European Journal of Medical and Health Research
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Antibiotic Prescribing Patterns in Primary Healthcare Centers in Saudi Arabia: A Comparative Analysis with Global Trends
No full textBackground: Antibiotic prescribing patterns in primary healthcare centers (PHCs) significantly influence antimicrobial resistance (AMR) development. The Kingdom of Saudi Arabia (KSA) implemented a nationwide antibiotic restriction policy in April 2018 to regulate antibiotic dispensing. Understanding prescribing patterns in Saudi PHCs compared to international benchmarks is essential for evaluating policy effectiveness and guiding stewardship initiatives. Objectives: This review aims to describe antibiotic prescribing patterns in Saudi Arabian PHCs, compare them with WHO standards and international data, and evaluate the impact of the 2018 antibiotic restriction policy on prescribing practices. Methods: A comprehensive review of published literature was conducted using data from studies examining antibiotic prescribing in Saudi PHCs and international comparative studies. WHO/INRUD prescribing indicators and the AWaRe classification system were used as standard benchmarks for comparison. Data sources included PubMed, PMC, and WHO databases covering the period 2017-2025. Results: In Saudi PHCs, antibiotic prescribing rates for upper respiratory tract infections (URTIs) range from 24.4% to 44.3% [1,2], with pediatric prescribing at approximately 12.34% following the 2018 restriction policy [3]. The most prescribed antibiotics are amoxicillin (58.6%), Augmentin (28.6%), and macrolides [1]. Watch-group antibiotics account for 51.1-67.3% of prescriptions [4,5], exceeding WHO recommendations. Globally, primary care antibiotic prescribing averages 42.1% (95% CI: 39.2-45.1%) [6], with higher rates in low-income countries (49.1-54.0%) [6,7] and lower rates in Europe (15.2%) [8]. The 2018 Saudi restriction policy resulted in a 23.2-31% reduction in antibiotic consumption [9,10]. After COVID19 it’s noticed that there is a substantial increase in the group of Azithromycin and Mix of Amoxicillin and Clavulinic Acid, while on the other hand a reduced rates of prescribing for amoxicillin and clarithromycin antibiotics groups compared to pre-COVID19. Conclusion: Antibiotic prescribing in Saudi PHCs remains above WHO optimal standards but has decreased following policy interventions. The predominance of Watch-group antibiotics and suboptimal guideline adherence indicate continued need for antimicrobial stewardship programs. Saudi Arabia's prescribing patterns align more closely with Middle Eastern and North African trends than with European benchmarks, highlighting the need for region-specific interventions
Coexistence of Vulvar Crohn's Disease and Hidradenitis Suppurativa: A Diagnostic and Therapeutic Challenge
No full textVulvar Crohn's disease is a rare condition, reported only in clinical cases; it may complicate luminal involvement of the disease or be its only clinical manifestation. Difficult to diagnose, the most commonly described clinical presentation is edema, deep linear fissures, erythema, and painful labial ulceration. Various treatment protocols have been discussed, but no recommendations have been established. Its association with other skin disorders, such as pyoderma gangrenosum, has been reported, but the association with Verneuil’s disease has never been published. We report the case of a 45-year-old woman diagnosed with isolated vulvar Crohn's disease after two years of suffering, associated with axillary hidradenitis suppurativa (HS)
Synergistic Effects of Atorvastatin and Ciprofloxacin against Aeromonas hydrophila Clinical Isolates
No full textBackground: Aeromonas hydrophila is a Gram-negative bacterium which infects humans and aquatic creatures. The concern of drug resistance development has spread. The aim was evaluating atorvastatin and ciprofloxacin effects in combination against A. hydrophila clinical isolates. Methods: 10 clinical isolates of A. hydrophila were collected and the effects of atorvastatin was assessed. The minimum inhibitory concentrations of atorvastatin and ciprofloxacin were evaluated. The synergistic effects were investigated. The expression of acrAB gene was evaluated by real-time PCR. Results: There was ciprofloxacin's high susceptibility in clinical isolates of A. hydrophila with MICs of 0.125 – 0.5 μg/mL and atorvastatin's low