Negative Nasopharyngeal SARS-CoV-2 PCR Conversion in Response to Different Therapeutic Interventions.

Background The current management practices for patients with COVID-19 consist of infection prevention and supportive care. We aimed to explore the association between negative nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) clearance and different therapeutic interventions. Methods This study is a retrospective cohort study of 93 patients who were admitted to a tertiary hospital in Saudi Arabia with a PCR confirmed diagnosis of COVID-19. There were three intervention subgroups (group A) (n = 45), which included those who received chloroquine or hydroxychloroquine (HCQ) only (A1), those who received chloroquine or HCQ in combination with azithromycin (A2), and those who received chloroquine or HCQ in combination with antiviral drugs with or without azithromycin (A3), as well as one supportive care group (group B) (n = 48). The primary and secondary endpoints were achieving negative SARS-CoV-2 nasopharyngeal PCR samples within five and 12 days from the start of the intervention, respectively. Results A median time of three days (interquartile range (IQR): 2.00-6.50) is needed from the time of starting the intervention/supportive care to the first negative PCR sample. There was no statistically significant difference neither between the percentage of patients in the intervention group and the supportive care group who achieved the primary or secondary endpoint nor in the median time needed to achieve the first negative PCR sample (p > 0.05). Conclusion Prescribing antimalarial medications was not shown to shorten the disease course nor to accelerate the negative PCR conversion rate.

Sleep quality and mental health in coronavirus disease 2019 patients and general population during the pandemic.

OBJECTIVE: Sleep problems during the coronavirus disease 2019 (COVID-19) pandemic commonly affected general populations. Data on the effect of the COVID-19 pandemic on sleep quality in Saudi Arabia are scarce. Thus, the aim of our study was to evaluate sleep quality and assess the psychological burden of the pandemic in COVID-19 patients and the general population. METHODS: This was a multicenter, observational, cross-sectional survey. Participants with COVID-19 were recruited from different health-care centers in the western region during the lockdown period from May 13, 2020 to September 2, 2020. All participants completed a validated online survey. The control group comprised individuals from the general public who responded to the online survey through social media. Demographic data, COVID-19 status, and history of chronic diseases were collected. Sleep quality, depression, and insomnia were assessed using validated questionnaires. RESULTS: In total, 1091 participants were surveyed and 643 (58.9%) were positive for COVID-19. Poor sleep quality was reported in 66.1% of COVID-19 patients (mean score ± standard deviation [SD] 6.9 ± 4.0) and 72.8% of controls (mean score ± SD 7.6 ± 4.3). Insomnia affected 50.5% of COVID-19 patients (mean score ± SD 6.5 ± 5.5) and 58.5% of controls (mean score ± SD 7.6 ± 5.5). Depression was diagnosed in 39.5% of COVID-19 patients (mean score ± SD 4.7 ± 4.6) and 70.1% of controls (mean score ± SD 8.9 ± 6.7). CONCLUSIONS: The COVID-19 pandemic had a great impact on mental health and sleep quality in both COVID-19 patients and the general population but more pronounced in the general population.

Incidence and Outcomes of Pulmonary Embolism among Hospitalized COVID-19 Patients.

OBJECTIVES: Patients with COVID-19 may be at high risk for thrombotic complications due to excess inflammatory response and stasis of blood flow. This study aims to assess the incidence of pulmonary embolism among hospitalized patients with COVID-19, risk factors, and the impact on survival. METHODS: A retrospective case-control study was conducted at Al-Noor Specialist Hospital in Saudi Arabia between 15 March 2020 and 15 June 2020. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and confirmed diagnosis of pulmonary embolism by Computed Tomography pulmonary angiogram (CTPA) formed the case group. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and without confirmed diagnose of pulmonary embolism formed the control group. Logistic regression analysis was used to identify predictors of pulmonary embolism and survival. RESULTS: A total of 159 patients participated were included in the study, of which 51 were the cases (patients with pulmonary embolism) and 108 patients formed the control group (patients without pulmonary embolism). The incidence of PE among those hospitalized was around 32%. Smoking history, low level of oxygen saturation, and higher D-dimer values were important risk factors that were associated with a higher risk of developing PE (p < 0.05). Higher respiratory rate was associated with higher odds of death, and decreased the possibility of survival among hospitalized patients with PE. CONCLUSIONS: Pulmonary embolism is common among hospitalized patients with COVID-19. Preventive measures should be considered for hospitalized patients with smoking history, low level of oxygen saturation, high D-dimer values, and high respiratory rate.

New disease and old threats: A case series of COVID-19 and tuberculosis coinfection in Saudi Arabia.

COVID-19 and TB coinfection are not common and may occur more in TB endemic countries. However, patients with pre-COVID-19 chronic respiratory symptoms should be screened for TB as well.

