King Saud Medical City Research Articles

Relationship between Genotype Variants and the Age of First Acute Splenic Sequestration in Patients with Sickle Cell Disease in a Tertiary Center of Saudi Arabia

BACKGROUND: Acute splenic sequestration crisis (ASSC) is one of the earliest life-threatening complications of sickle cell disease (SCD). Here, we aimed to identify the relation between the age of the first splenic sequestration episode and SCD variants. Episodes of acute splenic sequestration before 1 year of age are associated with a higher risk of recurrence. METHODS: We carried out a retrospective chart review study from the medical charts of SCD patients ≤12 years admitted to the Department of Pediatric Hematology King Saud Medical City, Riyadh with the first episode of ASSC and no other complications from January 2014 to December 2019. RESULTS: We included 47 patients (46.8% males, 53.2% females) diagnosed with SCD and having experienced their first ASSC in this review. The mean age of the patients at which the first episode of splenic sequestration happened was 3.26 years. The genotype distribution in the population was 74.5% HBSS, 21.3% HBS β0 thalassemia, and 4.3% HBSβ+ thalassemia. The crisis precipitated with fever in 74.5% of patients. Treatment included programmed blood transfusion (46.2%), splenectomy (29.8%). The recurrence rate after the first episode of ASSC was 59.6%. The high rate of recurrence was mainly due to the early age of presentation and poor compliance with suggested treatment. The use of hydroxyurea in 19.1% of patients showed a decrease of recurrence of ASSSC by 66.6% of patients. CONCLUSION: The study concluded that the HBSS variant of SCD had the earliest presentation with the first episode of ASSC but the differences were numerical without any statistical difference. Earlier age of presentation is associated with a higher rate of recurrence, but the difference was numerical not statistically significant. Our study shows hydroxyurea decreased recurrent splenic sequestrations; further research would help in establishing its role

The Intricate Relationship Between Client Perceptions of Physician Empathy and Physician Self-Assessment: Lessons for Reforming Clinical Practice.

Objectives: Clinical empathy is an important predictor of patient outcomes. Several factors affect physician’s empathy and client perceptions. We aimed to assess the association between physician and client perception of clinical empathy, accounting for client, physician, and health system factors. Methods: We conducted a hospital-based cross-sectional study in 3 departments (family medicine, internal medicine, and surgery) of King Saud Medical City in Riyadh, Saudi Arabia. We interviewed 30 physicians and 390 clients from 3 departments. Physicians completed the Jefferson Scale of Empathy (JSE) and the clients responded to the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). We used a hierarchical multilevel generalized structural equation approach to model factors associated with JSE and JSPPPE and their inter-relationship. Results: Mean (SD) score of client-rated physician empathy was 26.6 (6) and that of physician self-rated was 111 (12.8). We found no association between the 2 (b = 0.06; 95% confidence intervals CI: −0.1, 0.21), even after adjusting for client, physician, and health system factors. Physician's nationality (0.49; 0.12, 0.85), adequate consultation time (1.05; 0.72, 1.38), and trust (1.33; 0.9, 1.75) were positively associated whereas chronic disease (−0.32; −0.56, −0.07) and higher waiting times (−0.26; −0.47, −0.05) were negatively associated. Conclusion: A physician's self-assessed empathy does not correlate with clients’ perception. We recommend training and monitoring to enhance clinical empathy.

External Validation of 4C ISARIC Mortality Score in Critically ill COVID-19 Patients from Saudi Arabia.

