BACKGROUND:Multidrug-resistant (MDR) ESKAPE pathogens, including Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P. aeruginosa, and Enterobacter spp., pose a critical global health threat. OBJECTIVE:This narrative review evaluates microRNAs (miRNAs) as novel antibacterial agents against MDR ESKAPE, focusing on their mechanisms of action, preclinical efficacy, delivery innovations, and translational barriers. METHODS:PubMed and Google Scholar were searched using terms related to miRNA biology, antibacterial activity, ESKAPE pathogens, and delivery platforms RESULTS: miRNAs exert antibacterial effects through three mechanisms: innate and adaptive immune modulation, regulation of host antibacterial pathways (including antimicrobial peptide production), and direct cross-kingdom bacterial mRNA silencing with biofilm disruption. Preclinical evidence highlights key candidates: let-7b-5p achieved a 90% reduction in P. aeruginosa biofilm and restored aztreonam sensitivity, and miR-101-3p, delivered via DNA tetrahedron nanostructures, suppressed polymicrobial biofilms in cystic fibrosis (CF) models. The Rocket-miR platform identified miRNA candidates across all ESKAPE organisms, including miR-877-5p and miR-3127-5p, which target carbapenem-resistant K. pneumoniae and vancomycin-resistant E. faecium. The core translational challenges include miRNA instability, limited cellular uptake, off-target effects, and undefined regulatory pathways. Nanocarrier-based delivery, exosomal platforms, and machine learning-assisted target prediction offer promising solutions to these challenges. CONCLUSION:Current preclinical evidence suggests that miRNAs hold promise as early-stage candidate antibacterial agents through immunomodulation, host pathway regulation, and direct bacterial gene silencing with biofilm disruption. However, no miRNA-based antibacterial therapy has entered clinical evaluation, and substantial translational barriers, including delivery challenges, off-target effects, and undefined regulatory pathways, must be addressed before clinical application can be considered.

Introduction: Hepatitis B virus (HBV) infection still poses an important public health issue in Saudi Arabia, despite the availability of effective vaccines and national prevention programs. It is particularly important among women, who play a central role in family health and face a risk of transmitting the infection to their infants during pregnancy and childbirth. Objectives: This study intends to report the levels of knowledge, attitudes, and practices towards HBV prevalence among non-pregnant Saudi women in Bisha province and thus provide context-specific evidence that can inform a targeted preventive actions framework. Methods: A community-based cross-sectional study was conducted in Bisha province, Saudi Arabia, from January 2025 to February 2026 among 391 non-pregnant Saudi women aged ≥18 years or older. Data were collected via a structured Arabic questionnaire. We categorized the good knowledge, positive attitude, and good practice as scores ≥75%, ≥80%, and ≥70%, respectively. Statistical analysis was performed using STATA BE, 2025. We employed Chi-square and logistic regression to examine the associations. Results: The mean±SD scores of knowledge, attitude, and practice were 15.2±3.4, 5.9±1.6, and 6.7±2.1, respectively. Overall, good knowledge was reported by 65.5%, positive attitude by 69.3%, and good preventive practice by 46.8%. There were significant correlations between better KAP and higher education, working as health/education professionals, being richer (income), already vaccinated against HBV, and having taken the respective tests for HBV (p<0.05). Only 40.9% were fully vaccinated; ever-screening and HBV health education participants accounted for 45.5% and 31.7%, respectively. In multivariable analysis; good knowledge (adjusted odds ratio 2.12, 95% confidence interval 1.40–3.22), positive attitude (AOR=2.51, 95% CI: 1.64–3.85), vaccination (AOR=3.02, 95% CI: 1.88–4.84) and exposure to previoushealth education session (AOR=1.96, 95% CI: 1.23–3.13) were identified as a predictors of good practice. Conclusion: Awareness and attitudes toward HBV are generally positive among women in Bisha; however, the preventive practices are substandard. This knowledge–practice gap remains large and is influenced by education, occupation, income, and health service engagement. Tailored interventions integrating education, accessible vaccination, screening, and community-based outreach are needed to improve HBV prevention and align with national elimination goals.

