Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia.

BACKGROUND: Child abuse is a significant issue across many countries. Despite the situation's innate understanding, many children are not reported to authorities and continue to experience abuse, sometimes even death. Healthcare professionals must be alert for abuse in any child who appears with injuries that are out of the ordinary because it is easy for indicators of child abuse to go unnoticed in a busy emergency department. The current study aims to evaluate and detect the challenges in diagnosing and reporting cases of child abuse among healthcare practitioners in emergency, pediatrics, and family medicine. METHODS: A self-administered online disseminated questionnaire was used for data collection during the period from October 1 to December 30, 2022. A cross-sectional study was conducted on emergency, pediatrics, and family medicine healthcare practitioners working in hospitals in healthcare centers in Riyadh, Saudi Arabia. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for (IBM Corp., Armonk, NY) Windows. RESULTS: The study sample constituted 200 physicians working in the front lines of healthcare like emergency, pediatrics, and family medicine primary care services, 50.5% were males and 49.5% were females. 36.5% of participants were 31-39 years old. 42% were family medicine physicians, 36.5% were pediatricians, and 21.5% were emergency medicine. About 43% of participants attended an educational workshop on child abuse. Nineteen percent of participants are very familiar with the diagnosis of child abuse and 36% of participants reported one to three cases of child abuse in the emergency department in the last year, 5% reported four to six cases and 56.5% reported none. Forty-seven percent of participants reported diagnosing one to five cases of child abuse throughout their whole career, 13% reported 11-15 cases, 6.5% reported six to 10 cases and 28.5% reported none. Causes of underdiagnosis of child abuse by healthcare providers were reported as 63% inexperience, 59% inadequate time for physical examination, 59% lack of diagnosis protocol, 51% lack of confidence in communicating with parents, 36% physicians' cultural background, and 38% lack of confidence in the diagnosis. 93.5% of participants think that healthcare practices need further education for child abuse. CONCLUSION: In conclusion, physicians in Saudi Arabia who participated in the study had good knowledge to diagnose a case of child abuse. Inexperience, inadequate time for physical examination, lack of diagnosis protocol, lack of confidence in communicating with parents, and physicians' cultural background were the main identified challenges for diagnosing child abuse. Familiarity with cases of child abuse was significantly associated with physicians' age, specialty, and level of training.

The Principles of Treatment Staff Care of Elderly Patients under Burn & Plastic Surgery and with Covid-19 in ICU & Operating Room Based on Clinical Points: The Original Article

Co-occurrence of chronic diseases in the elderly is a common problem in the field of healthcare worldwide. In countries where life expectancy is high and non-communicable diseases are more common than communicable diseases, it has been reported that more than half of the elderly have at least two chronic diseases with different pathologies. The most common diseases in the elderly with Covid-19 are high blood pressure, diabetes, obesity, cardiovascular diseases and respiratory system diseases. Studies have shown that patients with multiple chronic diseases have a worse prognosis than patients with only one disease. However, the relationship between the type of disease and the number of concurrent diseases with the prognosis of elderly patients with Covid-19 is not definitely known. Due to the vulnerability of the elderly, prevention of the exacerbation of the disease, triage and prioritization of patients and reduction of mortality caused by Covid-19 is a big challenge. Many studies have focused on the clinical characteristics of Covid-19 patients, and information about the factors affecting the severity and lethality of the disease among the elderly is still limited. Therefore, this study was conducted in order to describe the demographic and clinical characteristics and investigate the relationship between co-morbidity and underlying diseases with the severity and mortality caused by Covid-19 in the elderly. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Clinical profile, risk factors and outcomes of ric COVID-19: a retrospective cohort multicentre study in Saudi Arabia.

