Autoimmune diabetes mellitus after COVID-19 vaccination in adult population: a systematic review of case reports.

BACKGROUND: Autoimmune/type 1 diabetes mellitus (T1DM) is a recently described rare occurrence following the administration of adjuvants such as coronavirus disease 2019 (COVID-19) vaccines. This systematic review aimed to review all available literature on the potential association between COVID-19 vaccines and T1DM. METHODS: The Directory of Open Access Journals, MEDLINE, Google Scholar, and Scopus were systematically searched for all published studies from inception to July 2022. Articles reporting T1DM development within 8 weeks of administration of COVID-19 vaccine were included. Two reviewers independently performed the risk of bias assessment following the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. RESULTS: Eight eligible studies were retrieved, comprising 12 patients diagnosed with T1DM after being vaccinated with a COVID-19 vaccine. Six patients (50%) reported T1DM after receiving the second dose. Five patients (41.7%) presented with diabetic ketoacidosis, of which four presented within the first eight days after vaccination. Five patients (41.7%) had genetic susceptibility, with RNA binding motif protein 45 (RBM45/DRB1) and major histocompatibility complex, class II, DQ beta 1 (HLA-DQB1) mutations being prominent. INTERPRETATION: In this review, we have shown a small number of new-onset diabetes cases coincidently occurring soon after the COVID-19 vaccine, especially in those with genetic susceptibility. Despite being older, these patients had a similar phenotype to T1DM. While there might be a causal relationship between COVID-19 vaccines and T1DM development, this should not influence decisions regarding vaccination since the overall benefit outweighs the risk. Further larger prospective trials are needed to assess causal relationship and to clarify the potential roles of COVID-19 vaccine-derived antigens in autoimmune disease development. PROTOCOL REGISTRATION: PROSPERO-CRD42022342093.

Medical research: what to expect in a student-supervisor relationship.

BACKGROUND: A medical research supervisor is of crucial importance to the undergraduate student enrolled in a research methodology course. A solid relationship between the two is vital to the success of the research project and the overall well-being of the student. The structure of the relationship between a student and a research supervisor is seldom discussed in the context of undergraduate medical research. This study evaluates students' expectations of their research contributions and their supervisors' roles. METHODS: This was an observational study in a large health university in Saudi Arabia. A total of 320 medical students enrolled in a two-year medical research program completed an online survey, of a previously validated instrument, that is, Role Perceptions Rating Scale. Demographic questions such as the current level in the research program (junior or senior) were added. RESULTS: The results showed that most students expected the responsibility to be equally shared between the supervisor and student during the development and execution of the research project. Additionally, students expected the research supervisor to be responsible for the research themes and contents, ensuring access to facilities, and assisting in the actual writing of the final research manuscript. Furthermore, the results indicated differences in expectations between junior and senior students. CONCLUSION: This study demonstrates that medical students expect their research supervisors to support them to a significant extent. Understanding medical students' expectations in a supervisor-student relationship is essential to successful research and collaboration. The evidence gathered in this study has practical implications for educational institutes to base their research training program on these insights. Providing clarity on the expectations and responsibilities of those participating in the research program is crucial, as this would, in turn likely advance the output of the research program and encourage clinicians to join the program as research supervisors.

Social anxiety in E-Learning: Scale validation and socio-demographic correlation study.

During the ongoing coronavirus disease 2019 pandemic, over 1.5 billion students worldwide have been deprived of access to traditional learning. This situation has necessitated the use of social distancing-based educational methods; consequently, a tremendous shift towards e-learning has been observed. This study assesses medical students' social anxiety levels in e-learning environments. The study was conducted in two phases. In the first phase, the original Turkish Social Anxiety Scale for E-Learning Environments (SASE) was adapted in English and tested for validity and reliability. This instrument has two subscales: social anxiety in learner-learner interaction and in learner-instructor interaction. In the second stage, we explored the associations of gender, age, and perceived academic performance with medical students' social anxiety levels in e-learning environments. A total of 325 responses were analysed. Consistent with the original version, the adapted scale is a reliable and valid measure of social anxiety in e-learning. Social anxiety in e-learning was related to gender (p = 0.008) and age (p = 0.013). Social anxiety levels were higher in students with lower perceived performance during e-learning compared to students with enhanced performance, but the difference was not significant. The SASE is a useful instrument for evaluating social anxiety in e-learning environments across English educational frameworks. Considering the shift in social interaction environments, efforts are required to reduce medical students' social anxiety levels and enhance learning.