The global prevalence of irritable bowel syndrome (IBS) is alarming, with approximately 10–15

Catheter-associated urinary tract infections (CAUTI) lead to increased morbidity, mortality, prolonged hospital stays, and frequent antimicrobial use, potentially leading to development of multidrug-resistant pathogens. This study aimed to determine the prevalence of CAUTI and identify risk factors among patients in intensive care units (ICU) at King Abdullah Hospital (KAH), Bisha, Saudi Arabia. A retrospective cross-sectional, hospital-based study was conducted between November 2023 and June 2024 among 327 patients admitted to the ICU at KAH and catheterized with a Foley catheter. Clinical data and general characteristics of the patients were gathered. Identification and antibiotic sensitivity testing of bacterial pathogens were performed as per standard laboratory methods. Univariate and multivariate logistic regressions identified factors associated with CAUTI. Results were presented as odds ratios with 95

We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal swelling. Doppler ultrasound revealed normal testicles but an enlarged, echogenic left epididymis with pyocele. Despite initial therapy with amoxicillin and cefotaxime, a repeated ultrasound indicated compromised testicular vascularity, necessitating emergency surgical exploration. This revealed purulent discharge and inflammation, with Escherichia coli as a causative agent. Post-surgery, the patient showed significant improvement and was discharged in good condition after a ten-day of hospitalization. The study emphasizes the significance of including EO in the possible diagnoses for neonatal scrotal swelling.

Background Preoperative investigations are important to assess the clinical condition of patients who undergo elective surgical procedures. However, there is still debate about the usefulness of performing preoperative investigations. We aimed to determine the prevalence of routine preoperative investigation abnormalities among elective general surgery patients. Methodology This retrospective hospital-record-based study was conducted at the King Abdullah Hospital in Bisha Province, southern Saudi Arabia. General and clinical data of 968 patients who underwent elective surgical interventions from February 2022 to January 2023 were retrieved and analyzed. Result A total of 968 patients (578 females and 390 males) aged between 14 and 80 years were included in the study. Four hundred and eleven (42.5%) patients were in the age group of 40 years and above. The commonly detected comorbidities among the patients were diabetes (15%), hypertension (12%), respiratory diseases (7.5%), and cardiac diseases (2.5%). Abnormalities related to hemoglobin (31%), total leucocyte count (12.7%), and platelets (8.5%) were found in 968 patients. Around 15% of patients had increased creatinine levels. Hypokalemia was observed in 6.8% of patients. Increased liver enzymes were reported in limited proportions (10% to 14%) of patients. Slightly abnormal radiological findings were reported for chest X-ray (CXR) (2.8%), electrocardiogram (ECG) (2%), and Doppler echocardiography (Echo) (0.8%). A statistically significant association between the age of the patient and abnormal findings of ECG (p <.001), Echo (p = .001), and CXR (p <.001). Cardiac abnormalities were commonly associated with patients of ≥ 40 years. Abnormal cardiac findings (CXR, ECG, Echo) were significantly (p<.05) increased with the presence of diabetes, hypertension, and cardiovascular comorbidities. Conclusions Preoperative testing revealed limited proportions of abnormal findings among patients with elective surgical procedures. Routine ordering of many preoperative investigations without specifications may not predict postoperative complications of the patients. Therefore, undertaking preoperative testing should be guided by targeted history, physical examination, clinical risk factors, and type of surgical procedure intended to be performed.

Introduction: Antibiotics are targeted to kill or inhibit the growth of bacteria and have no effect on viral agents. Unfortunately, viruses cause about 80% of respiratory tract infections, and up to 75% of antibiotics are prescribed for URTIs. Overuse of antibiotics is linked to a number of issues, including the emergence of antibacterial resistance, an increase in the prevalence of chronic illnesses, a rise in the expense of healthcare services, and the emergence of side effects. This study aimed to assess the awareness of antibiotic misuse for URTIs among adults in the Bisha governorate in 2024. Methods and materials: A community -based, cross-sectional study was conducted in the Bisha governorate among the adult population. Data was collected using an online standardized self-administered adapted questionnaire. The questions vary from multiple choice to Likert scale questions, and each question has 2 points. Data was analyzed using SPSS version 26 (IBM SPSS Statistics, Armonk, NY). Results: The response rate was about 85.3% (721/845). The ages of the participants ranged between 18 and 75 years. There were 360 (49.9%) male respondents and 361 (50.1%) female respondents. The study revealed that 83.1% (599) of the participants have poor awareness of antibiotic misuse in URTIs. Knowledge of antibiotic misuse consequences was poor at 66.7% (481). There was a significant difference observed between the residents of Bisha city compared to the residents of Bisha villages in total knowledge level about antibiotic misuse in URTIs (p = 0.030). Conclusion and recommendations: The population of the Bisha governorate has a poor knowledge of antibiotic misuse in URTIs. Therefore, efforts should be made to increase the knowledge and awareness of the general public about the problem.

