Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from academic hospital in Saudi Arabia.

The coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, of which 5% required intensive care, especially mechanical ventilation. The prognosis depends on several factors including comorbidities. This study was conducted to identify the comorbidities associated with the intensive care unit (ICU) admission in elderly with COVID-19 admitted to a tertiary academic hospital. A retrospective cross-sectional study was conducted at KSUMC including all hospitalized patients (age ≥ 65 years) with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted between March 2020 and August 2021. Data collection included sociodemographic characteristics, underlying comorbidities, and the Charlson comorbidity index. Comorbidities were compared between the elderly patients with COVID-19 admitted to the ICU and those not admitted to the ICU. The odds ratios were calculated and a P value of < .05 and 95% confidence intervals were used to report the statistical significance A total of 444 patients (ICU = 147, non-ICU = 297) were included in the study. The study revealed that elderly patients with COVID-19 admitted to ICU had a higher rate of mortality (n = 64, 67.4%; P < .0001) and a higher proportion of them had shortness of breath (n = 97, 38.3%; P = .007) compared to the elderly patients not admitted to ICU. The mean length of stay (P < .0001), and weight (P = .02) among ICU patients were higher than the values for the non-ICU group, while the mean oxygen saturation (SpO2; P = .006) was lower among the ICU group. The comorbidities that demonstrated a statistically significant association with ICU admission were heart failure (P = .004, odd ratio (OR) = 2.02, 95% confidence intervals (CI) [1.263, 3540]), chronic obstructive pulmonary disease (COPD; P = .027, OR = 3.361, 95% CI [1.080, 10.464]), and chronic kidney disease (P = .021, OR = 1.807, 95% CI [1.087, 3.006]). The current study identified that the comorbidities such as COPD, heart failure, and factors like SpO2 and length of stay are associated with an increased risk of ICU admission in elderly patients with COVID-19. These findings highlight the clinical implications of comorbidity among geriatric population.

Empathy among Saudi Residents at a Tertiary Academic Center during the COVID-19 Pandemic and Its Association with Perceived Stress.

Background and Objectives: Empathy is an important attribute of a healthy doctor-patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels of empathy and to identify if there is an association with stress in general and across the demographic and training characteristics of residents. Materials and Methods: A cross-sectional questionnaire-based study was carried out from December 2020 to March 2021 among residents training at a tertiary academic center in Riyadh, Saudi Arabia. Empathy and perceived stress were measured using the Jefferson Scale of Empathy (JSE) and the Perceived Stress Scale (PSS). Results: A total of 229 residents participated. The mean JSE score was 105.25 ± 15.35. The mean JSE scores were significantly higher among residents training in pediatrics (mean difference (MD) = 17.35, p < 0.001), family medicine (MD = 12.24, p = 0.007), and medical specialties (MD = 11.11, p = 0.012) when compared with surgical specialties and anesthesia. In addition, residents who worked 1-4 on-calls per month had a higher mean JSE score (MD = 11.23, p = 0.028) compared with those who worked 7 or more on-calls. Lastly, no correlation between empathy and perceived stress was detected in the whole sample (r = -0.007, p = 0.913); however, there was a correlation among residents training in medical specialties (r = -0.245, p = 0.025). Conclusion: Residents in our study had empathy levels comparable with Asian but lower than Western residents. We recommend qualitative studies that explore potential factors that might affect empathy among residents and studying the association between empathy and perceived stress among medical residents. Postgraduate curricula should incorporate interventions that foster a more empathetic doctor-patient relationship.

Health and Hygiene as a Factor of Destination Competitiveness: A Comparative Study Using Synchronic and Diachronic Data

Health and hygiene is a provision of conditions to maintain public health, and make tourists feel safer and tourism destinations become more competitive. The existing research has been conceptual or critical, and scarce empirical studies focus mainly on single-case studies. Therefore, this study came to fill a knowledge gap and analyse the importance and relationship between health and hygiene and destination competitiveness through a case study of the world's most visited tourism destinations. The study employed three techniques to analyse the synchronic and diachronic data of the destinations, i.e. comparative analysis, graphical analysis, and One-way ANOVA. The results show that health and hygiene are the most important of the 14 pillars measuring destination competitiveness. The graphical analysis indicates a positive correlation between the health and hygiene pillar and overall competitiveness. This study should be an impetus for applied scientific research for public health policy and tourism competitiveness.

Which Volunteering Settings Do Medical Students Prefer During a Novel Respiratory Virus Pandemic? A Cross-Sectional Study of Multiple Colleges in Central Saudi Arabia During the COVID-19 Pandemic.

