Declined Humoral Immunity of Kidney Transplant Recipients to SARS-CoV-2 Vaccines.

Background: Kidney transplant recipients (KTRs) commonly suffer from impaired immunity. KTRs' compromised immune response to COVID-19 vaccines indicates urgent revision of immunisation policies. Methods: A cross-sectional study was conducted in Madinah, Saudi Arabia of 84 KTRs who had received at least one dose of a COVID-19 vaccine. ELISA was used to evaluate anti-spike SARS-CoV-2 IgG and IgM antibody levels in blood samples obtained one month and seven months after vaccination. Univariate and multivariate analyses were performed to identify associations between seropositive status and factors such as the number of vaccine doses, transplant age, and immunosuppressive therapies. Results: The mean age of KTRs was 44.3 ± 14.7 years. The IgG antibody seropositivity rate (n=66, 78.5%) was significantly higher than the seronegativity rate (n=18, 21.4%) in the whole cohort (p<0.001). In KTRs seroconverting after one month (n=66), anti-SARS-CoV-2 IgG levels declined significantly between one month (median [IQR]:3 [3-3]) and seven months (2.4 [1.7-2.6]) after vaccination (p<0.01). In KTRs with hypertension, IgG levels significantly decreased between one and seven months after vaccination (p<0.01). IgG levels also decreased significantly in KTRs with a transplant of >10 years (p=0.02). Maintenance immunosuppressive regimens (triple immunosuppressive therapy and steroid-based and antimetabolite-based regimens) led to a significant decrease in IgG levels between the first and second sample (p<0.01). KTRs receiving three vaccine doses showed higher antibody levels than those receiving a single dose or two doses, but the levels decreased significantly between one (median [IQR]: 3 [3-3]) and seven months (2.4 [1.9-2.6]) after vaccination (p<0.01). Conclusion: KTRs' humoral response after SARS-CoV-2 vaccination is dramatically inhibited and wanes. Antibody levels show a significant decline over time in KTRs with hypertension; receiving triple immunosuppressive therapy or steroid-based or antimetabolite-based regimens; receiving mixed mRNA and viral vector vaccines; and with a transplant of >10 years.

Saudi Nurse Interns' Experiences during the COVID-19 Pandemic: A Thematic Approach.

BACKGROUND: The learning process for nurses, including internships, was affected during the COVID-19 pandemic, which may have made the nurse internship program more challenging and stressful for participants. Therefore, it is significant to explore the experiences of nurse interns during COVID-19. AIM: This study aimed to explore Saudi nurse interns' field experiences during the pandemic. DESIGN: The study utilised descriptive phenomenological qualitative research and a thematic approach. METHODS: A total of 19 nurse interns participated in the study, which was conducted in Saudi Arabia. Participants undertook an internship program at different government hospitals in five cities in Saudi Arabia. Unstructured individual interviews were conducted to gather data from the participants. RESULTS: The findings revealed five themes: being passionate, lacking knowledge and skills, being concerned about their families, being cautious, and being unoriented. CONCLUSION: The study findings document that the struggles of nurse interns in their internship programs during COVID-19 were related to their lack of knowledge, their family, and the working environment.

Prevalence of anti-SARS-CoV-2 antibody in hemodialysis facilities: a cross-sectional multicenter study from Madinah.

