Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis. METHODS: Observational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained. RESULT: Among the overall study population of 158 patients, the age median [IQR] was 24.5 [19-31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67-8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07-10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin. CONCLUSION: Elevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.

Post-COVID-19 fatigue and health-related quality of life in Saudi Arabia: a population-based study.

Background: Despite substantial literature on symptoms and long-term health implications associated with COVID-19; prevalence and determinants of post-acute COVID-19 fatigue (PCF) remain largely elusive and understudied, with scant research documenting health-related quality of life (HRQoL). Hence, prevalence of PCF and its associated factors, and HRQoL among those who have survived Covid-19 within the general population of Saudi Arabia (KSA) is the subject under examination in this research. Methods: This cross-sectional study was conducted on 2063 individuals, selected from the KSA's general population, using a non-probability sampling approach. An online survey was used to employ a self-administered questionnaire to the participants, which included socio-demographic information, the patient's COVID-19 infection history, 12-item Short Form Health Survey (SF-12) to assess quality of life, and Chalder Fatigue Scale (CFS) (CFQ 11) to evaluate the extent and severity of fatigue. Data were analyzed using SPSS version 26. A p < 0.05 was considered to be strong evidence against the null hypothesis. Results: The median age of participants was 34 (IQR = 22) years, with females comprising the majority (66.2%). According to the SF-12 questionnaire, 91.2% of patients experienced physical conditions, and 77% experienced depression. The prevalence of PCF was 52% on CFQ 11 scale. Female gender, higher levels of education, a pre-existing history of chronic disease, as well as the manifestations of shortness of breath and confusion during acute COVID-19 infection, were identified as independent predictors of fatigue. Conclusion: To facilitate timely and effective intervention for post-acute COVID-19 fatigue, it is essential to continuously monitor the individuals who have recovered from acute COVID-19 infection. Also, it is critical to raise health-education among these patients to improve their quality of life. Future research is required to determine whether COVID-19 survivors would experience fatigue for an extended duration and the impact of existing interventions on its prevalence and severity.

COVID-19 vaccine acceptance among pregnant women: a hospital-based cross-sectional study in Sudan.

Introduction: Pregnancy increases the risk of developing a severe illness due to COVID-19 infection. To the best of our knowledge, no previous study has been conducted on COVID-19 vaccine acceptance among pregnant women in Sudan. Hence, this study aimed to determine COVID-19 vaccination acceptance and its predictors among pregnant women. Methods: A cross-sectional study was conducted among 623 pregnant women attending Gadarif maternity hospital in eastern Sudan through a structured questionnaire. Data were obtained on sociodemographic characteristics, obstetric and health-related characteristics, COVID-19 infection, and vaccination-related information, as well as beliefs about and acceptance of COVID-19 vaccination. Results: COVID-19 vaccine acceptance among the pregnant women was 2.7%. The vaccine acceptance was higher if their husband's education was secondary school or higher [adjusted odds ratio [AOR] 4.30, 95% confidence interval (CI) 1.11-16.65, p = 0.035] and discussion of COVID-19 vaccine with the pregnant women by a health care professional in the hospital (AOR 5.46, 95% CI 1.94-15.35, p < 0.001). The most common reasons for resistance to the vaccine were concerns about the side effects of the vaccine for the mother and her baby. Conclusion: Acceptance of the COVID-19 vaccination among the pregnant women was very low. Discussions with pregnant women and their husbands by health care professionals regarding the safety of COVID-19 vaccine for the mother and her baby are highly recommended.

Healthcare adjustments and concerns: a qualitative study exploring the perspectives of healthcare providers and administrative staff during the COVID-19 pandemic in Saudi Arabia.

