A Misleading Apical Periodontitis Like Symptoms Post COVID-19 Vaccine (preprint)

Background: Adverse effects of vaccines are common, yet the reaction to vaccines widely varies between people. Companies provide an adverse effects list of their products. Adverse reactions might indicate the effectiveness of vaccines and that the immune system is responding. Case presentationIn this study, we present unusual side effects of the Pfizer/BioN-Tech vaccine. The patient had severe continuous pain related to the lower left first molar after the second dose of the Pfizer/BioN-Tech vaccine. The symptoms are typically resembling symptomatic apical periodontitis cases.ConclusionPfizer/BioN-Tech vaccine might lead to symptoms that mimic symptomatic apical periodontitis. The patient who develops such symptoms shortly after the covid -19 vaccine without an apparent cause should be assured and kept under observation for one to two weeks. A tentative diagnosis and treatment plan should be considered in the follow-up visit.

Favipiravir and Hydroxychloroquine Combination Therapy in Patients with Moderate to Severe COVID-19 (FACCT): An Open-Label, Multicentre, Randomised, Controlled Trial (preprint)

Background: No antiviral drug has been proven effective for the treatment of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). Favipiravir and hydroxychloroquine were introduced as potential antiviral agents to treat patients with COVID-19.Methods: We conducted an investigator-initiated, multicentre, open-label, randomised trial involving hospitalised patients with confirmed moderate-to-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at nine hospitals in Saudi Arabia. Eligible patients were adult with moderate-to-severe COVID-19 defined as oxygen saturation (Sao2) of 94% or less while breathing ambient air or significant clinical symptoms with chest X-ray changes requiring hospital admission. Randomisation was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The favipiravir loading dose was 1800 mg twice daily on day 1, then 800mg twice daily for nine days and hydroxychloroquine as 400mg twice daily, followed by 200mg twice daily for days 2-5. The primary outcome was time to clinical improvement of two points (from the status at randomisation) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population of patients to assess the primary and secondary endpoints. The trial is registered at ClinicalTrials.gov (NCT04392973).Findings: From May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 patients to the combination of favipiravir and hydroxychloroquine. The mean age was 52·65 ±13·06 years, 59·4% were men, and 229 (90·15%) required supplemental oxygen at randomisation (with or without non-invasive ventilation). The time to clinical improvement was not significantly different between the two groups; median of 9 days (95%CI: 8, 12) in the treatment group and 7 days (95%CI: 6, 10) in the control group (HR:0·845; 95% CI 0·617 to 1·157; p-value = 0·29). The median duration of hospitalisation among patients discharged on or before day 14 was 9 days (95%CI: 8, 12) for the treatment group and 8 days (95%CI: 7, 10) for the control group with a p-value of 0·42. The 28-day mortality was not significantly different between the two groups, 9 (7·63%) in the treatment group vs 13 (10·32%) in the control group; p-value=0·45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group.Interpretation: The combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19. No new safety signals were recognised for both medications.Trial Registration: This trial is registered with ClinicalTrials.gov, Identifier: NCT04392973, May 19, 2020.Funding Statement: King Abdullah International Medical Research Center, Saudi Arabia.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This trial was approved by the Saudi Food and Drug Authority (SFDA). Ethical approval was obtained from the Institutional Review Board (IRB) at the Ministry of National Guard-Health Affairs (MNGHA) and Ministry of Health (MOH). The trial was overseen by an independent data and safety monitoring board (DSMB). The trial was done according to the Declaration of Helsinki principles and the International Conference on Harmonization-Good Clinical Practice guidelines.

Clinical characteristics and treatment outcomes of mild to moderate COVID-19 patients in Saudi Arabia: A single centre study (preprint)

Background: Since the severity of symptoms affects the treatment option for Coronavirus Disease 2019 (COVID-19) patients, the treatment pattern for mild to moderate non-ICU cases must be evaluated, particularly in the current scenario of mutation and variant strain for effective decision making. Objectives This retrospective study’s objectives were to assess clinical and treatment outcomes in mild to moderate non-ICU COVID-19 patients in Saudi Arabia. Methods Non-ICU patients with COVID-19 with mild to moderate symptoms who were admitted to major tertiary care hospitals in Al Baha, Saudi Arabia, between April and August 2019 were studied retrospectively for clinical outcomes. Results A total of 811 people were admitted for COVID-19 treatment, with age ranging from 14 to 66, diabetes mellitus (31 %, n = 248) and hypertension (24%, n = 198) were the most common comorbid conditions. The majority of the patients (77 %, n = 621) had reported symptoms for COVID -19 infection. The hydroxychloroquine (HCQ) treated group (G1 n = 466) had an MD of 8 and an IQR of 5-13 for time in hospital with a 4.3 % mortality rate, while the non-HCQ group (G2 n = 345) had an MD of 6 and an IQR of 3-11 for time in hospital with a 3.2 % mortality rate. The mortality rate among non-HCQ treated patients varied, but a combination of antiviral and antibiotic treatment was found to be effective, other most frequent intervention was analgesics 85.7 %, anticoagulant 75 %, minerals (Zinc 83 % and Vit D3 82 %). Conclusions The COVID 19 therapy and clinical outcomes from the past will be the guiding factor to treat the mutant strain infection in the future. Patients treated HCQ had a higher mortality rate, whereas those who were given a non-HCQ combination had a greater clinical outcome profile.

Measuring the Patients' Satisfaction About Telemedicine Used in Saudi Arabia During COVID-19 Pandemic.

Background Many studies have found that telemedicine and telehealth services quality and patients' clinical outcomes, following telehealth visits, maybe comparable to those of traditional face-to-face office visits especially in a crisis like COVID-19 complete lockdown. Objective This study aimed to identify the patient's experience in using the telemedicine strategies during the COVID-19 pandemic and assess these patients' perception about their experience of using telemedicine in Saudi Arabia. Methods A cross-sectional survey study was done on 425 patients treated through telemedicine programs in Saudi Arabia from February to August 2020 during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was adopted and modified to elicit participants' socio-demographic data, participants' satisfaction and attitude toward telehealth and telemedicine, and their views on health care services. Results About 84.9% of the participants thought that telemedicine made healthcare easier during the COVID-19 pandemic. Almost half of the respondent was very satisfied with the ease of registration (52%), while 43.4% of respondents stated that they had the ability to talk freely over telemedicine. In the present study, The highest satisfaction was reported by 53.4% of respondents for ease registration, 40.1% for quality of the visual image, 41.9% for quality of the audio sound, and 44.8% for their ability to talk freely over telemedicine, respectively. The highest satisfaction was reported by 40.5% about the ability to understand the recommendations, 40.5% about the overall quality of care provided, 37.4% about the overall telemedicine consult experience. The results revealed a significant positive correlation between satisfaction and attitude scores. Conclusion This study revealed acceptable satisfaction and attitude of patients toward telemedicine programs in Saudi Arabia. However, more effort should be done by the Saudi Ministry of Health to increase the knowledge of patients about teleconsultation available services.