Urinary tract infections (UTIs) are among the most common infections and are associated with an increased rate of antimicrobial resistance in Saudi Arabia. Better knowledge of the most common pathogens and their antimicrobial resistance patterns will be useful for creating new treatment guidelines. PubMed, Web of Science, Scopus, and Google Scholar were searched using suitable keywords to identify UTI publications until November 2022. Eligible studies were selected and analyzed. A total of 110 records were found, but only 58 articles were analyzed. Most studies were retrospective, and just a few were cross-sectional or prospective. The majority of the studies were conducted in the central region followed by the Eastern region. Escherichia coli and Klebsiella spp. were the most common pathogens. There was a significant resistance rate against co-trimoxazole and ciprofloxacin. On the other hand, amikacin was one of the most effective antibiotics. Overall, only a few studies have been published on UTIs in Saudi Arabia. Moreover, not all regions have been represented, so the full scope of the issue is unknown. UTIs are still a major problem, and resistance has developed against commonly used antibiotics. Thus, large epidemiological studies are needed to battle the rapid emergence of antimicrobial resistance.

Neurotrauma is a significant cause of morbidity and mortality worldwide. For instance, traumatic brain injury (TBI) causes more than 30% of all injury-related deaths in the USA annually. The underlying cause and clinical sequela vary among cases. Patients are liable to both acute and chronic changes in the nervous system after such a type of injury. Cerebrovascular disruption has the most common and serious effect in such cases because cerebrovascular autoregulation, which is one of the main determinants of cerebral perfusion pressure, can be effaced in brain injuries even in the absence of evident vascular injury. Disruption of the blood–brain barrier regulatory function may also ensue whether due to direct injury to its structure or metabolic changes. Furthermore, the autonomic nervous system (ANS) can be affected leading to sympathetic hyperactivity in many patients. On a cellular scale, the neuroinflammatory cascade medicated by the glial cells gets triggered in response to TBI. Nevertheless, cellular and molecular reactions involved in cerebrovascular repair are not fully understood yet. Most studies were done on animals with many drawbacks in interpreting results. Therefore, future studies including human subjects are necessarily needed. This review will be of relevance to clinicians and researchers interested in understanding the underlying mechanisms in neurotrauma cases and the development of proper therapies as well as those with a general interest in the neurotrauma field.

Bushra Mohandes, Fatma Elsayed Ahmed Bayoumi, Aisha Abdulkarim AllahDiwaya, Maryam Salah Falah, Leen Hesham Alhamd, Razan Abid Alsawadi, Yipeng Sun, Aidi Ma, Idris Sula, Muhammad Candragupta Jihwaprani. J Pharmacopuncture 2024;27:177-89. https://doi.org/10.3831/KPI.2024.27.3.177

Introduction: Neonatal sepsis (NS) is a major healthcare burden in Gulf Cooperation Council (GCC) countries, with a prevalence higher than the global average. Microbial drug resistance has major implications for mortality and morbidity from NS. Objective: To synthesize data regarding the patterns of causative bacteria of NS in the GCC and their antimicrobial susceptibility profiles. Methods: Following the exploration of four electronic databases, i.e., EBSCOhost, ProQuest, PubMed/MEDLINE, and ScienceDirect, eligible studies were identified (i.e., published between 2013 and 2023 and reported bacterial profile and/or antimicrobial susceptibility patterns). The outcomes included the pooled prevalence of bacteria and their susceptibility patterns. Proportion meta-analysis was performed for each outcome of interest. Results: Fifteen studies were eligible (total positive cases = 2,473). Coagulase-negative Staphylococci (CoNS) (28.1%) were the most common gram-positive causative pathogen, followed by group B Streptococcus (GBS) (16.2%) and Staphylococcus aureus (9.9%); for gram-negative, Escherichia coli (12.7%) and Klebsiella species (11.4%) were most common. The susceptibility rates of these bacteria to first-line antibiotics were high; gram-positive bacteria had the highest susceptibility to ampicillin (72.8–98%), and gram-negative bacteria was most susceptible to amikacin (94.6–98%). Additionally, both gram-positive (67–77%) and negative (87–93%) bacteria exhibited high susceptibility to gentamicin. Conclusion: The most common pathogens among NS patients were gram-positive. The pathogens, irrespective of stain test, were susceptible to the current antibiotic therapy. We recommend the judicious use of empirical antibiotic therapy to prevent the growing risk of antimicrobial resistance.

