Association between receiving Covid-19 vaccine and menstrual cycle patterns among childbearing women: A cross-sectional study.

Background and Aims: Many women reported experiencing abnormalities in their cycle after being vaccinated with Covid-19 vaccination. To understand this issue further, our study aimed to evaluate the menstrual cycle patterns among women of childbearing age after receiving COVID-19 vaccinations. Methods: A cross-sectional study was conducted to investigate the impact of COVID-19 vaccine on women aged 18 years and above in Saudi Arabia. A self-administered online questionnaire was distributed among participants who had received at least one dose of COVID-19 vaccine. The questionnaire included questions about the participants' demographic characteristics, medical history, and vaccine-related adverse events. Results: The study included 383 female participants with an average age of 30.8 ± 8.1 years. The majority of participants, 92.7%, were Saudi, and more than half, 51.4%, were single. Of the participants, 78.9% were disease-free, and a majority of 67.9% had no history of Coronavirus Disease 2019 infection. A significant proportion of participants reported postvaccination changes in the menstrual cycle. Specifically, 43.1% reported changes after the first dose, and 38.4% reported changes after the second dose (p = 0.044). The severity of premenstrual symptoms increased from 44 (11.5%) to 113 (29.5%) after the first dose. Reported pain on the (WONG-BAKER) scale was also significantly elevated from 34 (8.9%) to 87 (22.7%) (p < 0.001) after the first dose. Conclusion: A relatively high prevalence of menstrual cycle irregularities was reported by Saudi vaccinated women, particularly young adults. These findings suggest the need to further research and explore the underlying causes of these irregularities and develop interventions that may help mitigate their impact on women's health. It is also recommended that women who observe long-term changes in their menstrual cycles seek follow-up and consultation with healthcare providers to ensure that any potential health concerns are addressed promptly.

Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility.

BACKGROUND: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge. OBJECTIVES: To investigate the complications following major lower limb amputations (MLLAs). STUDY DESIGN: Retrospective study. METHODS: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included. RESULTS: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012). CONCLUSIONS: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.

Pseudoaneurysm and Renal Artery Stenosis Post-renal Transplant: A Rare Presentation.

We report the case of a 51-year-old gentleman who underwent living renal transplantation in Pakistan for end-stage renal disease one and a half years ago. He presented to our hospital with renal artery stenosis and an extra-renal pseudoaneurysm at the anastomotic site of the transplanted kidney. This can cause graft dysfunction and hypertension due to impairment of arterial perfusion in the transplanted kidney. Treatment with percutaneous transluminal angioplasty and covered stenting of the pseudoaneurysm and stenosis improved kidney function and hypertension.

Factors that influence a patient's decision to engage in genetic research.

Introduction: The most challenging step in clinical research studies is patient recruitment. Many research studies do not reach their targets because of participant rejection. The purpose of this study was to assess patient as well as the community knowledge, motivation, and barriers to participate in genetic research. Methods: A cross-section study was conducted between September 2018 and February 2020 using face-to-face interviews with candidate patients from outpatient clinics at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Additionally, an online survey was conducted to assess the community's knowledge, motivation and barriers to participate in genetic research studies. Results: In total, 470 patients were interviewed for this study, with 341 being successfully recruited for the face to face interview, and the other patients being refused owing to time constraints. The majority percentage of the respondents were females. The respondents' mean age was 30, and 52.6% reported having a college degree. The survey results from 388 participants illustrated that around 90% of the participants, participated voluntarily due to a good understanding of genetics studies. The majority held positive attitudes toward being part of genetic research, which exceeded the reported motivation score of >75%. The survey indicated that >90% of individuals were willing to participate to acquire therapeutic benefits or to receive continued aftercare. However, 54.6% of survey participants were worried about the side effects and the risks involved in genetic testing. A higher proportion (71.4%) of respondents reported that lack of knowledge about genetic research was one of the barriers to rejecting participation. Conclusion: Respondents reported relatively high motivation and knowledge for participation in genetic research. However, study participants reported "do not know enough about genetic research" and "lack of time during clinic visit" as a barrier for participation in genetic research.

Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers.

Objective: To assess the knowledge and practice of breastfeeding and the effects of lactation counseling, as a health promotion intervention, on breastfeeding duration and exclusive breastfeeding (EBF) among Saudi women. Methods: In this quasi-experimental design study, 664 mothers attending a women's hospital from January 2017 to December 2018 were interviewed. Women were allocated into two groups, control and intervention groups, based on received lactation counseling. Interviews were performed using a structured questionnaire collecting data on the sociodemographic characteristics, knowledge, attitude and practice of breastfeeding mothers. A chi-squared test was used to determine the level of significance on breastfeeding practices among two groups. Propensity score matching was presented to control confounders, as women cannot be randomly assigned to lactation counseling. Results: Of 664 women, 592 were Saudi nationals, and the majority of mothers were literate (96.2%). A significantly higher number of mothers in the consultation group were employed as compared with the non-consultation group (p = 0.015). One third (33.3%) of the women practiced EBF, while 39.8% preferred mixed feeding for the first six months of the infant's life. The consultation group demonstrated a significantly higher response rate in their knowledge on the benefits of breastfeeding in babies (increased intelligence; p < 0.05) and mothers (breast engorgement; p = 0.004), colostrum and its importance (p = 0.027) and effective breastfeeding practices (initiate breastfeeding within 30 min after birth (p = 0.01), baby needs 10-20 min between each feed (p = 0.009), breastfeeding should last for 6 months (p = 0.01)) compared with the non-consultation group. The age of weaning (5.3 ± 2.8 vs. 5.9 ± 3.2 months) was similar across both the groups. However, "the intended duration of BF" was higher in the non-consultation group, and the difference was statistically significant (p = 0.002). The mean weight and length of the baby at follow-up were similar in both groups, with no statistical significance. The duration of exclusive breastfeeding among two groups was not statistically significantly different (8.7 ± 6.9 vs. 8.1 ± 7.1 weeks). Mothers in the two groups were satisfied with their breastfeeding experience. The mean scores lie within the range of 4.2 to 5.0. Baby age (month), mother LoE, mother job and type of BF were controlled for, and the propensity-score-matched 62.5% sample from both the groups yielded the same results. Conclusions: Breastfeeding women in our study showed a fair knowledge of EBF. However, the duration of actual EBF was very short, and the counseling intervention showed no impact on EBF in our study population. We recommend interventions that are tailored to the needs of this population, while identifying factors that improve breastfeeding practice among mothers.

External Carotid Artery-Jugular Vein Fistula Caused by Blunt Trauma: A Case Report & Literature Review.

Acquired carotid-jugular fistula usually occurs due to neck stab wounds, gunshots, or central vein catheterization. Blunt trauma is a rare cause. These cases usually present with pulsatile swelling, tinnitus, and continued thrills in the neck. Both surgical and endovascular options have been used to manage these fistulas. Coil embolization is also applied in high-flow fistulas. We present a case of a 38-year-old woman free of any pre-existing medical conditions, presenting with a fistula between the external carotid artery and external jugular vein distally and with a high flow. She was treated with fistula embolization using coils while limiting the high flow via a balloon in the jugular vein. Our case highlights the possibility of using coils in high-flow fistulas in anatomically challenging fistulas. Furthermore, relevant literature review is presented to recapitulate unique features and effective management of carotid-jugular fistulas.

Knowledge, Attitude and Beliefs of Nurses Regarding Antibiotic use and Prevention of Antibiotic Resistance.

