Comparison Between Physiological Scores SIPF, CURB-65, and APACHE II as Predictors of Prognosis and Mortality in Hospitalized Patients with COVID-19 Pneumonia: A Multicenter Study, Saudi Arabia.

Background: A coronavirus pandemic (COVID-19) is associated with catastrophic effects on the world with high morbidity and mortality. We aimed to evaluate the accuracy of physiological shock index (SIPF) (shock index and hypoxemia), CURB -65, acute physiology, and chronic health assessment II (APACHE II) as predictors of prognosis and in-hospital mortality in patients with COVID-19 pneumonia. Methods: In Saudi Arabia, a multicenter retrospective study was conducted on hospitalized adult patients confirmed to have COVID-19 pneumonia. Information needed to calculate SIPF, CURB-65, and APACHE II scores were obtained from medical records within 24 hours of admission. Results: The study included 1131 COVID-19 patients who met the inclusion criteria. They were divided into two groups: (A) the ICU group (n=340; 30.1%) and (B) the ward group (n=791; 69.9%). The most common concomitant diseases of patients at initial ICU admission were hypertension (71.5%) and diabetes (62.4%), and most of them were men (63.8%). The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001). The SIPF score showed a significantly higher ability to predict both ICU admission and mortality in patients with COVID-19 pneumonia compared with APACHE II and CURB -65; (AUC 0.89 vs 0.87; p < 0.001) and (AUC 0.89 vs 0.84; p < 0.001) for ICU admission and (AUC 0.90 vs 0.65; p < 0.001) and (AUC 0.90 vs 0.80; p < 0.001) for mortality, respectively. Conclusion: The ability of the SIPF score to predict ICU admission and mortality in COVID-19 pneumonia is higher than that of APACHE II and CURB-65. The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001).

Contained Jejunal Perforation Secondary to Ingestion of Magnet Balls in a Nonfatal Drowning Child.

Most ingested foreign bodies often pass through the gastrointestinal tract uneventfully; however, complications such as perforation do occur. Jejunal perforation is a known complication of abdominal trauma. While gastrointestinal tract injury due to the ingested foreign body such as a toothpick, fishbone, and battery among others are common, jejunal perforation is not very common in pediatrics. We report an unusual case of jejunal perforation that was diagnosed after a child was admitted to the pediatric intensive care unit for nonfatal drowning. A 15-month-old girl presented to our emergency room after she was found submerged in a swimming pool. She was unwitnessed for about ten minutes. At the scene, she was apneic, and cyanotic but had a pulse. Cardiopulmonary resuscitation was started and she was brought to our emergency room. She was managed for her drowning injuries and was accidentally found to have a foreign body on her abdomen by x-ray. She had no signs or symptoms of perforation, however, after questioning the parents they told us that they brought her a toy containing magnet balls about one month ago. After stabilizing her respiratory status and correcting her acidosis, an upper gastrointestinal (GI) endoscopy was done that showed jejunal perforation and multiple magnets. A consultation was done immediately for the pediatric surgery team then the perforation was repaired. High-powered magnets represent a serious health hazard if ingested due to risks of gastrointestinal perforation. It is important to have a high index of suspicion for potential injuries, especially silent ones. One of the rare complications is contained jejunal perforation.

Clustering of Covid-19 infections among healthcare workers: Experience from a tertiary care center in Saudi Arabia.

INTRODUCTION: Coronavirus infectious disease 2019 (COVID-19) had a significant impact on healthcare workers (HCWs) worldwide. Understanding the dynamics of infection transmission is important to develop strategies to prevent its spread. METHODS: A retrospective study of a cohort of HCWs with COVID-19 from a single tertiary care hospital during the first wave of the pandemic. Epidemiological investigations and identification of clusters of infection were done prospectively. RESULTS: A total of 326 HCWs had COVID-19 based on positive polymerase chain reaction tests for SARS-CoV-2. Ten clusters of infection were identified; nine clusters had HCWs as the index cases while one cluster had a patient as the index case. The largest cluster involved 15 transmissions, and one cluster included a secondary transmission. Sharing accommodation and social gatherings were the commonest epidemiological links. The majority of infected HCWs had mild infections, 23 (6%) required hospital admission and 3 (1%) required intensive care; all fully recovered. Majority of infections (80%) were community-acquired. Living in shared accommodation was associated with COVID-19 (120/690 versus 206/1610, P value = .01) while working in COVID-19 designated wards/units was not associated with COVID-19 (52/297 vs 274/2003, P value = .13). CONCLUSIONS: Clustering of COVID-19 was common among HCWs and related to shared accommodation and social gatherings, infection was of mild severity, and was not associated with caring for COVID-19 patients.