BACKGROUND: Since the occurrence of coronavirus disease in 2019 (COVID-19), the global community has witnessed its exponential spread with devastating outcomes within the general population and specifically within hemodialysis patients. OBJECTIVES: Compare the state of immunity to SARS-CoV-2 among hemodialysis patients and staff. DESIGN: Cross-sectional study with a prospective follow-up period. SETTING: Hemodialysis centers in Madinah region. PATIENTS AND METHODS: We prospectively tested for SARS-CoV-2 antibodies in dialysis patients using dialysis centers staff as controls. The participants were tested on four occasions when feasible for the presence of anti-SARS-CoV-2 antibodies. We also analyzed factors that might be associated with seropositivity. MAIN OUTCOME MEASURES: SARS-CoV-2 positivity using immunoglobulin G (IgG) levels SAMPLE SIZE: 830 participants, 677 patients and 153 dialysis centers staff as controls. RESULTS: Of the total participants, 325 (257 patients and 68 staff) were positive for SARS-CoV-2 IgG antibodies, for a prevalence of 38.0% and 44.4% among patients and staff, respectively (P=.1379). Participants with a history of COVID-19 or related symptoms were more likely to have positive IgG (P<.0001). Surprisingly, positivity was also center-dependent. In a multivariable logistic regression, a history of infection and related symptoms contributed significantly to developing immunity. CONCLUSION: The high prevalence of SARS-CoV-2 antibody among hemodialysis patients and previously asymptomatic staff suggested past asymptomatic infection. Some centers showed more immunity effects than others. LIMITATIONS: Unable to collect four samples for each participant; limited to one urban center. CONFLICT OF INTEREST: None.

Harmonizing ABC System with ERP System for Operational Effectiveness Improvement during Covid-19 Pandemic

Relying on modern technological systems has always been one of the most important means used to mitigate the negative effects of crises facing the economies of countries, especially if these systems are harmonized and integrated to achieve a competitive advantage for the company and improve operational effectiveness. The aim of this study is to measure the impact of harmonizing activity-based-costing system with enterprise resource planning in improving the operational effectiveness of manufacturing companies listed on the Amman Stock Exchange by implementing industry type as a mediating variable. In order to achieve the study objectives, a designed questionnaire was developed and distributed to specialists in the accounting department, enterprise resource planning system managers, and costing managers within the study population. The study revealed that industry type as a mediating variable has modified the role of enterprise resource planning system integration with the activity-based-costing system in improving operations effectiveness, especially in the food, supplies, and agricultural sectors, and it is recommended for managers to develop and improve their current systems by attracting software specialists to build the integration between information systems. © 2022 IEEE.

Parents' Hesitancy to Vaccinate Their Children Against COVID-19, a Country-Wide Survey.

Objective: Parents' hesitancy (PH) toward childhood vaccination, including the vaccine of coronavirus disease (COVID-19), is one of the top public health threats. We aim to assess the PH toward children COVID-19 vaccination as compared to PH toward children routine vaccination among the residents of Saudi Arabia. Method: Before the official approval of children's COVID-19 vaccination in the country, a cross-sectional study using an electronically distributed survey was performed. Responses from parents of children younger than 18 years of age were accepted. The Oxford COVID-19 vaccine hesitancy scale (OC19-VHS) and the routine vaccination hesitancy scale (R-VHS) were used. Parents were classified as hesitant, non-hesitant, and unsure. Results: Between June 18th-30th, 2021, we included 1,052 parents. More than half of the parents were positive toward the childhood COVID-19 vaccination (63%) while 10% were unsure. Higher parental hesitancy toward children COVID-19 vaccination among mothers, parents younger than 40 years, did not receive COVID-19 nor influenza vaccines, had higher educational levels, and parents who recovered from COVID-19 infection. Hesitancy was mainly driven by the novelty of the vaccines and the fear of serious adverse effects. Compared to the routine vaccination, parents were more hesitant toward COVID-19 vaccination (6 vs. 27%). Conclusion: Generally, parents in Saudi Arabia were positive toward children's COVID-19 vaccination. Focused education to reassure hesitant parents on the safety of the vaccine is essential to achieve larger vaccination coverage.

