Imaging Cascade - the Importance of Pre-Procedural 3-D Planning in Transcatheter Left Atrial Appendage Closure

Background With the COVID-19 pandemic and referral from out-reach centers, there has been a change in practice of assessing left atrial appendage (LAA) via TEE on the day of LAA closure (LAAC). We present a challenging case of inadequate LAAC with WATCHMAN FLX due to suboptimal TEE images. Follow up TEE and CT revealed a much larger LAA ostium that was mostly uncovered. Case An 84 yo male with AF and recent hepatic hematoma, was referred for LAAC. LAA dimensions were measured using a technically difficult intraprocedural (IP) 2D TEE and a 24mm Watchman FLX was successfully implanted. Follow up 3D TEE at 45 days revealed incomplete LAAC with a large PDL. Retrospective review of fluoroscopic images revealed unrecognized filling of a posterior LAA lobe. Decision-making Anticoagulation (AC) was continued for 3 more months, and Cardiac CT was performed which showed persistent under-coverage of the LAA with large PDL of 16.5 x 11.3 mm (159mm2). A much larger ostium was measured on 45 days TEE (27 mm max 2 D dimension) and 145 days CT (18 X 25 mm) vs. 12.9 mm on IP-TEE. AC was continued with consideration of a 2nd adjacent device placement in future. Conclusion TEE on the day of LAAC although implemented in several centers, has its limitations. In the presence of sub-optimal image quality, it can lead to incorrect device sizing and incomplete LAAC as in our case. Cardiac CT with 3D evaluation or 3D TEE are crucial for pre-planning to achieve successful device implantation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Skin Manifestations of Personal Protection Devices and Sanitizers Among COVID-19 Healthcare Providers: A Survey at Southern Region Hospitals, Saudi Arabia

Frontline worker's prevalence of occupational skin disease has increased as a result of staff infection control measures such increased personal protective equipment (PPE) and stricter hand hygiene procedures. During the COVID-19 pandemic, assess the frequency of occupational skin disorders among healthcare workers at the general hospitals in the Najran region of southern Saudi Arabia is our main aim. Our objective comprises a cross-sectional study that will be carried out at the general hospitals in the Najran region of southern Saudi Arabia between March 1 and April 31, 2022, in order to achieve the goal. All medical professionals received a self-administered online survey (physicians, nurses and paramedics). The questionnaire asked about the severity of skin damage and the frequency and length of time that various infection prevention strategies were used. It was found that 68.2% had new onset of obvious skin damage and 31.8 % did not. 21.6% of the new onset of obvious skin damage was on the fingertips, 46.6% was on the hands, 22.4% was in paws, 3.4% was on the face and 6.0% was under the eye. 29.8% of the symptoms of the damaged site was itching, 44.7% dryness, 12.8% burning/pain, and 12.8% tenderness. 16.5 % of the type of skin lesions was peeling, 28.2% fissure, 18.8% erosion/ulcer, 24.7% redness, 4.7% papule (pimples) and 7.1% others. In our study, 68.2% of our participants suffered obvious skin damage during the pandemic: 90.6% of this occurred on the hands and 9.4% on the face. Contact dermatitis in the form of itching, dryness, burning, pain and tenderness were the most common adverse effects noted. Therefore, it is important to organize training on the prevention and management of possible skin lesions due to PPE use according to guidelines.

Commitment level of social distancing among local community individuals at Najran Region, Saudi Arabia to limit the spread of coronavirus disease (COVID-19)

The current study aimed to identify the commitment level of social distancing among the local community individuals at Najran region in Saudi Arabia to limit the spread of Coronavirus disease (COVID-19). To achieve study objectives, a descriptive analytical design was used. The sample of the study consisted of (596) individuals selected from Najran region in southern Saudi Arabia using convenient sampling procedures. To measure the commitment level of indoor and outdoor commitment level, a questionnaire was used. Another questionnaire was also used to assess the reasons that led to social distancing success or failure, as well as the proposals that contribute to its activation. The results showed that the commitment level of social distancing among the local community individuals at Najran region in Saudi Arabia to limit the spread of (COVID-19) was high level (m=0.88). There were no statistically significant differences in that commitment level due to gender, age, and educational qualification. The study also revealed that there were reasons contributing to social distancing success or failure. The study concluded a set of suggestions and recommendations that may enhance the role of public agencies in the Kingdom of Saudi Arabia in enhancing the awareness of Saudi community about the commitment to social distancing in order to limit the s spread of Coronavirus pandemic (COVID-19).