Quality of Life Evaluation in Saudi Arabian Pediatric Patients with Primary Immunodeficiency Diseases Receiving 20% Subcutaneous IgG Infusions at Home.

BACKGROUND AND AIMS: Subcutaneous immunoglobulin (SCIG) home infusion is widely used as an alternative to intravenous immunoglobulin (IVIG). This study aimed to determine the quality of life (QoL) of patients with primary immunodeficiency (PID) after switching to home-based SCIG. METHODS: In this prospective open-label single-center study, QoL was determined using the validated Arabic version of the Child Health Questionnaire at baseline and 3 and 6 months after switching from IVIG to SCIG. RESULTS: Twenty-four patients were recruited from July 2018 to August 2021, including 14 females and 10 males. The median age of the patients was 5 years (range, 0-14 years). The patients' diagnoses included severe combined immunodeficiency, combined immunodeficiency, agammaglobulinemia, Omenn syndrome, immunodysregulation, hyper-IgE syndrome, common variable immunodeficiency, and bare lymphocyte syndrome. The median duration on IVIG before inclusion was 40 months (range, 5-125 months). The QoL score showed a significant improvement in the patients' global health at 3 and 6 months compared with those at baseline and a significant improvement in the patients' general health at 3 and 6 months compared with that at baseline. The mean baseline serum IgG trough level was 8.8 ± 2.1 g/L. The mean serum IgG level was significantly higher on SCIG at both 3 and 6 months (11.7 ± 2.3 and 11.7 ± 2.5 g/L, respectively). CONCLUSIONS: This is the first study involving an Arab population to show improvement in the QoL of patients with PID after switching from hospital-based IVIG to home-based 20% SCIG.

Institutional review boards in Saudi Arabia: the first survey-based report on their functions and operations.

BACKGROUND: Institutional review boards (IRBs) are formally designated to review, approve, and monitor biomedical research. They are responsible for ensuring that researchers comply with the ethical guidelines concerning human research participants. Given that IRBs might face different obstacles that cause delays in their processes or conflicts with investigators, this study aims to report the functions, roles, resources, and review process of IRBs in Saudi Arabia. METHOD: This was a cross-sectional self-reported survey conducted from March 2021 to March 2022. The survey was sent to 53 IRB chairpersons and the administration directors (or secretary) across the country through email after receiving verbal consent. The validated survey consisted of eight aspects: (a) organizational aspects, (b) membership and educational training, (c) submission arrangements and materials, (d) minutes, (e) review procedures, (f) communicating a decision, (g) continuing review, and (h) research ethics committee (REC) resources. A total of 200 points indicated optimal IRB functions. RESULTS: Twenty-six IRBs across Saudi Arabia responded to the survey. Overall, the IRBs in this study scored a total of 150/200 of the points on the self-assessment tool. Relatively newer IRBs (established less than ten years ago) conducted meetings at least once in a month, had annual funding, had more balanced gender representation, tended to score higher than older IRBs. The organizational aspect score was the lowest among all items in the survey (14.3 score difference, p-value < 0.01). The average turnaround time for expedited research from proposal submission to final decision was 7 days, while it was 20.5 days for the full committee review. CONCLUSION: Saudi IRBs performed generally well. However, there is room for focused improvement with respect to extra resources and organizational issues that require closer evaluation and guidance from the regulatory bodies.

Effect of perceived stigma on work and social roles among individuals with mental health disorders in Saudi Arabia: findings from a national survey.

BACKGROUND: It is known worldwide that stigma towards mental illness exists. Studies on stigma perceived by patients with mental illness have shown decreased quality of life and a negative impact on work, school and social life. The aim of this study was to estimate the prevalence of perceived stigma among respondents who had been diagnosed with a mental illness during the past 12 months, its association with socio-demographic variables and its effect on work and social roles limitations among Saudis. METHODS: The Saudi National Mental Health Survey (SNMHS) data were used for the analysis. The SNMHS is a nationally representative survey that was conducted using face-to -face interviews with Saudi individuals (age 15-65) in their households. Respondents were diagnosed (N = 639) with mental disorders based on a well-validated questionnaire-the Composite International Diagnostic Interview (CIDI) 3.0. Two dimensions from CIDI assessed perceived stigma: embarrassment and perceived discrimination. RESULTS: The prevalence of perceived stigma was 27.8% among mentally ill respondents. Stigma was lower among respondents who didn't seek any type of treatment than those who sought treatment OR = 0.28 (95% CI 0.084-0.935, P = 0.03). Respondents who reported perceived stigma had more work role limitations (OR = 1.1 95% CI 1.01-0.10 P 0.006) and social limitations (OR = 1.3 95% CI 0.99-1.62 P 0.05) than respondents who didn't report stigma. CONCLUSION: Perceived stigma is experienced by mentally ill individuals and it negatively affects their work and social roles. Awareness programs to remove stigma and educate the public are needed to be established by policymakers and healthcare providers in Saudi Arabia.