Willingness and Self-Perceived Competence of Final-Year Medical Students to Work as Part of the Healthcare Workforce During the COVID-19 Pandemic.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic may increase demand for healthcare professionals (HCPs), either because of a HCP shortage due to illness or because of the need to increase surge capacity. Final-year medical students are one of the resources potentially available to expand the workforce. There is a need to explore the willingness of final-year medical students to meet this demand, examine their perceived competence, and determine how their overall perceived competence correlates with their willingness. METHODS: A cross-sectional study using a self-administered electronic questionnaire was used. The questionnaire included demographic data, students' self-perceived competence derived from the patient care theme of the Saudi Medical Education Directives (SaudiMED) framework, and their willingness to be measured on a 5-point Likert scale. The study targeted final-year medical students at King Saud University, Riyadh, Saudi Arabia. RESULTS: The number of participants was 134 (56.1% response rate), of whom 47 students (34.3%) were willing to work, while 31 (23.1%) were somewhat willing. The mean total self-perceived-competence score was 58.36/88 (66.3%). Demonstration of essential clinical skills had the highest mean score 11.48/16 (71.8%) among learning outcomes. There was a positive moderate correlation between willingness and mean perceived-competence score (Spearman correlation coefficient=0.45, p<0.001). CONCLUSION: Fifty-seven percent of medical students were willing to work as part of the healthcare workforce during the COVID-19 pandemic. Better overall self-perceived competence appeared to correlate with more willingness. Students perceive themselves to be more competent in essential clinical skills. Appropriate training and supervision are suggested in all tasks assigned to them, with additional care required in areas with a lower perceived competence, such as prescription writing and essential clinical procedures.

Generalized Papulovesicular Eruption as a Side Effect of the Pfizer-BioNTech COVID-19 Vaccine.

COVID-19 is inflicted by SARS-CoV-2 and resulted in a global health crisis that necessitated the urgency of vaccine development to prevent its spreading among the public. Pfizer-BioNTech COVID-19 is one of the emergency use authorized (EUA) vaccines. This vaccine is efficacious against the SARS-CoV-2 virus; nonetheless, recipients have frequently reported side effects. Recipients of this vaccine experienced miscellaneous side effects like fatigue and headache. However, cutaneous eruptions of varying degrees of severity and involvements have been manifesting post-vaccination. Dermatological eruptions following vaccination against COVID-19 disease are poorly recognized. Dermatological manifestations triggered post-vaccination differ in the clinical context and patient's demographic features. The only constant factor is various clinical and histopathological relations to establish the diagnosis of cutaneous eruption post-vaccination. Herein, we report a case of an 18-year-old male with T-cell acute lymphocytic lymphoma (ALL) in remission since August 2018 and other comorbidities. After the administration of the first dose of the Pfizer-BioNTech COVID-19 vaccine, the patient developed pruritic eczematous eruption presenting as grouped erythematous-violaceous papulovesicular lesions with fine scales over his upper and lower extremities. These eruptions started two days after the administration of the vaccine. This eruption became generalized 21 days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. Clinical suspicion of the drug-induced vesicular eruption was suspected; thus, a biopsy was obtained and showed erosions and mixed inflammatory cell infiltrate. From a clinical and histopathological correlation, vesicular eruption following vaccination with Pfizer-BioNTech COVID-19 was confirmed. Nevertheless, other diagnoses cannot be ruled out, but from the clinical-histopathological association, the vaccine-inflicted eruption is the likely culprit. Reports are crucial to understanding the nature of such dermatological manifestation after emerging diseases and counteractions like vaccinations. The dermatological manifestations are vaguely recognized; thus, by reporting on the cases similar to the case in this report, more data will be available to understand the nature and underlying cause of such eruptions.

Determination the binding ability of n-acetyl cysteine and its derivatives with sars-cov-2 main protease using molecular docking and molecular dynamics studies

N-acetyl cysteine (NAC) drug has been used as an antioxidant and anti-inflammatory agent in clinical practice and more recently in the treatment of COVID-19 patients. Using docking analysis and molecular dynamics studies we compare the interaction between of N-acetyl cysteine and its derivatives with SARS-COV-2 main protease (Mpro) which is essential for processing the proteins translated from the viral RNA. The results obtained from this study showed that NAC benzyl ester (NACBn), NAC ethyl ester (NACEt) and NAC amide (NACA) could bind with SARS-COV-2 protease better than NAC drug. © 2021 Shntaif A.H. et al.