Background: Student-centered learning strategy increases the likelihood of graduation of competent, self-dependent, and problem-solving physicians. The University of Bisha, College of Medicine (UBCOM) adopted self-directed learning (SDL) represented by problem-based learning (PBL), and directed self-learning (DSL) represented by team-based learning (TBL). Aim: To compare the students' performance in SDL and DSL among UBCOM students. Methodology: A total of 502 multiple choice questions (MCQs) from the mid-course and final exams were collected by the relevant subject experts from nine courses during the period from September 2020 till June 2023 that adopted PBL and TBL; 247 MCQs related to PBL and 255 related to TBL. Psychometric analysis was used to determine difficult, easy, and optimum questions (<= 25%, >= 90%, and 26-89%, respectively). Point biserial as <0.19, 0.20-0.29, 0.30-0.39, and >0.40 which indicate poor, marginal, good, and excellent point biserial, respectively. Finally, the number of functional distractors was attempted by >5% of the candidates. Results: No significant differences were noted for the students' performance in MCQs related to PBL (representing self-directed, small group learning tool), and TBL (representing directed-self, large group learning tool) regarding difficulty index (DI), point biserial, and distractors functionality. Conclusion: It has been observed that there is no difference in students' performance whether PBL or TBL is used for learning Basic Medical Science courses. Small group learning such as PBL needs more resources in comparison to large group learning as in TBL, therefore any institute can decide on the adopted learning strategy depending on its resources and the number of students.

Epididymo-orchitis (EO) is a common genitourinary clinical syndrome in men, and delayed investigation and improper management can lead to complications. This study aimed to analyze clinical and laboratory findings and treatment outcomes in EO patients. We conducted a retrospective record-based study at King Abdullah Hospital in southern Saudi Arabia from 2018 to 2022, reviewing data from 63 EO patients who had a median age of 34 years (range: 16-82 years). The results showed that the most common complaints were scrotal pain and swelling (54%), followed by testicular pain (44.4%). Scrotal ultrasonography showed increased vascularity in both testes and epididymis in 49 patients (77.8%), while 14 patients (22.2%) had epididymal involvement alone. Reactive hydrocele was observed in 15 patients (23.8%), abscesses in seven (11.1%), and hypoechoic lesions in three (3.8%). Anti-Brucella antibody titers (>= 1:80) were detected in 22 cases, and 14.3% had positive urine cultures. Of the patients, 87.3% responded well to the initial treatment course, while four (6.3%) were cured after a second course of treatment. EO complications occurred in three cases (4.8%), and one patient (1.6%) succumbed to septicemia. Of the 15 patients treated with ceftriaxone and ciprofloxacin, one required orchiectomy due to non-response. Relapse occurred in one of the 10 patients treated with triple therapy (doxycycline, rifampicin and gentamicin). Among the nine patients treated with ceftriaxone and co-trimoxazole, one did not respond, developed a testicular abscess, and underwent incision and drainage. In conclusion, our study highlights that most cases of EO can be effectively resolved with appropriate antibiotic therapy, particularly combinations containing cefuroxime and/or ciprofloxacin. Clinicians in Brucella-endemic regions should consider the possibility of brucellosis as an underlying cause of EO.

