removed, as it has  shown to play a significant role in subsiding the candidemia and improving the clinical outcome. auris strains may continue to emerge independently and concurrently throughout the globe in the coming years that’s why it is essential that the healthcare workers should be aware about this notorious organism and infection control policies regarding control and spread of C. auris should be design and implemented along with an enhanced diagnostic and therapeutic strategies.

Objectives: Methotrexate (MTX) is a key therapeutic agent for leukemias. When given in high doses, leucovorin rescue is added to reduce its toxicity. It has been postulated that low albumin levels are associated with delayed clearance and increased toxicity of MTX. Hence, this prospective cohort study was proposed to evaluate the correlation between serum albumin level and HDMTX toxicity in acute lymphocytic leukemia (ALL) patients and to compare the MTX toxicity in hypo and normoalbuminemic patients. Methods: Forty-six ALL patients of either gender aged 2–40 years receiving HDMTX for 1st time were included in the study. The serum albumin levels were measured before chemotherapy before each cycle. The patients received 24-h infusion of HDMTX on days 8, 22, 36, and 50 (four cycles). The serum concentration of MTX was measured after first cycle only. The patients were followed for toxicities that were graded according to CTCAE-V4.0. Results: There was a negligible correlation between cumulative albumin levels of all four cycles and cumulative toxic events. The median toxic events were 19 (16–23). The Spearmen correlation coefficient ρ was 0.055 (P = 0.460). No association was found between albumin level and MTX toxicity in cycle wise analysis also. In each cycle, there was no significant difference in the toxicities between the hypo and normoalbuminemic patients. Only vomiting showed significant (P < 0.05) inverse correlation with albumin levels. Hypoalbuminemic patients showed significantly (P < 0.01) higher grade of nausea compared to normoalbuminemia. Conclusion: There was negligible correlation between albumin levels and MTX toxicity despite delayed clearance supporting the safety of MTX in mildly hypoabuminemic patients.

Objective: Snake bite-induced elevation of serum LDH and CRP-1 is considered as useful biomarkers of hemotoxic. The snake venom contains proteins and may result in various envenomation such as bleeding, inflammation, and pain, cytotoxic, cardiotoxic, or neurotoxic effects. This in silico study was aimed to screen the snake venom proteins and to find out the most interactive hemotoxic venom protein against LDH and CRP-1 proteins as biomarkers. Methods: To validate the hypothesis of the prospective interaction of snake venom proteins, molecular docking analysis was used in the current work by deploying a cutting-edge docking program. Snake venom peptides were screened from literature and both peptide as well as target protein were obtained from PDB. HDOCK online server was used for the molecular docking analysis of target proteins with hemotoxic snake venom peptides. Further, the toxicity properties of each docked complex of target proteins were subjected for ADME/T analysis. Results: The selected snake venom peptides were subjected to molecular docking study and the results generated from computational-based approach reveals that all the hematotoxin snake venom proteins are interactive with LDH and CRP-1 peptide. Further, this study indicates that snake venom metalloproteinase (SVMPS) peptide may be considered as the best interactive protein with both LDH and CRP-1 proteins; also, ADME/T screening revealed that all docked complex are safe and follow toxicity properties. Conclusion: This in silico study clearly shows that the greatest interaction of SVMPS peptide with LDH and CRP-1 may be due to strong binding in the active site of the target proteins LDH and CRP-1 with SVMPS. Results, further, confirmed LDH and CRP-1 as potential biomarkers against hemotoxic snake venoms. This study should be validated by in vitro and in vivo analysis as well as specific species snake venom should be assessed. For further studies, SVMPS can be consider as therapeutic point of view.

Objective: Physical inactivity in Saudi women is high, even among young women (60% of university students are physically inactive). We aimed to investigate the effect of a physical activity intervention on daily walking among female students at a Saudi university. Methods: Two hundred and seven female students (mean age: 22.6 ± 1.3; body mass index: 24.6 ± 5.9) participated in a parallel-group randomized trial. The intervention group wore pedometers and received health-promotion messages for 12 weeks through WhatsApp®; the control group received a similar number of messages unrelated to health. Average daily steps and self-reported activity were assessed at baseline and after 3 months. Analysis followed an intention-to-treat approach. Group differences in average daily steps were assessed using a two (group) by 2 (time) ANOVA. F-tests for main effects and the interaction were evaluated; P < 0.05 was considered significant. Results: There was a significant group-by-time interaction, that is, the intervention group had a significantly higher change in daily steps compared to the control group (+576 vs. −525; F = 4.33, P = 0.04). Self-reported daily activity was not significantly different by group. Conclusions: The intervention was effective at improving the number of daily steps in young women. Future studies could test this intervention among other student groups.

Objective: Untreated hepatitis C virus (HCV) infection can lead to cirrhosis, hepatocellular cancer, and even death and also increases liver diseases. The elbasvir/grazoprevir (EBR-GZR) treatment regimen when given in HCV genotype (GT) 1 and GT4 infection for 8 or 12 weeks showed a high sustained virolgical response (SVR) rates in different populations. This study was assessed the effectiveness as well as safety of EBR-GZR in 12 week treatment regimen in HCV GT4-infected treatment naïve Saudi patients. Methods: This study conducted from June 2017 and December 2020 on Saudi HCV patients infected with GT4. Treatment protocol was given for 12 weeks in treatment naive HCV GT4 infected cirrhotic and non-cirrhotic participants which were later followed for a total of 24 weeks for safety and efficacy of EBR-GZR. Results: We analyzed data of 54 participants with HCV GT 4 infection. Mean age was (53.46 ± 14.94) Treatment regimen was given to 14 cirrhotic (F4) and 40 noncirrhotic (F0–F3). SVR was seen in 98.1% of participants with tolerable side effects and improved model for end stage liver disease (MELD) scores as fall in percentage seen from 18.5% to 14.8% in participants with MELD > 10. Conclusion: This retrospective study confirms that EBR-GZR for 12 weeks is a safe and effective treatment regimen in HCV GT4 patients in studied Saudi population. Treatment completion was followed by high SVR12 rates with improvement in prognostic markers of liver disease in participants with compensated cirrhosis. In short, the EBR-GZR combination showed efficacy in achieving the SVR12 in Child-Pugh B cirrhotic and non-cirrhotic population with a favorable safety profile.

