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    Antibiotic resistance pattern of Acinetobacter baumannii strains: A retrospective study from Oman
    (2021) Sannathimmappa, Mohan; Nambiar, VinodAravindakshan, Rajeev
    Background: Multidrug-resistant (MDR) Acinetobacter baumannii is of serious health concern and associated with high mortality. Data regarding the antibiotic resistance pattern of A. baumannii strains in Oman is limited. Objectives: To determine the antibiotic resistance pattern of A. baumannii from various clinical samples in a tertiary care hospital in the North-Batinah region of Oman. Methods: A. baumannii isolates recovered from various clinical samples in the Microbiology laboratory of Sohar Hospital, Oman, during 2015–2019 were retrospectively analyzed. Organism identification and their antibiotic resistance patterns were performed as recommended by the Clinical and Laboratory Standards Institute. Results: A total of 1890 A. baumannii nonduplicate isolates were found from clinical samples of 1326 patients. The isolates were more frequently isolated from elderly patients (40%) and in-patient department patients (67%). Infection/colonization was more common among patients treated in the medicine, intensive-care unit, and surgery departments. A. baumannii strains were highly resistant (50-83%) to most of the tested antibiotics, with the highest against ceftriaxone (83%) and ceftazidime (75%), and lowest against colistin (1%) and tigecycline (8%). Among the isolates, 67% (1265) were MDR strains. Of these, 22%, 32% and 16% were resistant to all six, five and four classes of the tested antibiotics. Conclusion: The study found that the frequency of isolation of MDR A. baumannii isolates in the northern region of Oman is high.
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    Arabic Abstract
    (2021)
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    Arabic Abstracts
    (2021)
    Arabic Abstracts
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    Arabic Abstracts
    (2021)
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    Clinical practice and barriers of ventilatory support management in COVID-19 patients in Saudi Arabia: A survey of respiratory therapists
    (2021) Alqahtani, Jaber; Aldabayan, Yousef; AlAhmari, Mohammed; AlRabeeah, Saad; Aldhahir, Abdulelah; Alghamdi, Saeed; Oyelade, Tope; Althobiani, MalikAlrajeh, Ahmed
    Objective: This study was conducted to determine the clinical practice and barriers of ventilatory support management in COVID-19 patients in Saudi Arabia among respiratory therapists. Methods: A validated questionnaire comprising three parts was distributed to all critical care respiratory therapists registered with the Saudi Society for Respiratory Care through the official social networks. Results: A total of 74 respiratory therapists completed the survey. The mean (±standard deviation) of intensive care unit beds was 67 ± 79. Clinical presentation (54%) and arterial blood gas (38%) were the two main diagnostic tools used to initiate ventilatory support. While protocols for the initiation of invasive mechanical ventilation (IMV; 81%) were widely available, participants had limited availability of protocols for the use of non-invasive ventilation (NIV; 34%) and high-flow nasal cannula (HFNC; 34%). In mild cases of COVID-19, most respondents used HFNC (57%), while IMV was mostly used in moderate (43%) and severe (93%) cases. Regular ventilator check was mostly done every 4 h (57%). BiPAP (47.3%) and full-face masks (45.9%) were the most used mode and interface, respectively, while pressure-regulated volume control (55.4%) and pressure control (27%) were the most used mechanical ventilation modes for COVID-19 patients. In terms of use of proning, 62% used it on IMV, while 26% reported using awake proning. Staff shortage (51.4%), personal protective equipment (PPE) shortage (51.4%), increased workload (45.9%), inadequate training (43.2%) and lack of available protocols and policies (37.8%) were the main barriers. Conclusion: Ventilatory support management of COVID-19 in Saudi Arabia was inconsistent with the global practice, lacked uniformity, and there was limited use of standard protocols/treatment guidelines. Shortage of staff and PPE, increased workload and insufficient training were the most prevalent barriers.
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    Clinical profile and outcome of group B streptococcal colonization in mothers and neonates in Ras Al Khaimah, United Arab Emirates: A prospective observational study
    (2021) AlZuheiri, Shatha; Dube, Rajani; Menezes, GodfredQasem, Samar
    Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS. Conclusion: The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.