Perception of Parents Towards COVID-19 Vaccine for Children in Saudi Population.

Background Coronavirus disease 2019 (COVID-19) is a contagious disease that is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). With the rapid spread of this pandemic, vaccination has been a breakthrough solution. At the time of conducting the study, COVID-19 vaccines were only approved for adults 18 years and older. Therefore, the aim of the study was to assess the parents' likelihood of vaccinating their children once the recommendation for pediatric vaccination is established. Methods This was a cross-sectional study in which a self-administered survey was distributed to all parents visiting National Guard primary healthcare centers in Riyadh, Saudi Arabia. The questionnaires were distributed to parents attending primary care clinics. Data collected in the questionnaire include demographics (gender, marital status, educational level, and age), questions assessing parental perception towards the COVID-19 vaccine, and willingness to offer the vaccine to their children. Results A total of 333 respondents completed the survey with a response rate of 83.3%. Half of the participants were males and the other half were females with the majority (45.6%) aged between 31 and 40 years old. In terms of parental acceptability of vaccinating their children against COVID-19, 53.7% of the parents were willing to vaccinate their children as opposed to 27% who were reluctant to do so. Of those who refused, 97.5% and 96.6% cited lack of information and evidence, respectively, as the most common reasons for not accepting COVID-19 vaccine. We have found that age of the parents, especially those 31-40 years old, age of their children, especially 4-12 years old, and previous acceptance of the seasonal influenza vaccine were significantly associated with higher parental acceptability of COVID-19 vaccine. In contrast, gender, marital status and educational level were not statistically significant factors. Conclusion As COVID-19 spread globally and made people's lives in danger, vaccination became a highly important measure to halt the spread of the disease. Parents are now given the choice of protecting their beloved children from COVID-19 infection and its possible complications. Based on our findings, we noticed that majority of parents are going to vaccinate their children. In addition, some certain age groups of parents and children were significantly associated with decreased vaccine hesitancy to take the COVID-19 vaccine.

Factors and Determinants for Uptake of COVID-19 Vaccine in a Medical University in Riyadh, Saudi Arabia.

Background The coronavirus disease 2019 (COVID-19), which is also known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is an infection that is caused by the novel coronavirus. COVID-19 has severely affected the public health by causing more than 200 million cases and four million deaths worldwide. There are, presently, no specific antiviral treatments for COVID-19. As immunization is one of the most successful and cost-effective health interventions to prevent this infectious disease, a number of vaccines, around 112, have been developed. In Saudi Arabia, many vaccination campaigns have already started. There are currently four approved COVID-19 vaccines but only three are available for use in Saudi Arabia. Methods This was a cross-sectional study in which a web-based survey was distributed to medical students in their clinical years at the College of Medicine in King Saud bin Abdulaziz University, Riyadh, Saudi Arabia. A total of 209 questionnaires were distributed. The survey assessed the demographic data, perception towards COVID-19 vaccine, barriers and predictors for accepting COVID-19 vaccine. Results Two-hundred and four respondents completed the survey with a response rate of 96.7%. Overall, 118 of the participants were males and 86 were females. Sixty-six percent of our participants had taken the vaccine. Of those, males and females were distributed equally in half. Fifty-three percent of the participants who had taken the vaccine aged 21-23. This age group had a significant effect on acceptance of the vaccine. Most common deterrent to taking COVID-19 vaccine was safety issues despite not having a statistical significance. In terms of motivators, the majority thought that fear of getting COVID-19 infection was the most important motivator to taking COVID-19 vaccine, which was statistically significant as well. Conclusion In the setting of spreading COVID-19 infection, the vaccine is still the solution to halting infection spread. Based on our findings, we see that there was a high acceptance rate (66.2%) of COVID-19 vaccine.

