The effectiveness of visual triaging and testing of suspected COVID-19 cases in primary care setting in Saudi Arabia.

INTRODUCTION: Asymptomatic individuals could be a source of spreading the infection, especially in their households. Triaging and testing an individual for coronavirus disease (COVID-19) infection rely on the criteria included in the adopted triaging instrument, and adopted case definition of a suspected case. They both may need to be reviewed and modified to make them more effective in making the right decision. METHODS: A cross-sectional study was used to find out the effectiveness of triaging instrument and the case definition used in the fever clinic (FC) in one of our primary care centers. The data of 630 randomly selected participants who were tested in our center between April 12 and August 12 2020 were analyzed. RESULTS: About 36.8% of the 630 tested participants were positive for COVID-19. Symptomatic patients were 3.93 (95% CI; 2.58, 5.98; P < 0.001) times more likely to test positive than asymptomatic ones. The participants with a history of contact with a COVID-19 confirmed case were 1.47 (95% CI; 1.03, 2.10; P = 0.032) times more likely to test positive compared to those without such history. Symptomatic with and without history of contact were 8.40 (95% CI; 3.23, 21.86; P < 0.001) and 4.91 (95% CI; 1.84, 13.09; P < 0.001) times more likely to test positive compared to asymptomatic contact, respectively. Moreover, patients with comorbidity were also 1.85 (95% CI; 1.31, 2.60; P < 0.001) times more likely to test positive than healthy ones. The mean of the number of the households, and the mean of the number of households tested positive significantly exceeded the means of those tested negative by 1.03 (95% CI; 0.48, 1.57; P < 0.001), and 0.98 (95% CI; 0.68, 1.28; P < 0.001), respectively. From the studied triaging items only symptoms, comorbidities, and the number of households tested positive were independently associated with testing positive. Moreover, from studied symptoms, only fever, cough, myalgia, and loss of taste and smell were independently associated with testing positive. Finally, from the studied comorbidities, only diabetes mellitus was independently associated with testing positive. CONCLUSION: At the time of outbreak and pandemic, people get worried and need to be reassured, and contacts would then seek testing. However, resources including manpower, material, and money need to be protected and used wisely. Thus, the adoption of an evidence-based updated testing policy is crucially needed. Furthermore, early identification of the potential sources of the infection is also crucially needed to control the spreading of the infection.

Impact of Ramadan-focused diabetes education on hypoglycemia risk and metabolic control for patients with type 2 diabetes mellitus: A systematic review.

BACKGROUND: Ramadan fasting is regarded as a form of worship amongst Muslims. However, patients with a high risk of diabetic complications are advised to avoid fasting, as the practice is associated with significant impacts on several health factors for type 2 diabetic patients, including glycaemic control. Thus, a lack of focused education before Ramadan may result in negative health outcomes. AIM: To evaluate the impact of a Ramadan-focused diabetes education programme on hypoglycaemic risk and other clinical and metabolic parameters. METHODS: A systematic literature search was performed using Scopus, PubMed, Embase, and Google Scholar to identify relevant studies meeting the inclusion criteria from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and guidelines were followed when performing the search and identification of appropriate studies. RESULTS: Seventeen studies were included in this systemic review; five of them met the criteria to compile for a meta-analysis. The included studies were with various study designs, including randomised controlled trials, quasi-experimental and non-randomised studies. Overall, the results revealed a significant reduction of hypoglycemia risk (81% reduction) for fasting patients in intervention groups who received Ramadan-focused education compared with patients receiving conventional care (OR 0.19, 95% CI: 0.08-0.46). Moreover, HbA1c significantly improved amongst patients who received a Ramadan-focused diabetes education intervention, compared with those receiving conventional care. CONCLUSION: Ramadan-focused diabetes education had a significant impact on hypoglycemia and glycaemic control, with no significant effect on body weight, blood lipids or blood pressure.

Measles, Mumps, Rubella, and Varicella Immunity among Nursing Staff in a Major Hospital, Riyadh, Saudi Arabia.