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    Convalescent Plasma in COVID-19: To what Degree should Clinicians Rely on Currently Available Data?
    (2021) Alhazzani, Waleed; Jaeschke, Roman
    Editorial(Abstract Not Available)
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    COVID-19-Associated severe autoimmune hemolytic anemia: A rare case report
    (2021) Nair, Lakshmi; Regukumar, AravindBaalamurugan, K
    Autoimmune hemolytic anemia (AIHA) is a very rare presentation of COVID-19, and AIHA due to COVID-19 alone (i.e., in the absence of an associated underlying disorder) is extremely rare. Warm agglutinin disease accounts for the majority of AIHA in general. Here, we report a case of a 23-year-old male with bronchial asthma who was referred to our hospital with SARS-COV-2 infection and severe anemia presenting as acute immune-mediated hemolytic crisis due to warm autoimmune hemolytic anemia (AIHA). Extensive laboratory testing was performed, including polyspecific direct antiglobulin test, complete autoimmune workup and common infections leading to AIHA were ruled out by serology and molecular methods. The patient required multiple blood transfusions and other therapeutic interventions before clinical stabilization. Treatment of new-onset AIHA is always challenging in the presence of an active viral replication; combining immunosuppression with active COVID-19 infection creates extremely difficult diagnostic and management settings, as this case illustrates.
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    Determinants of telerehabilitation acceptance among patients attending pulmonary rehabilitation programs in the United States
    (2021) Almojaibel, Abdullah; Munk, Niki; Goodfellow, Lynda; Fisher, Thomas; Miller, Kristine; Comer, Amber; Bakas, TamilynJustiss, Michael
    Background: Pulmonary rehabilitation (PR) is an interdisciplinary intervention designed to improve the physical status and the psychological condition of people with chronic respiratory diseases. To improve patients' participation in PR programs, telerehabilitation has been introduced. Objective: This study aimed to identify factors that could influence the intention to use telerehabilitation among patients attending traditional PR programs. Methods: This cross-sectional study recruited subjects attending the PR centers in the hospitals of the Indiana State University, United States of America, between January and May 2017. Data were collected using self-administered Tele-Pulmonary Rehabilitation Acceptance Scale (TPRAS). TPRAS had two subscales: perceived usefulness and perceived ease of use. Behavioral intention (BI) was the dependent variable, and all responses were dichotomized into positive and negative intention to use. Multiple logistic regressions were performed to assess the influence of variables on the intention to use telerehabilitation. Results: A total of 134 respondents were included in this study, of which 61.2% indicated positive intention to use telerehabilitation. Perceived usefulness was a significant predictor of the positive intentions to use of telerehabilitation. Duration of respiratory disease was negatively associated with the use of telerehabilitation. Conclusion: Perceived usefulness was a significant predictor of using telerehabilitation. The findings of this study may be useful for health-care organizations in improving the adoption of telerehabilitation or in its implementation. Future telerehabilitation acceptance studies could explore the effects of additional factors including computer literacy and culture on the intention to use telerehabilitation.
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    Effects of apixaban, rivaroxaban, dabigatran and enoxaparin on histopathology and laboratory parameters in Achilles tendon injury: An in vivo study
    (2021) Avci, Sema; Gungor, Huseyin; Kumru, Alper; Sahin, Mahmut; Gezer, Arzu; Gok, Uzeyir; Kara, HakiAvcil, Mucahit
    Objectives: To compare the effects of apixaban, rivaroxaban, dabigatran and enoxaparin on histopathology and blood parameters in rats with Achilles tendon injury. Materials and Methods: Thirty adult, male Wistar albino rats weighting 220–240 g were randomly divided into five (one control and four treatment) groups and placed in a controlled environment. The Achilles tendon was incised and re-sutured in each rat, after which each group was provided the following treatment for 28 days: a) 2 ml saline to the control group, b) apixaban in 1 ml of saline (10 mg/kg/day) +1 ml of saline, c) rivaroxaban in 1 ml of saline (2 mg/kg/day) +1 ml saline, d) dabigatran in 1 ml of saline (30 mg/kg/day) +1 ml of saline, e) enoxaparin (80 μg/kg/day) + 2 ml of saline. Results: Hemogram, biochemical and coagulation parameters differed significantly between the control and treatment groups (P < 0.05). Compared with the control group, in the apixaban group, type I and type III collagen immunoreactivity were severe and moderate, respectively. In the rivaroxaban and dabigatran groups, both type I and type III collagen immunoreactivity were medium and severe, respectively. In the enoxaparin group, type I and type III collagen immunoreactivity were mild and severe, respectively. Conclusion: The higher concentration of type I collagen in the apixaban and dabigatran indicates faster tendon healing in these groups, and the higher concentration of the type III collagen in the enoxaparin group indicates slower healing in this group.