Background: Healthcare systems have modified their strategies to manage their staff, supplies, and space to deal systematically with the COVID-19 pandemic. This research aimed to explore the nature of hospital adjustments and the concerns of healthcare providers and administrative staff working in Governmental and private hospitals throughout the Qassim Region of the Kingdom of Saudi Arabia (KSA) during the pandemic. Methods: A qualitative phenomenological study using semi-structured in-depth interviews were conducted with 75 purposively selected healthcare providers and administrative staff working at three main hospitals in the Qassim Region, KSA. The maximum variation sampling technique was utilized. Recruitment of participants was continued until data saturation was reached. All interviews were audiotaped, transcribed verbatim, and analyzed thematically. Results: Four core themes were identified in this paper: (1) changes in hospital policy and procedures, (2) workforce management, (3) the well-being of the workforce, and (4) apprehensions and expectations of the workforce. The participants showed satisfaction with timely administrative decisions and new policies during the COVID-19 pandemic. Furthermore, the psychological health of healthcare professionals was affected more than their physical state. Finally, the providers perceived the emergence of multiple concerns in the coming months. Conclusion: Although healthcare providers were initially overwhelmed, they gradually accepted new administrative policies. Numerous innovative interventions effectively reduced their physical workload and increased their productivity, but they remained significantly affected by a wide range of psychological disorders, with a high prevalence of obsessive-compulsive disorder. There were some concerns about the new SARS-CoV-2 variant, but the majority were optimistic.

The Level of School Teachers' Knowledge About First-Aid Management and Control of Epistaxis in Qassim Region, Saudi Arabia.

BACKGROUND:  Epistaxis is an acute episode of nasal bleeding commonly caused in children by traumatic injuries in a school setting. It is one of the common ear, nose, and throat emergencies, which should be managed with first-aid measures. To the best of our knowledge, no studies have been conducted among school teachers in the Qassim region of Saudi Arabia regarding this information. This study thus aimed to assess levels of knowledge about first-aid management and control of epistaxis among school teachers in the Qassim region, Saudi Arabia. MATERIALS AND METHODS:  A cross-sectional study using a validated online questionnaire was distributed via social media platforms. Information was collected regarding sociodemographic characteristics, and eight items assessed participants' knowledge about epistaxis and its management. Univariate, bivariate, and multivariable analyses were conducted to assess the factors associated with good levels of knowledge. RESULTS:  The study had a total of 1,152 participants, of which 69.7% were female. The mean of knowledge was 3.29 (SD=1.39, range: 0-7). Only 19.4% of participants had a good level of knowledge. In multivariate analysis, females and those who had received information on first aid to stop nose-bleeds were significantly associated with good knowledge levels (adjusted odds ratio {AOR}: 1.72, 95% CI: 1.18-2.51, p=0.005; and AOR: 3.38, 95% CI: 2.47-4.64, p<0.001, respectively). CONCLUSION:  Less than one-quarter of participants had good knowledge levels. Health education sessions for teachers are highly recommended and should specifically target male teachers.

Assessment of health-related quality of life in patients with heart failure: a cross-sectional study in Saudi Arabia.

BACKGROUND: As a precarious clinical condition and a public health problem, heart failure (HF) is associated with a significant burden of morbidity, mortality, and health care costs. As almost all of the published research has been conducted in Western countries, there is a need for culturally relevant studies in Saudi Arabia. This is the first study to investigate health-related quality of life (HRQoL) and its associated factors among Saudi patients with HF in the Qassim region. METHODS: A cross-sectional study was conducted at the only tertiary care hospital in the Qassim region of Saudi Arabia during the period from November 2020 to July 2021. The participants were interviewed face-to-face by trained interviewers using the standard validated 36-item Short-Form Health Survey (SF-36) questionnaire for HRQoL assessment. The data were analyzed using STATA version 16. RESULTS: The participants included 246 HF patients whose mean (SD) age was 56.7 (10.9) years. A majority of the respondents (80%, n = 197) were male, and 49% (n = 121) had an education level of less than secondary school. The median scores were high for the domains of social functioning (100 points) and bodily pain (75 points) and low for role-physical functioning (25 points). In general, the median scores for the physical and mental component summaries were 58.1 and 63.7, respectively. Patients with an education level less than secondary school were more likely to have a low physical component summary score (aOR 3.00, 95% CI 1.46-6.17), while female patients were more likely to have a low mental component summary score (aOR 2.67, 95% CI 1.38-5.16). CONCLUSIONS: Health-related quality of life was found to be moderate among these HF patients. Periodic HRQoL assessment is recommended for HF patients to minimize their physical and psychological concerns, particularly for patients with low education levels and female patients.