Weighty Matters: The Obesity-Thyroid Nodule Connection Unveiling the Impact of Obesity on Thyroid Cancer Risk.

Background and Objectives: The effect of obesity on the development/progression of thyroid nodules with uncertain cytology is unknown. Therefore, our objective was to assess the role of body mass index (BMI) in predicting malignancy in patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) nodules. Materials and Methods: We retrospectively analyzed 113 patients with available BMI data and final histopathology of benign or differentiated thyroid cancer. Patients were classified into four groups based on BMI: <18.5 (underweight), 18.5-24.9 (normal weight), 25-29.9 (overweight), and ≥30 (obesity) kg/m2. The association between risk of malignancy and BMI was examined for all data and subgroups based on nodule size, sex, and age. Results: Overall, 44.2% were obese, 36.3% were ≥45 years, and 75.4% were women. Final pathological results showed malignant nodules in 52 patients (46%) and benign nodules in 61 patients (54%) (mean age: 41 ± 11.6 vs. 39.9 ± 11.7 years; p = 0.62). Men had more malignant nodules than benign nodules (32.7% vs. 16.4%, p < 0.05). Overall, no significant correlation was identified between the risk of thyroid cancer and BMI, and the risk of malignancy was not significantly different between obese men and women (p = 0.4). However, in individuals with BMI < 30 kg/m2 (non-obese group), malignant nodules were more frequent in men than in women (71% vs. 41%, p = 0.04). No significant difference was observed in mean nodule size between the benign and malignant groups. Furthermore, BMI was not related to increased risk of malignancy in multiple logistic regression models using all data, even after controlling for confounding variables (odds ratio, 0.99, 95% confidence interval: 0.93-1.06, p = 0.87) or when stratifying by sex. Conclusions: Our study showed no correlation between obesity and thyroid cancer in patients with AUS/FLUS. Moreover, men had more malignant nodules than benign nodules. Further well-designed prospective studies are required to confirm our findings.

Enhancing research support services in health organizations by implementing a "Research Concierge Desk", a case study.

Health organizations with teaching and research responsibilities face the need to establish a comprehensive system that addresses the processes and challenges associated with research activities; a system that assists local institutes in becoming research-active by identifying gaps and providing actionable recommendations. The involvement of epidemiologists, biostatisticians, and data scientists is paramount in offering technical and scientific support to health researchers. In our organization, research support services, such as technical, statistical, logistical, and scientific assistance, have been provided to researchers for the past 20 years under the name of "Data Clinic Service". This article discusses the establishment of a physical booth called the "Research Concierge Desk" within a medical center to offer on-site, free-of-charge, and direct consultations to researchers, thereby improving accessibility to data clinic services. The underlying concept of the "Research Concierge Desk" is to align the research workflow for busy clinicians, who require vital assistance in the technical aspects of their research. As well, the desk and its digital platform enabled us to assess research process workflow, such as research submission, data clinic requests, research progress tracking, and researcher satisfaction assessment. We present the initiation of the "Research Concierge Desk" as an innovative solution in hospital settings, outline the available resources, benefits, challenges, and propose areas for improvement. The experience gained from implementing the "Research Concierge Desk" model can greatly benefit other health centers in adopting a similar approach to develop enhanced services for clinical researchers.

The impact of nodule size on malignancy risk in indeterminate thyroid nodules.

