Knowledge, attitudes and practices of healthcare workers during the early COVID-19 pandemic in a main, academic tertiary care centre in Saudi Arabia.

As the Middle East respiratory syndrome coronavirus (MERS-CoV) continues to occur in small outbreaks in Saudi Arabia, we aimed to assess the knowledge, attitudes and intended practices of healthcare workers (HCWs) during the early stage of the COVID-19 pandemic and compare worry levels with previous findings during the MERS-CoV outbreak in 2015. We sent an adapted version of our previously published MERS-CoV questionnaire to the same cohort of HCWs at a tertiary hospital in Saudi Arabia. About 40% of our sample had previous experience with confirmed or suspected MERS-CoV patients, and those had a significantly higher knowledge score (13.16 ± 2.02 vs. 12.58 ± 2.27, P = 0.002) and higher adherence to protective hygienic practices (2.95 ± 0.80 vs. 2.74 ± 0.92, P = 0.003). The knowledge scores on COVID-19 were higher in the current cohort than the previous MERS-CoV outbreak cohort (68% vs. 79.7%, P < 0.001). HCWs from the current cohort who felt greater anxiety from COVID-19 compared to MERS-CoV were less likely to have been exposed to MERS-CoV infected/suspected cases (odds ratio (OR) = 0.646, P = 0.042) and were less likely to have attended the hospital awareness campaign on COVID-19 (OR = 0.654, P = 0.035). We concluded that previous experience with MERS-CoV was associated with increased knowledge and adherence to protective hygienic practices, and reduction of anxiety towards COVID-19.

Serogroups and antimicrobial susceptibility of non-typhoidal salmonellas in children.

OBJECTIVE: To update knowledge regarding the pattern of Serogroups and antimicrobial susceptibility of Salmonellas causing gastroenteritis in children at the King Khalid University Hospital in Riyadh, Saudi Arabia during the period of 1st April 1996 to 30th September 1999. METHODS: The case records of 416 children, from whom Salmonella species were isolated from stool cultures between April 1996 and September 1999 were reviewed. The isolates and susceptibility of these Salmonella were carried out accordingly to standard microbiological methods. RESULTS: During a period of 3 and 1/2 years a total of 412 non-typhoidal Salmonellas were isolated from stool cultures of 416 children who presented to King Khalid University Hospital complaining of gastroenteritis. The majority of these children (70%) belonged to the age group 0-4 years. Eighty seven percent of the Salmonella isolates were Serogroup D1, B and C1. The Serogroups and antimicrobial susceptibility of these Salmonellas differed from those previously reported from this country and other parts of the world. CONCLUSION: Salmonella gastroenteritis is an important clinical condition in infants and children in the Kingdom of Saudi Arabia. Salmonella Serogroups D1, B and C predominate as causative agents of this condition. Most of the salmonella serogroups isolated in this study were highly susceptible to commonly used antimicrobial agents but ampicillin showed a rising resistance pattern. This may make it unsuitable therapy for Salmonella gastroenteritis.

Home management of fever in children: rational or ritual?

Fever is extremely common in childhood. Parents have been shown to have unrealistic fears, resulting in inappropriate management of fever in their children. This study was conducted to survey parents about their knowledge concerning home management of fever in children in their care. Parents of 560 febrile children were randomly recruited and interviewed in the waiting areas of the outpatient clinics or emergency room in four hospitals in Riyadh city using a standard questionnaire. Most of the interviewees were mothers, aged within 20-39 years. Although more than one-half of fathers and one-third of mothers in the study were well educated, most were misinformed about recognition and definition of fever. Most parents had poor knowledge regarding minimum temperatures for administering correct doses of antipyretic drugs or for sponging/bathing with water of the correct temperature. Most parents demonstrated a poor understanding of the appropriate frequency for checking the child's temperature and administering antipyretics. Only one-third of parents indicated a reasonable educational imprint by health-care providers. Considerable efforts will be required to educate parents about fever and its management.

The dogma of identifying occult bacterial infections in young febrile children: a survey of primary-care physicians.

Management of undifferentiated febrile illness in young children continues to be a controversial issue among primary-care physicians. A self-administered questionnaire was mailed to 600 randomly selected physicians regarding their management of children with high fever and no focus of infection at various ages: 3 weeks, 7 weeks, 4 months and 20 months. Completed questionnaires were returned by 419 (70%) physicians. Nearly 77% of physicians would hospitalize a 3-week old infant with fever and 70% would treat these infants empirically with antibiotics. Sixty-one per cent of physicians would hospitalize a 7-week-old infant with fever and 46% would treat empirically with antibiotics. Approximately 80% and 93% of physicians, respectively, would not hospitalize 4- and 20-month-old infants with high fever and no focus of infection, but 72% and 59%, respectively, would treat such infants with antibiotics. There was considerable variation in the way physicians managed young febrile children with no focus of infection and the clinical approach of some physicians was remarkably different from current knowledge and recommendations.

Pattern of febrile illnesses in children seen at a pediatric ambulatory care setting.