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    Effects of Fear of COVID-19 on Mental Well-Being and Quality of Life among Saudi Adults: A Path Analysis
    (2021) Alyami, Mohsen; de Albuquerque, Julia; Krägeloh, Christian; Alyami, Hussain; Henning, Marcus
    Background: The coronavirus disease 2019 (COVID-19) pandemic has been very disruptive, and thus is likely to result in substantial challenges to mental health. Objectives: This study aimed to investigate the effects of fear of COVID-19 on the mental well-being and quality of life among Saudi adult population and to evaluate the impact of perceived social support. Materials and Methods: This cross-sectional study used an anonymous online survey, where participants were administered the Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, European Health Interview Survey-Quality of Life and Medical Outcomes Study Social Support Survey. A path analysis was used to investigate the proposed theoretical domain structure linking fear of COVID-19 with perceived social support, mental well-being and quality of life. Results: A total of 1029 Saudi adults with a mean age of 33.7 years (SD 11.5) responded to the survey. Descriptive analysis showed that this sample was fearful of COVID-19, anxious and depressed but, at the same time, reported high quality of life and perceived social support scores. Path analysis indicated that increased fear of COVID-19 was directly associated with diminished mental well-being, which in turn was associated with lower quality of life. The beneficial effects of perceived social support were stronger on quality of life than on mental well-being. No direct link was found between fear of COVID-19 and quality of life. Conclusion: These findings emphasize the importance of having effective social systems in place to minimize the impact of the COVID-19 pandemic on mental well-being and quality of life.
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    Efficacy and Safety of Azilsartan and Telmisartan in Hypertensive Patients
    (2021) Kumar, Alok; Khrime, Dorchhom
    Letter to the Editor(Abstract Not Available)
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    Emotional Intelligence and its Association with Academic Success and Performance in Medical Students
    (2021) Altwijri, Sulaiman; Alotaibi, Abdulaziz; Alsaeed, Mohammed; Alsalim, Abdulrahman; Alatiq, Abdulrahman; Al-Sarheed, Saud; Agha, Sajida; Omair, Aamir
    Background: Emotional intelligence (EI) is potentially associated with higher academic performance. However, no study from the Gulf region has previously assessed if EI affects academic success and academic performance in medical students. Objectives: To examine the relationship between EI and academic success and academic performance in a sample of Saudi Arabian medical students. Methods: This cross-sectional, questionnaire study included all 4th–6th year medical students enrolled at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia, in the academic year 2017–18. Eligible students were invited to complete the self-administered Schutte Self-Report Emotional Intelligence Test and the Academic Success Inventory for College Students (ASICS) along with a questionnaire eliciting demographic information between January and April 2018. Academic achievement was assessed based on each student's self-reported grade point average in the most recent examination. Results: Of 377 eligible students, 296 (78%) completed the questionnaires. A significant association was identified between overall EI and ASICS scores (r = 0.197 P < 0.001). EI scores were constant in males and females and the year of study. No statistically significant association was observed between EI and academic success across gender and academic years (P > 0.05 for all values). However, in terms of external motivation and career decidedness by level of study, final-year students had higher scores compared with students in the other two study years (P = 0.02 and P = 0.01, respectively). Conclusion: This study offers primary data on the impact of EI scores on academic success in medical education, and it identified several factors associated with EI and academic success. The findings of this study suggest that EI and academic success are linked, and that both are vital for increasing academic performance.