Background:ISARIC mortality score is a risk stratification tool that helps predict the in-hospital mortality of COVID-19 patients. However, this tool was developed and validated in a British population, and thus, the external validation of this tool in local populations is important.Objectives:External validation of the ISARIC mortality score in COVID-19 patients from a large Saudi Arabian intensive care unit (ICU).Methods:This is a retrospective study that included all adult patients with COVID-19 admitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, from March 2020 to June 2021. Patients who were pregnant or had pulmonary tuberculosis/human immunodeficiency virus were excluded along with patients with missing variables. Data were collected to calculate the ISARIC mortality score and then fitting receiver operator characteristic curve against patients’ outcome.Results:A total of 1493 critically ill COVID-19 patients were included. The mortality was 38%, the area under the curve of the score was 0.81 (95% confidence interval [CI]: 0.79–0.83, P < 0.001) and the cutoff value correctly classified 72.7% of the cohort. The cutoff value of >9 had sensitivity of 70.5% (95% CI: 66.6–74.3); specificity, 73.97% (95% CI: 71–76.8); positive predictive value, 62.4% (95% CI: 59.5–65.2) and negative predictive value, 80.2% (95% CI: 78.2–82.4).Conclusion:The ISARIC score was found to have excellent predictive ability for mortality in critically ill COVID-19 patients in our Saudi Arabian cohort. A cutoff score of >9 was the optimal criterion.

Blood Consumption in Placental Abnormalities

Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the burden on the blood bank caused by excessive use of blood and blood products. Methodology: This is a retrospective study conducted at King Saud Medical City Maternity Hospital in Riyadh, Kingdom of Saudi Arabia, from January 2019-September 2020. It includes 170 cases diagnosed with abnormal placentation (low-lying placenta or placenta previa, accreta, increta, or percreta). The primary purpose was to measure consumption of blood and blood products in cases of placental abnormalities and to investigate how much this affects blood bank capacity. A secondary aim was to report rates of admission to the ICU and maternal mortality. Results: This study included 170 women with placental abnormalities. Placental previa had occurred in 96 cases, followed by placenta accreta in 46 cases, placenta increta in 13 cases, placenta percreta in 8 cases, and low-lying placenta in 7 cases. Most patients (93) were treated with a Bakri balloon to prevent hemorrhage, but 38 patients had a hysterectomy. The average estimation of blood loss was 2210 ml, with no maternal mortality. An average of 3.39 units of packed red blood cells (PRBC) with a maximum of 20 units, 2.12 units of fresh frozen plasma (FFP) with a maximum of 20 units, and 0.7 units of packed platelets (PP) with maximum of 12 units consumed per patient. Eighty-seven patients (51.2%) were admitted to the ICU and 83 others (48.8%) were admitted to the high dependency unit. Conclusion: Blood and blood product volumes had a linear relationship with the severity of placental abnormalities and estimated blood loss. Therefore, blood bank services should be available to save mothers’ life.

Risk Factors for Dental Erosion After Bariatric Surgery: A Patient Survey

IntroductionTreatment of obesity by bariatric surgery has increased in recent years. Reported side effects that may predispose to dental erosion include reflux, vomiting, and an increased frequency of intake of food and drink.ObjectiveThe aim was to investigate long-term dietary behaviour and experiences related to symptoms of dental erosion at least 5 years after bariatric surgery.MethodsAn online questionnaire study was conducted amongst 250 patients who had undergone bariatric surgery at King Saud Medical City in Saudi Arabia 5 years ago or more. It comprised 36 questions on demographic data, dietary habits, general health, dental health, and oral symptoms. The data were analysed using Chi-square and sign tests (significance level P < .05).ResultsA significant increase in acidic reflux and vomiting was found after bariatric surgery and appeared to increase with time after surgery. Also, a significant association between presence of acidic reflux and symptoms of dental erosion was found. However, 68.5% reported improved overall well-being after surgery. The response rate was 21.6% (most were female, aged 30-59 years). Respondents were generally not advised to visit a dentist in connection with bariatric surgery.ConclusionsThis long-term cross-sectional study suggests a time-dependent, increasing occurrence of vomiting and acidic reflux after bariatric surgery. Vomiting and reflux became even more common after 5 to 10 years. A significant relationship emerged between a high frequency of acidic reflux and a high frequency of oral symptoms related to dental erosion. Daily occurrence of general symptoms related to dumping syndrome were reported by the majority. However, in a 5- to 10-year perspective, general symptoms related to dumping syndrome and symptoms from dental erosion did not seem to detract from the respondents’ overall satisfaction with daily living. Oral health problems might be reduced if patients who had bariatric surgery were referred to a dentist for prevention and monitoring.