BACKGROUND: Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine. OBJECTIVES: To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings. METHODS: A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives. RESULTS: Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them. CONCLUSION: The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.

Recurrent bacterial meningitis: report of two cases from Riyadh, Saudi Arabia.

We report two cases of recurrent bacterial meningitis after head injury in two Saudi boys. The brain CT scan showed bony defects in both despite normal otolaryngeal clinical findings. One child remained well after surgical repair but the other was lost to follow-up.

CAPD in saudi arabian children: ten years experience from a single center.

In this paper we describe our experience with chronic ambulatory peritoneal dialysis (CAPD) in children. Between 1984 and 1993, a total of 51 patients were treated by CAPD at King Khalid University Hospital. Eight patients were excluded from the study because of incomplete data. There were 25 boys and 18 girls aged three months to 16 years; 12 patients (27.9%) were below two years, 15 patients (34.9%) were between 2-6 years, and 16 patients (37.2%) were above six years of age. Reflux nephropathy secondary to obstructive uropathy was the main cause of ESRD in the study patients (27.9%). The total period of CAPD was 579 patient-months (48.25 years). The overall incidence of peritonitis was high, one episode per 4.7 patient months; one episode per 3.2 patient months in the first five years of the study and one episode per 6.2 patient-months in the 2nd five years of the study period. The cause of peritonitis was gram positive organisms in 38.7% and gram negative organisms in 24.9%. Seventeen (39.5%) of catheters were changed because of infection or mechanical obstruction. In 90.7% of patients, the mother was the person who was performing dialysis. At the end of the study, seven patients (16.2%) were still on CAPD, 10 patients (23.3%) shifted to heraodialysls, 16 patients (37.2%) were transplanted, six patients (14.0%) died and four patients (9.3%) recovered. We conclude that CAPD may be a suitable renal replacement therapy for children in a country with a wide geographical area and low population density as Saudi Arabia.

Spectrum of Haemophilus influenzae type b disease in children at a university hospital in Riyadh, Saudi Arabia.

During a period of 5 years, 42 cases of invasive Haemophilus influenzae type b (Hib) disease were studied. An outstanding finding in our patients was occult bacteraemia, which was detected in 13 (31 per cent) patients. Other clinical conditions encountered were nine (21 per cent) patients with pneumonia, nine (21 per cent) with meningitis, six (14 per cent) with cellulitis, three (7 per cent) with arthritis, one (2 per cent) with epiglottitis, and one (2 per cent) with urinary tract infection. The mean age of children was 21 months (range 1-156 months); the majority (62 per cent) belonged to the age group 7-18 months. There were 24 females and 18 males. Eighty-one per cent of these patients were Saudi nationals. Five isolates (12 per cent) of Hib were resistant to ampicillin and similar numbers were resistant to chlorampenicol. Twenty-five children (60 per cent) were treated with ampicillin, nine (21 per cent) with chlorampenicol and eight (19 per cent) with ceftriaxone. All patients made complete recovery.

Rett syndrome in Saudi Arabia: report of six patients.

Six girls (five Saudis and one Sudanese) aged between 3.5 and 12 years demonstrated the classic features of Rett syndrome (RS), including developmental regression with dementia, loss of acquired speech and hand function, and stereotypic hand movements. Myoclonic seizures were observed in two of them. Electroencephalography showed diffuse slowing in three cases generalized epileptic discharges in one, and normal findings in two. Cranial computed tomography revealed normal findings, except in the 12-year-old girl who had mild bilateral frontal lobe atrophy. Except for mildly elevated blood ammonia in three patients, associated with slightly elevated blood lactate in two of them, results of neurometabolic screening tests were normal. There are, as yet, no laboratory markers pathognomonic for RS. Hence, adherence to current diagnostic criteria is essential. To prevent unnecessary and costly investigations, especially in developing countries, wider knowledge of the clinical features of the syndrome is warranted.

Effect of beta-lactamase inhibitors on normal immune capabilities and their interactions with staphylococcal pathogenicity.

The effects of the beta-lactamase inhibitors, clavulanic acid, sulbactam and tazobactam on normal immune responses were investigated. These agents did not interfere with either humoral or cell-mediated immune responses as measured by the hemolytic plaque assay and delayed type hypersensitivity reaction assay respectively. In addition, human polymorphonuclear leukocyte phagocytic activity was not altered by these agents. When these agents were tested for their effect on Staphylococcus aureas adherence to buccal epithelial cells we found that all inhibitors suppressed staphylococcal adherence at therapeutic serum concentrations. Among the inhibitors investigated, sulbactam was found to significantly inhibit the hemolysin production of S. aureus. These data suggest that beta-lactamase inhibitors do not exhibit immunomodulating activity, but they interfere with some of the virulence factors of S. aureus. These findings suggest the advantage of preparations containing these inhibitors.

Down's syndrome in Saudi Arabia: incidence and cytogenetics.