Introduction: Resistance to antibiotics is a threat confronting health care system worldwide. Nurses play a significant role in combating this threat. Objectives: The present study examined the knowledge and attitude of nurses towards antibiotic use and prevention of antibiotic resistance. Methods: The research involved a cross-sectional study conducted in a multi-cultural tertiary healthcare setting. The participants were 341 nurses. A structured self-administered questionnaire with a good validity and reliability (α = 0.7) was used. Results: The nurses surveyed showed moderate awareness of antibiotic resistance and a fair attitude towards its prevention. There was no significant correlation of demographic features with their overall knowledge and attitude (p > 0.05). Conclusions: Nurses perform a crucial part in infection control, but often lack knowledge of methods to prevent antibiotic resistance. This paucity highlights the importance of tailored interventions to help nurses improve their awareness of antibiotic resistance and create a favorable attitude towards its prevention.

Bullet embolism: a rare cause of acute ischaemia.

Embolization of a bullet or shrapnel from the heart (left ventricle) to the peripheral arterial circulation is practically unknown. We present a 38-year-old man with no comorbidities who was referred to our centre with a bullet injury to the left side of his chest. The patient complained of mild pain and numbness in his right lower limb. A trauma series was advised. A contrast angiogram of the peripheral lower limbs showed a bullet in the right popliteal artery with no flow in the tibial arteries. A bullet was removed from the distal popliteal artery at its bifurcation with a long thrombus proximal to it. Removal of the foreign body is the widely accepted management, especially when it leads to symptoms like ischaemia or signs of infection, as was the situation in our case.

Endotracheal tube cuff position in relation to the cricoid in children: A retrospective computed tomography-based analysis.

BACKGROUND: The use of cuffed endotracheal tubes (ETT) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients. METHODS: In this retrospective study, the ETT cuff position was examined on the sagittal plane images of neck and chest CT scans of 44 children. The position of the proximal and the distal aspect of the ETT cuff inside the trachea was recorded in relation to the vertebral levels. The vertebral levels were used to estimate the location of the cricoid ring and its relationship to the cuff. RESULTS: The vertebrae were used as the primary landmarks to define the position of the cricoid and its relationship to the cuff of the ETT. Correlating vertebral levels with the cricoid for different age groups, the proximal (cephalad) edge of the ETT cuff was below the cricoid in 41 of 44 patients (93%). The ETT cuff was deep in 6 patients, below the 1st thoracic vertebra, with 2 ETTs in the right mainstem bronchus. CONCLUSION: This is the first study demonstrating that the cuff of the ETT and its position in the trachea can be identified on CT imaging in children. The ETT cuff was below the level of the cricoid in the majority of patients irrespective of the patient's age as well as the size, make, and type of ETT.

Point-of-care ultrasound to confirm endotracheal tube cuff position in relationship to the cricoid in the pediatric population.

BACKGROUND: Anatomically, the subglottic area and the cricoid ring are the narrowest portions of the larynx. To limit the potential for damage related to mucosal pressure injuries from the presence of an endotracheal tube, the cuff should be placed below the cricoid in children. Previously, no clinical or imaging method has been used in real time to determine the exact location of the endotracheal tube cuff after endotracheal intubation. Point-of-care ultrasound may provide an option as a safe and rapid means of visualizing the endotracheal tube cuff and its relationship to the cricoid ring thereby achieving ideal endotracheal tube cuff positioning-below the cricoid. METHODS: In this prospective, nonrandomized trial, point-of-care ultrasound was used following endotracheal intubation in children to evaluate the position of the endotracheal tube cuff in relationship to the cricoid and tracheal rings. After anesthesia was induced and the trachea was intubated, the endotracheal tube cuff and its position in relation to the cricoid and tracheal rings were identified in the longitudinal plane using point-of-care ultrasound. With the patient's neck in a neutral position, the level of the proximal (cephalad) margin of the saline-filled cuff of the endotracheal tube was identified and recorded in relationship to the cricoid and tracheal rings. The ideal position is defined as the cephalad margin of the endotracheal tube cuff below the level of the cricoid. RESULTS: The study cohort included 80 patients, ranging in age from 1 to 78 months. In all patients, the cuff of the ETT, cricoid, and tracheal rings were identified. The cephalad end of the endotracheal tube cuff was found at the level of the cricoid in 16.3% of patients, at the first tracheal ring in 27.5% of patients, at the second tracheal ring in 23.8% of patients, at the third tracheal ring in 17.5% of patients, and at below the fourth tracheal ring in 15% of patients. Initial endotracheal tube cuff position had no significant association with age, height, weight, endotracheal tube size, and endotracheal tube type. CONCLUSION: Point-of-care ultrasound provides a rapid and effective means of identifying the position of the endotracheal tube cuff in relationship to the cricoid ring. The technique may have applications in the perioperative arena, emergency departments, and intensive care units.