antibacterial activity at MIC levels of 64-128 μg/mL. The data suggest that atorvastatin increased ciprofloxacin activity and supports the existence of synergy between the two antimicrobial agents despite atorvastatin's limited independent antibacterial activity. The sub-MIC concentration of atorvastatin caused a decrease in the expression of acrAB efflux pump coding gene by 1.8 fold. Conclusion: The observed synergistic effects of atorvastatin and ciprofloxacin against A. hydrophila suggest a promising adjunctive therapeutic approach. By combining a widely used lipid-lowering agent with an established antibiotic, there is potential to enhance antimicrobial efficacy, reduce drug toxicity, and combat resistance
Prevalence of Stress and Neck Pain Among Accountants: A Cross-Sectional Study
No full textBackground: Neck pain is regarded as one of the most prevalent
musculoskeletal issues globally. Accountants are particularly vulnerable due to the nature of their work, which typically involves extended periods of sitting. These job-related requirements frequently result in discomfort, reduced productivity, and, in certain instances, chronic disability. The aim of the study is to assess the frequency and intensity of neck pain experienced by accountants in Port Sudan and its association to stress. Methodology: A cross-sectional analytical study was carried out involving 301 accountants in Port Sudan. Participants were randomly chosen and evaluated using Neck Disability Index (NDI) and sociodemographic factors collected using a structured questionnaire. Microsoft excel program used to analyze data. All necessary ethical approvals were secured. Results: The results indicated that (58.5%) of participants worked between 7 and 9 hours each day. Only 9% of the participants are setting with correct posture. Most of the participants (77.7%) didn’t undergone diagnosis for neck pain. Among those who have diagnosis history of neck pain, (61.2%) diagnosed with Neck Spondylosis. There were (59.8%) of the study participants reported work stress experience. Work stress effects the productivity of (75.1%) of the study participants. Conclusion: Neck spondylosis stands as the most frequent condition observed among accountants in this study. Prolonged hours at the desk with poor posture contribute to neck pain and stress, hindering productivity
Evaluation of Rohypnol-Induced Acute Neurotoxicity in Male Wistar Rats
No full textRohypnol (Flunitrazepam), a benzodiazepine, is commonly used as a pre- anaesthetic and for insomnia treatment. However, it is also frequently abused for its sedative and amnestic effects, raising concerns regarding its neurotoxic potential. This study aimed to evaluate the acute neurotoxic effects of Rohypnol on cognitive function, cholinergic activity, and oxidative stress in the brains of male Wistar rats. Twenty male Wistar rats (180–200 g) were divided into two groups: control (Group A) and Rohypnol-treated (Group B). Rohypnol was administered at a dose of 0.1 mg/kg orally for 7 days. Behavioral testing included the T-maze to assess spatial memory, the Y-maze for spontaneous alternation, and the Light-Dark box test for anxiety- like behavior. Biochemical assays were performed to measure acetylcholinesterase (AChE) activity, and oxidative stress markers, including malondialdehyde (MDA) levels, superoxide dismutase (SOD), glutathione peroxidase (GST), glutathione (GSH), and catalase activity in brain homogenates. Rats treated with Rohypnol showed a significant reduction in spontaneous alternation in the Y-maze, suggesting impairments in spatial memory (p < 0.05). Rohypnol-exposed rats also spent significantly more time in the dark compartment of the Light-Dark box test, indicating increased anxiety-like behavior (p < 0.05). Biochemically, Rohypnol administration led to a significant increase in AChE activity and MDA levels, indicating disrupted cholinergic signaling and neuronal oxidative damage (p < 0.05). Additionally, oxidative stress markers including SOD, GSH, GST, and catalase were significantly elevated in the brains of Rohypnol-treated rats (p < 0.05), suggesting a compensatory response to oxidative damage. Acute exposure to Rohypnol induces significant neurotoxic effects in male Wistar rats, as evidenced by impaired cognitive performance, increased anxiety-like behavior, and biochemical markers of oxidative stress and cholinergic dysfunction. These findings highlight the potential neurotoxic effects of Rohypnol, particularly in cases of misuse or overdose, and underscore the need for further research on its long-term impact on brain function and health