A study has been carried out in Riyadh to determine the incidence and distribution of Down's syndrome births during a 9-year period from July 1982 to June 1991. Down's syndrome was ascertained in 42 (23 females and 19 males) of 23,261 consecutive babies born alive to Saudi women, giving an incidence of 1 in 554 live births (1.8 per 1,000). A trend towards an increased incidence of Down's syndrome with advanced maternal age or increased maternal parity was found. Cytogenetic studies were performed on 37 cases of which all but 1 were non-disjunction trisomy 21, while the remaining infant had a translocation. This study provides the first step for further epidemiological surveys of Down's syndrome in the Kingdom of Saudi Arabia in order to prepare the ground for an effective antenatal screening programme for chromosomal disorders.

Meningococcaemia: a life threatening complication of upper gastrointestinal endoscopy.

Minor and major complications of diagnostic and therapeutic upper gastrointestinal endoscopy, especially after injection sclerotherapy, are well recognised. We report a case of septicaemia with Neisseria meningitidis serogroup A in a 4-year-old girl after diagnostic endoscopy.

Acute rheumatic fever in Saudi Arabia: mild pattern of initial attack.

Fifty-one children with the initial attack of acute rheumatic fever (ARF) were studied prospectively to verify the sociodemographic and clinical profile and to compare results with those from other countries. Most children belonged to large families who lived in an urban setting with ready access to medical care. Unlike reports from many developing countries, the clinical manifestations in this study paralleled data from the West and included arthritis in 76% of the cases, carditis in 43%, and chorea in 8%. Among the 22 cases with carditis, 18 had mitral regurgitation, three developed combined mitral and aortic regurgitation, and one had aortic regurgitation. This study demonstrates the mild nature of ARF in Saudi Arabia and supports the concept that climate and geography appear to bear little relationship to the incidence and severity of ARF.

Detection of pneumococci with increased resistance to penicillin and their clinical significance.

Streptococcus pneumoniae isolates from blood, CSF, respiratory tract and other clinical specimens from 626 patients were tested for sensitivity to penicillin. The bacteria were collected from patients in different hospitals in Riyadh, Saudi Arabia. Using 1 microg oxacillin disk, 147 (23.5%) of these isolates were found to be relatively resistant to penicillin (RPR). When 358 pneumococcal isolates were tested for RPR using 1 or 10 unit penicillin disks and compared with the MIC or oxacillin disk, as many as 18% were incorrectly designated as sensitive meningitis, septicemia and pneumonia, the significance of determining their correct susceptibility to penicillin cannot be over emphasized.

The relative importance of Shigella in the aetiology of childhood gastroenteritis in Saudi Arabia.

The role of shigella infection in childhood gastroenteritis was studied over a 2-year period. Shigella species were found in the faecal specimens of 70 (1%) of 7369 children with gastroenteritis, but in only 1 (0.1%) of 1130 controls. S. flexneri was the commonest isolate (51%), followed by S. sonnei (37%). Most shigella species were isolated during the winter. The prevalence of shigellosis was highest for children 1-5 years of age but equal for both sexes. Fever, abdominal cramps, vomiting, and bloody diarrhoea were the predominant clinical features. Of the shigella isolates, 73% were resistant to cotrimoxazole, 43% to ampicillin, and 41% to chloramphenicol. One-third of isolates were resistant to greater than or equal to 3 antibiotics. All isolates were susceptible to nalidixic acid. The illness was mild and self-limiting and most patients recovered without antimicrobial therapy.

Childhood brucellosis: a deceptive infectious disease.

Human brucellosis is a multisystem disease that may notoriously mimic many other illnesses leading to misdiagnosis and increased morbidity. Six pediatric cases of brucellosis who had no epidemiologic evidence of the infection escaped early or correct recognition. The diagnosis of brucellosis was later made on the basis of significant brucella serology and positive blood or bone marrow culture. In endemic areas, a high index of suspicion should prevail in the evaluation of patients with vague or unexplained symptoms.

Childhood brucellosis: a study of 102 cases.

One hundred two children, 45 days to 14 years of age, with proven brucellosis were studied to illustrate the epidemiologic, clinical and laboratory findings and to assess the outcome of antimicrobial therapy. The main source of infection was the consumption of raw milk in 80% of the patients. The predominant presenting symptoms and signs were fever, arthralgia, malaise, weight loss, arthritis, hepatosplenomegaly and lymphadenopathy. Brucella melitensis was isolated from 75% of 87 patients. Diverse hematologic and biochemical abnormalities were found. Different durations and combinations of trimethoprim-sulfamethoxazole or tetracycline plus streptomycin or rifampin were used for therapy. Eight-five patients were followed for an average of 14 months. Twelve (85.7%) of 14 patients treated with two-antibiotic combinations for 3 weeks relapsed, as did 5 (8%) of 62 patients treated for at least 6 weeks (P less than 0.001). No relapses occurred in 9 patients treated with trimethoprim-sulfamethoxazole and rifampin for 8 to 12 weeks plus streptomycin for the first 3 weeks. Longer duration and combination of antibiotic therapy seem warranted to improve outcome and to prevent relapses.