OBJECTIVE: To describe the risk factors, clinical profile and outcomes of COVID-19 in the paediatric population. DESIGN: Multicentre, retrospective observational study. SETTING: Four tertiary hospitals in Saudi Arabia. PATIENTS: We recruited 390 paediatric patients aged 0-18 years who presented from March to December 2020 and tested positive for COVID-19 on PCR. MAIN OUTCOME MEASURES: We retrospectively analysed medical records for sociodemographics, health indicators, clinical presentations, laboratory findings, clinical complications, and outcomes. RESULTS: The mean participant age was 5.66±4.90 years, and the mean hospital stay was 2.17±3.48 days. Forty patients, mostly school-aged children (16, 40.00%; p=0.005) and children with comorbidities (25, 62.50%; p<0.001), received more than just supportive care. Complications were seen in 15 (3.9%) patients, bacterial infection being the most common (6, 40.00%). Patients presented with dyspnoea (OR 6.89; 95% CI 2.89 to 20.72), abnormal chest radiographs (OR 6.11; 95% CI 1.26 to 29.38), lethargy (OR 9.04; 95% CI 2.91 to 28.06) and elevated ferritin (OR 14.21; 95% CI 4.18 to 48.37) and D-dimer (OR 48.40; 95% CI 14.32 to 163.62), with higher odds of developing complications. The odds of paediatric intensive care unit (ICU) admission were higher for patients with dyspnoea (adjusted OR 4.66; 95% CI 1.24 to 17.50) and elevated white blood cell count (adjusted OR 3.54; 95% CI 1.02 to 12.30). CONCLUSIONS: COVID-19 complications were limited among our patients. However, dyspnoea, abnormal chest radiographs, lethargy and elevated ferritin and D-dimer were associated with an increased risk of complications. Dyspnoea, leucocytosis, comorbidities and abnormal chest radiographs at presentation increased the risk of ICU admission.

Prediction Model for Mortality Analysis of Pregnant Women Affected with COVID-19

COVID-19 pandemic is an ongoing global pandemic which has caused unprecedented disruptions in the public health sector and global economy. The virus, SARS-CoV-2 is responsible for the rapid transmission of coronavirus disease. Due to its contagious nature, the virus can easily infect an unprotected and exposed individual from mild to severe symptoms. The study of the virus's effects on pregnant mothers and neonatal is now a concerning issue globally among civilians and public health workers considering how the virus will affect the mother and the neonate's health. This paper aims to develop a predictive model to estimate the possibility of death for a COVID-diagnosed mother based on documented symptoms: dyspnea, cough, rhinorrhea, arthralgia, and the diagnosis of pneumonia. The machine learning models that have been used in our study are support vector machine, decision tree, random forest, gradient boosting, and artificial neural network. The models have provided impressive results and can accurately predict the mortality of pregnant mother's with a given input. The precision rate for 3 models(ANN, Gradient Boost, Random Forest) is 100% The highest accuracy score(Gradient Boosting, ANN) is 95%, highest recall(Support Vector Machine) is 92.75% and highest f1 score(Gradient Boosting, ANN) is 94.66%. Due to the accuracy of the model, pregnant mother can expect immediate medical treatment based on their possibility of death due to the virus. The model can be utilized by health workers globally to list down emergency patients, which can ultimately reduce the death rate of COVID-19 diagnosed pregnant mothers. © 2021 IEEE.

Hypotheses for reactivation recurrence and reinfection recurrence of COVID-19

COVID-19 virus of the family Coronaviridae, is an enveloped virus with RNA nucleic acid. The virus spread rapidly from China and was declared a pandemic by the World Health Organization on March 11, 2020. Studies show that some patients who recovered from COVID-19 had a recurrence that arose concern among the scientists. The main purpose of this review is to provide potential hypotheses for the recurrence of COVID-19 infection in both clinical reactivation and reinfection. In reactivation recurrence, hypotheses such as hereditary immunodeficiency, the balance between angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme2 (ACE2), the presence of extracellular exosomes were presented, and in the field of reinfection recurrence, hypotheses such as a false primary RT-PCR test deals with positive, low load of COVID-19 virus, acquired immune system defects and mutations in viral RNA that alter viral epitopes were presented in this review. From the hypotheses presented in this paper, it can be concluded that an imbalance between ACE/AngII/AT1R and ACE2/Ang1-7/MasR and the defects in the immune system, can cause defects in the proliferation of NK cells and T lymphocytes, and exosomes contain viral mRNA ultimately leads to reactivation recurrence of the disease. Reinfection recurrence of the COVID-19 may be as a result of the primary false positive report in RT-PCR test, low viral load and inactivation of the immune system, defects in the acquired immune system, and mutations in virus RNA.