Face Mask Practice and Technique During the COVID-19 Pandemic: A Nonrepresentative Cross-Sectional Study in Sudan.

Background: The World Health Organization issued guidelines for face mask use in community settings during the current COVID-19 pandemic. However, data are limited on public compliance with those guidelines in Sudan. Therefore, this study assessed face mask-wearing practice and technique during the COVID-19 pandemic among residents of Sudan. Methods: A cross-sectional study was conducted from July to September 2021 among Sudanese aged ≥18 years. A web-based questionnaire was shared through different social media platforms. Personal characteristics, four knowledge-associated items, three attitude-associated items, one item concerning mask-wearing practice, and five items related to mask-wearing technique were determined. Univariate, bivariate, and multivariable analyses were performed using STATA v17. Results: The survey included 1059 participants (48% males, 52% females) from different regions of Sudan. The overall mean ± SD was 3 ± 0.73 for knowledge of COVID-19 transmission; 2.3 ± 0.71 for attitude toward wearing face masks; 0.38 ± 0.49 for the practice of wearing a face mask; and 4.17 ± 0.97 for face mask-wearing technique. Approximately one-third (38%) of participants always wore a face mask during the pandemic, with age, sex, education level, family income, face mask attitude, occupation, and history of COVID-19 infection affecting the practice. All steps of face mask-wearing technique were performed by 46% of participants (59% performed hand hygiene before putting on a mask and 86% after removing it; 98% covered mouth and nose; 90% adjusted masks at the nose bridge, and 84% tied masks securely), and associated with age, occupation, family income, history of COVID-19 infection, and face-mask attitude. Conclusion: Although knowledge and attitude were relatively good, the practice of wearing a face mask and using proper techniques among participants were low. To ensure optimal face mask use and proper mask-wearing techniques, educational intervention and establishing governmental regulations are highly recommended.

The Concern of COVID-19 Vaccine Safety Is behind Its Low Uptake among Patients with Diabetes Mellitus in Sudan.

Diabetic patients are vulnerable to developing severe complications and have a higher risk of death due to COVID-19 infection. Vaccination remains the mainstay during the current situation to mitigate the risks related to COVID-19 infection. Therefore, the aim of the current study was to assess the vaccination status and the factors associated with COVID-19 vaccine uptake among patients with diabetes mellitus (DM) in Sudan. A hospital-based cross-sectional study was conducted from January to February 2022 at Gadarif Hospital in eastern Sudan. Information on sociodemographics, the contracting of COVID-19 during the pandemic, beliefs toward COVID-19 vaccinations, and barriers related to COVID-19 vaccinations was obtained through an interview questionnaire among adult (≥18 years) patients with DM. Bivariate and multinomial logistic regression analyses performed. A total of 568 diabetic patients were enrolled, with a mean (SD) age of 53.07 (12.69) years. The majority of the participants were female (67.6%), urban residents (63.4%), uneducated (60.6%) and employed (73.2%). There was a history of COVID-19 in 97.4% of participants, and 29.2% of them had hypertension along with DM. About 31% received the vaccine, out of which 17.9% received the first dose, 13.2% received the second dose, and 0.2% received the third dose. Multinomial logistic regression analysis showed a significant association between belief in the safety of the COVID-19 vaccine and having had two doses of it (adjusted Odds ratio = 20.42, p < 0.001). The prevalence of COVID-19 infection was high, while the rate of COVID-19 vaccination uptake was low and inadequate among the participants. Appropriate health education and targeted interventions toward awareness of safety concerns are highly recommended.

