Background: Whole-genome sequencing is one of the best ways to investigate resistance mechanisms of clinical isolates as well as to detect and identify circulating multi-drug-resistant (MDR) clones or sub-clones in a given hospital setting. Methods: Here, we sequenced 37 isolates of Acinetobacter baumannii, 10 Klebsiella pneumoniae, and 5 Pseudomonas aeruginosa collected from the biobank of the hospital setting of the King Fahad Medical City. Complete phenotypic analyses were performed, including MALDI-TOF identification and antibiotic susceptibility testing. After the genome assembly of raw data, exhaustive genomic analysis was conducted including full resistome determination, genomic SNP (gSNP) analysis, and comparative genomics. Results: Almost all isolates were highly resistant to all tested antibiotics, including carbapenems and colistin. Resistome analysis revealed many antibiotic resistance genes, including those with resistance to β-lactams, aminoglycosides, macrolides, tetracyclines, sulfamids, quinolones, and phenicols. In A. baumannii isolates, the endemic carbapenemase bla_OXA-23 gene was detected in 36 of the 37 isolates. Non-synonymous mutations in pmrB were detected in almost all of the isolates and likely mediated colistin resistance. Interestingly, while classical analyses, such as MLST, revealed the predominance of an ST2 clone in A. baumannii isolates, the genomic analysis revealed the presence of five circulating sub-clones and identified several isolate transmissions between patients. In the 10 K. pneumoniae isolates, several resistance genes were identified, and the observed carbapenem resistance was likely mediated by overexpression of the detected extended-spectrum-β-lactamase (ESBL) genes associated with low membrane permeability as few carbapenemase genes were detected with just bla_OXA-48 in three isolates. Colistin resistance was mediated either by non-synonymous mutations in the MgrB regulator, PmrA, PmrB, and PhoQ proteins or the presence of the MCR-1 protein. Here, gSNP analysis also revealed the existence of bacterial clones and cases of isolate transmissions between patients. The five analyzed P. aeruginosa isolates were highly resistant to all tested antibiotics, including carbapenems mediated by loss or truncated OprD porin, and colistin resistance was associated with mutations in the genes encoding the PmrA, PmrB, or PhoQ proteins. Conclusion: We demonstrate here the usefulness of whole-genome sequencing to exhaustively investigate the dissemination of MDR isolates at the sub-clone level. Thus, we suggest implementing such an approach to monitor the emergence and spread of new clones or sub-clones, which classical molecular analyses cannot detect. Moreover, we recommend increasing the surveillance of the endemic and problematic colistin resistance mcr-1 gene to avoid extensive dissemination.

Background: In Saudi Arabia, breast cancer is the most common malignancy among women, significantly impacting cancer-related morbidity and mortality. The country’s unique demographics and rapid socioeconomic development contribute to distinct breast cancer patterns. Objective: To analyze demographic and pathological characteristics of breast cancer with an emphasis on associations between the Ki67 proliferation index, tumor stages, and molecular subtypes. Materials and Methods: An analytical cross-sectional study was conducted on 294 breast cancer patients from 2013 to 2019, recruited from the Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia. A one-way ANOVA and logistic regression were used to identify risk factors associated with elevated Ki67 levels. Significance was set at a 95% confidence level. Results: The mean age of patients was 51.58. Among them, 67% were overweight/obese, 21.1% were diabetic, and 17% were hypertensive. Approximately 28.9% of all tumors were classified as T3, 46.9% as Grade III, and 40% as Stage IV. Invasive ductal carcinomas (83.9%) were the most common. ER, PR, and HER2 expression were positive in 63.4%, 54.3%, and 34.9% of patients, respectively, with a high Ki67 index in 50.7%. As compared to Grade I cancer, grade II cancer increased the likelihood of elevated Ki67 by 41 times (p = 0.001), Grade III cancer by 7.43 times (p = 0.001), and Stage IV cancer by 2.26 times (p = 0.03). Conversely, invasive lobular carcinomas and other cancer types were significantly less likely to have high Ki67 levels (p < 0.05). Conclusions: Elevated Ki67 appeared to predict higher tumor grades and certain molecular subtypes cancer.