Background: The association between malignancy risk and nodule size in indeterminate thyroid nodules (ITNs) remains controversial. Thus, we aimed to explore the impact of nodule size as a predictor of cancer in patients with ITNs. Methods: This cross-sectional study assessed 113 patients who underwent surgical intervention for ITNs, comparing two groups based on nodule size (≥4 or <4 cm). The correlation between nodule size and malignancy risk was examined. Other variables of interest included demographics, thyroid-stimulating hormone (TSH) levels, type of surgery, and ultrasound features. Results: Of the 113 patients, 88.5% were aged <55 years, 76.1% were women, and 65.5% had nodules <4 cm. Mean nodule size was 3.4±2.3 cm. There was no significant correlation between malignancy risk and nodule size (P=0.55). An association was observed between <4 cm nodules and elevated TSH levels (P=0.03) and between ≥4 cm nodules and the presence of hypervascularity (P=0.04). Nodules <4 cm were more likely to have extrathyroidal extension, lymphovascular invasion, and positive margins than those ≥4 cm; however, this was not significant. Conclusions: Our findings showed no association between nodule size and malignancy risk, suggesting that size alone is not a predictor of cancer development. Further prospective studies are required to confirm these results.

Recurrent laryngeal nerve injury after thyroidectomy: A national study from Saudi Arabia.

OBJECTIVES: To determine the incidence and possible risk factors of recurrent laryngeal nerve injury, to provide a relevant literature review of studies from other centers in Saudi Arabia, and to present basic statistical data for future studies in our local community. METHODS: A retrospective study enrolled patients who were surgically treated for thyroid disease between January 2015 and December 2021. For concerns during the procedure, direct laryngoscopy was carried out before extubation to assess the vocal cords. Similarly, indirect laryngoscopy was carried out for patients who developed postoperative voice changes. All patients were evaluated clinically 2-3 weeks after surgery. Nerve monitors were not used in either case. RESULTS: The study examined 437 participants: 361 (82.6%) female and 76 (17.4%) male individuals. The incidence of recurrent laryngeal nerve injury was 1.1%. The demographic characteristics, pathology (benign vs. malignant), and extent of thyroidectomy were not significantly associated with the risk of recurrent laryngeal nerve injury. CONCLUSION: A recurrent laryngeal nerve injury is a serious complication, and further studies are required to determine the safest techniques for thyroidectomy. However, centralization of thyroid surgery in high-volume centers might reduce this risk.

Longevity of Immunoglobulin-G Antibody Response Against Nucleocapsid Protein Against SARS-CoV-2 Among Healthcare Workers.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the latest pandemic and the most significant challenge in public health worldwide. Studying the longevity of naturally developed antibodies is highly important clinically and epidemiologically. This paper assesses the longevity of antibodies developed against nucleocapsid protein amongst our health-care workers. Methods: This longitudinal cohort study was conducted at a tertiary hospital, Saudi Arabia. Anti-SARSsCoV-2 antibodies were tested among health-care workers at three-point intervals (baseline, eight weeks, and 16 weeks). Results: Of the 648 participants, 112 (17.2%) tested positive for Coronavirus (COVID-19) by PCR before the study. Of all participants, 87 (13.4%) tested positive for anti-SARS-CoV-2 antibodies, including 17 (2.6%) participants who never tested positive for COVID-19 using rt-PCR. Out of the 87 positive IgG participants at baseline, only 12 (13.7%) had remained positive for anti-SARS-CoV-2 antibodies by the end of the study. The IgG titer showed a significant reduction in values over time, where the median time for the confirmed positive rt-PCR subgroup from infection to the last positive antibody test was 70 (95% CI: 33.4-106.5) days. Conclusion: Health-care workers are at high risk of exposure to the SARS-CoV-2 virus, and contracting an asymptomatic infection is not unlikely. Developing and sustaining natural immunity differs from one person to another, while the rate of positive IgG anti-SARS-CoV-2 wanes over time. Clinicaltrialsgov Identifier: NCT04469647, July 14, 2020.

Urgent need to standardize labelling of acetaminophen-paediatric liquid drug products in Saudi Arabia.