Physician's Perception Toward Using Telemedicine During COVID-19 Pandemic in King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Introduction The novel coronavirus, officially known as COVID-19, was first reported in Wuhan, China, in December of 2019. Since that time, medical services in Saudi Arabia have adapted to the situation by delivering medical care via virtual clinics. Therefore, the aim of the study is to assess physicians' perception and the level of satisfaction with telemedicine during the COVID-19 pandemic in Riyadh, Saudi Arabia. Methods This was a cross-sectional study that included family medicine consultants and fellows who had used telemedicine in primary health care centers in Riyadh, Saudi Arabia. It was conducted using an online validated questionnaire. The questionnaire was completed by 219 family medicine consultants and fellows, after obtaining their informed consent. The data that were extracted from the questionnaire included demographics, level of satisfaction, and questions related to their experience with telemedicine. Results Two hundred and nineteen participants enrolled in this study with 50.6% males and 49.4% females. The overall level of physicians' satisfaction with telemedicine was 64.3%. However, only one-third preferred telemedicine over office visits. Of these, 60% were males and 40% were females. The only factor that had a statistically significant effect on the preference of office visits or telemedicine was time efficiency (p-value < 0.001). Of those who preferred office visits over telemedicine, 52% of them cited ease of discussion and the ability to make a comprehensive physical examination as the most important reasons for choosing office visits. Technologic issues were the least important factor for choosing either clinic (4.1%). Of those who preferred telemedicine, avoiding contact with patients suspected of COVID-19 was the most commonly cited factor (27.4%). Family medicine physicians face multiple barriers while using telemedicine during the COVID-19 pandemic. The most commonly cited barrier was the inability to make a full and comprehensive assessment of the patient. Conclusions In the setting of highly transmissible disease epidemics, telemedicine has a lot of potential for providing quick and safe care that is appropriate for screening and management. Based on our findings, using telemedicine should be encouraged by improving physicians' skills in this field since telemedicine is a crucial step to reduce the risk of COVID-19 transmission and provide community-wide treatment.

Feasibility of administrating a cognitive screening tool by telephone prior to surgery in older adults-preliminary results

Background: Preoperative cognitive assessment has been advocated for adults ≥ 65 years-old due to increased risk for post-operative complications such as postoperative delirium, postoperative cognitive decline, and increased mortality. Most screening tools for cognitive impairment require in-person evaluation. During the COVID-19 pandemic, most medical centers have changed their workflows to telemedicine platforms. In this study we aim to assess the feasibility of a telephone-based cognitive assessment tool, the Mini-Montreal Cognitive Assessment (Mini-MOCA) prior to surgery and 30-day post surgery to evaluate any changes in cognitive function. Methods: Patients age ≥70 year who were candidates for surgery and had a telemedicine visit in the preoperative clinic during December 2020 were included. Exclusion criteria included hearing impairment, day-surgery, inability to speak English and a prior diagnosis of Dementia. Eligible patients were asked to complete an attention test, the Mini-MOCA and function assessment using the Katz score for activities of daily living (ADL) and Lawton-Brody for instrumental activities of daily living (IADL). Anxiety was assessed using the Generalized Anxiety Disorder 2-item (GAD-2). Baseline demographics including medications and education level were collected. Anti-cholinergic effect was assessed using an anti-cholinergic score calculator (ACS). Results: Overall 24 patients completed the preoperative assessment. The cohort was 50% female, white (96%), with a median age of 74 years (range: 71-82). The median number of medications was 8 (range:2-20), 16/24 (67%) taking medications with anti-cholinergic effects and a median ACS of 1 (range 1-13), and 4/24 (17%) on Benzodiazepines. The median Katz score was 6 (range: 4-6) and Lawton-Brody score 8 (range: 5-8). The mean time for completion of the phone assessment was 10 minutes and 4 minutes for the Mini- MOCA. The median Mini-MOCA score was 13.5 (range: 9-15). Conclusions: In our preliminary results we show that a telephone- based cognitive assessment prior to surgery is well accepted and feasible among older adults who are candidates for surgery. Our study is ongoing, and will continue to conduct pre- and post-operative cognitive evaluations (updated results will be presented).