Helicobacter pylori (H. pylori) is a gastric microbial pathogen that infects approximately half of the global population. This bacterium significantly contributes to various gastroduodenal diseases, including chronic active gastritis, peptic ulcerations, and malignant transformations. This review focuses on epidemiology, pathogenicity, virulence genes, risk factors, and management of H. pylori infection, specifically within the context of Saudi Arabia. The results presented here are grounded in studies conducted in Saudi Arabia, contrasting with mere bibliographic reviews of findings from other countries. H. pylori infection has been observed in Saudi Arabia, with substantial differences in the prevalence, ranging between 10-96% among various studied populations. Several risk factors for H. pylori infection have been identified, encompassing socioeconomic status, medical history, personal hygiene, and behavioral practices. Among the virulence genes harbored by H. pylori, cytotoxin-associated gene A (cagA) and vacuolating cytotoxin (vacA) are most common, with their presence correlating with the pathogenicity and clinical manifestations of the associated diseases. A range of invasive and non-invasive diagnostic assays have been utilized to identify H. pylori infection, with their employment being influenced by factors like availability, cost, patient age, gastric symptoms, and the specifics of clinical information sought. While detection methods like the H. pylori stool antigen test and the urea breath test offer more accuracy and speed, culturing remains indispensable for determining the antimicrobial susceptibility profile. The emergence of resistant strains across varying regional settings poses a significant challenge to treatment endeavors, necessitating an assessment of local antimicrobial resistance rates prior to formulating treatment strategies. The findings of this review highlight the importance of continuous implementation of screening, control, and prevention of H. pylori infection to combat the spreading infection and other related complications.

INTRODUCTION The circumstances of the COVID-19 lockdown offered an opportunity to develop remote educational strategies in medical education. OBJECTIVES To assess medical students’ experiences with online e-learning (OeL) satisfaction, intellectual environment, and communication during the COVID-19 pandemic. METHODS A cross-sectional study was conducted at the College of Medicine, University of Bisha, Saudi Arabia. A self-administered questionnaire (21 items) was used to evaluate OeL in three domains of satisfaction (nine items), intellectual environment (seven items), and communication (five items). Students from years one to six were invited to fill out the questionnaire form with five-point Likert scale responses. Descriptive statistics, one-way analysis of variance (ANOVA), and independent t-test were used to evaluate the association between variables. RESULTS Out of 237 participants, 96.6% (158 male and 71 female) responded to the questionnaire. Most students (86.5%) preferred the blackboard for their e-learning. The mean total scores were 30.18 ± 6.9 out of 45 for satisfaction, 19.67 ± 5.4 out of 25 for communication 25.43 ± 5.1 out of 35 for the intellectual environment. Over 50% of the students rated moderate scores on satisfaction and intellectual environment domains. About 85% of the students rated moderate scores in the communication domain. Male students rated higher significant scores than female students for satisfaction (31.3 ± 6.3 vs 27.6 ± 7; P < .001) and intellectual environment (26.3 ± 4.32 vs 3.5 ± 6.1; P < .001). There were no significant differences in students’ responses to the tested domains related to GPA level. Significantly higher levels of scores for satisfaction (33.3 ± 5.6 vs 28.8 ± 6.9; P < .001) and communication (21.2 ± 4.5 vs 18.9 ± 5.7; P = .019) were obtained by clerkship students than pre-clerkship. CONCLUSIONS Medical students’ experiences with e-learning are encouraging, which might be more effective with continuous training programs for students and tutors. Although OeL is an acceptable methodology, further studies are needed to analyze its impact on the target learning outcomes and students’ academic achievement.

Background: Identifying the potential factors of depression among medical students is the first step towards academic excellence and future safe medical practice. Methods: A cross-sectional study was conducted from December 2019 to February 2020 at the University of Bisha, College of Medicine (UBCOM), Bisha Province, Saudi Arabia. Male medical students from year one to year six were involved. A self-administered questionnaire was used to collect data about students’ socio-demographic and academic characteristics. The Arabic version of the PHQ-9 scale with a score of ≥10 was used to identify depression. Logistic regression analysis was used to assess the prevalence and correlates of depression. Results: Of the 190 male students enrolled, 26.8% had depressive symptoms, of whom 45.1% were experiencing moderate to severe symptoms. The significantly highest depression rate was found among the second-year students, at 43.8% (OR = 2.544; 95% CI 1.178–5.714; p = 0.018), and the lowest rate was found among year one students, at 8.9% (OR = 0.203; 95% CI 0.075–0.560; p = 0.002). Univariate regression revealed a significant correlation between depression and dissatisfaction with family income, loss of family members, having psychological illness, difficulties in personal relationships, regretting studying medicine, failure in an academic year, a lower grade than expected, conflict with tutors, lack of college facilities and heavy academic load. In multivariate analysis, loss of family members (AOR = 3.69; 95% CI 1.86–7.413), difficulties in personal relationships (AOR = 2.371; 95% CI 1.009–5.575), regretting studying medicine (AOR = 3.764; 95% CI 1.657–8.550), and failing an academic year (AOR = 2.559; 95% CI 1.112–5.887) were independently correlated with depression. Conclusions: The study concluded that medical students at UBCOM experience depressive symptoms associated with various risk indicators. Optimizing the educational and social environment and infrastructure facilities at UBCOM might promote students’ mental health and well-being.

