Abstract Background Carbapenem-resistant Enterobacterales (CRE) infections are a growing global concern, with limited data in children. Objectives This study aimed to identify risk factors for pediatric CRE infections and characterize their resistance genes and antibiotic susceptibility. Methods From January 2020 to March 2024, pediatric patients diagnosed with CRE infections >48 h after admission at a tertiary-care hospital in Bangkok were consecutively enrolled. A matched case-control study was conducted, pairing each CRE case 1:1 with a carbapenem-susceptible Enterobacterales (CSE) control based on infection site and age. Risk factors were analyzed using conditional logistic regression. Carbapenemase genes were detected using multiplex polymerase chain reaction, and antibiotic susceptibilities were determined by minimal inhibitory concentration testing. Results Seventy-six CRE cases and 76 matched CSE controls were included. Urinary tract infections were most common (42.1%). Independent risk factors included referral from other hospitals (adjusted odds ratios [aOR] 4.32; 95% CI 1.57–11.96), prior exposure to carbapenems (aOR 7.24; 95% CI 1.06–25.42), and third-generation cephalosporins (aOR 3.68; 95% CI 1.32–10.25). Klebsiella pneumoniae (72.4%) predominated among CRE isolates; Escherichia coli (52.6%) among CSE. Carbapenemase genes were detected in 76.3% of CRE isolates, mainly bla NDM (60.3%) and bla OXA-48 (51.7%). Among non-carbapenems, amikacin showed the highest susceptibility against CSE (98.7%), and colistin against CRE isolates (88.2%). Ceftazidime/avibactam susceptibility was 100% among non-carbapenemase-producing CRE and 63.3% among CRE isolates with bla OXA-48 . Conclusions Pediatric CRE infections are associated with healthcare exposures and prior broad-spectrum antibiotic use. The high prevalence of carbapenemase genes and reduced antibiotic susceptibility emphasize the need for enhanced surveillance and targeted therapies.
Abstract Background Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by sacroiliitis and spinal osteophyte formation that needs sophisticated testing to improve the accuracy of activity assessment and clinical decision-making. Objective To investigate the clinical value of serum amyloid A (SAA) and platelet-to-lymphocyte ratio (PLR) in assessing disease activity in patients with AS. Methods Using the bath ankylosing spondylitis disease activity index (BASDAI), 160 AS patients were categorized into 3 subgroups: low activity (BASDAI <4, n = 60), moderate activity (4≤ BASDAI <6, n = 50), and high activity (BASDAI ≥6, n = 50). Quantitative measurements included SAA concentrations and PLR values, with subsequent analysis of their relationship to disease progression. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve methodology. Results The high-activity group showed significantly elevated SAA (48.3 mg/L ± 9.1 mg/L) and PLR (164.5 ± 29.2) versus moderate- (SAA: 29.0 mg/L ± 8.2 mg/L; PLR: 138.4 ± 27.6) and low-activity groups (SAA: 14.3 [11.7–17.2] mg/L; PLR: 102.7 ± 22.2) (all P < 0.001). Both markers correlated strongly with BASDAI (SAA: r = 0.76; PLR: r = 0.71, P < 0.001). ROC analysis demonstrated that an SAA cutoff of 30.6 mg/L predicted high activity (96% sensitivity, 80% specificity), while PLR ≥143.7 showed 78.0% sensitivity and 76.4% specificity. Combined detection achieved superior area under the curve (0.95) versus individual markers (SAA: 0.93; PLR: 0.86). Conclusion SAA and PLR are strongly associated with BASDAI-defined disease activity in AS, and combined assessment improves identification of high disease activity, supporting their potential role as objective adjunctive markers in clinical assessment.
