Parental COVID-19 Vaccine Hesitancy for Children and Its Influencing Factors: A Riyadh-Based Cross-Sectional Study.

It is well known that vaccination is the best clinical approach for successfully controlling COVID-19 infection. Understanding the disparities in COVID-19 vaccination apprehension among parents in different societies is crucial for effectively implementing COVID-19 vaccination programs. This observational cross-sectional study was carried out in the Riyadh region of Saudi Arabia between February and April 2022. The validated questionnaire was shared with parents who had children between the ages of five and eleven years. The collected data were analyzed using descriptive and inferential statistical methods. Multinomial regression analysis was conducted to determine the factors significantly affecting vaccine-use decisions. Of the 699 participants, 83% of the mothers were between the ages of 35 and 44 years, 67% were university educated, and only 14% were healthcare workers. A large proportion of parents, with an age range of 18-34 years (p = 0.001), and those with a higher income group (p = 0.014), demonstrated significant vaccine hesitancy. Further, parents who received one or two vaccination doses were significantly (p = 0.02) more hesitant than those who received more than two doses of the vaccine. Furthermore, a significantly (p = 0.002) high percentage of parents who follow the Ministry of Health (MOH) guidelines for personal preventive measures were hesitant about their children's vaccination. Concerns about side effects (31.4%) and a lack of safety data (31.2%) on the COVID-19 vaccines were the two most significant reasons for parents to develop vaccine hesitancy. Social media (24.3%), poor perceived immunity (16.3 %), and news articles (15.5%) were the top three contributors to this hesitancy. Vaccinated parents were 8.21 times more likely to be vaccination-hesitant than non-vaccinated parents. Additionally, parents with less education and a COVID-19-positive child at home increased the odds of vaccine hesitancy by 1.66 and 1.48 times, respectively. Overall, one-third of the parents were not prepared to vaccinate their children, and one-quarter of the respondents had not decided about vaccination. This study shows that parents in Riyadh are generally reluctant to vaccinate their children against COVID-19. As social media is a primary source of information for parents, public health professionals should utilize the platform to encourage parents to support vaccine acceptance.

Diagnostic lacunae and implications of an automated implantable cardioverter defibrillator implantation in a child with type 3 Long QT (LQT3) syndrome.

A diagnosis of congenital long QT interval syndrome based on history and electrocardiogram was made in a child in the absence of readily available genetic testing. A genotype 3 (LQT3) was suspected after exclusion of other variants as the child was non-responsive to beta-blocker and sodium channel blocker medication. As the child continues to show episodic bradycardia, polymorphic ventricular ectopy, and T-wave alternans, a single-chamber automated implantable cardioverter-defibrillator implantation was done successfully. This report highlights how the diagnosis of LQT3 was arrived at as well as the anesthetic challenges in the management of patients with LQTS.

Knowledge, Attitude, Practices and Viewpoints of Undergraduate University Students towards Self-Medication: An Institution-Based Study in Riyadh.

Rational and responsible self-medication (SM) is not only the key to better health outcomes, but also key to limiting adverse drug events. This institution-based cross-sectional study utilized seven- and four-item scales to assess the knowledge and attitude towards SM. Similarly, SM practices were measured using eight scale questions consisting of SM practice during the last six months, type of drug consumed, reason and frequency of SM, and so on. Statistical analyses were performed using SPSS. Overall, 371 students completed the questionnaire. The students with a good level of knowledge and positive attitude towards SM were 60.64% and 66.8%, respectively. About 55.5% of students practiced SM during the last six months using antipyretics (37.7%), multivitamins (36.4%), sleeping aids (20.2%), and anti-histamines (18.6%). Headache (79.2%), fever (37.7%), pain (25.9%), and colds and coughs (25.3%) were the illnesses for which they sought SM. The students admitted that drug side effects (75%), drug resistance (33.7%), drug interaction (41.5%), and poor treatment outcome (28.3%) were the consequences of irrational SM practice. Students (87.6%) propose that extending SM awareness through the Ministry of Health (83%) and pharmaceutical companies (48%) as major platforms would improvise the rational practice. Since AlMaarefa University students will be future healthcare professionals, their perception must be considered and accordingly educated to practice rational SM.

Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh.

BACKGROUND & OBJECTIVES: Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh. MATERIALS AND METHODS: This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25. RESULTS: Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior. INTERPRETATION & CONCLUSION: In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

Clinical efficacy of antivirals against novel coronavirus (COVID-19): A review.

The unprecedented challenge faced by mankind due to emergence of coronavirus 2019 (COVID-19) pandemic has obligated researchers across the globe to develop effective medicine for prevention and treatment of this deadly infection. The aim of this review is to compile recently published research articles on anti-COVID 19 management with their benefits and risk to facilitate decision making of the practitioners and policy makers. Unfortunately, clinical outcomes reported for antivirals are not consistent. Initial favorable reports on lopinavir/ritonavir contradicted by recent studies. Ostalmovir has conflicting reports. Short term therapy of remdesivir claimed to be beneficial. Favipiravir demonstrated good recovery in some of the cases of COVID-19. Umifenovir (Arbidol) was associated with reduction in mortality in few studies. Overall, until now, U.S. Food and Drug administration issued only emergency use authorization to remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease.

Early to mid-term results after total cavopulmonary connection performed in the second decade of life.

