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IFN-γ has been used in the treatment of IL-12Rß1 deficiency patients with disseminated BCG infection (BCGosis), but the optimal dose to reach efficacy is not clear. We used IFN-γ in the treatment of a 2.7-year-old patient with IL-12Rß1 deficiency and refractory BCG-osis. IFNγ was started at a dose of 50 µg/m² 3 times per week. The dose was upgraded to 100 mcg/m² after 3 months, then to 200 mcg/m² 6 months afterwards. Serum mycobactericidal activity and lymphocytes number and function were evaluated throughout the study. There was no clinical response to IFN-γ with 50 or 100 µg/m² doses. However, there was some response to the 200 µg/m² dose with no additional adverse effects. The serum mycobactericidal activity was not significantly different during the whole treatment period. Lymphocytes proliferation in response to PHA was significantly higher after 3 months of using the highest dose as compared to the lowest dose. The tuberculin skin test reaction remained persistently negative. We conclude that in a patient with IL-12Rß1 deficiency, IFN-γ at a dose of 200 µg/m², but not at lower dosages, was found to have a noticeable clinical effect with no additional adverse effects.
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Vacina BCG/efeitos adversos , Interferon gama/uso terapêutico , Infecções por Mycobacterium/tratamento farmacológico , Mycobacterium bovis/efeitos dos fármacos , Receptores de Interleucina-12/deficiência , Pré-Escolar , Feminino , Humanos , Interferon gama/administração & dosagem , Interferon gama/efeitos adversos , Ativação Linfocitária , Infecções por Mycobacterium/imunologia , Infecções por Mycobacterium/microbiologia , Mycobacterium bovis/imunologia , Receptores de Interleucina-12/genética , Resultado do TratamentoRESUMO
BACKGROUND: Lumbar puncture (LP) remains an essential diagnostic procedure for neurological and infectious diseases. However, it remains a source of anxiety to patients and families. This research aimed to assess the impact of a newly developed educational simplified video about LP, in the parents' native language, that is tailored to their social background and beliefs and to assess whether it can facilitate their consent for the procedure. METHODS: This prospective, interventional study was conducted at the outpatient pediatric clinics at a teaching hospital. The conventional arm used verbal explanation about LP. The second method utilized a standardized video, having the same information as the conventional arm, with streaming of graphic depictions. Parents' knowledge and perceived LP risks were measured before and after the intervention. RESULTS: Two hundred and one parents were enrolled, with no significant differences in the socio-demographic and baseline characteristics. Both verbal and video-based counseling were found to provide a statistically significant increase in knowledge scores, and a Wilcoxon signed-rank test showed that knowledge gains for both groups were statistically significant (Verbal Explanation: W = 2693, n = 83, P < .001 and Video: W = 5538, n = 117, P < .001). However, the conventional verbal counseling resulted in more consistent gain of knowledge (SD = 14.5) as compared to the video group (SD = 18.94). The video group reported higher perceived risk (Mean 8.2, SD 3.59) than the verbal explanation group (Mean 7.12, SD 2.51). The less educated parents perceived LP procedure to be of significantly higher risk after watching the video (P < .001). It was found that 73.6% of persons with perceived intention to refuse LP changed their opinion after either of the counseling interventions, with significant opinion difference pre- and post-counseling intervention (P value .002). CONCLUSIONS: Video education in parents' native language about LP is as effective as conventional verbal education for informed consent, with the additional advantage of reproducibility and more illustrations to give parents better insight. However, this video should be followed by direct interaction with parents to ensure their full understanding and address any further concerns.
