Rheumatologic Aspects of the COVID-19 Pandemic: A Practical Resource for Physicians in Kuwait and the Gulf region as Recommended by the Kuwait Association of Rheumatology.

The Kuwait Association of Rheumatology members met thrice in April 2020 to quickly address and support local practitioners treating rheumatic disease in Kuwait and the Gulf region during the coronavirus disease 2019 (COVID-19) pandemic. Because patients with rheumatic and musculoskeletal disease (RMD) may need treatment modifications during the COVID-19 pandemic, we voted online for the general guidance needed by local practitioners. In this review, we have addressed patients' vulnerability with rheumatic disease and issues associated with their optimum management. Our recommendations were based on the formulation of national/international guidelines and expert consensus among KAR members in the context of the Kuwaiti healthcare system for patients with RMD. The most recent reports from the World Health Organization, the Center for Disease Control, the National Institutes of Health-National Medical Library, and the COVID-19 educational website of the United Kingdom National Health Service have been incorporated. We discuss the management of RMD in various clinical scenarios: screening protocols in an infusion clinic, medication protocols for stable patients, and care for patients with suspected or confirmed COVID infection and whether they are stable, in a disease flare or newly diagnosed. Further, we outline the conditions for the hospital admission. This guidance is for the specialist and non-specialist readership and should be considered interim as the virus is relatively new, and we rely on the experience and necessity more than evidence collection. The guidance presented should be supplemented with recent scientific evidence wherever applicable.

Comparison of trauma management between two major trauma services in Riyadh, Kingdom of Saudi Arabia and Melbourne, Australia.

INTRODUCTION: The burden of injury in the Kingdom of Saudi Arabia (KSA) has increased in recent years, but the country has lacked a consistent methodology for collecting injury data. A trauma registry has been established at a large public hospital in Riyadh from which these data are now available. OBJECTIVES: We aimed to provide an overview of trauma epidemiology by reviewing the first calendar year of data collection for the registry. Risk-adjusted analyses were performed to benchmark outcomes with a large Australian major trauma service in Melbourne. The findings are the first to report the trauma profile from a centre in the KSA and compare outcomes with an international level I trauma centre. METHODS: This was an observational study using records with injury dates in 2018 from the registries at both hospitals. Demographics, processes and outcomes were extracted, as were baseline characteristics. Risk-adjusted endpoints were inpatient mortality and length of stay. Binary logistic regression was used to measure the association between site and inpatient mortality. RESULTS: A total of 2436 and 4069 records were registered on the Riyadh and Melbourne databases, respectively. There were proportionally more men in the Saudi cohort than the Australian cohort (86% to 69%). The Saudi cohort was younger, the median age being 36 years compared with 50 years, with 51% of injuries caused by road traffic incidents. The risk-adjusted length of stay was 4.4 days less at the Melbourne hospital (95% CI 3.95 days to 4.86 days, p<0.001). The odds of in-hospital death were also less (OR 0.25; 95% CI 0.15 to 0.43, p<0.001). CONCLUSIONS: This is the first hospital-based study of trauma in the kingdom that benchmarks with an individual international centre. There are limitations to interpreting the comparisons, however the findings have established a baseline for measuring continuous improvement in outcomes for KSA trauma services.

Logistic regression analysis of repeated radioiodine therapy treatments for papillary thyroid carcinoma patients.

PURPOSE: Radioiodine ablation treatment (RAT) is administered to papillary thyroid carcinoma patients post thyroidectomy. Multivariable logistic regression analysis can be applied to predict treatment failure. In this study, we propose a logistic regression model (LRM) to estimate the probability of repeating the treatment more than one time. MATERIALS AND METHODS: A retrospective review of the last 5 years of RAT data revealed that 30 patients had received the RAT more than one time. Various factors including age, sex, pretreatment serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH) and administered activity were analyzed to predict RAT failure and therefore the necessity to repeat the treatment by administering additional doses of radioiodine. RESULTS: The administered activity, the patient age, the presence of distant lymph nodes on the whole-body radioiodine scan (WBS) and the level of Tg before the treatment were found to be the predictive variables. The following LRM is proposed: Y = 7.8295 - 0.0012 [Activity in (MBq) - 0.0541 (Age) - 34.3 (Lymph Nodes) - 0.0042 (Tg)]. The prediction accuracy of the LRM was assessed using receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC). We found the AUC = 0.8972. CONCLUSION: Patients who are older in age, who receive higher administered radioiodine activity, have higher serum thyroglobulin levels and have lymph node uptake reported in their post-ablation WBS are more likely to have unsuccessful treatment outcome and will repeat the treatment. This LRM could help in adjusting RAT options in order to reduce the repeat rate.

Variability in the amount of fluorine-18 fluorodeoxyglucose excreted in urine measured from oncology patients during PET/computed tomography imaging.

