Characteristics and Outcomes of Middle East Respiratory Syndrome Coronavirus Patients Admitted to an Intensive Care Unit in Jeddah, Saudi Arabia.

BACKGROUND: An increasing number of patients are being infected with Middle East respiratory syndrome coronavirus (MERS-CoV) since the first case was identified in September 2012. We report the characteristics and outcomes of MERS-CoV-confirmed patients who developed critical illness requiring admission to an intensive care unit (ICU). METHODS: We conducted a prospective cohort study of all MERS-CoV-confirmed cases who were admitted to our ICU from March 20, 2014, till June 1, 2014. Presenting symptoms, comorbid conditions, and details of their ICU stay were recorded. RESULTS: Eight patients were admitted to the ICU with MERS-CoV infection. All had signs of respiratory distress with 7 requiring mechanical ventilation. Three patients were health care workers. In all, 6 patients had comorbid conditions and 5 patients developed multiorgan system failure (MOSF). In all, 5 patients expired, 2 were discharged alive, and 1 remained intubated at the end of the study period. CONCLUSIONS: Middle East respiratory syndrome coronavirus carries a high mortality rate in patients who require ICU admission, with a significant number of patients developing MOSF. Further investigation is needed to determine optimal management guidelines for these patients.

Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection.

BACKGROUND: Since September 2012, 170 confirmed infections with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization, including 72 deaths. Data on critically ill patients with MERS-CoV infection are limited. OBJECTIVE: To describe the critical illness associated with MERS-CoV. DESIGN: Case series. SETTING: 3 intensive care units (ICUs) at 2 tertiary care hospitals in Saudi Arabia. PATIENTS: 12 patients with confirmed or probable MERS-CoV infection. MEASUREMENTS: Presenting symptoms, comorbid conditions, pulmonary and extrapulmonary manifestations, measures of severity of illness and organ failure, ICU course, and outcome are described, as are the results of surveillance of health care workers (HCWs) and patients with potential exposure. RESULTS: Between December 2012 and August 2013, 114 patients were tested for suspected MERS-CoV; of these, 11 ICU patients (10%) met the definition of confirmed or probable cases. Three of these patients were part of a health care-associated cluster that also included 3 HCWs. One HCW became critically ill and was the 12th patient in this case series. Median Acute Physiology and Chronic Health Evaluation II score was 28 (range, 16 to 36). All 12 patients had underlying comorbid conditions and presented with acute severe hypoxemic respiratory failure. Most patients (92%) had extrapulmonary manifestations, including shock, acute kidney injury, and thrombocytopenia. Five (42%) were alive at day 90. Of the 520 exposed HCWs, only 4 (1%) were positive. LIMITATION: The sample size was small. CONCLUSION: MERS-CoV causes severe acute hypoxemic respiratory failure and considerable extrapulmonary organ dysfunction and is associated with high mortality. Community-acquired and health care-associated MERS-CoV infection occurs in patients with chronic comorbid conditions. The health care-associated cluster suggests that human-to-human transmission does occur with unprotected exposure. PRIMARY FUNDING SOURCE: None.

Clinical Characteristics and Risk Factors of Mechanical Ventilation Among COVID-19 Patients on High-Flow Nasal Oxygen (HFNO).

INTRODUCTION: COVID-19 is a viral infection affecting the respiratory system, primarily. It has spread globally ever since it first appeared in China in 2019. The use of high-flow nasal oxygen (HFNO) for the treatment of COVID-19 has not been well established. OBJECTIVES: The primary objectives of this study are to observe the success of HFNO in preventing escalation to mechanical ventilation (MV) and to measure the prevalence of HFNO in King Abdulaziz Medical City (KAMC). The secondary objective is to describe patients who received HFNO clinically. METHODS: This is a retrospective cohort study of all polymerase chain reaction (PCR)-confirmed COVID-19 patients who require oxygen therapy in KAMC, Jeddah between March 1st, 2020, and December 31st, 2020. Any patients requiring MV on admission were excluded. RESULTS: 259 patients fit the inclusion criteria, and 25.5% of those included received HFNO. The number of non-survivors is 47 (18.1%). Mortality for HFNO, MV, and intensive care unit (ICU) are 30 (45.5%), 31 (60.8%), and 24 (32%), respectively. Their demographic was as follows; 160 were males, with a mean age of 60.93±15.01. Regarding the types of oxygen, low-flow nasal oxygen (LFNO) was administered to 243 out of the 259 patients, 66 received HFNO, 42 received MV, and 49 received other modes of ventilation. Additionally, 43.9% received HFNO escalated to MV. Patients who did not receive HFNO or MV were 178 (68.7%) in total. CONCLUSION: The use of HFNO in COVID-19 patients could show better outcomes than MV in addition to preventing the use of MV. Larger studies are required to determine the efficacy of HFNO in COVID-19 patients.