In this study, dosing instructions in package inserts of all 12 paediatric liquid acetaminophen products registered in pharmacies in the Kingdom of Saudi Arabia were analysed to determine the potential for administering a supratherapeutic dose of acetaminophen. Doses in millilitres were calculated as mg/kg for four age groups: three months old, one year old, six years old, and twelve years old, and based on the 3rd, 50th, and 75th weight percentiles of each age group. Acetaminophen concentrations in the products varied, and only two products included Arabic language instructions. The dosing instructions in eight products included an age overlap. The most affected age group was the 1-year-old group, with 21 supratherapeutic doses across all 12 products. The least affected age group was the 12-year-old group, with 8 supratherapeutic doses in total. The absence of strict supervision and monitoring of labels of paediatric liquid acetaminophen products increases the risk of liver toxicity in children. Therefore, we call for an immediate standardisation of all dosing instructions regarding the dose per weight and the inclusion of instructions in Arabic.

Epidemiological characteristics, clinical course, and laboratory investigation of pediatric COVID-19 patients in a tertiary care center in Saudi Arabia.

Background: Since the initial emergence of the novel SARS-CoV-2 coronavirus responsible for the 2019 coronavirus disease (COVID-19) pandemic, many studies have been exploring the nature and characteristics of this virus and its associated clinical manifestations. The present study aimed to describe the clinical presentation and outcomes of COVID-19 infections in pediatric patients. Methods: A retrospective review of findings associated with 143 pediatric patients (age <14 years) with a confirmed COVID-19 diagnosis who had undergone inpatient or outpatient treatment at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between March 2020 and October 2020, was conducted. The analyzed data included patient demographic information, pre-existing medical conditions, symptoms, interventions, and outcomes. Results: The median age of this patient population was 7 years. Of these 143 patients, 67 (46.8%) had known pre-existing medical conditions including bronchial asthma (12.8%), chronic lung disease (CLD) (3%), congenital heart disease (CHD) (17%), primary immunodeficiencies (1.5%), malignancies (9.8%), and 7.5% were post-transplant patients. Thirty-seven patients (26%) were overweight or obese. Sixty-three of these patients (51%) were symptomatic, with the most common symptom being fever (55%). Ultimately, 45 patients (31%) required admission to the hospital, with a median duration of hospitalization of 9.6 days for admitted patients. There were no documented cases of infection-related mortality among this pediatric cohort, although 11 patients experienced post-infectious complications that primarily manifested as a loss of taste and smell. Conclusion: These findings suggest that pediatric COVID-19 patients tend to experience mild forms of the disease, without any significant differences in disease severity as a function of patient gender or immune status.

Ursodeoxycholic Acid and SMOFlipid for Treating Parenteral Nutrition Associated Cholestasis in Infants.

BACKGROUND:  Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. The pathogenesis of PNAC is believed to be multifactorial; however, phytosterols are hepatotoxic, resulting in cholestasis. A novel lipid emulsion consisting of a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) with a low level of phytosterols has been shown to improve cholestasis. Moreover, ursodeoxycholic acid (UDCA) has improved bile flow and normalized liver function tests. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants. METHODS:  We conducted a retrospective cohort study that included all infants who received TPN for at least five days between January 2010 and December 2018, who also received UDCA for the treatment of cholestasis, and infants who developed cholestasis but were not treated with UDCA. In addition, any infants who received SMOFlipid for parenteral nutrition during the same period were included. We recorded multiple variables, including neonatal demographic data, major medical diagnosis, liver function, medications, and maternal variables. RESULTS:  A total of 58 infants with cholestasis who received UDCA for treatment were identified. The infants were divided into two groups, Group 1 infants had gestational age (GA) of ≤32 weeks, and Group 2 had GA of >32 weeks. We found that combining SMOFlipid with UDCA resulted in a significant reduction in cholestasis duration in both groups. Infants in Group 1 who received SMOFlipid had cholestasis for a mean of 67 ± 57 days, and those who did not receive SMOFlipid had cholestasis for a mean of 145 ± 102 days (p=0.04). Infants in Group 2 who received SMOFlipid had cholestasis for a mean of 38.2 ± 28 days, and those who did not receive SMOFlipid had cholestasis for a mean of 117 ± 119 days (p=0.02). CONCLUSIONS:  According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants.

Post-Thyroidectomy Hematoma: Risk Factors To Be Considered for Ambulatory Thyroidectomy.