Sociodemographic and Behavioral Predictors of COVID-19 Vaccine Hesitancy in Pakistan.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic continues with resurgent second and third waves worldwide. Vaccination is one of several measures that are needed to end this pervasive threat. Pakistan, however, has a relatively low rate of routine vaccine acceptance. Our study aimed to determine the proportion and predictors of COVID-19 vaccine hesitancy (VH) among adults in Pakistan. METHODS: An online cross-sectional study was conducted from December 27, 2020 to March 6, 2021. Non-probability sampling was applied to recruit study participants through social media platforms (ie, Facebook and Twitter) and through free messaging services (WhatsApp). Stata 16 was used to generate descriptive statistics and logistic regression models for identifying predictive variables of vaccine hesitancy. A p-value of <0.05 was considered strong evidence against the null hypothesis. RESULTS: Out of 1014 participants, 35.8% (n=363) were hesitant about receiving the COVID-19 vaccine. Reasons for VH included concerns about side effects (42.4%), belief in conspiracy theories (20.1%), perceived inefficacy of the vaccine (13.2%), and perceived protection through precautionary measures (12.6%). Urban residency (AOR 2.34, 95% CI 1.54-3.57), reservations about vaccine safety (AOR 3.29, 95% CI 1.68-6.44), uncertainty about vaccine efficacy (AOR 2.70, 95% CI 1.50-4.86), failure of the vaccine to reduce hospitalization and death (AOR 6.36, 95% CI 4.01-10.22), and unfelt need for vaccination awareness among public (AOR 2.02, 95% CI 1.28-3.14) were associated with higher rates of VH. At least one chronic disease (AOR 0.60, 95% CI 0.39-0.92), knowing someone infected with COVID-19 (AOR 0.56, 95% CI 0.39-0.81), and trusting information from the ministry of health (AOR 0.64, 95% CI 0.41-0.99) and physicians (AOR 0.27, 95% CI 0.13-0.53) were found to be associated with lower rates of COVID-19 VH. CONCLUSION: More than one third of survey participants were VH. COVID-19 vaccine uptake in Pakistan can be improved through targeted health education strategies and planned interventions that address the barriers identified in the present study.

Trends, Uptake, and Predictors of Influenza Vaccination Among Healthcare Practitioners During the COVID-19 Pandemic Flu Season (2020) and the Following Season (2021) in Saudi Arabia.

BACKGROUND: Healthcare practitioners (HCPs) are at high risk of influenza. Seasonal influenza vaccines can reduce influenza-associated morbidity in healthcare settings, but despite mandatory influenza vaccination in the Kingdom of Saudi Arabia, the vaccination uptake rate among HCPs is below expectations. This study investigated vaccination trends from 2017 to 2020 to identify factors affecting vaccination among HCPs during the COVID-19 pandemic flu and subsequent seasons. METHODS: Cross-sectional study among HCPs was conducted in January 2021. A structured questionnaire was shared via social media. Vaccine uptake predictors were identified using descriptive statistics and logistic regression models (p-value 0.05). RESULTS: A total of 424 HCPs (118 physicians and 306 nurses) completed the questionnaire. Vaccine uptake increased from 2017 to 2019 (45% to 52% to 62%) but fell (to 59%) during the 2020 COVID-19 pandemic flu season. Multivariable analysis indicated participants >40 years old (AOR 3.09, 95% CI 1.64-5.83), female (AOR 1.74, 95% CI 1.13-2.67), non-Saudi (AOR 2.62, 95% CI 1.72-4.01), nurses (AOR 2.70, 95% CI 1.75-4.17), and who possessed accurate knowledge of the flu vaccine efficacy duration (AOR 3.04, 95% CI 1.87-4.94) were more likely to have received the vaccine. However, 79% of HCPs declared their intention to be vaccinated in the 2021 flu season, with participants >40 years old, female (AOR 2.25, 95% CI 1.38-3.68), non-Saudi (AOR 3.79, 95% CI 2.34-6.16), or nurses (AOR 2.94, 95% CI 1.82-4.76) more likely to do so. CONCLUSION: Influenza vaccination uptake declined among HCPs during the 2020 flu season compared with the previous season but is expected to increase in the upcoming 2021 season. Nevertheless, the findings are encouraging and indicate increased willingness of HCPs to become vaccinated in the upcoming 2021 season, but coverage could be further increased by policymakers via a comprehensive plan focusing particularly on younger HCPs, Saudis, males, and physicians.

The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives.