Point prevalence of delirium among critically ill patients in Saudi Arabia: A multicenter observational study.

Background: Delirium in critically ill patients is independently associated with poor clinical outcomes. There is a scarcity of published data on the prevalence of delirium among critically ill patients in Saudi Arabia. Therefore, we sought to determine, in a multicenter fashion, the prevalence of delirium in critically ill patients in Saudi Arabia and explore associated risk factors. Methods: A cross-sectional point prevalence study was conducted on January 28, 2020, at 14 intensive care units (ICUs) across 3 universities and 11 other tertiary care hospitals in Saudi Arabia. Delirium was screened once using the Intensive Care Delirium Screening Checklist. We excluded patients who were unable to participate in a valid delirium assessment, patients admitted with traumatic brain injury, and patients with documented dementia in their medical charts. Results: Of the 407 screened ICU patients, 233 patients were enrolled and 45.9% were diagnosed with delirium. The prevalence was higher in mechanically ventilated patients compared to patients not mechanically ventilated (57.5% vs. 33.6%; P < 0.001). In a multivariate model, risk factors independently associated with delirium included age (adjusted odds ratio [AOR], 1.021; 95% confidence interval [CI], 1.01-1.04; P = 0.008), mechanical ventilation (AOR, 2.39; 95% CI, 1.34-4.28; P = 0.003), and higher severity of illness (AOR, 1.01; 95% CI, 1.001-1.021; P = 0.026). Conclusion: In our study, delirium remains a prevalent complication, with distinct risk factors. Further studies are necessary to investigate long-term outcomes of delirium in critically ill patients in Saudi Arabia.

Effect of Electronic Device Addiction on Sleep Quality and Academic Performance Among Health Care Students: Cross-sectional Study.

BACKGROUND: Sleep quality ensures better physical and psychological well-being. It is regulated through endogenous hemostatic, neurogenic, and circadian processes. Nonetheless, environmental and behavioral factors also play a role in sleep hygiene. Electronic device use is increasing rapidly and has been linked to many adverse effects, raising public health concerns. OBJECTIVE: This study aimed to investigate the impact of electronic device addiction on sleep quality and academic performance among health care students in Saudi Arabia. METHODS: A descriptive cross-sectional study was conducted from June to December 2019 at 3 universities in Jeddah. Of the 1000 students contacted, 608 students from 5 health sciences disciplines completed the questionnaires. The following outcome measures were used: Smartphone Addiction Scale for Adolescents-short version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), and grade point average (GPA). RESULTS: The median age of participants was 21 years, with 71.9% (437/608) being female. Almost all of the cohort used smartphones, and 75.0% (456/608) of them always use them at bedtime. Half of the students (53%) have poor sleep quality, while 32% are addicted to smartphone use. Using multivariable logistic regression, addiction to smartphones (SAS-SV score >31 males and >33 females) was significantly associated with poor sleep quality (PSQI >5) with an odds ratio of 1.8 (1.2-2.7). In addition, male gender and older students (age ≥21 years) were significantly associated with lower GPA (<4.5), with an odds ratio of 1.6 (1.1-2.3) and 2.3 (1.5-3.6), respectively; however, addiction to smartphones and poor sleep quality were not significantly associated with a lower GPA. CONCLUSIONS: Electronic device addiction is associated with increased risk for poor sleep quality; however, electronic device addiction and poor sleep quality are not associated with increased risk for a lower GPA.

Psychological Effects on Health Science Students After Implementation of COVID-19 Quarantine and Distance Learning in Saudi Arabia.