Background: A widespread and serious eye condition is a refractive error (RE). Globally, uncorrected refractive defects affect numerous individuals, with some who are blind. Numerous studies in Saudi Arabia have been conducted to assess reflective error. However, there is a lack of knowledge regarding RE among school-age children in Bisha province, southwest Saudi Arabia. This study aimed to determine the prevalence and types of RE among school-age children in Bisha, Saudi Arabia. Methods: A cross-sectional study involved 360 schoolchildren from primary schools was carried out between December 2022 and November 2023 in Bisha. A validated questionnaire form was used to collect sociodemographic information and clinical data (history of the ocular problem, visual acuity test findings, and the refractor machine's result). Result: A total of 360 schoolchildren aged from seven to 14 years, with a mean of 10.1 years (standard deviation (SD)=2.05). The prevalence of hyperopia was 21% in the right eye and 23% in the left eye. In addition, the prevalence of myopia was 20% in the right eye and 22.5% in the left eye. A significant association between visual acuity and myopia (p=0.001). By contrast, there was no significant correlation between hyperopia and visual acuity (p=0.412). Conclusion: The current study summarized the prevalence of REs among school-age children in Bisha, Saudi Arabia. The study population included nearly half of those with at least some degree of RE. These results highlight the need for prompt and careful screening programs to detect and treat refractive disorders across this age range.

The plasmid-mediated quinolone resistance (PMQR) and 16S ribosomal RNA (rRNA) methylase genes can lead to high-level bacterial resistance to various antibiotics, including quinolones and aminoglycosides. This study determined the prevalence of PMQR and 16S rRNA methylase determinants in clinical Escherichia coli. Non-duplicate E. coli resistant to quinolones (nalidixic acid, ciprofloxacin, or norfloxacin) and/or aminoglycosides (amikacin or gentamicin) were collected from patients at King Abdullah Hospital, Bisha, Saudi Arabia. A multiplex PCR was performed to identify the targeted genes. Out of 107 screened isolates, 44 (41%) were found to carry resistance genes, individually or in combination, including 41 PMQR and 14 16S rRNA methylase. The qnrS gene had the highest prevalence (23.4%) among PMQR, followed by aac(6')-Ib (16.8%). Of the 14 identified 16S rRNA methylase, 8 were rmtB and 6 were armA. Out of 44 positive isolates, 72.7% carried only one resistance gene, 25% had co-existing resistance genes, with qnrS and rmtB or aac(6)-Ib and armA being the most common pairs. A single isolate was carried three genes (qnrS, aac(6')-Ib and rmtB). As antibiotic resistance continues to become more prevalent, there is a need for extensive research to identify the genetic determinants of resistance and to develop new antibiotic therapies.

Since the peak of the coronavirus disease 2019 (COVID-19) pandemic, concerns around multidrug-resistant (MDR) bacterial pathogens have increased. This study aimed to characterize aminoglycoside resistance genes in MDR Klebsiella pneumonia e ( K . pneumoniae ) collected during the COVID-19 pandemic. A total of 220 clinical isolates of gram-negative bacteria were collected from tertiary hospitals in Makkah, Saudi Arabia, between April 2020 and January 2021. The prevalence of K . pneumoniae was 40.5%; of the 89 K . pneumoniae isolates, MDR patterns were found among 51 (57.3%) strains. The MDR isolates showed elevated resistance rates to aminoglycoside agents, including amikacin (100%), gentamicin (98%), and tobramycin (98%). PCR assays detected one or more aminoglycoside genes in 42 (82.3%) MDR K . pneumoniae strains. The rmtD gene was the most predominant gene (66.7%; 34/51), followed by aac(6′)-Ib and aph(3′)-Ia (45.1%; 23/51). The aac(3)-II gene was the least frequent gene (7.8%; 4/51) produced by our isolates. The rmtC gene was not detected in the studied isolates. Our findings indicated a high risk of MDR bacterial infections through the COVID-19 outbreak. Therefore, there is a need for continuous implementation of effective infection prevention control (IPC) measures to monitor the occurrence of MDR pathogens and the emergence of MDR bacterial infections through the COVID-19 outbreak.