Early oral switch to combined cefixime therapy for management of osteoarticular infections in pediatric sickle cell disease patients: A descriptive analysis

BackgroundThe treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. MethodsThis study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1–16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. ResultsA total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. ConclusionThe study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.

Characteristics of healthcare workers with COVID-19: A retrospective descriptive study in a quaternary care center in Riyadh, Saudi Arabia

BackgroundThe aim of this study was to describe the epidemiological and clinical presentation of Healthcare Workers (HCWs) affected by COVID-19. MethodsA cross-sectional retrospective study was conducted at King Saud Medical City (KSMC), Saudi Arabia (KSA). All KSMC employees who acquired COVID-19 between March 22nd to July 15th, 2020 have been included. Their data has been anonymously analyzed. FindingsDuring the study period, among the 12000 HCWs working at KSMC, 9.75% tested positive for COVID-19. The source of HCWs infections was mainly community acquired (85%) which included incidences of transmission in hospital dormitories. Transmission among coworkers was the main source of hospital acquired incidences. Direct patient care was reported in 99.8% of study subjects among the high-risk areas, compared to 3.4% in low-risk areas (p-value <0.001), 12-h shifts were more common in the medium and high-risk areas, and at least one symptom was reported by 93.1% of HCWs in high-risk areas compared to 81.6% in low-risk areas (p-value <0.001). ConclusionIn KSA, for HCWs, reducing lapses in compliance with masking in non-patient care areas should be considered. In KSA the role that hospital dormitories play in the community transmission of COVID-19 among HCWs need further studies.

99mTc-Sulfur Colloid SPECT/CT in Diagnosis of Splenogonadal Fusion.

A congenital abnormal connection between an accessory spleen and a gonad is called splenogonadal fusion. The parent of a 3-y-old boy brought him to King Saud Medical City because he had left scrotal swelling that had begun 1 y previously. 99mTc-sulfur colloid (SC) imaging has superior sensitivity and specificity in targeting the liver, spleen, and bone marrow, in that these are the only organs that 99mTc-SC can visualize. Furthermore, if these tissues appear anywhere other than their usual locations, such as in the case of an accessory spleen, 99mTc-SC imaging can identify them even without biopsy or-in the case of splenogonadal fusion-orchiectomy. In the current case, the patient underwent laparoscopy, the masses were removed, and orchiectomy was avoided. Histopathologic examination confirmed normal splenic tissue, matching the imaging results.

Emergence of Colistin Resistance against Multi-Drug Resistance Microorganisms and its Clinical Outcomes

Background: Over the past decade, excessive use of Colistin against multidrug-resistant, Gram-negative bacteria have resulted in the evolution of resistance to Colistin. Objective: To evaluate efficacy of Colistin against multidrug-resistant organisms (MDRO), the emergence of Colistin resistance and its effects on clinical outcomes. Study Design: Retrospective study Place and Duration of Study: King Saud Medical City (KSMC) from 1st October 2015 till 31st January 2016. Methodology: Forty-three patients, resistant to Colistin on blood culture and sensitivity were enrolled. Results: Colistin was not effective at breaking the MDRO. The results revealed no significant impact of Colistin on site of infection such as chest, urinary tract or skin (p=0.612), types of organisms (p=0.629), length of hospital stay and the IV Colistin days (p=0.097 and p=0.166 respectively) in the past 12 months. The positive finding was that more than two third (76.7%) of the ICU patients were alive. Conclusion: Emergence of Multi drug resistance organism is matter of global concern that caused the ineffectiveness of many potent antibiotics and led to the drastic clinical outcomes. Collaboration between medical, paramedical, and administrative staff, with strict implementation of preventive protocol can slow down the velocity of microbial multidrug resistance. Keywords: Multi-drug resistant, Colistin, Outbreak, Intensive care unit, critically ill patients

Efficacy Assessment of High Dose Colistin against Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) in Critically Ill Patients: A Retrospective Non-Inferiority Trial