Severe acquired haemophilia associated with asymptomatic SARS-CoV-2 infection.

A 65-year-old man presented with symptoms of severe subcutaneous bleeding in his arm, which led to compartment syndrome requiring fasciotomy and massive blood transfusion protocol. Medical history was significant for history of autoimmune thyroid disease. Workup revealed elevated partial thromboplastin time, decreased factor VIII levels and elevated factor VIII inhibitor levels. He was worked up for causes of acquired haemophilia A and was found to have an elevated SARS-CoV-2 antibody level. Given his negative workup for other secondary aetiologies, we suspect that the cause of his haemophilia A was from his SARS-CoV-2 infection, which has been observed previously in various case reports.

Laboratory findings in COVID-19 patients and biomarkers for early assessment of severity and mortality

The novel coronavirus-19 (severe acute respiratory syndrome coronavirus-2) pandemic has crossed more than 4,006,257 cases with 278,892 deaths worldwide and 67,152 cases and 2206 deaths in India. The disease has a variable clinical course ranging from mild to severe disease. Although most of the patients are asymptomatic, some patients with comorbidities have a high propensity of clinical worsening and mortality and it is this chunk of patients that we need to recuperate. Studies have shown that a number of laboratory parameters, which are easily available and inexpensive, can adequately predict the disease severity at an early stage. In a resource-limited country like India, where costly investigations cannot be routinely carried out in the magnitude as big as that of this pandemic, it is imperative that patients be monitored with these simple and inexpensive parameters that are elucidated in this review. We carried out an electronic search on PubMed and Google Scholar with keywords “laboratory abnormalities in COVID-19,” “coagulopathy in COVID-19,” “sepsis in COVID-19,” “hematologic abnormalities in COVID-19,” “kidney injury in COVID-19,” “acute respiratory distress syndrome in COVID-19,” “cardiac injury in COVID-19,” “liver injury in COVID-19,” and “severity indicators in COVID-19” till present date (May 11, 2020). All studies that appeared in our search results were scrutinized and 40 studies were selected for the study.

Radiation resistance of novel SARS-CoV-2: A Monte Carlo investigation on characterization and determination of gamma-ray attenuation properties (preprint)

In late December 2019, the new viral pneumonia outbreak was first detected in Wuhan, the largest metropolitan area in China's Hubei province. The 2019–20 coronavirus pandemic is an ongoing pandemic, caused by the severe acute respiratory syndrome-2 (SARS-CoV-2), was named as Coronavirus disease 2019 (COVID-19) by World Health Organization (WHO). It is well known that radiation can cause mutations in bacteria and viruses. Therefore, characterization of the radiation resistance and interaction properties of viruses provides the opportunity in terms of risk assessment and future aspects. In this study, 3 types of viruses (SARS-CoV-CAS Number 587886-51-9, Influenza-CAS Number 141368-69-6 and SARS-CoV-2 GlycoProtein 6VSB.) were modeled with the Monte Carlo simulation method (MCNPX version 2.6.0). The vital radiation attenuation properties such as linear attenuation coefficients, energy absorption buildup factors (EABF), exposure buildup factors (EBF), relative dose distributions (RDD) were examined using advanced simulation methods. Moreover, the spike protein of SARS-CoV-2 is modelled from the structures in the Protein Data Bank. As a result of the study, we could say that the most radiation resistance was observed in SARS-CoV when compared with Influenza and Covid-19. It could be one of the reasons for SARS-CoV’s resistance to mutation from its outbreak time. On the other hand, Covid-19 is more resistant to radiation than Influenza. Therefore it could be expected that Covid-19 would have the similar behaviors against ionizing radiation as Influenza has.