Over the last decades, the prevalence of multidrug-resistant (MDR) Klebsiella pneumoniae in clinical settings has increased progressively. This study determined the prevalence and risk factors associated with MDR K. pneumoniae infection among hospitalized patients in a referral hospital located in southern Saudi Arabia. A prospective cross-sectional study was conducted in King Abdullah Hospital from April 2021 to March 2022. K. pneumoniae (n = 211) bacteria were recovered from clinical samples of adult patients and examined for antibiotic susceptibility. Univariate and multivariate logistic regressions were applied to determine the factors associated with MDR K. pneumoniae infection. MDR K. pneumoniae strains was found in 66.8% (142/211) of the patients. Among MDR K. pneumoniae , the highest resistance rate was determined for ampicillin (100%), cefuroxime (97.9%), ceftriaxone (94.3%), and aztreonam (92.2%). The lowest resistance rate was determined for colistin (16.3%), and tigecycline (6.4%). Further, the patients’ gender, age group, intensive care unit (ICU) admission, invasive medical devices, and chronic illness were found to be significantly associated with MDR K. pneumoniae infection. The independent risk factors associated with MDR K. pneumoniae infection were the male gender (adjusted odds ratio [AOR] 2.107, 95% confidence interval CI 1.125‒3.945, p = 0.02), patients ≥ 65 years of age (AOR 1.905; CI 1.003‒3.616, p = 0.049), ICU admission (AOR 1.963; CI 1.033‒3.732, p = 0.04), diabetes (AOR 1.95; CI 1.02‒3.727, p = 0.043) and chronic obstructive pulmonary disease (AOR 7.172; CI 1.557‒33.032, p = 0.011). The study offered a vision of MDR K. pneumoniae infection in our setting and provided essential indications for further studies that may lead to the prevention and reduction of MDR bacteria.

Hospitalized patients are likely to have chronic illnesses and are at an increased risk of mortality due to infection caused by MDR bacteria. We aimed to identify carbapenem-resistant genes carrying Klebsiella pneumoniae (K. pneumoniae) isolates and their risk factors recovered from adult patients with comorbidities. A cross-sectional study was carried out between April 2021 and December 2021 at King Abdullah Hospital (KAH) in Bisha province, Saudi Arabia. Seventy-one multi-drug resistant K. pneumoniae recovered from clinical samples and screened for carbapenemase genes of blaOXA-48-like, blaNDM-1, blaKPC, blaVIM, and blaIMP. Of 71 MDR K. pneumoniae examined, 47 (66.2%) isolates harbored various carbapenemase genes. The most prevalent single resistance gene was blaOXA-48-like (62.5%; n = 25), and 33.3% of them were recovered from sputum isolates. The blaNDM-1 gene was detected in 12 (30.0%) isolates, and eight of them were recovered from urine (n = 4) and blood (n = 4). Two (5.0%) single blaKPC genes were recovered from the sputum (n = 1) and blood (n = 1) isolates. In contrast, no blaIMP- and blaVIM-carrying isolates were detected. The co-existence of two resistance genes between blaOXA-48-like and blaNDM-1 was found in six strains, whereas only one strain was found to be produced in the three genes of blaNDM-1, blaKPC, and blaOXA-48-like. There were statistically significant associations between the presence of carbapenem-gene-carrying K. pneumoniae and patients' gender (χ2(1) = 5.94, p = 0.015), intensive care unit admission (χ2(1) = 7.649, p = 0.002), and chronic obstructive pulmonary disease (χ2(1) = 4.851, p = 0.028). The study highlighted the existence of carbapenemase-producing K. pneumoniae, particularly blaOXA-48-like and blaNDM-1, in patients with comorbidities. Our findings emphasize the importance of the molecular characterization of resistance-determinant-carrying bacterial pathogens as a part of infection control and prevention in hospital settings.