Background: Colistin is an effective treatment option, recommended for carbapenem resistant gram-negative bacilli (CR-GNB) in critically ill patients. Due to high nephrotoxicity, dose management of Colistin is a tough decision to make. At standard dosage the efficacy of Colistin is not well defined. Consequently, strategies involving higher dosages were suggested. Objective: To evaluate the high dose of Colistin as non-inferior to standard dose in the treatment of CR-GNB in critically ill patients. Study Design: Retrospective comparative study Place and Duration of Study: Intensive Care Unit, King Saud Medical City Riyadh, Saudi Arabia from 1st January 2015 to 31st December 2017. Methodology: One hundred and ninety two patients that met the inclusion criteria from all participants were further divided into two groups. Group H (High dose) given the high dose of Colistin (9 million units intravenously (IV) loading dose, and then 9 million units/day in 2 or three divided doses) whereas group S was administered with standard dose (no loading dose, 6 million units/day). The primary endpoint of the study was the assessment of nephrotoxicity after the start of Colistin and secondary endpoints were the mortality within 14 days of commencing Colistin along with clinical effects and microbial clearance upon completion of treatment. Results: The results of the study established the non-inferiority of high dose of Colistin for the renal safety and also showed significant improvement in microbial clearance and length of ICU stay as compared to the standard dose. The other secondary end points such as mortality (p = 0.99), length of hospital stay (p = 0.39), and global improvement (p value of 0.06) revealed no significant difference between the two groups. Conclusion: The high dose of Colistin for the treatment of carbapenem resistance gram negative bacilli (CRGNB) was as safe as the standard dose for renal safety. But we also found that it also accelerates microbial clearance and reduces the time spent in the intensive care unit. Key words: Colistin, Colestimethate sodium, Gram negative bacteraemia, Sepsis, Multi-drug resistant organisms, Acute kidney injury

Causes of Hospitalization for Systemic Lupus Erythematosus in Saudi Arabia Compared With the Global Setting: A Retrospective Single-center Observational Study.

Background: This study sought to evaluate the main causes of hospitalization of patients with systemic lupus erythematosus (SLE) in a tertiary health center in Saudi Arabia.Methods: A retrospective observational study was performed for all the SLE patients admitted to King Saud Medical City between 2016 and 2019. The primary reason for hospitalization was determined by the primary physician caring for the patient at the time of admission.Results: Of the 98 hospitalizations for SLE, 49% of patients were admitted from the emergency department (ED) and 51% from the rheumatology clinic. The most common reason for hospitalization was lupus flare (68.4%) followed by infection (20.4%). The lupus flare patients commonly presented with musculoskeletal (MSK)symptoms (34.6%), renal manifestations (25.5%), and skin rash (24.5%), whereas patients admitted with infection were commonly diagnosed with community-acquired pneumonia (12.2%). Other hospitalization causes were obstetric complications, adverse drug reactions, and thrombosis. Intensive care unit (ICU) admission was necessary for 7% of patients due to acute respiratory distress syndrome (ARDS) and pulmonary hemorrhage (28.6%) or other reasons (14.1%), such as pleural effusion, cardiac tamponade, and thrombotic thrombocytopenic purpura (TTP).Conclusions: The two most common reasons for SLE hospitalization were lupus flare and infection. Lupus flare was mainly due to MSK, renal, and dermatologic manifestations. The most common infection leading to hospitalization was community-acquired pneumonia, and ICU admission was mainly due to ARDS and pulmonary hemorrhage.

Knowledge and attitude towards antibiotics use among mothers attending pediatric clinics in king Saud medical city, Riyadh, Saudi Arabia 2021

