Identification of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Healthcare Workers at Sultan Qaboos University Hospital, Oman.

Objectives: This study aimed to describe the incidence and features of asymptomatic COVID-19 infections among healthcare workers (HCWs) at a tertiary hospital in Oman. Methods: This cross-sectional study was conducted between August 2020 and February 2021 among HCWs with no history of COVID-19 infection. An online questionnaire collected sociodemographic and clinical data. COVID-19 infection was diagnosed using nasopharyngeal/throat swabs, which were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Analyses were performed using the Chi-squared test, Fisher's exact test or univariate ordinary least squares regression, as appropriate. Results: A total of 583 HCWs participated in the study, most of whom were female (56.6%), and the mean age was 35 ± 8 years. Only 9.6% (95% confidence interval [CI]: 7.3-12.3%) of the HCWs were at high exposure risk as they were directly involved in the care of COVID-19-infected patients. Overall, 4.1% (95% CI: 2.7-6.1%) of the HCWs screened positive for SARS-CoV-2, of which 20.8% developed symptoms within two weeks. The frequency of SARS-CoV-2 positivity among HCWs working in high-, intermediate-, low- and miscellaneous-risk areas was 1.8% (95% CI: <0.1-9.6%), 2.6% (95% CI: <0.1-6.5%), 5.3% (95% CI: 0.3-9.3%) and 4.8% (95% CI: <0.1-69.3%), respectively. Working in high-risk areas was associated with increased compliance with various infection control strategies (P <0.001). Conclusion: There was a greater frequency of SARS-CoV-2 positivity among HCWs working in low-risk areas, whereas HCWs who worked in high-risk areas were significantly more likely to report increased compliance with infection control strategies.

The Accuracy of Point-of-Care Ultrasound Performed by Emergency Physicians in Detecting Hydronephrosis in Patients with Renal Colic.

Objectives: This study aimed to determine the accuracy of renal point-of-care ultrasound (POCUS) performed by emergency physicians in detecting hydronephrosis in patients with renal colic. Methods: This prospective cross-sectional diagnostic study was conducted at the Emergency Department (ED) of Sultan Qaboos University Hospital from February 2017 to February 2018. All adult patients with suspected renal colic and who could give informed consent were included. The emergency physicians performed POCUS on both kidneys and graded hydronephrosis as none, mild, moderate or severe. The POCUS grade was compared to the non-contrast computed tomography (NCCT) grade. Results: A total of 303 participants were enrolled in the analysis. The majority of the study population comprised adult males (247 [81.5%]), and the mean age was 39 years. Among the samples, 71.3% of the patients exhibited a degree of hydronephrosis based on CT findings. Ultrasounds performed by emergency physicians had a sensitivity of 75.8% (95% CI: 69.5-81.4), specificity of 55.2% (95% CI: 44.1-65.8), a positive likelihood ratio of 1.69 (95% CI: 1.32-2.16) and a negative likelihood ratio of 0.43 (95% CI: 0.32-0.59) for hydronephrosis using CT as the criterion standard. Conclusion: When evaluating patients with suspected renal colic, a bedside renal POCUS performed by emergency physicians has a moderate sensitivity to detect hydronephrosis and grade its severity. Therefore, it should be utilised in the ED to screen patients for hydronephrosis; however, more training is required to improve the test's accuracy.

Determination of the Pretibial Soft Tissue Thickness in Children: Are Intraosseous Infusion Needles Long Enough?

OBJECTIVE: The EZ-IO intraosseous (IO) needle is available in 2 needle sizes for children based on the patient weight. To date, there is no published evidence validating the use of weight-based scaling in children. We hypothesized that pretibial subcutaneous tissue thickness (PSTT) does not correspond with patient weight but rather with age and body mass index (BMI). Our objective was to describe the relationship of a patient's PSTT to their weight, age, and BMI in children less than 40 kg. METHOD: One hundred patients who weighed less than 40 kg were recruited prospectively from October 2013 to April 2015 at a tertiary care pediatric emergency department. All sonographic assessments were performed by 1 of 2 emergency physicians certified in point-of-care ultrasound. A single sonographic image was taken over the proximal tibia corresponding to the site of IO insertion. In patients where both sonographers performed independent measurements, a Pearson correlation coefficient was determined. Univariate linear regression was performed to determine the relationship between age, weight, and BMI with PSTT. RESULTS: One hundred participants were recruited and ranged in age from 10 days to 14 years (mean [SD], 5.01 [3.14] years). Fifty-seven percent of participants were male. Patients' weights ranged from 3.5 to 39.3 kg (mean [SD], 21.42 [9.12] kg), and BMI ranged from 12.1 to 45.0 kg/m (mean [SD], 17.31 [4.00]). The mean (SD) PSTT across participants was 0.68 (0.2) cm. The intraclass correlation coefficient for agreement between the 2 sonographers was moderate (intraclass correlation coefficient, 0.602 [confidence interval, 0.385-0.757]). There were significant positive correlations between BMI and PSTT (r = 0.562, P = <0.001) as well as weight and PSTT (r = 0.293, P < 0.003). There was a weak correlation between age and PSTT (0.065, P = 0.521). CONCLUSIONS: Pretibial subcutaneous tissue thickness correlates most strongly with BMI, followed by weight, and weakly with age. Our findings suggest that current IO needle length recommendations should be based on BMI rather than weight. This would suggest that clinicians need to be aware that young patients in particular with large BMIs may pose problems with current weight-based needle length recommendations.

Pediatric Abdominal Trauma.

Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Nonoperative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed Tomography (CT) is the gold standard in the identification of intra-abdominal injury. Focused Assessment with Sonography for Trauma (FAST) can detect the presence of free fluid suggestive of intra-abdominal injury. In children, the utility of FAST is limited because less than half of pediatric patients with abdominal injury have free fluid. Bowel perforation and pancreatic injuries may not be evident on initial CT scanning of the abdomen. Initial management of the trauma patient in shock includes fluid boluses of normal saline or Ringer's lactate with two, large-bore upper extremity catheters. Transfusion with packed red blood cells is done if the patient remains hypotensive after the second fluid bolus. Emergent laparotomy is indicated in patients with: free intraperitoneal air, hemodynamic instability despite maximal resuscitative efforts (transfusion of greater than 50% of total blood volume), gunshot wound to the abdomen or other penetrating traumas, and evisceration of intraperitoneal contents. Initial FAST followed by abdominal computed tomography is important in the evaluation of the seriously or critically injured patient. The combination of the FAST exam along with selected abdominal computed tomography can further aid in the detection of injuries that may not be clinically apparent.

Acute-on-Chronic Anterolateral Tibiofibular Joint Dislocation in a Child.

Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute injuries in sports that involve aggressive twisting of the knee, such as soccer and snowboarding. We present a case of a 17-year-old male adolescent who sustained an acute dislocation of the anterolateral tibiofibular joint with routine ambulation, who had a chronic history of subluxation. To our knowledge, this has not been previously reported. The diagnosis requires a high level of awareness and suspicion, and plain radiographs may aid in the diagnosis especially if contralateral comparison views are obtained.