Saudi Aramco Medical Services Organization

Oropouche virus (OROV) has re-emerged since late 2023 with expanding urban transmission in Latin America. OROV causes an acute febrile illness with symptoms overlapping other arboviral infections, complicating diagnosis. Recent reports of fatalities and suspected vertical transmission have raised concerns regarding disease severity. This study aims to provide a comprehensive analysis of epidemiological and clinical features of OROV infection. We conducted a PRISMA-compliant systematic review by searching major bibliographic databases and preprint servers. Observational studies reporting OROV infection in febrile patients or the general population were included, and pooled prevalence estimates were calculated. 59 studies were included. The pooled seroprevalence of anti-OROV antibodies in the general population was 7% (95% CI, 0-21%). Among febrile patients, pooled prevalence was 16% (95% CI, 10-24%) by virus detection and 24% (95% CI, 13-36%) by serology. Sex distribution was comparable (male 51% vs female 49%), while infections were most common among individuals aged 20-39 years (38%; 95% CI, 32-43%). The most frequent symptoms were fever (94%; 95% CI, 90-98%), headache (87%; 95% CI, 84-91%), and myalgia (73%; 95% CI, 67-80%), with gastrointestinal and ocular manifestations also common. Compilation of reported fatal cases showed a rapidly progressive clinical course. 17 pregnancy-associated cases suggested possible vertical transmission with heterogeneous outcomes, including congenital abnormalities and fetal loss. OROV contributes to acute febrile illness in Latin America and presents as a multisystem disease. Emerging reports of fatal outcomes and pregnancy-associated adverse events warrant heightened clinical awareness, improved diagnostics, and strengthened surveillance.

Zika virus (ZIKV) infection, primarily transmitted by Aedes mosquitoes, has been linked to various ocular manifestations ranging from mild conjunctivitis to severe conditions like uveitis and macular scarring. This systematic review and meta-analysis aimed to synthesize data on the ocular manifestations of ZIKV infection, highlighting their prevalence and clinical implications. We conducted a comprehensive literature search in PubMed, Web of Science, and EMBASE up to May 5, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were cross-sectional, cohort, and case-control studies that reported primary data on ocular manifestations in humans infected with ZIKV. Meta-analytical procedures were implemented using R software to calculate pooled prevalences and assess heterogeneity and publication bias. Our search yielded 25 eligible studies, encompassing data from various countries including the United States, Brazil, and Mexico. The meta-analysis revealed a pooled prevalence of 39.4% (95% CI: 25.5% to 55.3%) for conjunctivitis and 25.9% (95% CI: 12.5% to 46.1%) for eye pain or retro-orbital pain among ZIKV cases. The studies documented a range of ocular manifestations, notably conjunctivitis, retro-orbital pain, and more severe complications like uveitis. Ocular manifestations of ZIKV infection are common and diverse, with significant implications for public health, especially in areas susceptible to Zika outbreaks. Future research should prioritize longitudinal studies to elucidate the mechanisms of ZIKV-related ocular conditions and develop targeted treatments. This study highlights the importance of integrating ophthalmological assessments into standard care for ZIKV and improving global surveillance and response strategies.