Exploring the outcome of multiple sclerosis among Saudi adult patients. A single-centered cross-sectional study at King Abdulaziz Medical City in Riyadh, Saudi Arabia.

OBJECTIVE: To assess the outcome and impact of multiple sclerosis (MS) using validated Arabic versions of the Barthel index (BI) multiple sclerosis impact scale (MSIS-29), the modified Rankin scale (mRS), and the expanded disability status scale (EDSS). METHODS: A cross-sectional study conducted at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia, during July-November 2017. All Saudi adult patients diagnosed with MS between 2000-2016 (269 patients) were included. Patients were contacted via phone calls and were assessed using a newly developed and validated multi-component questionnaire that included demographic data, disease course, and Arabic versions of the scales RESULTS: Out of 269 patients, 210 (78.2%) responded. The average patient age was 37.44+/-10.3 years. The majority were females (69.5%). Only, 51 (24.3%) patients reported worsening conditions. Annually, the average relapse rate was 2.28+/-1.91. In regard to patient outcomes, 120 (57.1%) showed no significant disability in mRS, 146 (69.5%) were ambulatory without aid in EDSS, and 185 (89.4%) were independent in BI scores. The average MSIS-29-PHYS score was 33.6+/-27.6 and MSIS-29-PSYCH score was 38.2+/-25.8. Modified Rankin scale and EDSS were significantly associated with the current use of disease-modifying therapy (DMT). Modified Rankin scale was negatively associated with delayed diagnosis. Barthel index showed significant association with medication compliance and the absence of attacks. CONCLUSION: Majority of patients had a favorable outcome that was linked with the use of DMT, compliance, early diagnosis, and absence of attacks.

The effect of epidural education on Primigravid Women's decision to request epidural analgesia: a cross-sectional study.

BACKGROUND: Epidural analgesia represents one of the most effective pharmacological ways to relieve labour pain. Women's awareness regarding the use of epidurals is increasing. As the decision to use epidural analgesia during labour is affected by many social, personal and medical factors, this study aimed to explore the factors contributing to a pregnant women's decision to use epidurals and to understand the benefit of implementing a health education program regarding epidural analgesia. METHODS: A cross-sectional study was conducted with primigravid women visiting the Obstetric Clinics for their routine antenatal care at King Abdul-Aziz Medical City in Riyadh from October 2014 to December 2016. The participating pregnant women were educated on the use of epidural analgesia during labour by a professional health educator utilizing specially designed educational materials. We assessed the relationship between the women's decision to request epidural analgesia and their age, place of residence, occupation, income and education level using a questionnaire. RESULTS: A total of 81 primigravid women were included in the study. Employed pregnant women were more likely to request epidural analgesia than non-employed women (46.7% vs. 18.2%, P = 0.019). After education, significantly more pregnant women were planning to request epidurals (mean score for answers before education was 2.12 ± 0.578 vs. 2.27 ± 0.592 after education, P = 0.013). Other variables, such as age, level of education, income and place of residence were not significantly associated with the participants' decision to request epidural analgesia. CONCLUSION: Health education on epidural analgesia is an important factor in increasing primigravid women's desire to request epidural analgesia. Education on epidural analgesia during antenatal care is needed for better decision making regarding the use of epidural analgesia during labour.

Iatrogenic Hypoparathyroidism Development After Thyroidectomy: A Retrospective Cohort Study.