Knowledge of non-healthcare individuals towards cardiopulmonary resuscitation: a cross-sectional study in Riyadh City, Saudi Arabia.

BACKGROUND: Most sudden cardiac arrests occur at home, with low rates of bystander cardiopulmonary resuscitation being performed. We aimed to assess knowledge of cardiopulmonary resuscitation among individuals in Riyadh City, Saudi Arabia, who are not involved in health care. METHODS: A community-based cross-sectional study was conducted between January and February 2020 in 4 different areas in Riyadh City: North, South, East, and West. The participants were surveyed using a validated self-administered questionnaire. The Statistical Package for Social Sciences version 25.0 was used for inferential statistics and binary logistic regression analysis. RESULTS: A total of 856 participants completed the questionnaire, 51.8% were unaware of cardiopulmonary resuscitation. Only 4.4% of the participants had attended a formal cardiopulmonary resuscitation training course, 5.1% were campaign attendees, and 38.7% acquired their experience through the media. Having a higher level of education was positively associated with having knowledge of cardiopulmonary resuscitation. The main concern among attendees of cardiopulmonary resuscitation training courses and campaigns was legal issues, whereas inadequate knowledge was the major barrier for those who had learned about cardiopulmonary resuscitation through the media. CONCLUSION: The level of knowledge of cardiopulmonary resuscitation among non-health care individuals in Riyadh City was found to be insufficient. Therefore, coordinated efforts among different authorities should be considered to implement a structured strategy aiming to increase awareness and knowledge of cardiopulmonary resuscitation among non-health care individuals.

Stress Reactions and Coping Strategy among Healthcare Professionals during COVID-19 Outbreak.

BACKGROUND: Psychological impacts among healthcare professionals have increased significantly due to the increasing number of COVID-19 cases. This study aimed to identify stress and coping strategies among healthcare professionals in Saudi Arabia during the COVID-19 outbreak. SUBJECTS AND METHODS: A cross-sectional study online survey was conducted for health care professionals during a peak of COVID-19 from March to June 2020 at different healthcare institutions at KSA (n=342). RESULTS: Sixty-five percent of responders often and always feel fears about infection and subsequent effects on themselves, the patient, and the family. 57% of them stated that they felt sometimes depressed mode and 47% anxiety during the outbreak. Eighty-four percent of the respondent always focusing on prevention as the first biosecurity measures such as hand-washing habits and using hand sanitizer, and 38.3% of them make sometimes relax and rest. While half of the responses (50%) sometimes had physical exercise. Also, thirty-eight percent joined sometimes community and/or group online chat groups, and 56.1% always keep contact with family and friends through social messaging or phone calls. CONCLUSION: Understanding this topic is important for healthcare organizations, effective strategies, and programs is needed to provide holistic staff care and wellbeing during outbreaks that focus on the value of mental and emotional support.

Mainstem Bronchial Diameters and Dimensions in Infants and Children: A Systematic Review of the Literature.