BackgroundAntibiotic resistance in multidrug-resistant Klebsiella pneumoniae (MDR-KP), particularly against carbapenems and colistin, is a critical concern, increasing morbidity and mortality among hospitalized patients. This systematic review aims to identify methylase genes in K. pneumoniae and examine their co-existence with β-lactamase and carbapenemase genes contributing to antibiotic resistance.MethodsA literature search was conducted across three electronic databases from inception until 6 December 2023. The quality assessment followed Critical Appraisal Skills Programme (CASP) criteria. Studies focusing on methylase genes and antibiotic resistance in K. pneumoniae were included. Two authors independently screened titles, abstracts, and full texts, with a third resolving disagreements.ResultsThirty-four studies met the inclusion criteria. Methylase genes in K. pneumoniae isolates were predominantly reported in Europe and Asia, particularly in Iran, China, Japan, and India (8.8%, N = 3). The most prevalent 16S rRNA methyltransferase genes identified were armA (76.5%, N = 26), rmtB (61.8%, N = 21), and rmtC (29.4%, N = 10). Common extended-spectrum β-lactamase (ESBL) genes included blaCTXM (64.7%, N = 22) and blaSHV (47%, N = 16), while blaKPC (26.5%, N = 9) and blaNDM (23.5%, N = 8) were the predominant carbapenemase genes. The coexistence of methylase genes with ESBL and carbapenemase genes conferred significant resistance to aminoglycosides (gentamicin, kanamycin, tobramycin, amikacin, arbekacin), cephalosporins (cefazolin, cefoxitin, cefotaxime), and carbapenems (imipenem, meropenem).ConclusionsThe widespread distribution of resistance mechanisms in K. pneumoniae highlights a global challenge, emphasizing the need for strategic antimicrobial use to reduce resistance rates.

Green endoscopy, the integration of environmentally sustainable practices into gastrointestinal endoscopy services, is gaining global momentum amid rising concerns about healthcare's carbon footprint. Endoscopy contributes significantly to greenhouse gas emissions, medical waste, and energy consumption due to its reliance on single-use plastics, energy-intensive reprocessing, and high procedural volumes. International initiatives, including those by the British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy (ESGE), have highlighted strategies such as life cycle assessments, structured waste segregation, reusable devices, and carbon tracking, to reduce the environmental burden of endoscopy. While several high-income countries have adopted these approaches, Saudi Arabia has only begun to explore green endoscopy, despite its alignment with the sustainability objectives of Vision 2030 and the Saudi Green Initiative. Current barriers include lack of national guidelines, limited awareness among healthcare providers, inadequate recycling infrastructure, and infection control concerns. However, opportunities exist through centralized healthcare governance, investment in modern infrastructure, and integration of sustainability into training programs. This first of its kind review based on an extensive appraisal of existing literature examines the current status, challenges, and future opportunities for green endoscopy in Saudi Arabia, highlighting the urgent need for robust local data, supportive policy frameworks, and coordinated cross-sector collaboration. Embedding sustainability into endoscopy practice will not only reduce ecological impact but also position Saudi Arabia as a regional leader in sustainable healthcare.

Abstract Background Surgical site infections (SSIs) are common but preventable complications of abdominal surgery, influenced by patient, procedural, and systemic factors. The COVID-19 pandemic introduced new perioperative protocols that may have altered infection patterns. This is the first retrospective cohort study of 809 abdominal surgery patients from a large tertiary center in Saudi Arabia to assess changes in SSI timing using survival analysis during the pandemic. Objectives To determine SSI incidence, identify independent risk factors, and examine the impact of the COVID-19 pandemic on infection timing and outcomes in patients undergoing abdominal surgery. Methods We conducted a retrospective cohort study of 809 patients who underwent abdominal surgery between January 2019 and December 2022. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted from electronic health records. SSIs were defined per CDC criteria. We compared SSI trends before and during the pandemic using multivariable logistic regression and time-to-event analyses (Kaplan-Meier and Cox regression). Results Among 809 patients, 47 (5.8%) developed SSIs—consistent with international benchmarks. Independent risk factors included diabetes (OR: 2.14; 95% CI: 1.05–4.34), contaminated wounds (OR: 3.67; 95% CI: 1.58–8.54), and postoperative glucose ≥ 7 mmol/L (OR: 2.95; 95% CI: 1.32–6.57). SSIs occurred later during the pandemic period, with survival analysis indicating delayed onset, despite a similar median time (8 days). Model diagnostics confirmed stability, with no significant multicollinearity. Conclusion SSIs remain a significant postoperative risk, with diabetes, wound contamination, and hyperglycemia as key predictors. The observed delay in infection onset during the COVID-19 pandemic underscores the need for extended postoperative surveillance and adaptable infection control strategies during healthcare disruptions. These findings suggest that pandemic-related changes in surgical protocols may delay SSI onset, necessitating extended postoperative monitoring.