Objective: The prostate-specific antigen (PSA) is the primary biomarker to diagnose prostate cancer. Hepcidin has been reported as an alternative for this diagnosis; however, it is unclear how PSA and hepcidin function at high altitude (HA). This study aims to assess the association between hepcidin with PSA in HA residents chronically exposed to hypobaric hypoxia. Methods: We retrospectively examined data of 70 healthy males (aged 18–65-years-old) from four different altitudes cities in Peru: Lima (<150 m), Huancayo (2380 m), Puno (3800 m), and Cerro de Pasco (4320 m). Serum hepcidin, testosterone, and PSA were analyzed by chemiluminescence immunoassay. HA parameters (hemoglobin [Hb], pulse oxygen saturation [SpO2], and chronic mountain sickness [CMS] score) were also included in the study. Bivariate analyses and a multivariate linear mixed model were used to evaluate the association between hepcidin and PSA, adjusted by HA parameters, age, and body mass index (BMI). Results: Cases of excessive erythrocytosis (EE) (Hb >21 g/dL) were observed in the three highest cities. Hepcidin was positively correlated with Hb, CMS score, and BMI (P ≤ 0.05). Hepcidin was higher in Huancayo with respect to Puno, while PSA was lower in Cerro de Pasco in regard to Puno and Lima (P ≤ 0.05). Neither hepcidin nor PSA was increased by altitude in each city (P > 0.05). We did not find an association between hepcidin and PSA, even adjusted by age, BMI, Hb, and SpO2 (P ≤ 0.05). Conclusion: These findings showed no association between hepcidin and PSA levels in healthy residents at HA.

Objectives:  In newborns, developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint but its accurate detection is challenging. This study was designed to determine an accurate detection of DDH and their associated risk factors in infants younger than six months using sonographic and clinical examinations.    Methods:  Infants younger than six months (n=404) with their hip instability were recruited. Infants’ hips were examined by ultrasonographic and clinical examinations. Ultrasonographic data were accessed in relation with the risk factors. Omni calculator was used to measure sensitivity, specificity and accuracy. Results:  Out of 808 hips, 97.3% hips were categorized as Graf I type, 1.4% hips were Graf type IIa, 0.87% were type IIb and 0.49% were type IIc. The data revealed that 93.9% hips were congruous and 6.1% hips were immature. Importantly, the data showed that risk factors such as mode of delivery, breech presentation, oligohydramnios, family history and malformations were proportionally associated with positive DDH cases. Interestingly, the sensitivity, specificity and accuracy of ultrasonography in relation with clinical positivity of DDH infants were 51.83%, 99.43% and 73.16%, respectively. Conclusions:  This   study   proved that ultrasonographic assessments are highly sensitive, specific and accurate for the detection of DDH onset in infants younger than 6 months. In addition, the study investigated a number of risk factors associated with the onset of DDH, therefore, it is extremely important that ultrasonography and clinical examination should be performed by those sonographers and orthopedic surgeons, who will have the knowledge of associated risk factors.  

Objective: This is a case series study of 14 cases of chronic unhealed ulcers involving patients of 19-85 years, aimed to demonstrate the positive therapeutic outcomes of using autologous platelet rich plasma (PRP) in diabetic fool ulcer (DFU) and other chronic wound healing. Methods : This is a formal consecutive clinical case series. Patients with chronic unhealed ulcers  were enrolled from the  amputation prevention clinic by an interdisciplinary team includes  podiatrist, general surgeon, orthopedic, vascular surgeon, and wound care nurses at Kahel Specialized Centre, a specialized center for managing foot and ankle diseases, located in Riyadh, Saudi Arabia. Those patients who presented with chronic wounds and showed no significant wound reduction despite following the standard wound care protocol were included in the study. There were no specific predetermined exclusion criteria when considering patients for treatment with this modality. Results : In this case series, majority (80%) of the patients were above 50 years of age, and 10 (66.7%) patients were male and 5 (33.3%) were female. Of all the cases presented to  the amputation prevention clinic, majority (73.3%) reported suffering from type 2 diabetes mellitus (T2DM) and also, one reported type 1 diabetes mellitus (T1DM;[6.7%]). All the cases of DFU received a combination of hydrogel and autologous PRP treatment and were put of suitable offloading devices, except one case received a combination of Cadexomer iodine, hydrogel and PRP treatment. In the present case series involving 3 to 14 weeks of the treatment duration, only 2 to 3 doses of autologous PRP provided complete healing and or maximum wound closure. Conclusion : Autologous PRP therapy is efficacious in facilitating, enhancing wound healing and aids in complete wound closure. This case series was limited in term of the sample size which is the number patients enrolled for the study, hence, the study finding remain inconclusive to some extent and hence, further study is required with greater number of sample size. The strength of this study is that it is the first study in Saudi Arabia and gulf region, to report the beneficial effect of PRP in chronic unhealed ulcers including diabetic ulcers.