The objectives of this work were to estimate the amount of fluorine-18 fluorodeoxyglucose (F-FDG) excreted (AFE) in the patient urine during the uptake phase as percentage of the injected activity and to examine the effect of blood glucose levels (BGL) on the excreted amount and whether it varies among men and women using statistical analysis methods. Radiation dose rates were measured at 1 m from 50 patients, 24 men and 26 women, before and after the first void using a calibrated ionization chamber. The F-FDG was injected in the patients using a calibrated automatic dose injection system. Statistical analysis using hypothesis testing was carried out. Patients with BGL above 5 mmol/l had a higher AFE of 12.3% in comparison with 8.3% of the patients with BGL below 5 mmol/l. A statistically nonsignificant correlation (r=0.183, P<0.249) between AFE and BGL was found; a nonsignificant difference was found in the AFE measured among the male and female patients. The AFE measured was 12±6%, with a range of (2-30%). There was a wide variation in the first void time of 39±8 min, with a range of (17-68) min. A simple noninvasive measurement method is presented that enabled the estimation of the amount of F-FDG excreted from the patient during voiding. Statistical analysis concluded that the amount of F-FDG excreted does not depend on sex, but is perhaps influenced by BGL.

Estimation of patient attenuation factor for iodine-131 based on direct dose rate measurements from radioiodine therapy patients.

The aim of the study was to measure the actual dose at 1 m from the patients per unit activity with the aim of providing a more accurate prediction of the dose levels around radioiodine patients in the hospital, as well as to compare our results with the literature. In this work the demonstration of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the patients with those measured from the unshielded radioiodine capsules immediately after administration of the radioactivity. The normalized dose rate per unit activity is therefore proposed as an operational quantity that can be used to predict exposure rates to staff and patients' relatives. The average dose rate measured from our patient per unit activity was 38.4±11.8 µSv/h/GBq. The calculated attenuation correction factor based on our measurements was 0.55±0.17. The calculated dose rate from a radioiodine therapy patient should normally include a factor accounting for patient body tissue attenuation and scatter. The attenuation factor is currently neglected and not applied in operational radiation protection. Realistic estimation of radiation dose levels from radioiodine therapy patients when properly performed will reduce the operational cost and optimize institutional radiation protection practice. It is recommended to include patient attenuation factors in risk assessment exercises - in particular, when accurate estimates of total effective doses to exposed individuals are required when direct measurements are not possible. The information provided about patient attenuation might benefit radiation protection specialists and regulators.

Narcolepsy in Saudi Arabia. Demographic and clinical perspective of an under-recognized disorder.

OBJECTIVE: To assess the clinical and polysomnographic features of narcolepsy in Saudis. METHODS: All patients diagnosed to have narcolepsy in the Sleep Disorders Center at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between March 1998 and December 2005 based on the International Classifications of Sleep Disorders Diagnostic and Coding Manual criteria were included. A data entry form collecting the demographic, clinical features, medications, referring specialty, prior diagnoses and daytime sleepiness was used. All patients underwent polysomnography followed by multiple sleep latency. RESULTS: Forty-seven patients with a mean age of 28.9 +/- 1.9 years were included. The mean age at onset of symptoms was 20.5 +/- 1.4 years. The interval between symptoms onset and diagnosis was 8.4 +/- 1.2 years. While 22 (46.8%) of the patients were referred to the sleep disorders clinic by different specialties, 25 (53.2%) patients sought an appointment in the sleep disorders clinic directly. Only 3 patients were referred with the correct diagnosis. Nocturnal sleep quality was worse in narcoleptics with cataplexy compared to those without cataplexy. CONCLUSION: Saudi patients with narcolepsy have the same clinical presentation as reported in the Western literature. Narcoleptics with cataplexy had disturbed quality compared to narcoleptics without cataplexy. A long time was reported between symptoms onset and diagnosis, which may reflect the under-recognition of the problem among physicians.

Narcolepsy in Saudi Arabia. Demographic and clinical perspective of an under-recognized disorder.

OBJECTIVE: To assess the clinical and polysomnographic features of narcolepsy in Saudis. METHODS: All patients diagnosed to have narcolepsy in the Sleep Disorders Center at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between March 1998 and December 2005 based on the International Classifications of Sleep Disorders Diagnostic and Coding Manual criteria were included. A data entry form collecting the demographic, clinical features, medications, referring specialty, prior diagnoses and daytime sleepiness was used. All patients underwent polysomnography followed by multiple sleep latency. RESULTS: Forty-seven patients with a mean age of 28.9 +/- 1.9 years were included. The mean age at onset of symptoms was 20.5 +/- 1.4 years. The interval between symptoms onset and diagnosis was 8.4 +/- 1.2 years. While 22 (46.8%) of the patients were referred to the sleep disorders clinic by different specialties, 25 (53.2%) patients sought an appointment in the sleep disorders clinic directly. Only 3 patients were referred with the correct diagnosis. Nocturnal sleep quality was worse in narcoleptics with cataplexy compared to those without cataplexy. CONCLUSION: Saudi patients with narcolepsy have the same clinical presentation as reported in the Western literature. Narcoleptics with cataplexy had disturbed quality compared to narcoleptics without cataplexy. A long time was reported between symptoms onset and diagnosis, which may reflect the under-recognition of the problem among physicians.