OBJECTIVES: Total cavopulmonary connection (TCPC) performed in the second decade of life has rarely been studied. Thus, we investigated (bicentric study) early and late morbidity and mortality following completion of TCPC in these patients. METHODS: From January 1999 to June 2014, 63 patients (14.5 ± 2.9 years) underwent TCPC (extracardiac conduit). Palliation before completion was an isolated bidirectional cavopulmonary shunt (BCPS) in 3 patients or BCPS associated with additional pulmonary blood flow (APBF) that was either antegrade (Group 1) in 38 (63%) or retrograde (Group 2) in 22 (37%). Preoperative and perioperative data were reviewed retrospectively. RESULTS: Mean pulmonary arterial and ventricular end-diastolic pressures were 12.2 and 9.2 mmHg, respectively. Mean Nakata index was 279 ± 123 and 228 ± 87 mm 2 /m 2 in Groups 1 and 2, respectively ( P = 0.01). Aortic cross-clamping was performed in 22 from Group 1 and 8 from Group 2 ( P = 0.04). Mean follow-up was 4.57 years [0.8-15]. Nine patients had prolonged stays in the intensive care unit (>6 days). There were 1 early and 2 late deaths (non-cardiac related). Actuarial survival was 96% at 4 years. At last follow-up, single-ventricle function remained normal or improved in all patients (Group 1) compared to 82% in Group 2 ( P = 0.02). New York Heart Association (NYHA) class had improved in both groups: 47 patients were NYHA class II and 16 class III preoperatively vs 50 class I and 10 class II postoperatively ( P < 0.001). CONCLUSIONS: Single-ventricle palliation with BCPS and APBF allowed completion of TCPC in the second decade of life, with encouraging mid-term results. However, BCPS with retrograde APBF was associated with single-ventricle dysfunction: thus, this technique needs to be used cautiously as long-lasting palliation.

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot.

BACKGROUND: Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated. OBJECTIVE: We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF. METHODS: We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014). RESULTS: Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR (P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair (P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair. CONCLUSIONS: In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR.

Right Thoracotomy to Repair Scimitar Syndrome and an Accessory Hemidiaphragm.

The association of an accessory hemidiaphragm and scimitar syndrome is extremely rare and occurs exclusively in the right hemithorax. We present the case of a 27-year-old female, who underwent complete resection of the accessory hemidiaphragm and direct anastomosis of the scimitar vein to the left atrium through a lateral right thoracotomy. This surgical approach offered easy access to both anomalies and allowed single-stage concomitant repair; this approach avoided postoperative respiratory complications and possible torsion or stenosis of the scimitar vein.

Scimitar Syndrome Repair in Adults: Intermediate-Term Results Using an Extracardiac Conduit.

BACKGROUND: Scimitar syndrome may be corrected using different techniques. Repair using an extracardiac conduit has rarely been performed. This study assessed the intermediate-term outcomes of this technique in adults. METHODS: From January 2000 to June 2011, 7 adult patients underwent correction with a ringed polytetrafluoroethylene conduit used to connect the scimitar vein (SV) to the left atrium, posterior to the inferior vena cava (IVC). Preoperative and perioperative data were reviewed retrospectively. RESULTS: All patients (32 ± 10.6 years old) were symptomatic (3 patients were New York Heart Association [NYHA] functional class II, 4 had recurrent pneumonia), with a ratio of pulmonary to systemic blood flow greater than 2, without significant pulmonary hypertension. In all patients, the SV drained the entire right lung venous return to the IVC below the diaphragm. Surgical repair was performed by sternotomy, normothermic cardiopulmonary bypass, and aortic cross-clamping. Four patients required additional closure of an atrial septal defect. Mean conduit diameter was 14 mm (range, 12 to 16 mm). Patients received long-term platelet suppression therapy with aspirin. There were no deaths and no reoperations. Mean follow-up time was 9.1 ± 3.6 years. Postoperative morbidity was nil. No evidence of subclinical stroke or embolization was found in postoperative magnetic resonance imaging of the brain. No thrombi on the prosthesis or in the left atria were detected at the latest echocardiogram, with laminar flow from the SV to the left atrium. At last follow-up, all patients were in NYHA class I. CONCLUSIONS: Correction of scimitar syndrome with an extracardiac conduit can be easily and safely performed in adults, with excellent intermediate-term durability, without graft thrombi or stenosis. This technique avoids deep hypothermic circulatory arrest when the SV is short or enters the IVC in an unusually caudad location.

Upper Sternal Cleft With a Complex Congenital Heart Defect: Repair in a Single Stage.

Sternal clefts are extremely rare in association with complex congenital heart defects, and their management can be challenging. Complete surgical repair in early infancy, of both anomalies in a single stage, is advocated. Different surgical techniques exist for isolated sternal cleft repair, but they do not consider the difficulties of combining sternal defect closure and a cardiac operation with the unavoidable postoperative cardiac edema. We describe a successful surgical technique to repair a sternal cleft in a 3-month-old infant in a concomitant cardiac operation using an absorbable polyglactin 910 mesh plate and sternal osseous autografting to avoid postoperative cardiac distention.

Right coronary cusp perforation after mitral valve replacement.

Secondary to leaflet injury, which is a well-known technical mistake, aortic regurgitation can occur during mitral valve replacement or repair. In most cases, the left or the non-coronary cusps are affected. For the first time, we report the case of a patient who had severe aortic regurgitation due to right coronary cusp perforation after mitral valve replacement. This complication was not identified until reoperation. Had transoesophageal echocardiography (TOE) been used during the first procedure, a delayed reoperation could have been avoided. During mitral surgery, every aortic cusp is at risk and peroperative TOE should be a mandatory procedure.