Novel anti-tuberculosis (TB) drugs have been shown to effectively treat drug-resistant TB (DR-TB). However, there is a risk of hepatotoxicity. We aimed to evaluate the incidence of hepatotoxicity in TB patients receiving bedaquiline (BDQ), delamanid (DLM), and/or pretomanid (Pa). This meta-analysis (PROSPERO: CRD42024564922) systematically explored electronic databases (i.e., Clinicaltrials.gov, Cochrane CENTRAL, Embase, PROQUEST, PubMed, ScienceDirect, and SinoMed) for clinical trials reporting the incidence of hepatotoxicity upon administering BDQ, DLM, and/or Pa. Primary endpoints were the overall incidence of elevated liver enzymes, particularly alanine transferase (ALT), aspartate transferase (AST), and gamma-glutamyl transferase (GGT). Proportion meta-analysis was performed for each outcome of interest. Sixteen trials with pooled 4086 participants. The combination of BDQ + Pa was associated with increased ALT (10.6%) and AST (10.4%). Among the individual drugs, Pa-containing regimens had the highest incidence of elevated liver enzymes (ALT [18.9%], AST [20.3%], and GGT [12.8%]). DLM-containing regimens had the lowest incidence (ALT [0.2%], AST [0.7%], and GGT [1%]). For BDQ-containing regimens, the incidence of elevated liver enzymes was similar to the standard of care (SOC): ALT (5.5%) vs. (6.9%) and AST (7.5%) vs. (10.8%), respectively. GGT elevation was more common among the groups receiving BDQ compared to SOC (10% vs. 3.1%). Overall, all the included trials were of high or fair quality. Among all the studied drugs, DLM alone demonstrated the highest hepatic safety, while regimens containing BDQ, Pa, or their combination showed higher hepatotoxic risks compared to SOC. We recommend regular liver function monitoring for DR-TB patients receiving these novel anti-TB drugs.

The risks and benefits of bedaquiline (BDQ) for treatment of drug‐resistant tuberculosis (DR‐TB) have not been firmly established. We aimed to assess the safety and efficacy of BDQ‐containing regimens for the treatment of DR‐TB as evidenced in available randomized controlled trials (RCTs). In this systematic review and meta‐analysis, five databases (i.e., ClinicalTrials.gov, Cochrane CENTRAL, PubMed, ScienceDirect, and SinoMed) were searched. RCTs among DR‐TB patients that had a control arm were eligible. The safety endpoints were all‐cause mortality and serious adverse effects (SAEs). Efficacy outcomes were sputum culture conversion rate at 8–12 weeks and 24–26 weeks, treatment success, and time to culture conversion. A total of 476 records were screened; 18 met the eligibility criteria. The pooled analysis included 2520 participants (55.8% received BDQ‐containing regimens, n = 1408). Pooled safety outcomes showed no significant reduction in all‐cause mortality (relative risk [RR] [95%confidence interval (CI)] = 0.94 [0.41–2.20]) or SAEs (RR [95%CI] = 0.91 [0.67–1.23]) in the BDQ‐regimen group. Pooled efficacy outcomes showed significantly superior culture conversion rates at 8–12 weeks (RR [95%CI] = 1.35 [1.10–1.65]) and 24–26 weeks (RR [95%CI] = 1.25 [1.15–1.36]), more treatment success (RR [95%CI] = 1.30 [1.17–1.44]), and a 17‐day reduction in the time to culture conversion (standardized mean difference [SMD] [95%CI] = −17.46 [−34.82 to −0.11]) in the BDQ‐regimen group (reference: non‐BDQ regimen). Overall, BDQ regimens showed significant treatment effect against DR‐TB but did not reduce mortality or SAEs.