BACKGROUND: Iatrogenic hypoparathyroidism is a common cause of postthyroidectomy hypocalcaemia. It has varying incidence rates after neck surgery in Saudi Arabia, ranging from 0.07% to 65.30%. Hypoparathyroidism can manifest with a spectrum of symptoms, ranging from mild to severe and life-threatening. This study aimed to assess the rate and predictors of iatrogenic hypoparathyroidism after thyroid surgery and its natural course. METHODS: This retrospective cohort study used a data collection form to extract patient information from the electronic healthcare system (Best-Care) for patients treated from 2017 to 2022. Patients' demographics, surgical specifics and biochemical profiles were recorded for subsequent analysis. RESULTS: Among the 343 patients who underwent thyroidectomy, 130 (37.9%) developed hypoparathyroidism, primarily within the first day after surgery. Calcium or vitamin D supplementation before surgery did not significantly influence hypoparathyroidism development. Notably, extensive combined lymph node dissection was significantly associated with postoperative hypoparathyroidism development (p = 0.0004). More patients who underwent central and lateral lymph node dissection (n = 19, 79.17%) developed hypoparathyroidism than patients who underwent central (n = 18, 40.91%) or lateral (n = 8, 38.10%) dissection alone. Permanent hypoparathyroidism was observed in 40 patients (11.66%). CONCLUSION: This study revealed a high incidence of iatrogenic hypoparathyroidism and high rates of permanent hypoparathyroidism. Further research is warranted to better comprehend the risk factors and optimise management strategies for iatrogenic hypoparathyroidism. Overall, our findings emphasise the need for vigilant monitoring and effective management of patients undergoing thyroidectomy and the significance of postoperative replacement therapies.

Comparison of Remotely Applied and Face-to-Face Disease Activity Scores in Saudi Arabian Patients With Rheumatoid Arthritis: A Prospective Cohort Study.

OBJECTIVES:  This study aimed to assess the disease activity indices (DAI) of rheumatoid arthritis (RA) by telephone-based tele-visits compared to face-to-face clinic encounters. METHODS: Patients with RA attending outpatient clinics between December 2021 and May 2022 were prospectively recruited. Disease activity assessments were initially performed in the clinic using the disease activity score 28-C-reactive protein (DAS28-CRP) and disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR). Within two weeks of the clinic visit, a telephone-based assessment gathered information on demographics, Routine Assessment of Patient Index Data 3 (RAPID3) score, and satisfaction. Disease activity scores were dichotomized into remission or low disease activity and moderate to high disease activity. RESULTS:  A total of 78 patients completed the two-point interview. Of those, 62 (79.49%) were women, with a mean age of 54.73±13.71 years. Seropositivity for rheumatoid factor and/or anti-citrullinated peptide was observed in 51 (83.61%) participants. Twenty-seven percent of the patients were classified as in remission or low disease activity by RAPID3. This was 71% for DAS28-CRP and 33% for DAS28-ESR. Based on the dichotomized disease activity classification, the agreement percentage between RAPID3 and DAS28-ESR was 78.08%, while it was 47.22% between RAPID3 and DAS28-CRP, which resulted in kappa statistic values of 0.48 (moderate agreement) and 0.14 (low agreement), respectively. Satisfaction rates were low. CONCLUSION:  Telephone-based RAPID3 showed a low-moderate agreeability compared to DAS28 and had low satisfaction rates. This suggests that tele-rheumatology care by this means was not feasible for following up with patients with RA and warrants further development.

Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia.

Background There is a lack of local studies on vitamin D deficiency in children with cancer. This study aims to estimate the prevalence of vitamin D deficiency in the pediatric oncology population at King Abdul-Aziz Medical City (KAMC) in Jeddah, addressing knowledge gaps for improved clinical practice and future research. Methods This retrospective observational study was conducted from 2016 to 2021 at the pediatric oncology clinic in National Guard Hospital, Jeddah. The study focused on children aged 14 or younger at cancer diagnosis, data encompassed patient demographics, cancer details, and treatment information, including serum measurements of vitamin D (25(OH)D, calcium, phosphate, alkaline phosphatase). Vitamin D levels were categorized as deficient (<25 ng/ml), insufficient (25-49 ng/ml), sufficient (≥50- 125 ng/ml), or hypervitaminosis (>125 ng/ml), based on our center reference range and the validation of the assay. Results In this retrospective study of 155 pediatric oncology patients, the majority aged 0 to 10 years (78%), findings reveal a male preponderance (54.2%) and a more prevalent in patients with hematological malignancies (85%). Chemotherapy was administered to 98%, with 7% underwent radiotherapy, and 89% received steroids. Analysis of serum 25-OH vitamin D levels indicated an overall deficiency and insufficiency at diagnosis (63%) and post-therapy (43%). Age and gender had a significant influence on vitamin D levels at diagnosis, with older children and females exhibiting lower concentrations. However, these differences diminished by the end of therapy. Notably, hematological malignancy patients often presented insufficient vitamin D levels, while solid tumor patients frequently had sufficient levels. Clinical outcomes showed a high survival rate (90.7%), limited bone density assessments (18.1%), and a 14.2% prevalence of hypervitaminosis. Conclusion In summary, our study reveals that over two-thirds of pediatric oncology patients experience vitamin D deficiency and insufficiency at the time of diagnosis, particularly notable in females and older children. Notably, those with solid tumors exhibit higher baseline 25-OH vitamin D concentrations compared to counterparts with hematological malignancies. The findings underscore the importance of educating both patients and caregivers on supplementation and sun exposure to mitigate the prevalence of deficient and insufficient vitamin D levels in pediatric oncology cases.