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    Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent
    (2021) Aljahdli, Emad; Aldabbagh, Ammar; Salah, Fatima; Alsahafi, Majid; Maghrabi, Ashraf
    Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed surgery to treat morbid obesity. Post-LSG leak and stenosis are serious complications that can be associated with significant morbidity and mortality. Objective: The objective was to report the efficacy and safety profile of using specifically designed fully covered self-expandable metallic stent for the treatment of post-LSG complications. Methods: This retrospective study included adult patients who underwent placement of a fully covered esophagogastric, self-expandable metallic stent for post-LSG leak or stenosis. The procedure was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between September 2017 and May 2019. Data regarding demographics, indication for stenting, size of the stent, procedural success and poststenting adverse events were collected. Results: A total of 14 patients met the inclusion criteria, with indication for endoscopic stenting being post-LSG leak in 11 patients and stenosis in 3 patients. The technical success rate of self-expandable metallic stent placement was 100%, and the clinical success was 85.7% (12 of 14 patients). Nausea (71.4%) and vomiting (85.7%) were the most frequent mild adverse events reported. Stent-induced esophageal stricture was the only major adverse event reported in two patients. Conclusion: Placement of specifically designed self-expandable metallic stent for the treatment of post-LSG leak and stenosis is an effective and safe approach. Further studies with larger cohorts are needed to assess the optimal duration needed to treat such complications.
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    FDG PET/CT in the evaluation of a rare case of multisystem involvement in newly diagnosed Rosai–Dorfman–Destombes disease
    (2021) Fathala, Ahmed; Edathodu, JameelaBakshi, Nasir
    Rosai–Dorfman–Destombes disease (RDD) is a rare histocytic disorder with a broad spectrum of clinical presentations. The disease typically presents with lymphadenopathy but may involve multiple systems. Usually, RDD lesions demonstrate intense [18]F-Fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT) imaging due to the inflammation and infiltration with high metabolic process of the disease. Here, we describe a rare case of 37-year-old man who presented with multiple systemic symptoms, including fever, weight loss and bilateral cervical, and inguinal lymphadenopathy who underwent FDG PET/CT for detection of disease extension. This case highlights the role of FDG PET/CT in establishing the disease extent in newly diagnosed RDD and guiding the therapeutic recommendations and for follow-up to monitor the disease response to therapy. To the best of our knowledge, this is the first case report from Saudi Arabia highlighting the role of FDG PET/CT in newly diagnosed RDD.
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    Gemcitabine plus platinum versus docetaxel plus platinum as first line therapy for metastatic nasopharyngeal carcinoma: A randomized clinical study
    (2021) Yang, Hui; Lu, Ying; Xu, Zhuohua; Wei, MingjingHuang, Haixin
    Background:A well-established first-line chemotherapy standard for metastatic nasopharyngeal carcinoma is yet lacking. Objectives:To compare the efficacy and safety of gemcitabine plus platinum versus docetaxel plus platinum regimen as first-line therapies for distal metastatic nasopharyngeal carcinoma. Study Design and Participants: A single center, randomized, open-label, parallel-arm study. The study included 120 patients with metastatic nasopharyngeal carcinoma who met the study requirements. Interventions: Participants were randomized in a 1:1 ratio through a sealed envelope selection. Gemcitabine 1000 mg/m2/d intravenously (IV) for >30 min (days 1 and 8) or docetaxel 75 mg/m2/d IV for 1 h (day 1) were administered to the respective group participants. Nedaplatin 75 mg/m2/d, IV (day 1), cisplatin 75 mg/m2/d IV (day 1) or carboplatin (area under the curve set as 5) IV (day 1) were used in both groups. One cycle duration was 21 days, with 4–6 cycles for all participants. Outcomes: The primary assessed outcomes were progression-free survival (PFS) and overall survival (OS), and the secondary outcomes were short-term efficacy [i.e., response rate (RR) and disease control rate (DCR)] and safety. Results: Seven patients withdrew from the study, and efficacy and adverse reactions were obtained for 113 patients (gemcitabine: 56; docetaxel: 57). Compared with the docetaxel plus platinum group, the gemcitabine plus platinum group had significantly higher RR (71.4% vs. 52.6%, P < 0.05); mPFS (9.7 vs. 7.8 months, P < 0.05), and mOS (20.6 vs. 16.8 months, P < 0.01). The significance was not associated with increased adverse reactions, as both groups showed similar Grades 3 and 4 adverse reactions (P > 0.05). DCR was non-significantly higher in the gemcitabine group (85.7% vs. 75.4%, P > 0.05). Multivariable analysis revealed that time to disease progression, number of involved organs, liver metastasis, and grouping were associated with mPFS and mOS (all P < 0.05). Conclusion: The combination of gemcitabine with platinum is likely superior to that of docetaxel with platinum as first-line treatment for metastatic nasopharyngeal carcinoma.