Background: Upper respiratory tract infections (URTIs) are particularly common in children and are a major source of antibiotic misuse, which leads to antibiotic resistance development. Aims: To assess the Knowledge and Attitude towards antibiotics use among mothers Attending pediatric clinics in King Saud medical city |(KSMC), Riyadh, Saudi Arabia. Materials and Methods: This cross sectional study was conducted in pediatric clinics in KSMC, Riyadh, Saudi Arabia between March 2021 and August 2021. Desired population in this study was mothers of children aged ≤ 14 years Attending pediatric clinics in KSMC, Riyadh, they were selected via a convenient non-probability sampling technique. Data was collected using self-administered questionnaire and analysis was performed using (SPSS). Results: A total of 422 mothers participated in this study. 77.3% of the parents had poor knowledge of the use of antibiotics in children for URTIs, even though the majority of the participants (93.4%) considered physicians as the primary source of information. Only 17.3% of the participants strongly agreed that most of the URTIs are of viral origin and only 12.3% of the participants correctly know that antibiotics have side effects and 39.8% strongly agreed that the inappropriate use of antibiotics reduces their efficacy and drives bacterial resistance. Fever and ear ache were the most common reasons for which parents visited the physician. Additionally, mothers have child with history of chronic disease considered as have good knowledge compared to mothers not have child with history of chronic disease, with significant association (P = 0.007). Conclusion:The relationship between mothers and physicians is trusted, but Saudi mothers are insufficiently informed about antibiotics' use for URTIs, which results in inappropriate attitudes and practices. Educational interventions for both parents and physicians will reduce unnecessary antibiotic use and resistance.

Prevalence and Outcome of Cholelithiasis in Children with Sickle Cell Disease at King Saud Medical City, Saudi Arabia

BACKGROUND: Sickle cell disease (SCD) is one of the common hereditary blood diseases in Saudi Arabia. The hepatobiliary system is one of the common organs to be affected either directly from the sickling process or indirectly as a result of chronic hemolysis and multiple blood transfusions. Cholelithiasis is one of the common complications of sickle cell anemia. OBJECTIVES: To assess the prevalence of cholelithiasis in children with SCD treated at King Saud Medical City (KSMC); Pediatric Hospital in Saudi Arabia and describe the outcome, management, and clinical profile of children with SCD and cholelithiasis. MATERIALS AND METHODS: This is a retrospective descriptive study conducted at a single tertiary health care center, KSMC, Pediatric Hospital, Riyadh from 2012 to 2019 on 277 patients aged &lt;14 years. Medical records of all pediatric patients with SCD included in the study were identified and reviewed. RESULTS: From total of 277 patients, 87 (31.4%) had cholelithiasis. Forty three (49.4%) of them were female and 44 (50.6%) were male. From 87 patients who developed cholelithiasis, 15 patients aged &lt;5 years old, 50 aged (5–10 years), and 22 aged &gt;10 years. According to the genotype of sickle cell (SS), the occurrence of cholelithiasis were (75.9% in SS, 23% in S/BETA 0 and 1.1% in S/BETA+). The majority were symptomatic (59.8%) compared to asymptomatic (40.2%) and 26 patients (29.9%) were complicated. In our study, we found that complications for the gallstones were acute calcular cholecystitis, chronic cholecystitis, direct hyperbilirubinemia, transaminitis, and acute pancreatitis. CONCLUSION: The prevalence of cholelithiasis in our study was significant. The large majority of patients were symptomatic. Cholecystectomy must be strongly recommended in symptomatic patients.

Outcomes and complications of pharmacological induction of labor in women with previous one cesarean section, in a referral center in Saudi Arabia.

Objectives:To review the outcomes, success rate, and safety of women undergoing labor induction following a cesarean section.Methods:This study is a retrospective review of all patients who had previous cesarean sections and were induced with prostaglandin (PGE2) or for various indications. This study was carried out at King Saud Medical City, Riyadh, Saudi Arabia between 2014 and 2019. Inclusion criteria were pregnant women with previous one lower segment cesarean section, singleton cephalic fetus, normal placenta, and passed 18 months or more from previous cesarean section.Results:Records of 145 women were reviewed in the study, and the success rate of induction of labor was 59.3% (95% CI: 50.8-67.4%). The rate of uterine rupture was 1.4% and maternal complication was 4.8%. The induction success rate is higher in women who had previous successful vaginal delivery than those who had no previous vaginal delivery.Conclusions:Labor induction can be considered safe in carefully selected cases owing to its good chance of success and no significant increase in maternal or fetal mortality and morbidity.