Patient satisfaction with virtual clinic during Coronavirus disease (COVID-19) pandemic in primary healthcare, Riyadh, Saudi Arabia.

BACKGROUND: The novel coronavirus, officially known as COVID-19, was first reported in Wuhan, China in December of 2019. Since that time, medical services in Saudi Arabia have adapted to the situation by delivering medical care via virtual clinics. Therefore, the present study aimed to assess patients' level of satisfaction with virtual clinics during the COVID-19 pandemic in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted among patients who had experienced virtual clinics in primary healthcare centers in Riyadh, Saudi Arabia. An online validated questionnaire was sent to all participants who had at least one virtual visit between March 2020 to July 2020. The data sought included demographics, level of satisfaction and questions related to their experience with virtual clinics. Computed frequencies and percentages for categorical variables, and median, mean, and standard deviation for continuous variables. Satisfaction scores were compared between groups using Mann-Whitney U test and Kruskal Wallis test. RESULTS: A total of 439 patients completed the questionnaire (response rate 97.5%); 54% were male. The participants were divided into three age groups: 18-39, 40-59, and ≥60 years. Overall level of patients' satisfaction with virtual clinic was 68.1%. Factors statistically significantly associated with satisfaction included gender, age group and level of education (post-graduate and middle school) and being well-informed on the use of telemedicine. Specific age groups that were significant were 18-39 and 40-59 years; 50.2% of the males found telemedicine very convenient, compared to only 36.1% females. Family medicine clinics were the most commonly visited virtual clinics, whereas obstetrics and gynecology clinics were the least attended virtual clinics. The inability to meet the health-care professional face-to-face was reported by 53.8% as the most important disadvantage. CONCLUSION: This study shows a high level of satisfaction with virtual clinics in Saudi Arabia during the COVID-19 pandemic despite the service being relatively new in healthcare service in the country. Our study demonstrated that satisfaction was linked to age, gender, education and the type of clinic used.

Adoption of telemedicine applications among Saudi citizens during COVID-19 pandemic: An alternative health delivery system.

This study aims to investigate individual behavior towards adoption of telemedicine application based on wireless sensor network applications (WSN) during COVID-19 pandemic. Therefore, the research model extends the unified theory of acceptance and use of technology with the task technology fit model, awareness and self-efficacy to determine user intention to adopt wireless sensor network application for medical assistance. A research survey was conducted towards Saudi citizens in voluntary setting. In response, 348 valid responses were retrieved. Sample size was computed with prior-power analysis using G-power software. The research model is empirically tested with latest statistical approach namely structural equation modeling (SEM). Findings of the structural model indicate that wireless sensor network application was jointly predicted by performance expectancy, social influence, effort expectancy, facilitating condition, task technology fit, awareness and self-efficacy and explained substantial variance R2 79.5% in individual behavior to adopt wireless sensor network application. The effect size analysis (f2) revealed that task technology fit and facilitating condition were the most important factors to determine user intention to adopt wireless sensor network application. The current study contributes to theory by extending the unified theory of acceptance and use of technology with task technology fit model, self-efficacy and awareness and enrich information system literature in the context of user intention to adopt wireless sensor network application. Practically, this study suggest that health consultant should focus on technology fitness including wireless devices and the number of facilities to operate wireless sensor network which in turn boost user confidence towards adoption of wireless sensor network application for health consultation. This study develops a unique research model that inspects user behavior towards adoption of wireless sensor network technology for better health care system. The findings of this study answer how to monitor COVID-19 while using of wireless sensor network applications. Moreover, this study is useful for clinical management through virtual environment and guides health advisors, software developers and physicians to design user friendly telemedicine application by using wireless sensor network technology.