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ABSTRACT: Coronavirus disease 2019 (COVID-19) has caused an unprecedented health crisis around the world, not least because of its heterogeneous clinical presentation and course. The new information on the pandemic emerging daily has made it challenging for healthcare workers (HCWs) to stay current with the latest knowledge, which could influence their attitudes and practices during patient care.This study is a follow-up evaluation of changes in HCWs' knowledge, attitudes, and practices as well as anxiety levels regarding COVID-19 since the beginning of the pandemic. Data were collected through an anonymous, predesigned, self-administered questionnaire that was sent online to HCWs in Saudi Arabia.The questionnaire was sent to 1500 HCWs, with a 63.8% response rate (Nâ=â957). The majority of respondents were female (83%), and the most common age group was 31 to 40âyears (52.2%). Nurses constituted 86.3% of the respondents. HCWs reported higher anxiety during the COVID-19 pandemic which increased from 4.91â±â2.84 to 8.6â±â2.27 on an 11-point Likert scale compared to other viral outbreaks. HCWs believed that their own preparedness as well as that of their hospital's intensive care unit or emergency room was higher during the COVID-19 pandemic than during the Middle East respiratory syndrome coronavirus pandemic (2012-2015). About 58% of HCWs attended one or more simulations concerning the management of COVID-19 patients in their intensive care unit/emergency room, and nearly all had undergone N95 mask fit testing. The mean score of HCWs' knowledge of COVID-19 was 9.89/12. For most respondents (94.6%), the perception of being at increased risk of infection was the main cause of anxiety related to COVID-19; the mean score of anxiety over COVID-19 increased from 4.91â±â2.84 before to 8.6â±â2.27 during the pandemic in Saudi Arabia.HCWs' anxiety levels regarding COVID-19 have increased since a pandemic was declared. It is vital that healthcare facilities provide more emotional and psychological support for all HCWs.
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Transtornos de Ansiedade/epidemiologia , COVID-19/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Estresse Ocupacional/epidemiologia , Adulto , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Arábia Saudita/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND OBJECTIVES: Middle East Respiratory Syndrome Corona Virus (MERS-CoV) outbreak in 2014 was associated with high public anxiety in the affected countries. Media speculations may have increased this psychological distress. The healthcare community was the most distressed because they were at the highest risk of infection. This study is the first to explore MERS-CoV epidemic impact on medical students' perception and determinants of their psychological distress during this outbreak. METHODS: We randomly selected and surveyed 200 students from the College of Medicine at King Saud University, Riyadh, Saudi Arabia. A predesigned questionnaire was answered by participants, and the collected data were statistically analyzed. RESULTS: One hundred and seventy-four (87%) responded. Female students had a significantly higher mean stress level than males (P < 0.001). Participants had a mean GAD score of 2.7 ± 3.1 and a median of 2. Perceived sufficiency of information score was the highest mean and median (17.4 ± 4.2 and 18 respectively). College and hospital announcements were the most common source of information (25.4%). One hundred and thirty-four (77%) reported minimal anxiety, thirty-two (18.4%) reported mild anxiety, 8 (4.6%) reported moderate anxiety, and none of them reported severe anxiety (score >14). The stress level (as reported on 1-10 scale) shows significant correlation with Generalized Anxiety Disorder (GAD-7) score. We found in this study that significant predictors in our model, in terms of more significant to the least, were: an increased self-report on hygienic habits, self-reported social avoidance, the generalized anxiety score and finally being female gander while other variables including numbers of resources access, agreeing with public fear and knowledge score on MERS-CoV all were found to be non-significant. However, the number of accessed resources, as per students, has borderline significant correlation with higher self-reported anxiety from MERS-CoV. CONCLUSIONS: Medical students' psychological needs during the MERS-CoV outbreak should be addressed appropriately. Our results highlight the need to establish psychological support programs for medical students during an infectious disease outbreak.
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Infecções por Coronavirus/psicologia , Coronavírus da Síndrome Respiratória do Oriente Médio , Estresse Psicológico/epidemiologia , Estudantes de Medicina/psicologia , Ansiedade/epidemiologia , Epidemias , Medo/psicologia , Feminino , Hospitais de Ensino , Hospitais Universitários , Humanos , Masculino , Fatores de Risco , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Acute septic arthritis is a health-care problem in growing children. The aim of the present study was to determine the demographic features, clinical presentation, diagnostic evaluation, treatment and outcome of children suffering from acute septic arthritis. METHODS: Retrospective review of consecutive admissions of children < or =14 years of age with a bacteriologically and/or radiologically confirmed diagnosis of septic arthritis during the 10 year period, January 1997-December 2006 at King Fahad Hospital, King Abdulaziz Medical City was undertaken. RESULTS: Sixty-five patients (male : female, 2.4:1), 10 days-14 years of age (mean +/- SD: 3.3 +/- 3.2 years), met the inclusion criteria. More than half of the patients were under 2 years. The most frequent clinical features were pain (92%), fever (77%), limitation of joint movement (77%) and joint swelling (72%). Joint involvement was monoarticular in 97% of knees, and hips were affected in 75% of patients. Bacteria were isolated from joint aspirate or blood in 28 patients (43%), and Staphylococcus aureus was the most common organism, comprising 39% of the total bacterial isolates. Radiological diagnostic findings were observed in 19 (32%) of 60 patients with plain radiographs, nine (69%) of 16 patients with sonograms of the hip, 36 (80%) of 45 patients with Tc-labeled bone scan and nine (100%) of nine patients with magnetic resonance imaging. The joint infection resolved with no sequelae in 46 patients who were followed up for 6-36 months, but two had bone deformity and 17 were lost to follow up. CONCLUSION: According to the present series, septic arthritis is most common in young infants, mainly monoarticular, and is frequently localized in the knee and hip joints. Early diagnosis and appropriate treatment are associated with excellent outcome.