Background The 2019 novel coronavirus disease (COVID-19) pandemic has impacted the globe dramatically. It has affected daily life noticeably and the teaching process is one of the significantly affected aspects as the learning approach has been shifted to distance learning (DL). These new changes may affect student performance and emotional well-being. This study aimed to assess the psychological impact of the COVID-19 pandemic and distance learning on healthcare students. Method An online self-administered cross-sectional survey was distributed to healthcare students for the period between April 2020 to June 2020. The study included students from different universities in Saudi Arabia. Knowledge and perception of COVID-19 and the experience of distance learning during the pandemic period were assessed using a 5-point Likert scale. Psychological effect was evaluated using Four-Item Patient Health Questionnaire for Anxiety and Depression (PHQ-4). Results A total of 721 students completed the survey with the majority being females. Around 25% of students had experienced anxiety, while 35% had depression. Severe anxiety and depression were noted in over 6% of the participants. Younger age and female gender were more affected psychologically. Students with higher scores in PHQ-4 were strongly disagreeing that hand gloves and surgical masks may help in preventing COVID-19 transmission. Students with normal psychological assessment were more likely to favor DL, while students with moderate to severe anxiety and depression disagreed. Conclusion Healthcare students have alarmingly high levels of anxiety and depression during the COVID-19 pandemic. General knowledge of the pandemic is not associated with the psychological impact. DL is a convenient approach for students with normal PHQ-4 scores. Programs to help students overcome the psychological impact of COVID-19 are highly recommended.

Obesity and its correlation with spirometric variables in patients with asthma.

BACKGROUND: The severity of bronchial asthma has been associated with increased body mass index (BMI) in several studies. We studied obesity in the asthmatic population and its possible correlation with spirometric variables. METHODS: We reviewed the medical records of 200 patients who underwent spirometry and were followed up in a pulmonary clinic for asthma. Ninety patients fulfilled the inclusion criteria. Patients were divided into Group? (forced expiratory volume in 1 second [FEV1] = 80%, n = 64) and Group II (FEV1 60% to 79%, n = 26). Patients with BMI = 30 were labeled as obese. In each group, correlates of BMI and forced expiratory flow, midexpiratory phase (FEF25%-75%) were analyzed with linear regression. RESULTS: The mean ages were 33.9 -/+ 13 years and 33.73 -/+ 10 years in Groups I and II, respectively. The mean BMI was 30.2 +/ 6 (Group I) and 30.36 -/+ 6 (Group II). BMI = 30 was seen in 56.7% of patients in Group I and 53.3% in Group II. BMI did not correlate with spirometric variables in both groups. FEF25%-75% correlated with FEV1 and FEV1:forced vital capacity (FVC) in Group I (P = .003 and .0001, respectively) and FEV1:FVC in Group II (P = .0001). In Group 1, 38% of the patients had FEF25%-75% less than 80%. CONCLUSION: Although obesity was prevalent in asthmatic patients, BMI did not correlate with any of the spirometric variables. A significant number of patients with normal FEV1 had impaired midflow rates that may reflect ongoing small airway inflammation.

Venous thromboembolism risk and prophylaxis in a Saudi hospital.

OBJECTIVE: To evaluate the risk factors and physician's compliance to American College of Chest Physicians (ACCP) guidelines recommendations for venous thromboembolism (VTE) prevention at our hospital. METHODS: This retrospective cohort study was conducted at King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia from November 2009 to December 2009. We used the American College of Chest Physicians (ACCP) 2008 guidelines and Caprini's scores to assess VTE risk and to determine whether patients had received recommended prophylaxis. All hospital in-patients aged 15 years or above were assessed for risk of VTE by reviewing the hospital chart. A data sheet was developed to obtain the data on demographics, VTE prophylaxis medication, dose, route, duration, and associated risk factors. The primary endpoint was the rate of appropriate thromboprophylaxis. RESULTS: Nine hundred and sixty-eight patients were included. The mean age was 40 +/- 18.7 years, and 647 (66.8%) were women. According to the ACCP criteria, 547 (56.5%) patients were at risk for VTE. Of 210 patients that qualified for prophylaxis, 117 (55.7%) received some form of prophylaxis. However, 46 (39.3%) of them received ACCP-recommended VTE prophylaxis. In contrast, 25.6% of patients with no risk, according to Caprini score, had thromboprophylaxis prescribed. CONCLUSION: This study demonstrates that only a small proportion of eligible patients received the recommended VTE prophylaxis. Efforts should be made to develop strategies to improve patient safety practices.