Patterns of Chief Complaints in Breast Disorders and Their Association with Diagnosis and Family History
No full textBackground: Breast disorders represent a major cause of morbidity among women and account for a substantial proportion of visits to breast clinics. The pattern of presenting symptoms may reflect underlying pathology and is influenced by demographic and familial factors. Understanding the relationship between chief complaints, diagnostic outcomes, and family history is essential for improving early detection and clinical management of breast diseases. Objective: This study aimed to analyze the patterns of chief complaints among women with breast disorders and to examine their association with diagnostic categories and family history. Methods: A retrospective observational study was conducted at the Breast Clinic of Al- Karkh Teaching Hospital, Baghdad, from June 2022 to June 2023. Medical records of 267 female patients were reviewed. Data on age, family history, menstrual cycle history, chief complaint, and final diagnosis were collected. Diagnoses were classified into benign and malignant lesions. Results: The mean age of patients was 47.7 ± 11.3 years, with 72.7% aged over 40 years. Most patients had no family history of breast cancer (58.4%), and irregular menstrual cycles were observed in 53.2%. Mastalgia and consultation were the most common complaints among patients with benign lesions, whereas a palpable breast mass was the predominant presenting symptom in malignant cases (63.2%). Significant associations were found between chief complaints and diagnosis, as well as between family history and presenting symptoms (P < 0.001). Conclusion: Distinct patterns of chief complaints were associated with diagnostic outcomes and family history. Recognition of symptom profiles may enhance early detection strategies and improve clinical assessment of breast disorders
Congenital Aplasia Cutis: Unveiling a Rare Malformation through Case Report and Literature Review
No full textIntroduction: Aplasia cutis congenita (ACC) is a rare developmental anomaly defined by the congenital absence of skin in localized areas of the body. Its prevalence is estimated at 0.5 to 1 per 10,000 live births. The scalp is the most commonly affected site (60–70% of cases), followed by the trunk and limbs. Case report: We report the case of a male neonate, born at term, who presented with a congenital skin defect on the trunk. The lesion was butterfly-shaped, well-demarcated, and without evidence of local infection or hemorrhage. No associated malformations were identified on physical examination. The diagnosis of congenital cutaneous aplasia was established based on the typical clinical features. Management consisted of conservative local wound care and close clinical monitoring. The outcome was favorable, with progressive epithelialization and no functional impairment. Discussion: CCA may occur in isolation or in association with syndromic or chromosomal anomalies. While small, localized lesions often heal spontaneously under conservative management, extensive defects or those involving deeper structures may require surgical intervention. The trunk localization, particularly in a butterfly distribution, is less frequent than scalp involvement, making this case noteworthy. Conclusion: This observation illustrates an uncommon presentation of congenital cutaneous aplasia involving the trunk. Early recognition and appropriate management are essential to ensure a favorable outcome and to rule out associated anomalies
Diagnostic Accuracy of Glutathione Peroxidase in Serum of Children with Chronic Kidney Disease