INTRODUCTION: Post-thyroidectomy hematoma is a serious, potentially life-threatening complication and it is the most frequent indication for reoperation. In this study, we aimed to identify the risk factors and prevalence of post-thyroidectomy hematoma and perform a literature review of the incidence of post-thyroidectomy hematoma at other centers in Saudi Arabia. METHODS: We retrospectively enrolled 372 consecutive patients who had undergone thyroidectomy between January 2015 and December 2020. Patients with bleeding disorders were excluded from the study. Data were analyzed using SPSS software, version 20.0 (IBM Corp., Armonk, NY). RESULTS: Three female (0.8%) patients developed a hematoma after thyroidectomy. Two patients developed a hematoma 24 hours after surgery and were treated conservatively. The third patient developed a hematoma within two hours of surgery and required surgical intervention. None of the patients required a tracheostomy, and there was no mortality. No significant association was found between age, sex, final pathology, the extent of thyroidectomy, and risk of hematoma. CONCLUSION: A post-thyroidectomy hematoma is a rare but dangerous complication. Identifying the risk factors for hematoma formation is of great importance, particularly when considering outpatient thyroidectomy. A large prospective multicenter study is needed for further investigation.

Psychological distress reported by healthcare workers in Saudi Arabia during the COVID-19 pandemic: A cross-sectional study.

INTRODUCTION: Few studies have considered the impact of COVID-19 on the mental health of healthcare workers (HCWs) in the Kingdom of Saudi Arabia (KSA). We estimated the prevalence and severity of psychological distress and characterized predisposing risk factors among HCWs in KSA during the COVID-19 pandemic. METHODS: We conducted a cross-sectional online survey of 1,985 HCWs from 6 hospitals across the country designated with caring for COVID-19 patients between April 16 and June 21, 2020. Our data analysis was performed using logistic regressions. Ordered logistic regressions were also performed using forward stepwise model selection to explore the effects of risk factors on psychological distress. RESULTS: The prevalence of psychological distress reported by HCWs in KSA was high, ranging from mild-moderate to severe in severity. Younger HCWs, women, those in contact with COVID-19 patients, and those who either had loved ones affected or who were themselves affected by COVID-19 were the most at-risk of psychological distress. Risk factors such as insomnia, loneliness, fear of transmission, and separation from loved ones most significantly predicted elevated levels of distress among HCWs. CONCLUSIONS: Increasing psychological distress was commonly reported by HCWs during the early months of COVID-19 pandemic in KSA. Public health policy makers and mental health professionals must give special attention to risk factors that predispose HCWs in KSA to psychological distress.

Hematologic reference intervals for healthy adult Saudis in Riyadh.

BACKGROUND: Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region. OBJECTIVES: Provide reference values of routine hematological parameters in Saudi adults according to age and gender. DESIGN: Cross-sectional SETTING: Central province of Saudi Arabia. PATIENTS AND METHODS: Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire. MAIN OUTCOME MEASURES: Hematological reference values based on the local population. SAMPLE SIZE AND CHARACTERISTICS: 637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years. RESULTS: The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks. CONCLUSION: The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population. LIMITATIONS: Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population. CONFLICT OF INTEREST: None.

Prevalence of Aggressive Behavior Toward Fellows, Residents, and Nurses at a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Background Workplace bullying (WPB) is a form of mistreatment toward an individual manifested by physical, verbal, or indirect aggression. Affected victims display a wide range of signs and symptoms that impact their health. This study aimed to investigate the prevalence of aggressive behavior toward healthcare workers and its effects on job satisfaction, general health, and mental health. Methodology An online survey comprising a revised version of the Negative Acts Questionnaire-Revised (NAQ-R) was distributed to the fellows, residents, and nurses working in a tertiary care hospital. The survey collected information regarding the group's demographics and their exposure to WPB encountered in the work environment while maintaining confidentiality. Survey results were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Results Among the 339 participants who filled the survey, 53% of healthcare practitioners in different services had experienced some form of WPB. Among the targeted group, it was noted that female gender (50%), age between 31 and 41 years (57.03%), nurses (51.98%), non-Saudi practitioners (41.94%), and those working in inpatient settings (49.74%) were the most commonly affected individuals in the medical facility. Furthermore, higher bullying prevalence was correlated with lower job satisfaction and mental health levels. Conclusions Age, gender, job, and nationality were factors associated with increased susceptibility to WPB. WPB in any facility is an unfortunate event, especially in a healthcare setting. It affects health practitioners by decreasing job satisfaction, jeopardizing health, and increasing the risk of harm to patients. WPB will eventually have a negative impact on the medical facility and the healthcare sector. Hence, hospital administrations should be alarmed about the rise in WPB, and adequate measures must be taken to deal with the root cause of the problem.