Anatomic measurements of the right (RMB) and left mainstem bronchi (LMB) in infants and children have been accomplished using various modalities. The objective of the present review was to determine whether enough data were available to provide standardized lower airway dimensions in the pediatric population. For the present study, 12 studies with data of the lower pediatric airway dimensions of 1,611 children published from 1923-2020 were reviewed and analyzed. The eligible criteria included studies measuring lower airway dimensions in the pediatric population. Various techniques were used for airway measurement, with computed tomography studies being most abundant. There was a progressive increase in the size of RMB and LMB with age, with a close approximation of the LMB-to-RMB ratio across all studies. In children younger than 1 year old, the RMB and LMB diameters were between 4 and 5 mm and 3 and 5 mm, respectively. Overall, there was significant variation in the methods and modality used to obtain measurements, and therefore it was difficult to establish standardized lower airway dimensions in the pediatric population. Additional homogeneous data with standardized measurement techniques and modalities across different pediatric age groups are needed to define these dimensions further. Such data may be helpful in designing airway equipment, lung isolation devices, and airway stents.

Relationship of Oncotype Dx score with tumor grade, size, nodal status, proliferative marker Ki67 and Nottingham Prognostic Index in early breast cancer tumors in Saudi Population.

BACKGROUND: Oncotype Dx is a 21-gene recurrence score, which is used as a diagnostic tool for the recurrence of breast cancer. It is also used to determine the benefit of chemotherapy for breast cancer in early stages. This study investigates the relationship of Oncotype Dx with pathological prognostic markers of protein Ki 67, Nottingham Prognostic Index (NPI) and tumor grade. METHODS: Data for early breast cancer patients treated at our tertiary care center was collected for statistical analysis. Data for patients from 2014 to 2018 was recorded for patient's age, ER/PR status, Ki 67, nodal status, tumor grade, NPI along with Oncotype Dx score. Metric measurements were described as mean ± SD and the non-metric data was represented by frequency (%). Chi-square or Fisher's exact tests as well as logistic regression was applied to assess the associations at 95% CI. RESULTS: Among 156 breast cancer patients, the mean age was 55.7 ± 9.4 years. The tumors were classified into Grade-I (12.8%), Grade-II (67.3%) and Grade-III (19.9%). Ki67 score was 12.8 ± 12.0 and NPI score was 3.7 ± 0.8. The mean Oncotype Dx score was 17.0 ± 9.1; it was 14.1 ± 6.8 for Grade-I tumors; 15.7 ± 7.5 for grade -II tumors; and 23.2 ± 12.3 for grade-III tumors [Mean Oncotype Dx score across Tumor grades was compared by ANOVA (η = 0.121), p < 0.001]. While logistic regression analyses for the dichotomized Oncotype Dx higher score (≥25) was significantly associated with grade-III tumors odds ratio (OR) = 13.72 (95% CI: 1.62-115.89), higher Ki67 (>20) OR = 14.40, (95% CI: 1.44-143.71), average NPI score (2.41-3.40), OR = 13.60, (95% CI: 1.57-117.94) to poor NPI (>5.4). The association of Oncotype Dx with age, tumor size and nodal status was statistically not significant. CONCLUSIONS: This study revealed that age, Ki67, tumor size and nodal status did not have a statistically significant impact on Oncotypye Dx recurrence score in the targeted patient population. There was a significant correlation of low grade node negative patients with Oncotype Dx while high grade node negative patients had poor correlations with Oncotype Dx. The use of Oncotype Dx has shown to be less cost-effective and has no noticeable association with improved life expectancy in the targeted patient population (i.e., hormone positive, node negative cases) in comparison with current clinical practices in Saudi Arabia and it is less likely to be cost-effective in this group of patients.

Echocardiographic parameters associated with recovery in heart failure with reduced ejection fraction.