End-stage renal disease (ESRD), chronic kidney disease (CKD), and acute kidney failure (AKF) are serious global health issues that contribute to high sickness and death rates. This King Fahad Medical City study investigated the importance of reliable biomarker monitoring and early treatment to enhance patient outcomes. 220 people had their serum levels of albumin, C-reactive protein (CRP), urea, creatinine, salt and phosphate assessed. Creatinine (χ² = 60.73, p < 0.001), urea (χ² = 48.66, p < 0.001), phosphate (χ² = 19.20, p = 0.004), sodium (χ² = 14.10, p = 0.029) and body weight (χ² = 13.24, p = 0.039) showed significant differences across diagnostic groups, according to the Kruskal-Wallis test. Significant activity was indicated by the highest CRP values (103.9 mg/L; 95% CI: 83.9–123.9 mg/L) in AKF patients, whereas the highest average creatinine levels (428.6 µmol/L; 95% CI: 330.0–527.2 µmol/L) were seen in ESRD patients. The above results show that every disease has an unique biomarker signature. Also a gender study revealed that, on average, male patients weighed 7.29 kg heavier than female patients (t = 2.739, p = 0.007). The study shows that kidney-related illnesses may be effectively treated with biomarker-based diagnostics.Important biomarkers for CKD, ESRD and AKF detection include creatinine, urea, CRP and sodium. This highlights how helpful these indicators are for supporting timely diagnosis, improving clinical intervention techniques and directing customized treatment plans.

Background: Ovarian Cancer also is known as the silent killer is the fifth most common cancer in females worldwide carrying a high mortality rate. In this study, we looked at clinical characteristics and outcomes of different stages and histopathological subtypes of epithelial ovarian cancer in 85 patients, following standard treatment with surgery and chemotherapy. Methods: Patients newly diagnosed with EOC between 2014 to 2017 who were treated with TAHBSO (150 TAHBSO in total with 15 HIPEC) were identified from a medical record maintained database. Surgery consisted of total hysterectomy, bilateral salpingo-oophorectomy, and total/partial omentectomy or HIPEC. The same chemotherapy was given adjuvant post-surgery as per standard guidelines. Results: The median age at the time of diagnosis for patients with Serous tumors was 55 years. Majority i.e. 94.1% of patients were high-grade serous type.The recurrence rate was 75 % for stage 4 patients who had surgery within 42 days of chemotherapy as opposed to 36.6 % of patients treated at an interval of greater than 42 days. This difference was not statistically significant despite slightly worse progression for patients who had a delay in surgery. Conclusions: Our study revealed a non –significant increased risk of recurrence with delaying chemotherapy for greater than 42 days for stage 4 disease while the delay in chemotherapy in stage 3c and lower ovarian cancer did not show any adverse outcome. We have identified the advanced stage of presentation of ovarian cancer being a more relevant factor for recurrence.

Systemic lupus erythematosus (SLE) is a complex autoimmune and idiopathic condition that affects connective tissues. It is characterized by the formation of autoantibodies, the accumulation of immune complexes, inflammation, and, ultimately, irreversible organ damage. It can affect individuals of various ages, ethnicities, and genders. Nonetheless, nearly 90% of newly diagnosed SLE patients are women of reproductive age. The early mortality associated with SLE is primarily due to significant disease activity. However, subsequent mortality is linked to chronic illness and the use of immunosuppressive agents. Despite extensive research, the precise etiology of SLE remains partially understood; however, its onset involves a complex interplay of genetic predispositions, environmental stimuli, hormonal factors, and immune system abnormalities. The predominant clinical signs include fatigue, fever, weight loss, arthritis, pericarditis, anemia, and pulmonary complications. Diagnosing SLE requires a combination of clinical evaluations and laboratory testing, including antinuclear antibodies and anti-double-stranded DNA antibodies, among others. Managing SLE patients involves various approaches and lifestyle recommendations, including avoiding direct or reflected sunlight. This article presents an updated review of the mortality and pathophysiology of SLE. We also elucidate the clinical manifestations and the primary diagnostic and therapeutic strategies for this condition.