BACKGROUND: The closure of educational activities in the Kingdom of Saudi Arabia due to the ongoing COVID-19 pandemic resulted in an unplanned shift from traditional learning to a setup that exclusively involves digital teaching and learning. Within this context, the present study aimed to explore undergraduate medical students' perceptions regarding the effectiveness of synchronized online learning at Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia. METHODS: A qualitative study was conducted using virtual focus group discussions synchronously with the help of a discussion guide consisting of seven open-ended questions. Overall, 60 medical students were recruited using a maximum variation sampling technique; these students then participated in eight focus group discussions. All interviews were recorded, transcribed verbatim, and analyzed for thematic contents using the standard (Mayring, Kiger. M. E. and Braun.V) content analysis framework. RESULTS: A thematic content analysis yielded four core themes: (1) educational impact, (2) time management, (3) challenges encountered, and (4) preferences for the future. The online modality was well-received, and all participants agreed that online sessions were time saving and that their performance was improved due to enhanced utility of time; however, they indicated that they encountered some challenges, including methodological, content perception, technical, and behavioral challenges during sessions and online exams. Most of the preclinical students preferred online learning for the upcoming academic years. CONCLUSION: Synchronized online classes were well-accepted by the medical students. This represents significant and promising potential for the future of medical education. The principles of the online learning model and learning outcomes should be rigorously and regularly evaluated to monitor its effectiveness.

Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan.

OBJECTIVES: To assess newborn care knowledge and practices among mothers. METHODOLOGY: A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 170 mothers accompanying their infants attending the Paediatric Out Patient Department were interviewed through a structured questionnaire. Areas of inquiry included Antenatal care seeking, delivery care, cord care, eye care, bathing and breastfeeding practices. RESULTS: Ninety-two percent mothers reported at least one antenatal care visit. Tetanus Toxoid coverage was 88%. Home deliveries were 18%. Seventy-four percent reported applying various substances like coconut oil, mustard oil, purified butter and turmeric to the cord stump. Kohl application to newborn's eyes was 68%, while 86% reported first bath within 24 hrs of birth. 48% mothers initiated breastfeeding within 2 hours of delivery. Colostrum was discarded by 43% and prelacteal feeds given by 73%. Exclusive Breast Feeding rate was 26%. Family income of Rs. 10, 000 (USD120) or less/month and maternal education level of primary or less were significantly associated with home delivery, unhygienic cord care and kohl application to the newborn's eyes. Home delivery was a risk factor for poor cord care (OR=4.07) and discarding colostrum (OR= 3.18). CONCLUSION: Antenatal care coverage was good, but knowledge regarding newborn care was poor. Harmful practices regarding newborn care were prevalent among mothers. Institutional deliveries did not guarantee optimal practices. Tradition and culture played a significant role. Health education can improve the mothers' knowledge regarding newborn care practices.

Hepatitis B vaccination among primary health care workers in Northwest Pakistan.

BACKGROUND: We assessed hepatitis B vaccination and its determinants among health care workers (HCW) in rural Northwest Pakistan. METHODS: This cross sectional study was conducted among 485 HCWs from both public and private clinics. Data about hepatitis B vaccination, socio-demographic, knowledge regarding modes of transmission of hepatitis B virus, perceived disease severity and benefits of vaccination was collected through questionnaire. Multivariable logistic regression analysis was performed. RESULTS: Prevalence of complete hepatitis B vaccination was 40% (among Physicians with MBBS/MD qualification; 86% and lowest among non-qualified Dispensers;16%). Also, prevalence was higher among HCWs from public Dispensaries (77%) than those working in private clinics (35%). Being MBBS/MD Physician (Adj. OR 26.60; 95%CI 9.27-73.23), Non-MBBS/MD Physician (Adj.OR 1.89; 95%CI 0.78-4.59), qualified Dispensers (Adj. OR 3.58; 95%CI 1.34-9.54) compared to non-qualified Dispensers, working in public clinics (Adj. OR 2.54; 95%CI 1.13-5.69) as compared to private, perceived disease threat after exposure to blood and body fluids (Adj. OR 1.11; 95%CI 1.03-1.19) and perceived benefits of hepatitis B vaccination (Adj. OR 1.13; 95%CI 1.09-1.19) were significant predictors of complete hepatitis B vaccination. CONCLUSION: Improved perception of disease threat and benefits of vaccination and qualification of HCWs are associated with hepatitis B vaccination among Primary HCWs.