INTRODUCTION: Measles, mumps, rubella, and varicella (MMRV) represent risk to HCWs. Checking on antibodies against MMRV is an important part of infection control among nursing staff for their own health, their colleagues and for the health of patients. Screening for immunity against MMRV is an initial step before vaccination of nursing staff. This study is to describe immunity status against MMRV by screening nursing staff in a tertiary care hospital in Riyadh. METHODS: A cross sectional survey among nursing staff was conducted from July to August 2019 at Prince Sultan Military Medical City. A convenience sampling was used to screen 1534 nursing staff working at several high-risk departments. Record for their immune status and antibody titer for MMRV were reviewed using a data collection form. RESULTS: Screening for immunity among nursing staff found that; 79.3% were immune against measles; 75.5% to be immune against mumps; 95.8% were immune against rubella; and 67% were immune against varicella. The highest proportion of immune nursing staff against measles (96.3%) and varicella (93.5%) was found in Intensive care department while the highest proportion of immune staff against mumps (89.4%) was found in Long Stay department, and against rubella (97.5%) in Hemodialysis department. On the other hand, It was found that Hemodialysis Department had the Highest proportion of non-immune staff against measles (35.6%), mumps (39%), and varicella (56.3%), while Emergency Department had the lowest proportion of immune staff (6%) against rubella. CONCLUSION: Despite that immunity among nurses screened was good on some departments; however, such results need improvement in these critical areas. These finding emphasize the importance of the currently mandatory screening for MMRV before employment. We suggest conducting comprehensive programs to increase awareness and vaccination coverage in areas with low rates of immunity.

Impact of Ramadan Focused Education Program on medications adjustment for patients with type 2 diabetes in a primary health care institution in Saudi Arabia.

AIMS: To examine the impact of Ramadan Focused Education Program (RFEP) on medications adjustment in type 2 diabetes patients in Ramadan. METHODS: This is a controlled, intervention based study. It was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n = 140) received RFEP on medications doses & timing adjustment before and after Ramadan, while the control group (n = 122) received standard care. RESULTS: The dose of insulin glargine was reduced from 42.51 ±â€¯22.16 at the baseline to 40.11 ±â€¯18.51-units during Ramadan (p = 0.002) in the intervention group while it remained the same in the control group before Ramadan and during Ramadan (38.51 ±â€¯18.63 and 38.14 ±â€¯18.46, P = 0.428, respectively). The hypoglycemia score was 14.2 ± (8.5) pre-Ramadan in the intervention and reduced to 6.36 ±â€¯6.17 during Ramadan (p < 0.001) while in the control group, no significant changes were noted before and during Ramadan (14.01 ±â€¯5.10 versus 13.46 ±â€¯5.30). CONCLUSIONS: Ramadan Focused Education Program done at a primary healthcare setting had a positive impact on medication adjustment for dose and timing during fasting in Ramadan in diabetic patients, and it can be a useful tool to achieve better outcomes; less hypoglycemia and safe fasting among T2D patients during Ramadan.

Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article.

Hypoglycemia is an essential issue for diabetic patients and considered a limiting factor in the glycemic management. Heterogeneity of the diseases in Type 2 Diabetes Mellitus can affect the frequency of hypoglycemia, especially when the patient has cardiovascular diseases. There are several factors that lead to hypoglycemia including sulfonylurea therapy, insulin therapy, delaying or missing a meal, physical exercise, or alcohol consumption. Long-term studies reported that repeated hypoglycemia could increase the risk of cardiovascular diseases. During Ramadan fasting, diabetic patients have high incidence of hypoglycemia. Therefore, focused education about hypoglycemia in routine life of diabetic patients and during fasting in Ramadan is important to reduce the complications.

Awareness of basic life support and cardiopulmonary resuscitation among female secondary school students in government schools in Riyadh city, KSA.

BACKGROUND AND OBJECTIVE: Basic life support (BLS) and cardiopulmonary resuscitation (CPR) are urgently required and must be performed when cardiac arrest occurs. These lifesaving procedures must be learned by healthcare professionals. In developed countries, members of the public, academics, and students learn how to carry out these emergency procedures. Knowledge of these simple procedures determines successful outcome. This study was conducted to determine the level of awareness of BLS and CPR among female secondary students at governmental schools in Riyadh city, Saudi Arabia (SA). METHODS: This cross-sectional study was conducted in five governmental secondary schools in Riyadh city, SA, between June 2015 and June 2016. Total of 1224 female students were selected randomly, and data were collected using a self-reported structured questionnaire. RESULTS: A total of 1170 participants completed the questionnaire. Most of the participants (81.5%) were Saudis. More than 50% of the students (54.8%) did not have information about BLS, and 82.6% felt their knowledge about BLS was insufficient. Only 10.8% of the participants had taken a BLS course, and only 38.5% believe BLS courses should be mandatory. CONCLUSION: The level of awareness regarding BLS among female secondary school students in governmental schools in Riyadh was found to be insufficient. The introduction of BLS and CPR courses in the curriculum of governmental secondary schools in Riyadh city is highly recommended.