First report on the prevalence of bacteria in cystic fibrosis patients (CF) in a tertiary care center in Saudi Arabia.

Introduction: Bacterial infections in CF patients are common and start early in life. The prognosis of the disease is substantially dependent on chronic respiratory infection and inflammation. Pseudomonas aeruginosa (PA) infection or chronic colonization have been established to cause a chronic decline in pulmonary function (PFT), and/or increase CF mortality. Objectives: To obtain the prevalence of all bacterial pathogens in our CF patients and assess their evolution over time. Method: A retrospective review of 327 patients with confirmed CF of all age groups, who had respiratory culture samples at the first visit and on a regular follow-up between January 1, 1990 and December 2018, was conducted. Results: A total of 327 patients had a respiratory culture obtained at presentation. Two hundred and sixteen (66%) of 327 patients are alive, while 111 (34%) have died. Respiratory cultures were taken from nasopharyngeal aspiration (NPA) in 199 patients (61%), tracheal aspirate in 9 (3%), bronchoalveolar lavage (BAL)in one (0.29%), and in 124 patients (38%), sputum was induced. The eastern province contributed to the highest number of patients (122, 37.7%). There is a persistent increase in the prevalence of the common bacteria over the follow-up period of 7 years, namely Hemophilus influenzae (H. influenzae), Staphylococcus aureus (S. aureus), and all Pseudomonas (P. aeruginosa) culture types.Comparing cultures from the first and last follow-up visits, there was an increase in the prevalence of all (P. aeruginosa) cultures from 120 (34%) to 137 (53%), and a decrease in the prevalence of (S. aureus) and (H. influenzae) during the same follow-up period. Conclusion: There is a progressive increase in the number of patients with the most pathogenic types of bacteria because of the advanced age at presentation. As more adult patients are enrolled, there is a need for improved awareness regarding the early eradication of pathogenic bacteria to prevent progressive pulmonary damage.

Breaking bad news to children with chronic kidney disease: A questionnaire-based study and literature review.

INTRODUCTION: Breaking bad ne ws to caregivers of children with (CKD) [I can't comment in the box] Title says to breaking bad news to children but in here, breaking bad news to caregivers. Please clarify and edit accordingly. is an important role of nephrologists. In our practice there has been a thought about parental dissatisfaction from breaking bad news to CKD patients. Caregiver's preferences on how to be told the bad news in CKD children has not been studied adequately. Our objective was to identify how much is the emotional and knowledge satisfaction of CKD caregivers and the relation of their socioeconomic and educational levels with their preferences in breaking bad news. METHODS: A questionnaire based study was conducted for caregivers of CKD children, in the outpatient clinics, and peritoneal dialysis and hemodialysis units at the King Faisal Specialist Hospital and Research Centre for three months. RESULTS: 83 questionnaires from caregivers of CKD patients age (1-14) years, mean age of 8.5 ± 3.9 years. (47.6%) were emotionally very satisfied, 29.5% were very satisfied about the knowledge they had. CONCLUSION: Caregivers of CKD patients are satisfied emotionally more than the satisfaction about the amount of information they got. Different demographic data might affect their preferences in the way of receiving the bad news. The dissatisfaction suggesting that physicians' communication skills needs improvement.

Ten public health strategies to control the Covid-19 pandemic: the Saudi Experience.

