COVID-19 Contact Tracing Experience at a Tertiary Healthcare Center in Saudi Arabia.

Introduction As of May 2023, the end of the pandemic, the cumulative number of COVID-19 cases reached more than 841,000 cases. Healthcare workers (HCWs) especially have been at the frontline during this pandemic and are at a higher chance of contracting COVID-19. Approximately half of all high-risk exposures were to healthcare personnel with COVID-19. While several tools for contact tracing were developed for the general public, contact tracing for infectious diseases in the healthcare setting is limited, and global testing of HCWs, or in-hospital digital tracing, is not performed in most facilities. The King Faisal Specialist Hospital and Research Center (KFSH&RC) collaborated with the Infection Control and Health Information Technology Affairs (HITA) to create an automated COVID-19 contact tracing tool specifically for HCWs who worked at the institute. This study aims to describe the contact tracing experience at KFSH&RC. Methods A retrospective study was conducted to describe the use of an automated tool that was developed to assist in the contact tracing process and that was to be used by KFSH&RC employees who had been in contact with a COVID-19-positive individual. This tool is utilized for the early identification of possible COVID-19 cases and risk stratification of the exposed individuals. The tool can be accessed through the KFSH&RC website; it also collects information about the COVID-19 exposure rate among the different departments such as administration, capital projects/facilities, and healthcare at a tertiary care hospital in Riyadh, Saudi Arabia Results The tool has been utilized 7,353 times by contact cases. Approximately 7% of those tested later developed a COVID-19 infection. When assessing the positivity rates per department, The Environmental Services Department had the highest positivity rate of 28.21%, followed by Health Information Technology and Analytics (HITA), and then the Central Transportation Department. Conclusion This study acts as the first of its kind to describe the successful use of the healthcare contact tracing system in one of Saudi Arabia's largest hospitals (KFSH&RC) and describe the infection trends in different departments of the hospital. Through the tracing system, the departments with the highest COVID-19 infection occurrences at the hospital were identified in a timely manner, and safety protocols were implemented.

Extramedullary Involvement of the Ascending Colon in Relapsing Acute Lymphocytic Leukemia: A Case Report.

Acute lymphoblastic leukemia (ALL) accounts for <1% of adult cancers. Extramedullary relapse of ALL has been primarily reported in pediatric patients or hematopoietic stem cell transplant recipients, and the gastrointestinal (GI) tract is a less frequently reported site of extramedullary relapse. Here, we report a case of a 30-year-old male who was a known case of ALL with multiple relapses and allogenic stem cell transplantations. The patient presented with acute lower GI bleeding and was confirmed to have an extramedullary relapse of ALL in the ascending colon. As the patient already had early relapses after two hematopoietic stem cell transplants in the past, he was managed with palliative chemotherapy, consisting of vincristine, dexamethasone, and rituximab, following which the patient achieved complete remission. This case highlights the importance of recognizing uncommon presentations of ALL such as those involving the GI tract.

Transient Cell Cycle Induction in Cardiomyocytes to Treat Subacute Ischemic Heart Failure.

BACKGROUND: The regenerative capacity of the heart after myocardial infarction is limited. Our previous study showed that ectopic introduction of 4 cell cycle factors (4F; CDK1 [cyclin-dependent kinase 1], CDK4 [cyclin-dependent kinase 4], CCNB [cyclin B1], and CCND [cyclin D1]) promotes cardiomyocyte proliferation in 15% to 20% of infected cardiomyocytes in vitro and in vivo and improves cardiac function after myocardial infarction in mice. METHODS: Using temporal single-cell RNA sequencing, we aimed to identify the necessary reprogramming stages during the forced cardiomyocyte proliferation with 4F on a single cell basis. Using rat and pig models of ischemic heart failure, we aimed to start the first preclinical testing to introduce 4F gene therapy as a candidate for the treatment of ischemia-induced heart failure. RESULTS: Temporal bulk and single-cell RNA sequencing and further biochemical validations of mature human induced pluripotent stem cell-derived cardiomyocytes treated with either LacZ or 4F adenoviruses revealed full cell cycle reprogramming in 15% of the cardiomyocyte population at 48 hours after infection with 4F, which was associated mainly with sarcomere disassembly and metabolic reprogramming (n=3/time point/group). Transient overexpression of 4F, specifically in cardiomyocytes, was achieved using a polycistronic nonintegrating lentivirus (NIL) encoding 4F; each is driven by a TNNT2 (cardiac troponin T isoform 2) promoter (TNNT2-4Fpolycistronic-NIL). TNNT2-4Fpolycistronic-NIL or control virus was injected intramyocardially 1 week after myocardial infarction in rats (n=10/group) or pigs (n=6-7/group). Four weeks after injection, TNNT2-4Fpolycistronic-NIL-treated animals showed significant improvement in left ventricular ejection fraction and scar size compared with the control virus-treated animals. At 4 months after treatment, rats that received TNNT2-4Fpolycistronic-NIL still showed a sustained improvement in cardiac function and no obvious development of cardiac arrhythmias or systemic tumorigenesis (n=10/group). CONCLUSIONS: This study provides mechanistic insights into the process of forced cardiomyocyte proliferation and advances the clinical feasibility of this approach by minimizing the oncogenic potential of the cell cycle factors owing to the use of a novel transient and cardiomyocyte-specific viral construct.

Simultaneous Central Slip and Volar Plate Injuries at PIP Joint: A Novel Therapeutic Approach.

BACKGROUND: Central slip and volar plate injuries rarely occur in the same finger, with only two cases previously reported in published literature. In these two patients, both teenagers, two highly distinct protocols were used. Here, we report a third case involving a 51-year-old gentleman who closed a door on his left third finger. METHODS: Because the fractures were noncomminuted and only minimally displaced, he was treated nonsurgically using a multi-step process of splinting to prevent impairment of either proximal interphalangeal joint extension or flexion, combined with active range of motion exercises. This included five weeks of splinting in neutral, 24-hour daily use of a proximal interphalangeal dorsal block, followed by active range of motion exercises combined with nocturnal splinting using a PIP volar block over the next 7 weeks, with relative motion and Joint Jack splints added over the final 4 of these 7 weeks. RESULTS: Twelve weeks after initial splinting, the patient's finger was pain free, with swelling largely resolved, normal extension (-10 degrees) and near-normal flexion (95 degrees) achieved, and full function restored. The patient was very satisfied with the result. CONCLUSIONS: Ours is just the third case of concomitant central slip and volar plate injuries reported in the literature. Other surgeons are strongly encouraged to publish similar cases, approaches, and results, as clinical wisdom can sometimes be gleaned from even a small number of well-documented clinical cases.