Sample size determination: A practical guide for health researchers.

Although sample size calculations play an essential role in health research, published research often fails to report sample size selection. This study aims to explain the importance of sample size calculation and to provide considerations for determining sample size in a simplified manner. Approaches to sample size calculation according to study design are presented with examples in health research. For sample size estimation, researchers need to (1) provide information regarding the statistical analysis to be applied, (2) determine acceptable precision levels, (3) decide on study power, (4) specify the confidence level, and (5) determine the magnitude of practical significance differences (effect size). Most importantly, research team members need to engage in an open and realistic dialog on the appropriateness of the calculated sample size for the research question(s), available data records, research timeline, and cost. This study aims to further inform researchers and health practitioners interested in quantitative research, so as to improve their knowledge of sample size calculation.

Dysmenorrhea, intermenstrual bleeding, menstrual flow volume changes, and irregularities following COVID-19 vaccination and the association with vaccine skepticism: A retrospective observational study.

BACKGROUND: COVID-19 vaccines have provided fertile ground for research, especially with the unprecedented spread of misinformation about this disease and its vaccines. Among women, one of the most frequently reported side effects of the vaccine has been menstrual disturbance. OBJECTIVE: To investigate the perceived impact of COVID-19 vaccines on the menstrual cycle. In addition, the research seeks to identify factors that could predispose certain individuals to experience these effects, thereby contributing to a deeper understanding of the interplay between vaccines and menstrual health. DESIGN: We conducted a retrospective observational cross-sectional study. METHODS: Any woman of menstruating age who received at least one dose of the COVID-19 vaccine and currently resides in Saudi Arabia was invited to complete an online questionnaire. The questionnaire compared menstruation characteristics-regularity, volume, intermenstrual bleeding, and dysmenorrhea-before and after receiving the COVID-19 vaccine, taking into consideration possible predisposing factors such as polycystic ovarian syndrome, contraceptives, or period-blocking pills. RESULTS: Women without polycystic ovarian syndrome experienced less change in dysmenorrhea post-vaccine compared to those with polycystic ovarian syndrome (23.88% versus 37.78%, p = 0.045). Women using hormonal contraceptives were about two times more likely to experience changes in volume compared to those not using contraceptives (odds ratio = 2.09, 95% confidence interval = 1.23-3.57, p = 0.006). COVID-19 vaccine skeptics were about three times more likely to perceive changes in regularity post-vaccine compared to non-skeptics (odds ratio = 2.96, 95% confidence interval = 1.79-4.90, p < 0.001). They were also three times more likely to perceive changes in volume post-vaccine (odds ratio = 3.04, 95% confidence interval = 1.95-4.74, p < 0.001). CONCLUSION: Our data suggest significant associations between COVID-19 skepticism, the use of hormonal contraceptives, and the reported post-vaccine menstrual disturbances. This underscores the importance of public education efforts aimed at dispelling misinformation and addressing controversies related to these vaccines.

"Publish or Perish": barriers to research publication in an undergraduate medical research program.