Purpose: Novel respiratory virus outbreaks are a recurring public health concern. Volunteering medical students can be a valuable asset during such times. This study investigated the willingness of medical students to volunteer during the coronavirus disease of 2019 (COVID-19) pandemic and the barriers to doing so, considering the possibility of exposure to COVID-19 and mode of contact. Patients and methods: This cross-sectional study was conducted using a self-administered online questionnaire adapted from the literature. The questionnaire comprised four parts: demographic variables, COVID-19-related variables, willingness scale, and barrier scale. The target population was medical students at four different colleges in Riyadh, Saudi Arabia. Results: A total of 802 students participated in the study. A small proportion of students (10.6%) were willing to participate in volunteering activities that could involve contact with patients with COVID-19 as compared to other settings (39.4-43.4%). More than one-quarter of students (26.8%) had risk factors for severe COVID-19. The main barrier to volunteering was the concern of transmitting the infection to family members (76.8%). Registration to receive the COVID-19 vaccine was positively associated with more willingness to volunteer (ß=0.17, p <0.001), whereas residing in a household with an elderly person was negatively associated (ß=-0.13, p <0.001). Female sex was positively associated with higher barrier score (ß=0.12, p <0.001). Conclusion: Medical students were more willing to volunteer in activities that did not involve direct contact with patients with COVID-19. A considerable proportion of participants had risk factors for severe illness. Sharing a household with an elderly person or child was associated with lower willingness to volunteer. Organizers of volunteering activities should offer various volunteering options considering the risk of infection; and be mindful of barriers to volunteering, especially risk factors for severe illness and eldercare and childcare responsibilities.

Diabetes mellitus and ischemic heart disease patients in Babylon governorate

Ischemic heart disease is the most common cardiovascular disease and causeof death in both males and females. Our study, conducted in Babylon governorate, aim of study To determine association between diabetic millets with risk factors among patients with ischemic heart disease in shaheedAlmuhrab center of cath& cardiac surgery in Hilla city. The method of study A cross-sectional study was conducted in center shaheedAlmuhrab center of cath& cardiac surgery The apparent association of diabetic Miletus with age, gender, and socioeconomic status is highly significant (0.019,0.047 and 0.045) respectively. And family history is not significant with diabetic Miletus p-value 0.142. While diabetes mellitus with hypertension, chronic kidney disease, and COVID-19 are highly significant (0.0001,0.029 and 0.01) respectively, whereas diabetic Miletus, smoking and exercise are significantp-value (0.013 and 0.005) respectively, but drinking alcohol is not significant p-value 0.410. Even though waist circumference and body mass index are linked to diabetes, they are very importantp-value (0.002 and 0.006) respectively. conclusion show result risk factor diabetic highly association between age,gender, socioeconomic status, hypertension and chronic kidney disease and covid-19 can cause ischemic heart disease. Also sedentary exercise smoking and anthropometric measurement.

A HYBRID REXCEPTION NETWORK FOR COVID-19 CLASSIFICATION FROM CHEST X-RAY IMAGES

Nowadays, with the rapid spread of Coronavirus disease (COVID-19) across the globe, the necessity to develop an intelligent system for early diagnosis and detection the COVID-19 infectious disease increases. In recent researches, Chest X-ray (CXR) of individual lungs became a common method to identify COVID-19 virus. Manual interpretation of the CXR images can be a lengthy process and subjective to human errors. In this paper, a hybrid Deep Learning model called ReXception is implemented, trained, and evaluated using two types of datasets;Mutliclass and Binary. The network is evaluated based on its overall accuracy, loss, precision, and recall, in addition to the running time and network size. The results show positive indications of the network's performance, especially when compared to other state-of-the-art networks.

Attitudes and Belief among the Population in Saudi Arabia about the Consumption of Herbal Products for the Prevention of COVID-19 Infection: A Cross-Sectional Study

The purpose of this study was to assess the Saudi population's perceptions about the use of herbal products to prevent coronavirus disease 2019 infection in Saudi Arabia. Here, 803 subjects participated in the online survey, which was cross-sectional in nature and self-administrated. The study included all Saudi Arabian adults, whereas pregnant women were excluded. Participants who decided to participate in the study filled out the questionnaire completed by 803 people. During the coronavirus disease 2019 pandemic, most participants were aware of alternative and complementary medicines, whereas 60.1 % obtained their knowledge from social media sites. Prior to online shops/pharmacies and homemade remedies, the traditional apothecary was the most common source for alternative and complementary medicines. About 56 % of participants (p<0.05) did not believe that the complementary and alternative therapies could prevent or treat coronavirus disease 2019 infection, whereas 53.9 % of them considered safe. Only 22 % of those who took part in the survey agreed that alternative and complementary therapies could successfully combat coronavirus disease 2019 and could be used as a substitute for vaccines. Finally, our study found that during coronavirus disease 2019, medicinal plants and other complementary and alternative therapies were used and considered to be more effective. © 2022 Indian Pharmaceutical Association. All rights reserved.

Contracting COVID-19 in the first and second trimester of pregnancy: what we know - a concise qualitative systematic review.