Given the limited evidence on the optimal caspofungin dose for patients with obesity and candidemia, this study aims to evaluate the clinical outcomes of the standard caspofungin dose in critically ill patients with obesity and candidemia. A multicenter, retrospective cohort study was conducted in three tertiary care hospitals in Saudi Arabia. Eligible critically ill patients with confirmed candidemia who received standard dose of caspofungin were stratified according to their Body Mass Index (BMI) at the time of caspofungin initiation into two groups: control (BMI: 18-29.9kg/m2) or obese (BMI: ≥30kg/m2). The primary outcome was the incidence of clinical success. All other outcomes were considered secondary. The significance level was set at a P-value of<.05, and statistical analysis was conducted using SAS 9.4 software. A total of 108 patients were included; forty-six (42.6%) were obese. There were no significant differences in terms of clinical success between the groups (aOR, 1.38; 95% CI, 0.54-3.54; P=.50). Microbiological success rate was numerically higher in the control group compared to obese patients (83.9% vs. 69.6%; P=.07); notably, the difference was statistically significant in the regression analysis (aOR, 3.40; 95% CI, 1.040-11.099; P=.04). No significant differences were observed in other outcomes, including time for microbiological success, treatment failure, infection recurrence within 90 days, mortality, and length of stay. In conclusion, patients with obesity had similar clinical success to control group; however, a lower microbiological success rate was observed in patients with obesity. Further research is needed to explore long-term implications of caspofungin therapy in obese patients with candidemia.

Abstract In extended open-hole sections, the industry's typical operational sequence to preserve wellbore cleaning is performing frequent wiper trips to remove ledges/tight sections (example of the frequency is every 2,000 ft drilled) or performing single wiper trip across the entire open-hole. To reduce the operational time and operational risks of tripping in/out of the extended drilled section, level-1 casing-while-drilling (CwD) is utilized to hard ream the casing string across the entire open-hole to section total depth. It also serves to optimize the casing design of different areas to interest by combining multiple trouble zones in one section. To ease running casing through the extended already drilled open-hole, single or several wiper trips are performed clear ledge/obstructions/tight holes if any. After reaching the previous casing, the drill string is run back through the drilled section, reaming through obstructions/tight holes. The drill string is pulled out again to surface. This operational sequence consumes about 2.5-3 days, in addition to the increasing risk of getting the string stuck. All these operational sequences are replaced by the utilization of the Level-1 CwD technology to hard ream the casing string. The operational days and associated extra cost are controlled and reduced. Main challenge in drilling through unconsolidated sand zones in shallow sections, and time-dependent unstable shale zones in deeper sections is inability to secure them without significant rig time delay. Loss circulation zones exist around these problematic zones. When severe to complete loss of circulation is experienced, the complexity of securing the problematic zones increases. The level-I casing-while-drilling (CwD) technology was utilized successfully to hard ream and permanently isolate the problematic zones without nonproductive time. CwD were successfully utilized to hard ream the casing strings to target depth to case-off the severely unstable zones experienced in the offsets. The additional NPT trips were eliminated completely. In addition, the 9-5/8-in casing string hard reaming was performed while incorporating a multistage differential valve (DV) and cemented in two stages. During the job execution, the reaming parameters are constantly monitored to not exceed casing strings limitations, especially the accumulated fatigue on the string as they are rotated. As a result, the troubles experienced in offset wells were successfully managed. Complexity in drilling wells is increasing. Therefore, introducing innovative solutions that enable reducing the number of extra trips, is essential to reducing NPT. The offset wells drilling troubles related to securing unstable formations were studies thoroughly. Level-I CwD technology was successfully utilized to eliminate those identified troubles without adding additional time-delaying trips. The unstable zones were secured in a record time compared to the offsets. The results were reaming the casing through extended open-hole sections until reaching the longest open-hole interval worldwide to be reamed with the 9-5/8-in casing allowing combining and isolating multiple trouble zones together.