We report a case of congenital brucellosis subsequently associated with Klebsiella pneumoniae infection in a Saudi preterm neonate. A girl born with severe respiratory distress was admitted to a neonatal intensive care unit. Laboratory examinations revealed thrombocytopenia and slight leukocytosis. Her mother was a confirmed case of brucellosis. Initial blood culture confirmed the diagnosis of infection, and the baby was treated empirically with rifampicin, gentamicin, and ciprofloxacin. Follow-up revealed that her general condition was gradually improved. On day 27, the baby deteriorated, showing abdominal distension and signs of sepsis and requiring intubation. Rifampicin was replaced by amikacin. A septic workup showed a normal total leukocyte count, with 68.3% neutrophils, decreased platelet count, and increased C-reactive protein level. Blood culture and sensitivity testing reported multidrug-resistant K. pneumoniae susceptible to amikacin and resistance to gentamicin, ciprofloxacin, and beta-lactam antibiotics. The baby remains critically ill, showing a poor treatment response with rapid deterioration, and arrested on day 33. Concomitant bacterial infections might explain signs of sepsis and respiratory distress among neonates with congenital brucellosis. Accurate and early diagnosis, parental history, and adequate treatment are associated with the prognosis of congenital brucellosis and other related bacterial infections.

IntroductionThe implication of viral infection in alterations of vital cellular pathways and genomic integration and thus, human carcinogenesis is well documented in molecular epidemiology studies. EBV and CMV are two of the most studied human viruses for potential association with cancer risk, progression, and outcome. The contradicting reports as for the etiologic role of these viruses in breast cancer entailed the conduction of the current meta-analysisMaterial and methodsA thorough comprehensive electronic search was performed using PubMed, EMBASE, and Web of Science databases for relevant publications until February 28, 2021 based on predefined eligibility criteria. Extracted data from eligible studies were used to calculate the pooled effect size, heterogeneity, publication bias, sensitivity, and subgroup analyses for both viruses independently. Meta-analyses were performed using Prometa 3 software.ResultsFor EBV, a total of 19 studies were included, while 8 studies were included for CMV. A significantly high risk of breast cancer with EBV infection (OR = 5.04, 95%CI: 3.44 – 7.39, P < 0.05), a similar, though smaller risk with CMV (OR = 4.53, 95%CI: 2.04 – 10.03, P < 0.05). EBV studies in which viral genetic material was detected in fresh breast cancer tissue showed higher risk compared to studies relied upon FFPE specimen. Conversely, for CMV, the FFPE studies showed a higher risk compared to studies relying upon fresh breast cancer tissues.ConclusionsIt can be inferred that infection with either of the two viruses increases the risk of breast cancer, suggesting an etiologic role of these viruses in breast carcinogenesis.

BACKGROUND Helicobacter pylori (H. pylori) infection represents one of the most common chronic bacterial infections in developing countries. However, in Sudan, the infection is not well diagnosed with standard laboratory methods in many parts of the country. This study aimed to detect H. pylori in gastric biopsies of patients with gastric disorders, using three diagnostic methods. MATERIALS AND METHODS A cross-sectional study was conducted among 100 patients in Gezira state, central Sudan. Giemsa stain for histopathological examination (HPE), rapid urease test (RUT), and polymerase chain reaction (PCR) techniques were performed to detect H. pylori from the gastric biopsy samples as per standard assays. RESULTS Most of the patients were males (66%), from rural areas (72%) and in the age group 31 to 50 years. H. pylori were identified in 85% of the samples by at least one of the three tests. The highest positivity was detected by HPE (83%), followed by PCR (67%) and RUT (63%), while 59% were positive by the three diagnostic methods. PCR showed higher sensitivity (80.72% vs. 73.49%) and specificity (100% vs. 88.24%) than RUT. Positive predictive values were reported as 100% for PCR and 96.83% for RUT. Considering PCR as a gold standard method, HPE revealed higher sensitivity (100%) than RUT (88.06%). On the contrary, RUT showed higher specificity (87.88%) than PCR (51.52%). There were no significant associations between H. pylori infection patients' gender (p = 0.747). Loss of weight (p = 0.007) and nausea (p = 0.032) were significantly associated with H. pylori infection. CONCLUSIONS There was a high prevalence of H. pylori infection in central Sudan. This highlights the need to analyze epidemiological status, virulence factors, and strain characteristics to control disease transmission. PCR is a reliable and valuable technique in detecting H. pylori infection from gastric biopsy samples.