OBJECTIVE: The study aims to determine the clinical and echocardiographic parameters of patients with recovered heart failure (HFrecEF). METHODOLOGY: Sixty-seven patients (cases) were identified as heart failure with recovered ejection fraction (HFrecEF), defined as improvement in EF ≥ 10%. Sixty-nine patients (controls) were randomly selected by convenience sampling with no or <10% improvement in EF (HFrEF non-recovered). RESULTS: The mean interval between baseline and follow-up echocardiography was 10.5 months in cases and 11.2 months in the control group. HFrecEF showed a 22.7% improvement in mean ejection fraction, and HFrEF non-recovered group also showed a minor increment of 5.5%. HFrecEF patients were significantly younger (49.51 vs 57.54 years, P .001) with non-ischemic cardiomyopathy (86.6% vs 52.2%). Patients with HFrecEF had significantly less left ventricular end-diastolic and end-systolic volumes (LVEDV: 162.51 mL vs 208.54 mL, P < .001; LVESV: 119.81 mL vs 157.13 mL, P < .001) and index left atrial volume (37.66 mL vs 47.09 mL, P < .001) than patients with non-recovered EF. The right ventricle (RV) and inferior vena cava were significantly dilated with higher mean tricuspid annular plane systolic excursion (TAPSE) among patients with HFrecEF than HFrEF non-recovered. CONCLUSION: Based on univariate analysis, younger age, non-ischemic etiology, LVEDV, LVESV, deceleration time, better TAPSE, dilated right ventricle, dilated IVC, and smaller left atrial volumes were found significant, but on multivariate logistic regression model only left ventricle end-diastolic volume, left atrial volume, and TAPSE were linked to the recovery of ejection fraction.

Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia.

OBJECTIVE: To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI). METHODS: This retrospective study identified 140 patients aged >/=16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge. RESULTS: Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47+/-38, 264+/-357, and 75+/-52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p<0.001, r=0.390). Employed patients had high FIM scores at admission (p=0.029, r=0.184) and discharge (p=0.003, r=0.252). CONCLUSION: Reduction in disability at discharge was positively associated with the severity of disability at admission and negatively with the time duration from injury to IPR admission, indicating a need to reduce time before admittance to an IPR setup. The high incidence of MVA causing TBI in a young male population strongly points to a need for appropriate measures of prevention.

Comparison of the skin-to-epidural space distance at the thoracic and lumbar levels in children using magnetic resonance imaging.

BACKGROUND: Several studies have attempted to estimate the approximate distance from the skin-to-epidural space using different imaging modalities (computed tomography [CT], ultrasound, and magnetic resonance imaging [MRI]) and direct needle measurements. The objective of our study was to compare the distance from the skin to the epidural space (SED) at multiple levels, focusing on T6-7, T9-10, and L2-3 using MRI. METHODS: After institutional review board (IRB) approval, sagittal T2-weighted MRI images of the spine of 108 children in the age group ranging from 3 months to 8 years undergoing radiological evaluation in the supine position at our institution were analyzed. The SED at T6-7 and T9-10 levels (straight and inclined) and SED at L2-3 (straight) were determined and compared using repeated-measures ANOVA and paired t-tests with a Bonferroni correction for 10 pairwise comparisons (P < 0.005 was considered statistically significant). RESULTS: The average SED (measured straight and inclined) was 18.2 mm and 21.6 mm at T6-7; 18.3 mm and 20.5 mm at T9-10; and 21.8 mm (straight) at L2-3. The repeated-measures ANOVA F-test indicated significant variability in SED (P < 0.001) among the 5 measurements obtained. At the P < 0.005 significance level, corrected for multiple comparisons, the SED (straight) at T9-10 straight was shorter than the other measured distances. CONCLUSION: The distance from the skin to the epidural space is not constant at various vertebral levels. At the levels measured, it was greatest at the lumbar level and at least at the thoracic level of T9-10. A single predictive formula was not applicable for calculating the approximate SED at all vertebral levels.

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia.