OBJECTIVES: Publication is one of the crucial parameters in research, and the inability to publish has been noted in many medical students' projects due to different reasons. This cross-sectional study aimed to determine the obstacles that prevented medical students in a health science university from publishing their research from 2018 to 2021. First, an online survey was distributed to assess the obstacles to publication perceived by the medical students. Second, a total of 81 research projects were evaluated by scientific reviewers and their final decision about the publication was recorded. RESULTS: In total, 162 students filled out the survey. The barriers faced by the students were various. They included an unsupportive research supervisor, a lack of time, an insufficient sample size, and many others. In the reviewer's evaluation, out of 81 projects, 70 projects (86.4%) were recommended to be published after minor or major modifications, while 11 projects (13.6%) were rejected due to poor writing style, poor results interpretation, and incorrect methodology. CONCLUSION: Articulating the barriers to undergraduate medical research publication is important in boosting publication rates and research experience of graduating medical students. Medical research educators and research supervisors should strongly consider creating a framework that tackles existing obstacles and any future matters.

Tele-clinics in palliative care during the COVID-19 outbreak: Tertiary care cancer center experience.

OBJECTIVES: To investigate the effect of tele-clinics on palliative care patients during the COVID-19 pandemic. METHODS: This is a retrospective cross-sectional study (chart review) carried out from March 17, 2020, to September 16, 2020, included all patients who were booked into the palliative care clinic. Patients were assessed by the palliative nurse specialist for COVID-19 symptoms using the acute respiratory illness screening form and Edmonton Symptoms Assessment System, also identifies the needs of the patient. Data were analyzed to investigate the effect of tele-clinics on the patients regarding ER visits and admission. RESULTS: A total of 167 individuals were analyzed and the results showed that 234 of 447 visits were virtual, supporting the increasing value of telemedicine. The number of virtual patients' visits dropped slightly at the beginning of the pandemic (46.4% in March to 39.8% in July). Subsequently, it increased steadily to 72.2% in September. The choice of virtual/non-virtual visits for individuals with cancer diagnosis significantly depends on other factors. Code status, palliative patients or follow-up service, and the frequency of oncology center visits, admissions, or ER visits were crucial in explaining the means of receiving treatment. CONCLUSION: Virtual visits in palliative care are efficient means of decreasing the threat of COVID-19 contagion. It is recommended to increase the palliative care patients' awareness of tele-clinics and their positive outcomes, particularly during the pandemic.

Digital transformation in medical education: Factors that influence readiness.

Digital transformation has become inseparable from education, and its implementation has broadly increased due to the increased adoption of e-learning during the COVID-19 pandemic. The present study evaluated the levels and influence of computer anxiety and digital readiness for academic engagement among undergraduate students. A cross-sectional study was conducted on 272 medical students enrolled in a medicine program. Two previously validated instruments were adopted. We examined the association between students' sociodemographic variables, internet use, and perceived academic performance during e-learning and their computer anxiety and digital readiness. The results show a significant effect of gender, age, and internet use on students' computer anxiety and digital readiness. Males' information-sharing behavior and skills outperformed those of females, and students' computer anxiety decreased with increasing age. In addition, the results indicate that the greater the students' internet use, the better their digital readiness for academic engagement. Furthermore, computer anxiety and digital readiness affect students' perceptions of their academic performance in e-learning. The rapid rate of technological advancements and the integration of e-learning into education means that careful attention must be paid to student characteristics as well as their skills. This will allow educators to create a successful, personalized learning framework.

A Retrospective Chart Review: The Prevalence of Hyponatremia Among Elderly Inpatients in a Tertiary Care Centre in Saudi Arabia.

INTRODUCTION: Hyponatremia is commonly seen in inpatient care; however, the availability of data regarding the prevalence of hyponatremia in the elderly in Jeddah, Saudi Arabia is insufficient. OBJECTIVES: The objective of this study is to estimate the prevalence of hyponatremia in a sample of older inpatients. MATERIALS AND METHODS: A retrospective chart review conducted in a tertiary care hospital, Jeddah, Saudi Arabia included all patients 60 years and older who were admitted to the internal medicine department between January 2017 and November 2020. Patients with hyponatremia were identified by looking through the hospital's laboratory database of inpatients. Patients' demographics, serum sodium level, medication history, and disease history were recorded and those with pseudohyponatremia were excluded. RESULTS: During the study period, 322 out of a total of 2,893 elderly patients admitted to the internal medicine department were diagnosed with hyponatremia (11.1%). Of these patients, 183 (56.8%) were female and 139 (43.2%) were male. Hyponatremia was more prevalent in patients with cardiovascular diseases (84.2%), followed by endocrine diseases (73.3%). The most prescribed medications for the studied hyponatremic patients were proton pump inhibitors (38.8%), diuretics (29.8%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (22.4%), all of which are commonly known to be associated with hyponatremia. CONCLUSIONS: Hyponatremia has severe consequences if left untreated. Therefore, estimating the prevalence of this condition in the older population will direct more clinical attention to evaluate the serum sodium level on a regular basis. It is recommended that future studies focus on finding an association between hyponatremia and older patients with multi-drug usage as well as identifying the causes of hyponatremia.