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    High-Flow nasal cannula treatment in patients with COVID-19 acute hypoxemic respiratory failure: A prospective cohort study
    (2021) Alshahrani, Mohammed; Alshaqaq, Hassan; Alhumaid, Jehan; Binammar, Ammar; AlSalem, Khalid; Alghamdi, Abdulazez; Abdulhady, Ahmed; Yehia, Moamen; AlSulaibikh, Amal; Al Jumaan, Mohammed; Albuli, Waleed; Ibrahim, Talal; Yousef, Abdullah; Almubarak, YousefAlhazzani, Waleed
    Background: Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different respiratory failure causes. While HFNC is used in coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) under weak recommendations, its efficacy remains to be investigated. Objectives: The primary objective was to examine HFNC efficacy in preventing EI among COVID-19 patients with AHRF. Secondary objectives were to determine predictors of HFNC success/failure, mortality rate, and length of hospital and intensive care unit (ICU) stay. Patients and Methods: This is a prospective cohort study conducted at a single tertiary care centre in Saudi Arabia from April to August 2020. Adult patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded patients who were intubated or managed with non-invasive ventilation before HFNC. Results: Forty-four patients received HFNC for a median duration of 3 days (interquartile range, 1–5 days). The mean age was 57 ± 14 years, and 86% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients in whom HNFC treatment failed had a higher risk of death (52% versus 0%; P = 0.001). After adjusting for confounding factors, a high SOFA score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04–1.93; P = 0.025; and HR, 0.61; 95% CI, 0.42–0.88; P = 0.008, respectively). Conclusions: One-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure.
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    IRMC Abstracts
    (2021)
    IRMC Abstracts
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    Ketamine for Sickle Cell Vaso-Occlusive Crises: A Systematic Review
    (2021) Alshahrani, Mohammed; Alghamdi, Mohannad
    Introduction: Vaso-occlusive crisis (VOC) is one of the main causes of hospital admission in patients with sickle cell disease (SCD). Ketamine is often used as an adjuvant to opioids to control sickle cell crisis however, there is a lack of evidence about its safety and efficacy for VOC in SCD patients. Objective: To synthesize evidence from published reports about the efficacy and safety of ketamine in the management of acute painful VOC in both pediatric and adult SCD patients. Methods: A systematic literature search of PubMed, Scopus, Web of Science, EBSCO and Cochrane Library was conducted, up to March 2019. Studies reporting the analgesic effects and side effects of ketamine in the management of acute painful VOC in pediatric and adult SCD patients were included. The primary outcome measure was improvement in pain scale, and the secondary outcomes were reduction in opioid utilization and side effects. Studies were narratively summarized in this review. Results: Fourteen studies (with a total of 604 patients) were included in the final analysis. Several case reports and case series showed that ketamine significantly reduced pain scales and opioid utilization in both populations. The only randomized controlled trial available showed that ketamine was noninferior to morphine in reducing pain scores, but had a higher incidence of nonlife-threatening, reversible adverse effects. However, a retrospective study of 33 patients showed a higher pain score in the ketamine group with an acceptable short-term adverse effect. Conclusion: Ketamine has a potentially comparable efficacy with other opioids in reducing the pain during VOC in SCD patients. However, it also likely has a higher rate of transient adverse events. Owing to the lack of published randomized controlled trials, current evidence is not sufficient to confirm the safety and efficacy of ketamine. Future well-designed randomized controlled trials are strongly recommended.