Introduction: Regular testing of the international normalized ratio (INR) is essential for people taking vitamin K antagonists as part of anticoagulation therapy. This study was undertaken to ascertain the efficacy of point-of-care testing (POCT)-INR versus conventional core laboratory testing in terms of result adequacy, waiting-time reduction, and patient satisfaction enhancement at the thrombosis clinic of the outpatient Medical Specialties Department in King Fahad Medical City, Saudi Arabia. Methods: The study was conducted prospectively for 6 months (from June 2017 to December 2017) on 182 eligible participants out of 250 entitled patients who were attending the thrombosis clinic for warfarin dose adjustment and who fulfilled all the prerequisites for performing dual testing by fingerstick at the clinic and venipuncture by the core laboratory. The data-capturing template created on Microsoft Excel recorded turnaround times (TATs), clinical concordance of INR result variables by POCT, and laboratory methods. Individual patient experience was recorded to gauge satisfaction rate, and all the data were analyzed statistically. Results: Of 182 patients included in the study, overall good concord was observed between POCT whole blood and laboratory plasma INR results with median bias of 0.07 and 92.3% agreement using acceptability criteria for clinical concordance of Clinical Laboratory Standards Institute (CLSI) 14-A and International Standards Organization (ISO) 17593-2007, respectively. Marked improvement in terms of patient's time spent at the clinic was noted, with substantial reduction from 180 to ∼30 minutes (p < 0.001). Survey questionnaire responses indicated that POCT of INR was highly convenient and enhanced patient experience in terms of shorter wait time, minimal invasive procedures, and immediate result availability (p < 0.001). Predominantly, participants (75.4%) endorsed and expressed a strong preference for the POCT procedure over conventional laboratory testing. Conclusions: Whole blood INR testing for warfarin dose adjustment with validated POCT devices is adequately comparable to the core laboratory results. It also simplifies workflow steps at the thrombosis clinic, enhancing patient experience and convenience via the immediate availability of results, a less invasive procedure, and a marked reduction in waiting time. However, caution is needed with regard to higher INR results (≥4.7), which call for core laboratory confirmation.

Characteristics of neonatal Sepsis at a tertiary care hospital in Saudi Arabia.

AIM: To identify the risk factors, laboratory profile, microbial profile, mortality and complications, mortality causing organisms and antimicrobial susceptibility patterns of neonatal sepsis at a tertiary care hospital. METHODS: A retrospective study was conducted using the neonatal intensive care unit (NICU) database in King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. All neonates born in KFMC with clinically diagnosed sepsis in the NICU were included in this study. RESULTS: During the study period, a total of 245 neonates with a culture-proven diagnosis of neonatal sepsis were included in this study and 298 episodes of sepsis were observed. Out of the 298 episodes, EOS occurred 33 (11.1%) times, and LOS occurred 265 (88.9%) times. For both neonates with EOS and LOS prematurity was the major neonatal risk factors for sepsis 16 (48.5%), 214 (80.8%); respectively. Multiparty and delivery by caesarean section were the top maternal risk factors of both EOS and LOS. Nneonates with LOS had high CRP, Total WBC count and thrombocytopenia compared to EOS neonates. Our results showed that in the EOS neonates, GBS was the most common pathogen followed by Escherichia Coli. In LOS neonates, the common organisms were Staphylococcus spp., Klebsiella and Pseudomonas aeruginosa. Mortality rate of neonatal sepsis is higher in EOS 5 (15.2%) from total EOS compared to LOS 24 (11.3%) from total LOS. All Gram-negative bacteria were sensitive to Amikacin. Gram-negative non-fermenting bacteria, such as P. aeruginosa and Acinetobacter were sensitive to amikacin and gentamycin. All Gram-positive bacteria were sensitive to gentamycin. Among thirteen Candida albicans isolates, 85% were sensitive to fluconazole. CONCLUSION: Concerted efforts are needed to determine the spectrum of risk factors and the clinical characteristics of EOS and LOS in order to implement appropriate treatment strategies as sepsis remains to be a serious danger to neonatal wellbeing. Moreover, our study emphasizes that use of aminoglycosides is much agreeable as compared to the broad spectrum antibiotics which are more rampantly used nowadays.