No full textBackground: Chronic kidney disease (CKD) causes permanent renal function decrease and may lead to ESRD. CKD is a serious public health issue despite medical improvements that have increased survival. Over the past two decades, CKD in children has progressively grown, disproportionately affecting socioeconomically disadvantaged and ethnic minority groups. Overproduction of reactive oxygen species and inadequate antioxidant defenses cause oxidative stress, which causes kidney disorders like CKD. Glutathione peroxidase (GSH-Px) neutralizes oxidative damage. This study aimed to evaluate the diagnostic accuracy of serum GSH-Px levels in differentiating stages of CKD in children. Methods: A case–control study was conducted including 120 children who attended Al-Imamin Al-Kadhimeen City Hospital. Participants were divided into three groups: 40 children with CKD stages 1–4, 40 children with end-stage CKD, and 40 apparently healthy controls. All children underwent clinical assessment and medical history evaluation. Serum GSH-Px levels were measured using a colorimetric method, and receiver operating characteristic (ROC) curve analysis was applied to assess diagnostic performance. Results: Serum GSH-Px levels were significantly higher in children with end-stage CKD compared with those with CKD stages 1–4 and healthy controls. GSH-Px demonstrated very good discriminatory power between CKD and healthy children (AUC = 0.823), fair discrimination between end-stage CKD and non-dialysis CKD, and poor discrimination between early-stage CKD and controls. Conclusions: Serum GSH-Px may serve as a useful biomarker for differentiating children with CKD from healthy peers, particularly in advanced disease stages, reflecting the role of oxidative stress in CKD progression
Evaluation of the Factors Impacting the Performance of Nurses Working in Duhok Govenmental Hospitals in the Kurdistan Region, Iraq
No full textHospitals play a crucial role in community health moving forward and the significance of nurses, as an essential component in healthcare services is underlined. It emphasizes that nurses are interested in patient care not only brain, emotional social and spiritual needs. Furthermore, it considers issues that drive performance of the nurses regarding salary structure and working conditions. The study aims to evaluate the factors affecting nurses' performance in government hospitals in Duhok city, Iraq. Data was collected from 110 nurses using a questionnaire that was assessed by specialists. Findings show a wide range of concerns, from poor public perception of the nursing role to confusion over what we actually do and even being treated poorly by colleagues or patients. Inadequate financial income, risk of infection and stress were other issues that exacerbated the profession. The results also indicate problems related to how the leave of absence is granted and lack of clear task norms that compromise nurses' performance. This study concluded that there was a low level of salary among nurses and a low level of career development
The Diagnostic Yield and Safety of Pleuroscopy in Evaluation of Lymphocytic Exudative Pleural Effusion: A Single Center Study
No full textBackground: Diagnosis of lymphocytic exudative pleural effusion is challenging , where significant part of cases remain undiagnosed despite pleural fluid analysis , microbiological and radiological evaluation. Pleural biopsy is often needed for determine the causes. Pleuroscopy permit direct inspection of pleural cavity and targeted biopsy and thus increasing diagnostic yield. This study aimed to evaluate diagnostic yield of pleuroscopy and its safety in lymphocytic exudative pleural effusion. Methods: Current study is descriptive retrospective and prospective study, conducted in Babylon/Iraq between April 2022 and September 2025 on 50 adults patients who underwent pleuroscopy for evaluate lymphocytic exudative pleural effusion which remained undiagnosed despite cytological, microbiological ,biochemical and radiological investigations. The study recorded and analyzed the demographic data, clinical features, imaging findings, pleuroscopical findings, histopathological diagnosis and procedure related complication . Results: The mean age was 56.1 ± 16.5 years with predominance of male (66%). Shortness of breath was most common symptom (94%) followed by cough (82%). Unilateral pleural effusion was predominant (86%). Pleuroscopy demonstrated pleural nodules or masses in 74% of cases and erythematous/inflamed in 20 %. Pleural tissue was sufficient for histopathological diagnosis in all patients. Histopathological examination showed malignancy in 42%, infection in 42%, non-specific pleuritis in 10% and non-conclusive in 6%. The diagnostic yield was 94% with no significant procedure related complication. Conclusion: Current study showed that pleuroscopy had a high diagnostic yield and a high safety profile in evaluation of lymphocytic exudative pleural effusion. The malignancy and infection had constituted the majority of the final diagnosis of lymphocytic exudative pleural effusion