INTRODUCTION: Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data. MATERIAL AND METHODS: A structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings. RESULTS: In total 1387 articles were screened and finally 22 studies were evaluated (179 1st/2nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1st/2nd trimesters are yet to complete their pregnancy. CONCLUSIONS: Evidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.

Laminar flowmeter for mechanical ventilator: Manufacturing challenge of Covid-19 pandemic.

The rapid and sudden attack of the covid-19 pandemic has emerged the urgent need for pulmonary resuscitation devices (ventilators). The airflow sensor is a main element in the ventilator. Sensing very low airflow rates is an essential requirement to meet the least significant bit of the analogue to digital converter included in the ventilator. This short communication describes the fabrication and test of five flow sensors using basic and the 3D printing techniques to overcome the severe challenge arising from the pandemic under strict quarantine. The principle of these five flow sensors is based on Fleisch pneumotachograph technology, which creates a pseudo-laminar flow within a bundle of capillary tubes. Amongst the five tested sensors, those fabricated by 3D printing technique were the most accurate and reliable. Results show that the 3D printed sensor of 33 trapezoidal capillary tubes and displaced pressure taps meet the requirement of sensing flowrates with less resistance to patient at exhalation and more linearity figure. The experimental data were correlated using a sophisticated MMF correlation with an R-squared factor of 0.9999 and a percentage error of 1.68%.

Clinical Characteristics and Survival Analysis in a Small Sample of Older COVID-19 Patients with Defined 60-Day Outcome.

The older population is one of the most vulnerable to experience adverse outcomes of COVID-19. Exploring different clinical features that may act as detrimental to this population's survival is pivotal for recognizing the highest risk individuals for poor outcome. We thus aimed to characterize the clinical differences between 60-day survivors and non-survivors, as well as analyze variables influencing survival in the first older adults hospitalized in Poznan, Poland, with COVID-19. Symptoms, comorbidities, complications, laboratory results, and functional capacity regarding the first 50 older patients (≥60 years) hospitalized due to COVID-19 were retrospectively studied. Functional status before admission (dependent/independent) was determined based on medical history. The 60-day survivors (n = 30/50) and non-survivors (n = 20/50) were compared across clinical parameters. The patients had a mean age of 74.8 ± 9.4 years. Overall, 20/50 patients died during hospitalization, with no further fatal outcomes reported during the 60-day period. The non-survivors were on average older (78.3 ± 9.7 years), more commonly experienced concurrent heart disease (75%), and displayed functional dependence (65%) (p < 0.05). When assessing the variables influencing survival (age, heart disease, and functional dependence), using a multivariate proportional hazards regression, functional dependence (requiring assistance in core activities of daily living) was the main factor affecting 60-day survival (HR, 3.34; 95% CI: 1.29-8.63; p = 0.01). In our study, functional dependence was the most important prognostic factor associated with mortality. Elderly with COVID-19 who required assistance in core activities of daily living prior to hospitalization had a three times increased risk to experience mortality, as compared to those with complete independence. Exploring geriatric approaches, such as assessment of functional capacity, may assist in constructing comprehensive survival prognosis in the elderly COVID-19 population.

COVID 19 - Clinical Picture in the Elderly Population: A Qualitative Systematic Review.

The SARS-CoV-2 tendency to affect the older individuals more severely, raises the need for a concise summary isolating this age population. Analysis of clinical features in light of most recently published data allows for improved understanding, and better clinical judgement. A thorough search was performed to collect all articles published from 1st of January to 1st of June 2020, using the keywords COVID-19 and SARS-CoV-2 followed by the generic terms elderly, older adults or older individuals. The quality assessment of studies and findings was performed by an adaptation of the STROBE statement and CERQual approach. Excluding duplicates, a total of 1598 articles were screened, of which 20 studies were included in the final analysis, pertaining to 4965 older COVID-19 patients (≥60 years old). Variety in symptoms was observed, with fever, cough, dyspnea, fatigue, or sputum production being the most common. Prominent changes in laboratory findings consistently indicated lymphopenia and inflammation and in some cases organ damage. Radiological examination reveals ground glass opacities with occasional consolidations, bilaterally, with a possible peripheral tendency. An evident fraction of the elderly population (25.7%) developed renal injury or impairment as a complication. Roughly 71.4% of the older adults require supplementary oxygen, while invasive mechanical ventilation was required in almost a third of the reported hospitalized older individuals. In this review, death occurred in 20.0% of total patients with a recorded outcome (907/4531). Variability in confidence of findings is documented. Variety in symptom presentation is to be expected, and abnormalities in laboratory findings are present. Risk for mortality is evident, and attention to the need for supplementary oxygen and possible mechanical ventilation is advised. Further data is required isolating this age population. Presented literature may allow for the construction of better predictive models of COVID-19 in older populations.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group.

BACKGROUND: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database. RESULTS: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey. CONCLUSIONS: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.