Abstract Background Digital health is central to Saudi Arabia’s Vision 2030, with hospital clustering introduced to improve efficiency, interoperability, and patient outcomes. However, comparative evidence on digital health adoption between clustered and non-clustered hospitals remains limited. Objectives This study evaluates the integration of electronic medical records (EMRs), telemedicine, and mobile health applications in clustered and non-clustered hospitals in Saudi Arabia, assessing their impact on patient-centered care and system performance. Methods A convergent mixed-methods observational design was applied. Quantitative hospital-level data (2016–2024) from two clustered and two non-clustered hospitals were analyzed for EMR adoption, telemedicine use, patient satisfaction, and chronic disease management. Logistic regression and ARIMA models assessed adoption patterns. Qualitative data were obtained through semi-structured interviews with 53 participants (30 patients, 23 physicians) purposively sampled from an initial pool of 80; saturation was reached at the 30th patient and 23rd physician. Thematic analysis identified facilitators, barriers, and perceived benefits. Results Clustered hospitals consistently outperformed non-clustered hospitals across all digital health indicators. By 2024, clustered hospitals achieved higher Patient-Centered Care Index (95.1% vs. 92.2%) and Chronic Disease Management Scores (96.1% vs. 92.8%). Logistic regression showed clustered hospitals had 1.8-fold higher odds of EMR adoption (95% confidence interval [CI]: 1.3–2.5) and 2.1-fold higher odds of telemedicine use (95% CI: 1.5–2.8). Qualitative findings revealed facilitators (system integration, leadership support), barriers (digital illiteracy, fragmented systems, limited training), and perceived benefits (reduced waiting times, improved follow-up, patient engagement). Conclusions Clustering enhances digital health adoption by strengthening interoperability, standardization, and institutional support. Persistent challenges, particularly in non-clustered hospitals, highlight the need for targeted investment in infrastructure, workforce training, and digital literacy to ensure equity in achieving Vision 2030 goals.
Abstract Background Endometriosis is a chronic inflammatory condition and is one of the leading causes of infertility. The role of T helper (Th) cytokines in infertility remains largely unexamined, despite their recognized importance in endometriosis. Objectives To investigate the serum and peritoneal fluid levels of IL-4, IL-5, IL-10, IL-17A, IL-17F, and IFN-γ in women with endometriosis and to explore their correlations with disease severity. Methods Eighty-seven infertile women undergoing diagnostic laparoscopy were included, comprising 44 endometriosis patients and 43 controls with benign gynecologic disorders. Serum and peritoneal cytokines were measured using Enzyme-linked immunosorbent assay. Statistical analyses assessed differences and correlations with clinical parameters. Results Both serum and peritoneal fluid levels of IL-4 and IL-5 were markedly higher in endometriosis patients compared to controls ( P < 0.001). Although serum IL-10 levels did not show significant differences, there was an increase in peritoneal fluid ( P < 0.001). Among those with endometriosis, serum levels of IL-4, IL-10, IL-17A, and IL-17F exhibited a positive correlation with the revised American Society for Reproductive Medicine score, while IL-17F indicated an inverse correlation with the Endometriosis Fertility Index (EFI) scores ( r = −0.422, P = 0.004). Receiver operating characteristic curve analysis demonstrated that IL-4 and IL-5 effectively distinguished endometriosis cases from controls, with IL-17F also providing significant predictive value for EFI scores ( P = 0.015). Conclusions Elevated IL-4 and IL-5 levels in endometriosis suggest a Th2-skewed immune response. Meanwhile, the correlation of IL-17A with disease severity and the inverse relationship of IL-17F with fertility scores highlight the complex role of the Th17 response. These findings enhance understanding of cytokine dysregulation in endometriosis and may guide future therapeutic strategies.
Abstract Background Ginger has been shown to effectively decrease the risk of nausea and vomiting in different medical conditions. In this meta-analysis, we investigated the effect of ginger on the risk of nausea and vomiting after chemotherapy. Methods We searched the Cochrane Library, Scopus, PubMed, and Web of Science from inception to April 17, 2025, to identify randomized controlled trials assessing the effect of ginger on the incidence of nausea and vomiting after chemotherapy. Results Finally, we included 13 randomized controlled trials with 639 participants in the ginger group and 626 participants in the comparator group assessing the efficacy of ginger for chemotherapy-induced nausea and vomiting. Overall, the risk of bias was generally low, with only 2 studies showing high risks of bias. We found that ginger could not significantly lower the risk of acute nausea (RR 0.83, 95% CI (0.60, 1.15), I 2 = 38.35%) and acute vomiting (RR 0.73, 95% CI [0.51, 1.06], I 2 = 0.00%) after chemotherapy. Similarly, ginger did not significantly decrease the risk of delayed nausea (RR 0.92, 95% CI [0.66, 1.28], I 2 = 23.71%) and delayed vomiting (RR 1.17, 95% CI [0.75, 1.83], I 2 = 17.43%) among those receiving emetogenic chemotherapy. In subgroup analysis, age was the only factor associated with the preventive effect of ginger on chemotherapy-induced nausea and vomiting, and ginger was more effective among those younger than 50 years. Conclusion This meta-analysis indicated that ginger could not significantly alter the risk of nausea and vomiting after chemotherapy.