Healthcare Provider Attitudes toward the Newly Developed COVID-19 Vaccine: Cross-Sectional Study.

BACKGROUND: During the long wait and the global anxiety for a vaccine against COVID-19, impressively high-safety and effective vaccines were invented by multiple pharmaceutical companies. AIM: We aimed to assess the attitudes of healthcare providers and evaluate their intention to advocate for the vaccine. METHODS: This was a cross-sectional study conducted in a tertiary private hospital where an electronic survey was distributed among healthcare providers (HCPs). The survey contained two sections: socio-demographic characteristics and Likert-scale perception, with 72% internal consistency. RESULTS: The response rate to the email survey was 37% (n = 236). In addition, 169 (71.6%) of respondents were women, with more than half (134, 56.8%) aged ≤35 years. A total of 110 (46.6%) had over 10 years of experience, and most of them were nurses (146, 62%). Univariate analysis revealed that older participants significantly accepted and advocated for the new vaccine more than the younger ones. In the multivariate analysis, men were significantly more likely than women to accept and advocate for the new vaccine, as were those with chronic illnesses. Participants with allergy were significantly less likely to accept the vaccine than others. odds ratio (OR) and p-values were 2.5, 0.003; 2.3, 0.04; and 0.4, 0.01, respectively. CONCLUSION: The acceptance rate for the newly-developed COVID-19 vaccines was average among HCPs. Sex, age, presence of chronic illnesses, and allergy were significant predictors of accepting the vaccine.

Favipiravir versus standard of care in patients with severe COVID-19 infections: A retrospective comparative study.

OBJECTIVE: To assess the efficacy of Favipiravir compared to the standard therapy in treating patients with severe COVID-19 infection. METHODS: This is a retrospective cohort of patients with COVID-19 pneumonia who were treated with favipiravir, versus comparison group that received the standard of care. RESULTS: A total of 226 patients were included; 110 patients received favipiravir and 116 patients received standard of care. Patients who received favipiravir had longer time to recovery (14.2 ± 8.8 versus 12.8 ± 5.2, p = 0.17). Favipiravir was associated with an improved early day 14 mortality (4 [3.6%] versus 11 [9.5%]), p = 0.008), but was associated with a higher day 28 mortality (26 [23.6%] versus 11 [9.5%], p = 0.02). The overall mortality was higher in the favipiravir versus the standard of care group but difference was not statistically significant (33 [30.0%] versus 24 [20.7%], p = 0.10). CONCLUSION: The addition of favipiravir to standard of care was not associated with any improvement in clinical outcomes or mortality. Larger randomized controlled clinical trials are needed to further assess the efficacy of favipiravir.

Serum Sickness following Tetanus Toxoid Injection.

Serum sickness is an allergic reaction that frequently occurs in patients after the injection of foreign protein or serum. It is characterized by fever, skin rash, enlarged lymph nodes, and painful joints. In this case, we describe a case of 6-year-old girl who developed a rash and arthralgia after being vaccinated with tetanus toxoid injection after a cut wound.

Multisystem Inflammatory Syndrome in Children, the Real Disease of COVID-19 in Pediatrics - A Multicenter Case Series From Al-Ahsa, Saudi Arabia.

Fortunately, coronavirus disease 2019 (COVID-19) infection in pediatric populations exhibits a mild course of disease. However, a small number have recently been identified who develop a significant systemic inflammatory response, a new disease entity called multisystem inflammatory syndrome in children (MIS-C), especially after the peak of the wave in Al-Ahsa, Saudi Arabia, in early June to mid-July. In MIS-C children usually present a few days to a few weeks after recovery from COVID-19 with high grade fever, GI symptoms, Kawasaki-like picture or even toxic shock-like syndrome. Raising awareness about this disease entity is very fundamental to enable pediatricians and other health care providers to identify and manage these patients before it is too late. We describe 10 different cases of MIS-C with different risk factors and presentations.

Pediatric gastrointestinal basidiobolomycosis mimicking malignancy.

Basidiobolomycosis is a rare fungal infection with high prevalence in southwestern province of Saudi Arabia (Tohama region); it mainly causes subcutaneous infections and rarely gastrointestinal disease. Because of its indolent presentation, it is often misdiagnosed as IBD, tuberculosis or Malignancy. We are reporting a 7 year old Saudi girl with abdominal mass, fever and eosinophilia resembling malignancy on radiological and pathological picture fully recovered with only medical therapy in the form of oral Voriconazole 2012 Elsevier Ltd. All rights reserved.

Pott's puffy tumor due to Aspergillus fumigatus: A case report and review.

Pott's puffy tumor (PPT) is a very rare, nearly forgotten condition. We describe a 9-year-old girl with PPT due to trauma and surgical cultures that revealed Aspergillus fumigatus.