Saudi Arabia plays an important strategic role within the Middle East and afar because of its geographical location, and being the host of one of the largest annual religious mass gatherings in the world "The Hajj". During the recent coronavirus pandemic, the Kingdom of Saudi Arabia (KSA) developed a multisectoral plan that adopted multiple measures to limit the spread of Covid-19 transmission both domestically and internationally. In this article, we review all public health related policy decisions from the Saudi Ministry of Health, other government departments, and the private sector that contributed to limiting the severe consequences from Covid-19. Ten effective strategies are outlined and the challenges related to their implementation are explored. The strategies include: 1. Quarantine and travel restriction, 2. Expansion of serological screening, 3. Mask wearing (covering the face and nose) and social distancing, 4. Preparation of hospitals to deal with the influx of coronavirus cases, 5. Use of artificial intelligence, 6.Public assurance, 7.Removal of slum areas and re housing of its inhabitants, 8. Cancellation of the Hajj season, 9. Economic stimulus packages to safeguard the economy, and 10. fair and priority driven vaccine distribution. Conclusion: The government of Saudi Arabia demonstrated responsibility at the highest level to prioritize the safety and well-being of its citizens and residents. Rapid early response to the pandemic warnings, extensive experience in previous epidemics and in mass gathering medicine, wise management of healthcare resources, and unprecedented harmonization of governmental and private sectors were significant factors for this success.

Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study.

COVID-19 was declared a pandemic by the WHO in 2020. In light of the global shortage of PPE and concerns regarding the safety of healthcare providers, clinicians have resorted to the use of novel protective barriers, such as aerosol boxes and plastic sheets, during aerosol generating procedures, especially tracheal intubation. We compared the effect of these barriers on the tracheal intubation of simulated patients with severe COVID-19 in a crossover study. The study was approved by the Ethics Committee of King Faisal Specialist Hospital, and the procedures were compliant with the COVID-19 airway management guidelines of the Saudi Anesthesia Society. The time to intubation was our primary outcome. Secondary outcomes included number of optimization maneuvers, number of intubation attempts, time to glottic view and ventilation of the lungs, and damage to PPE. Thirteen consultant anesthetists performed 39 tracheal intubations on a manikin using each of three approaches (aerosol box, plastic sheet, and no-barrier). Data were collected via direct and video observation. The plastic sheet approach demonstrated the highest time to intubation (mean ± StE [95% CI]: 33.3s ± 3.5 [25.8- 40.9]) compared to the aerosol box (22.0s ± 2.5 [16.5 - 27.5], P < 0.01) and no-barrier approaches (16.1s ± 1.1 [13.7 - 18.4], P < 0.0001). Similarly, the plastic sheet approach had the highest time to glottic view, and ventilation intervals compared to the other two approaches, while the no-barrier approach had the shortest time intervals. There were no failed intubations or damage to the PPE sustained during the use of any of the three approaches. The aerosol box does not impose a significant delay in tracheal intubation using video laryngoscopy, unlike the plastic sheet barrier. Further research on the aerosolization risk is warranted before these protective barriers can be considered as mainstay approaches during aerosol generating procedures.

Effects of Probiotics and Lactoferrin on Necrotizing Enterocolitis in Preterm Infants.

Background Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in neonates. Despite intensive research, the etiology and pathophysiology of NEC is still obscure. Evidence from recent studies and meta-analyses showed a significant role of probiotics as a prophylactic measure in reducing NEC, sepsis, and mortality. However, obstacles against the generalization of the results still remain. The aim of the study was to evaluate the role of prophylactic administration of probiotics and lactoferrin in reducing the rate of NEC in preterm infants. Methods In this retrospective cohort study, all medical records of infants born with a birth weight of 1,500 g and less who were born between 2012 and 2017 were reviewed. The enrolled infants were divided into two groups: group 1 included infants born between January 2012 and August 2014, a period before probiotics were started in our unit, and group 2 included infants born between January 2014 and December 2017 after starting probiotics and lactoferrin. Multiple variables were collected including maternal data, neonatal data, and risk factors for NEC. Results Medical records of 284 infants who met our inclusion criteria were reviewed. Of the 284 infants, 134 were in group 1 and 150 infants were in group 2. There were no significant statistical differences between group 1 and group 2 in neonatal and maternal demographic data and clinical data. Of 134 infants who received probiotics and lactoferrin, 11 developed NEC, while 26 of the 150 infants in group 2 developed NEC, and the difference was statistically significant (p = 0.023). Conclusion Probiotics and lactoferrin given orally to very low birth weight preterm infants were associated with a decreased rate of NEC.