LIFESTYLE HABITS AMONG KSMC PHYSICIANS

Background: Most medical research today focuses on three aspects: stress and burnout at work mental illness such as depression and suicide and drug addiction. On the other hand, little research has been done among physicians so far on behavioral and preventive interventions including healthy lifestyles habits among physicians. Therefore, the aim of this study to assess the lifestyle habits practicing among KSMC physicians, Saudi Arabia. Methodology: This is an analytical cross-sectional study conducted in Kingdom of Saudi Arabia, Riyadh (including all physicians in King Saud Medical City), from April, 2020 till December 2021 using pre-designed questionnaire which was distributed online. The questionnaire was prepared to assess the demographic factors, physical activity, eating pattern, health concern. Statistical Package for the Social Sciences (SPSS) version 23 for data analysis. Results: we were able to collect data from 104 physicians in response to our questionnaire where all of them where medicine physicians and 57.7 % of them were males. The prevalence of overweight and obesity were 18.4 % and 27.2 % respectively. Moreover, 55.8 % of physicians reported that they did not practice any type of exercises however, 32.7 % practiced endurance or aerobic exercise. Furthermore, 24 % of the participants reported being on diet where 8.7 % were on keto diet and 1.9 % were on Mediterranean diet. In our study, poor exercise and diet habits were associated with poor BMI, poor sleep pattern and higher prevalence of medical conditions. Conclusion: We found that there is high prevalence of obesity and overweight among physicians at KSMC, Saudi Arabia which in addition to poor sleep pattern and high incidence of other medical conditions were significantly associated with the poor life-style habits including low level of practicing exercise and having health diet regime.

The effectiveness of the ERP program in raising the efficiency of supply management – A field study on King Saud medical city in Riyadh –: مدى فاعلية تطبيق (برنامج موارد ERP) في رفع كفاءة إدارة الإمداد بالمدن الطبية السعودية – دراسة ميدانية على مدينة الملك سعود الطبية بالرياض –

The current study aims to demonstrate the effectiveness of the ERP resource program in raising the efficiency of supply management at King Saud Medical City in Riyadh. This is in light of the high demand witnessed for a resource planning program and system by medical institutions in Saudi Arabia. To achieve the main objective of this study, the researcher adopted the descriptive and analytical approach as an approach to preparing the study. In addition to the use of the questionnaire as a main tool for collecting data from the members of the study population, who number (85) employees of the users of (ERP Resources Program) in the Supply Department in King Saud Medical City in Riyadh. Following the collection and analysis of data from the study community, a set of results were reached, the most prominent of which are: Emphasizing the existence of a positive statistically significant relationship between (ERP Resource Program) in its various roles (achieving compatibility and effectiveness, managing and planning medical stocks, effective control) in King Saud Medical City, And the degree of improvement in the efficiency of the dimensions of supply management (economic cost, response and cooperation) in King Saud Medical City in Riyadh, where the value of the correlation coefficient was 0.996. In light of the results reached, several recommendations were suggested, the most important of which are: the need to enhancing the best use of the ERP system in reducing storage costs within the departments and departments of King Saud Medical City. The maximum benefit from the ERP system must be made to accelerate the decision-making process within King Saud Medical City in Riyadh.