The Association Between Vitamin D Serum Level and COVID-19 Patients' Outcomes in a Tertiary Center in Saudi Arabia: A Retrospective Cohort Study.

Vitamin D deficiency has been associated with the risk for immune-mediated inflammatory reactions in various respiratory infections. Our study investigated the association between vitamin D deficiency and coronavirus disease 2019 (COVID-19) patients' outcomes. We included 545 patients who were admitted to a tertiary center in Jeddah, Saudi Arabia from March 2020 to July 2021 with a vitamin D serum test result at the time of infection or prior to disease onset. The data were extracted retrospectively using a data collection sheet. Our primary outcomes were intensive care unit (ICU) admission and in-hospital mortality. The cut-off values for vitamin D were <25, 25-49, and 50-250 for deficient, suboptimal, and optimal levels respectively. Our result revealed that there is no association between vitamin D serum levels deficiency and ICU admission (OR=1.08, p=0.75) or in-hospital mortality (OR=1.74, p=0.97). ICU admission and in-hospital mortality percentages in patients with vitamin D deficiency were 14.1% and 6.4%, respectively. In comparison, percentages for patients with optimal levels were 16.67% and 6.15% for ICU admission and in-hospital mortality, respectively. Smoking was not associated with ICU admission (p=0.05) or in-hospital mortality (p=0.38). Our study does not support a relationship between vitamin D deficiency and COVID-19 patients' outcomes. Future studies should be directed toward conducting randomized clinical trials to determine whether vitamin D has an effective role in reducing COVID-19 severity.

Awareness among Pregnant Women about Epidural Analgesia: A Cross-Sectional Study.

Background: Epidural analgesia (EPA) is an effective anesthetic technique to overcome pain during labor. This study aimed to evaluate the current awareness of EPA among pregnant women. Methods: We carried out a cross-sectional study using a questionnaire to measure awareness about EPA among pregnant women visiting the obstetrics and gynaecology clinic in King Abdulaziz Medical City in Jeddah. Following the results, a group of women was selected and educated by trained medical students. Results: This study comprised 105 women. We found that 25 (23.8%) respondents revealed a complete lack of knowledge regarding EPA, 63 (60%) showed minimal awareness, and 17 (16.2%) were aware of EPA from various sources. The gravidity and history of EPA administration were significantly associated with knowledge. Multigravida women and those who had received EPA showed higher level of knowledge (p=0.048 and p < 0.001, respectively). In addition, there was a significant association between the level of education and request for EPA (p=0.027). Forty-one participants were enrolled in an educational program that explained the importance of EPA. Twenty (48.8%) women decided to undergo EPA during delivery; however, 7 (17.7%) refused and 14 (34.1%) were not sure about their decision. Conclusion: This study revealed a lack of awareness about EPA among pregnant women. Educational programs were effective as many participants chose EPA following the educational session as a form of pain relief during labor. We recommend the implementation of routine education on EPA in vaginal delivery during antenatal visits for all pregnant women.

Managing Type 1 Diabetes among Saudi adults on insulin pump therapy during the COVID-19 lockdown.

BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has affected people's lives including patients with type 1 diabetes mellitus (T1DM). We aimed to investigate the impact of the COVID-19 lockdown on psychological status, self-management behaviors, and diabetes care maintenance among Saudi adults with T1DM using insulin pump therapy. METHODS: This cross-sectional study used a web survey to collect data on Saudi adults with T1DM who were treated in the specialized insulin pump clinic at King Abdulaziz Medical City-Jeddah, Saudi Arabia. We used the Patient Health Questionnaire-9 and General Anxiety Disorder-7 scales to measure depression and anxiety. RESULTS: Of the 70 patients who received the survey, 65 completed it. Overall, 23.1% and 29.2% of the patients reported moderate to severe and mild depression, respectively; 18.5% and 24.6% reported moderate to severe and mild anxiety, respectively. Compared with pre-lockdown, adherence to a healthy diet and regular physical activity decreased in 67.7% and 41.5% of the patients, respectively. Most patients maintained their adherence to insulin pump behaviors; frequent self-monitoring of blood glucose increased in 47% of glucometer users. Most patients benefited from phone visits or virtual education sessions, but 66.2% of the patients reported difficulty obtaining at least one type of insulin pump supply. CONCLUSIONS: Promoting self-management behaviors and psychological wellbeing of patients with T1DM using insulin pump therapy is crucial during a lockdown. Telemedicine is a useful alternative to in-person appointments, but strategies to ensure that patients have access to adequate resources during lockdown must be developed.

Risk factors for the systemic inflammatory response syndrome and sepsis following surgical management of acute intestinal obstruction.

OBJECTIVES: Infection is one of the major complications following intestinal obstruction surgery, yet predictors of its occurrence are not sufficiently reported. In this study, we examine the factors leading to postoperative inflammatory response syndrome (SIRS) and sepsis. METHODS: The data of 213 patients who underwent intestinal obstruction surgery between 2015 to 2020 in King Abdulaziz Medical City, Riyadh, Saudi Arabia, were reviewed retrospectively. Patients' demographic characteristics and preoperative, intraoperative, and 30-day postoperative data were compared between patients who had postoperative SIRS/sepsis and patients who had no complications. RESULTS: Ninety-six patients (44%) developed SIRS/sepsis within 30 days after surgery. More than half of the patients were males (55.8%), and the mean age at operation was 56.7(SD=20.0)years. Preoperative high heart rate, low albumin levels, and postoperative intensive care unit (ICU) admission were independently and significantly associated with developing SIRS/sepsis post-operation. The mortality rate in this study was estimated to be 7.5%; of those, 93.8% had SIRS/sepsis. CONCLUSION: The 30-day mortality rate is considerably higher among patients who developed SIRS/sepsis after intestinal obstruction surgery. The independent risk factors of developing SIRS/sepsis after operation were elevated heart rate, low albumin levels preoperation, and ICU admission post-operation.

Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors.

BACKGROUND: Surgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery. METHODS: Patients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed. RESULTS: The SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3-13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4-7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1-8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2-5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%]. CONCLUSIONS: SSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.

Referral Time of Advance Cancer Patients to Palliative Care Services and Its Predictors in Specialized Cancer Center.

Background and aim Globally, there is a discrepancy in whether terminal cancer patients are early referred to palliative care service (PCS) or not. A late referral can lead to a delay in treating and palliating those patients in need. The aim of this study is to investigate the referral time patterns of advanced cancer patients to PCS in Princess Noorah Oncology Center (PNOC) at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia. In addition, this study evaluates the factors that influence referral time to the palliative care unit (PCU), along with the overall survival rate. Methods This was a retrospective cross-sectional study (chart review) conducted at the inpatient unit in PNOC and included all patients referred to PCS between January 1st, 2016, and December 31, 2016. In total, 153 patients met the inclusion criteria, and their data were collected and analyzed. Results The median length of stay (LOS) was five days (95% CI: 3.85-6.15). Among the 153 patients, 22 (14.4%) died within 24 hours of enrollment to PCU. Patients who were referred to the PCU with non-metastasis disease had a median LOS of nine days, which is significantly longer than the median LOS in patients with metastatic disease (95% CI: 0.35-0.82, p=0.004), which indicates that they referred relatively earlier to PCU. The hazard ratio for death in patients with non-metastatic cancer stage was 0.54 (95% CI: 0.35-0.82, p=0.004). Conclusion Referral of advanced cancer patients to palliative care services occurs late in their disease course in our institution, like other institutions, with variation in LOS, which shorten their stay at palliative, as well as, affects their quality of life (QOL) and ability to plan or make a decision regarding their care. Education of the public and, most importantly, the medical community is needed.