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Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Doença Aguda , Adolescente , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologiaRESUMO
This study was conducted to assess the impact of Hib vaccination on the Haemophilus influenzae type b incidence and occurrence of Streptococcus pneumoniae in the University Hospital of Riyadh, Saudi Arabia. The study also meant to consider the need for the introduction of routine conjugated pneumococcal vaccine for children. It was a retrospective study during the period of January 1996 to July 2007 reviewing all positive blood and CSF in children up to 18 years of age who were admitted to the hospital with a diagnosis of invasive disease with Haemophilus influenzae type b and Streptococcus pneumoniae. Eighty cases with invasive disease due to Haemophilus influenzae were admitted between 1996 and 2000. Hib conjugated vaccine has become routine in Saudi Arabia since the year 2000 and since then a significant steady drop of Haemophilus influenzae type b cases was observed with only 36 cases occurring between June 2001 and July 2007. On the other hand, no change was observed in the incidence of Streptococcus pneumoniae invasive disease. This study suggests that the prevention of invasive pneumococcal disease by immunization may be an attractive proposition. These results should initiate health authorities to encourage similar local and nation wide studies to support this suggestion.
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OBJECTIVES: To assess the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), against smear microscopy and culture method for diagnosis of MTB infection. Methods: This is a retrospective analysis of 103 respiratory and 137 non-respiratory patient specimens suspected of tuberculosis at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia performed between April 2014 and March 2015. Each sample underwent smear microscopy, mycobacterial culture, and GeneXpert MTB/RIF test. Results: Fifteen out of 103 respiratory samples were smear and culture positive, whereas 9 out of 137 non-respiratory samples were smear positive. Out of 9 smear positive specimens, 8 were also culture positive. All 15 culture positive respiratory samples were detected by Xpert MTB/RIF (sensitivity and positive predictive value [PPV]=100%). Similarly, all 8 culture positive non-respiratory specimens were identified by Xpert MTB/RIF (sensitivity 100%; PPV 88.8%). The Xpert MTB/RIF detected only one false positive result in 88 smear negative respiratory specimens (specificity 98.9%; negative predictive value [NPV]= 100%). All 125 smear negative non-respiratory specimens tested negative by culture and Xpert MTB/RIF (sensitivity, specificity, PPV, NPV= 100%). Conclusion: The performance of Xpert MTB/RIF was comparable to the gold standard culture method for identification of MTB in both respiratory and non-respiratory clinical specimens.
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Proteínas de Bactérias/genética , RNA Polimerases Dirigidas por DNA/genética , Mycobacterium tuberculosis/isolamento & purificação , Hospitais de Ensino , Humanos , Mycobacterium tuberculosis/genética , Estudos Retrospectivos , Arábia SauditaRESUMO
BACKGROUND: Serogroup distribution of sterile site pneumococcal isolates varies between developing and developed countries as well as between different geographical regions. The potential efficacy of any pneumococcal vaccine depends on the degree of representation of the prevalent serogroups in the vaccine. We conducted this study to determine the prevalent pneumococcal serogroups causing invasive infections in Riyadh, Saudi Arabia and to estimate the coverage by the various pneumococcal conjugate vaccines. METHODS: S. pneumoniae isolated between February 2000 and November 2001 from sterile sites of patients of all age groups were collected from 8 major hospitals in Riyadh and serogrouped using the latex agglutination method. RESULTS: Isolates from 78 patients, 72% of whom were children, were studied. Eighty-eight percent of the isolates belonged to only 10 serogroups/serotypes, namely 6 and 19, 1 and 15, 14 and 23, 7, 18 and 22, in descending order of frequency. Potential coverage of the 7-valent, 9-valent, and 11-valent conjugate vaccines were 54%, 65% and 73%, respectively. The rate of reduced penicillin susceptibility in the serogroups represented in the 7-valent conjugate vaccine was significantly higher than in the non-vaccine serogroups (62% vs. 25%; P=0.0023). CONCLUSION: The currently available 7-valent pneumococcal conjugate vaccine provides sub-optimal coverage to serogroups causing invasive diseases in our community. However, this vaccine would be a useful adjunct to penicillin prophylaxis in at-risk patients in the community. The effectiveness of the vaccine would be greater if serotype 15 could be included.