FACTORS THAT DELAY RETURN TO WORK OF COVID-19 POSITIVE HEALTH CARE WORKERS AT KSMC , MARCH- AUGUST 2020

This study about Factors that delay return to work of COVID-19 positive health care workers at King Saud medical city Riyadh Saudi Arabia.2020 Coronaviruses (CoV) are a large family of RNA viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). The aim of this study is to determine the factors that delay return to return to work among COVID-19 positive HCPs also to study the relationship of the associated risk factors and the delay in return to work among positive COVID-19 HCPs and to minimize the delay in return to work among COVID-19 positive HCPs which will maintain staffing levels to provide adequate care to all patients. Health care professional is defined as all staff in the health care facility involved in the provision of care for a COVID-19 infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items or environmental surfaces. Sampling method: The design of the sampling for this study will be Stratified Random Sampling (StRS) cross section study. This study about Factors that delay return to work of COVID-19 positive health care workers at King Saud medical city Riyadh Saudi Arabia mc.2020 Coronaviruses (CoV) are a large family of RNA viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). The aim of this study is to determine the factors that delay return to return to work among COVID-19 positive HCPs also to study the relationship of the associated risk factors and the delay in return to work among positive COVID-19 HCPs and to minimize the delay in return to work among COVID-19 positive HCPs which will maintain staffing levels to provide adequate care to all patients. Health care professional is defined as all staff in the health care facility involved in the provision of care for a COVID-19 infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items or environmental surfaces. Sampling method: The design of the sampling for this study will be Stratified Random Sampling (STRS) cross section study will use SPSS to analysis.

The impact of emergency antibiotic administration time on patients with sepsis.

Objectives:To assess the mortality benefits of timely antibiotic treatment of adults present at the emergency department with sepsis and compare one-hour administration and 3-hour administration starting from the time of triage.Methods:In this retrospective study, we used secondary data analysis to investigate the utility of the National Early Warning Score as a predictor of mortality in sepsis patients between July 2018 and June 2019, at the Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia. The patients were grouped into 2 based on the time interval from triage to the first antibiotic administration: the immediate group received antibiotics within the first hour, and the early group received antibiotics between one and 3 hours. The primary outcome of interest was in-hospital mortality.Results:Out of 495 septic patients, only 292 patients (mean age of 56.3 ± 23.6 years) met the inclusion criteria. Two hundred fifty (85.6%) patients received antibiotics within one hour of triage (immediate), while 42 (14.4%) patients received antibiotics between one and 3 hours (early). Overall, in-hospital mortality was 31.8%. The mortality rates among patients who received early antibiotic was 31.6% and who received immediate antibiotic was 33.3%, with a p-value of 0.823.Conclusion:Our findings did not support immediate antibiotic administration over early administration in patients with sepsis. However, further studies are recommended to investigate the effects of antibiotic timing on the outcome of severe sepsis patients.

PERCEPTIONS, ATTITUDE AND PRACTICES TOWARD ELDERLY DEPRESSION AMONG PRIMARY HEALTH CARE PHYSICIANS, RIYADH, SAUDI ARABIA 2021

Background: Elderly people need care services in particular to maintain a high quality of life and health status. Managing the health needs of geriatric patients is part of the continuity of care family physicians provide to their patients. Aims: to assess physicians attitude, perception and practice toward depression in elderly in primary care sitting. Methodology: A cross- sectional study to assess primary health care physicians attitude and perceptions and practices toward depression in elderly patients in primary health care centers of King Saud medical city in Riyadh, kingdom of Saudi Arabia using self-administrated questionnaire Results: We received 210 responses to our questionnaire with response rate of 100 % where 51 % of them were females. Furthermore, 37 % of them have experience in PHC less than 5 years while 32 % have experience for more than 10 years. PHC physicians routinely screen for sleep disturbance (79 %), loss of interest or pleasure (79 %), sad mood (72 %), and decreased energy (63 %) in order to diagnosis of depression. Moreover, we found that 56 % of physicians would use clinical guidelines for diagnosis and treatment of geriatric depression where PHQ-9 was the most reported used tool (28 %) followed by geriatric depression scales (24%). Moreover, 71 % of physicians would refer patients with depression to psychiatry and 65 % to CBT instead to prescribe medications including SNRI (29 %), TCA (17 %) and SSRI (2 %). Moreover, the main barriers to adequate diagnosis and treatment of elderly depressed patients were rejection of patients to treatment (22 % of them indicated it as major problem) and difficulty for access to mental health care in our community (19 % of them indicated it as major problem). Conclusion: we found that most of physicians in Riyadh show high positive attitude toward depression of elderly however, there is some limitations in knowledge about symptoms of depression and restriction to guideline. Main barriers to adequate diagnosis and treatment of elderly depressed patients were rejection of patients to treatment and difficulty for access to mental health care in our community.

Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants' demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group's time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6-20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.