Predictors of Length of Hospital Stay, Mortality, and Outcomes Among Hospitalised COVID-19 Patients in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: COVID-19 pandemic is a major strain on health and economic systems, with rapidly increasing demand for in patients' facilities. Disease diagnosis and estimating patients at higher risk is important for the optimal management during the pandemic. This study aimed to identify the predictors of mortality and length of hospital stay in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted between March 2020 and August 2020 at Al-Noor Specialist Hospital in Mecca, Saudi Arabia. All patients who were admitted and had a confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) were included in the study. Descriptive statistics were used to describe patients' demographic characteristics, laboratory findings, and clinical outcomes. Multiple logistic/linear regression analysis was used to identify predictors of death and length of stay at the hospital. RESULTS: A total of 706 patients were hospitalised for COVID-19. The mean age was 48.0 years (SD: 15.6 years). More than half of the patients (68.5%; n= 292) were males. The median duration of stay at the hospital was 6.0 days (IQR: 300-10:00). The prevalence rate of venous thromboembolism (VTE) among the patients was 3.0% (n= 21). In the multivariate logistic regression analysis, age (AOR: 1.05; 1.02-1.09), patients with end-stage renal disease (AOR: 6.44; 2.20-18.87), low Oxygen saturation SPO2 (AOR: 9.92; 4.19-23.50), D.dimer >0.5 (AOR: 13.31; 5.45-32.49), ESR>10 mm/h (AOR: 4.08; 1.72-9.68), Ferritin>400mcg/L (AOR: 18.55; 6.89-49.96), and Procalcitonin>0.5ug/L (AOR: 8.23; 1.81- 37.40) were associated with a higher risk of death among patients with COVID-19. Patients with VTE (AOR: 12.86; 3.07- 53.92) were at higher risk of death due to COVID-19. CONCLUSION: Hospitalised COVID-19 patients have multiple negative consequences in terms of their laboratory findings, signs and symptoms. Age and end-stage renal diseases have a significant impact on the mortality rate and the length of hospital stay among COVID-19 patients.

Psychological Effects on Health Science Students After Implementation of COVID-19 Quarantine and Distance Learning in Saudi Arabia.

Background The 2019 novel coronavirus disease (COVID-19) pandemic has impacted the globe dramatically. It has affected daily life noticeably and the teaching process is one of the significantly affected aspects as the learning approach has been shifted to distance learning (DL). These new changes may affect student performance and emotional well-being. This study aimed to assess the psychological impact of the COVID-19 pandemic and distance learning on healthcare students. Method An online self-administered cross-sectional survey was distributed to healthcare students for the period between April 2020 to June 2020. The study included students from different universities in Saudi Arabia. Knowledge and perception of COVID-19 and the experience of distance learning during the pandemic period were assessed using a 5-point Likert scale. Psychological effect was evaluated using Four-Item Patient Health Questionnaire for Anxiety and Depression (PHQ-4). Results A total of 721 students completed the survey with the majority being females. Around 25% of students had experienced anxiety, while 35% had depression. Severe anxiety and depression were noted in over 6% of the participants. Younger age and female gender were more affected psychologically. Students with higher scores in PHQ-4 were strongly disagreeing that hand gloves and surgical masks may help in preventing COVID-19 transmission. Students with normal psychological assessment were more likely to favor DL, while students with moderate to severe anxiety and depression disagreed. Conclusion Healthcare students have alarmingly high levels of anxiety and depression during the COVID-19 pandemic. General knowledge of the pandemic is not associated with the psychological impact. DL is a convenient approach for students with normal PHQ-4 scores. Programs to help students overcome the psychological impact of COVID-19 are highly recommended.

Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global pandemic. The clinical characteristics of COVID-19 have been reported; however, there is limited research investigating the clinical characteristics of COVID-19 in the Middle East. This study aims to investigate the clinical, radiological and therapeutic characteristics of patients diagnosed with COVID19 in Saudi Arabia. METHODS: This study is a retrospective single-centre case series study. We extracted data for patients who were admitted to the Al-Noor Specialist Hospital with a PCR confirming SARS-COV-2 between 12th and 31st of March 2020. Descriptive statistics were used to describe patients' characteristics. Continuous data were reported as mean ± SD. Chi-squared test/Fisher test were used as appropriate to compare proportions for categorical variables. RESULTS: A total of 150 patients were hospitalised for COVID-19 during the study period. The mean age was 46.1 years (SD: 15.3 years). The most common comorbidities were hypertension (28.8%, n = 42) and diabetes mellitus (26.0%, n = 38). Regarding the severity of the hospitalised patients, 105 patients (70.0%) were mild, 29 (19.3%) were moderate, and 16 patients (10.7%) were severe or required ICU care. CONCLUSION: This case series provides clinical, radiological and therapeutic characteristics of hospitalised patients with confirmed COVID-19 in Saudi Arabia.