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Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/classificação , Vacinas Conjugadas/uso terapêutico , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Testes de Sensibilidade Microbiana , Arábia Saudita , SorotipagemRESUMO
Basidiobolomycosisis an unusual fungal infection that manifests in the skin and rarely involves other systems including the gastrointestinal tract. We retrospectively reviewed records of six pediatric patients (< or =14 years of age) diagnosed with gastrointestinal basidiobolomycosis from March 2000 to March 2002. Four patients came from the same region, suggesting environmental exposure. Basidiobolomycosis should be considered in the differential diagnosis in pediatric patients presenting with abdominal mass and eosinophilia.
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Entomophthorales , Gastroenteropatias/diagnóstico , Zigomicose/diagnóstico , Criança , Pré-Escolar , Gastroenteropatias/epidemiologia , Gastroenteropatias/microbiologia , Gastroenteropatias/terapia , Humanos , Masculino , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Zigomicose/epidemiologia , Zigomicose/terapiaRESUMO
OBJECTIVE: To determine the minimum inhibitory concentrations (MICs) of penicillin, ceftriaxone and vancomycin of serogroups/serotypes of Streptococcus pneumoniae (S. pneumoniae) from invasive diseases in all age groups from major hospitals in Riyadh, Kingdom of Saudi Arabia (KSA). METHODS: All isolates of S. pneumoniae from patients with invasive pneumococcal infections between February 2000 and November 2001 were prospectively collected from 8 major hospitals in Riyadh, KSA. The isolates were confirmed as S. pneumoniae at the King Khalid University Hospitals, Riyadh, KSA and then serogrouped/serotyped using the agglutination method. The MICs for penicillin, ceftriaxone and vancomycin were carried out using the E-test. RESULTS: Forty-three percent of the isolates were resistant to penicillin mostly of the intermediate type (97%). The resistant strains were mainly confined to serogroups/serotypes 6, 23, 19 and 15 and the 7-valent conjugate vaccine covers 76% of the penicillin-resistant strains. Only one isolate was resistant to ceftriaxone. CONCLUSION: In view of the rather insignificant level of highly resistant-penicillin strains and the virtual absence of resistance to ceftriaxone we would like to suggest using ceftriaxone for treating invasive pneumococcal infections outside the central nervous system. We recommend that the conjugate vaccine would be a useful adjunct to penicillin prophylaxis in patients at risk in our community.
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Resistência às Penicilinas , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Arábia Saudita/epidemiologia , Sorotipagem , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidadeRESUMO
In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.
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BACKGROUND: Bacteremia is a major pediatric health care problem despite the availability of new modalities in the management of this disease. The aim of the present study was to determine the incidence and pattern of bacteremia in pediatric group at a tertiary hospital in Riyadh, SaudiArabia. METHODS: This retrospective study was conducted at the Department of Pediatrics, College of Medicine, King Khalid University Hospital, Riyadh in the period of January 2003 to January 2005. Positive culture was found in 259 patients aged below 15 years with a total of 8244 admissions in the period. RESULTS: The highest incidence of bacteremia was found in patients aged less than 1 year (57.9%), and the majority of patients (30.5%) were infants aged less than 1 month. Staphylococcus aureus was the most common isolated pathogen (18.7%). Prematurity was associated with 13.2% of the cases, and respiratory tract infection (10.1%) and fever (76.1%) were chief complaints. CONCLUSIONS: Staphylococcus aureus is the most common isolated pathogen. The most common primary infections are respiratory tract infection and septic meningitis. Klebsiellapneumoniae and E. coli are the most common isolated Gram-negative organisms.
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Bacteriemia/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Adolescente , Fatores Etários , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Causalidade , Criança , Pré-Escolar , Comorbidade , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/microbiologia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Masculino , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologiaRESUMO
Umbilical venous catheterization in neonates is an intravascular infusion route for resuscitation and maintenance fluids, blood and blood products, parenteral nutrition, and hypertonic solutions that can be used as an alternative when peripheral venous access is not possible. When used, special precautions should be taken and guidelines followed to prevent rare but often fatal complications.