COVID-19 and Pediatric Rheumatology: A Comprehensive Study from a Leading Tertiary Center in Saudi Arabia.

The Coronavirus disease 2019 (COVID-19) pandemic has emerged as a significant global health concern, impacting millions of individuals worldwide. However, there remains a notable gap in the literature regarding pediatric studies, specifically focusing on children with rheumatic diseases and the potential risk factors associated with COVID-19 contraction in this specific patient population. Patients with rheumatic diseases are often undergoing immunemodulator/immunosuppressant therapies, which can further complicate their immune system response to infections. This is a retrospective cohort study conducted at King Abdullah Specialized Children's Hospital (KASCH), the largest tertiary care children's hospital in Saudi Arabia. The aim was to investigate the rate, clinical manifestations, risk factors, and outcomes of COVID-19 infection in pediatric patients with rheumatic diseases. All rheumatology patients (< 19 years) who presented to the hospital as outpatients, inpatients, and/or ER visits during the period of March 2020 to March 2022 were reviewed for confirmed diagnosis of COVID-19. Among 482 patients included in this study, 126 (26.1%, 95% CI 21.8-31.1) had COVID-19 infection, and no factors were identified to increase the risk of contracting the virus. Fever (55.6%, n = 70) followed by respiratory symptoms (55.6%, n = 70) were the most common clinical manifestations, and around 30% of the patients were asymptomatic. Though most of the patients recovered without complications (97.6%, n = 123), mortality was reported in 3 patients (2.38%). The risk of hospitalization was almost 6 times higher in males (OR = 5.97), and higher in patients receiving t-DMARDs (OR = 17.53) or glucocorticoids (OR = 6.69). The study also revealed that vaccinated children were at lower risk of hospitalization due to COVID-19 than non-vaccinated children. The findings of this study help to identify the risk factors for COVID-19 among children with rheumatic diseases and provide insight into the impact of the pandemic on this group. Overall, while most cases were mild and resolved on their own, unvaccinated patients and those receiving t-DMARDs or glucocorticoids needs vigilant monitoring during the COVID-19 infection. Furthermore, we strongly advocate for the widespread promotion of COVID-19 vaccination among pediatric rheumatology patients as it significantly reduces their risk of COVID-19-related hospitalization.

Helicobacter pylori Infection: Current Status and Future Prospects on Diagnostic, Therapeutic and Control Challenges.

Helicobacter pylori (H. pylori) infection, which affects approximately half of the world's population, remains a serious public health problem. As H. pylori infection leads to a number of gastric pathologies, including inflammation, gastroduodenal ulcers, and malignancies, early detection and treatment are crucial to preventing the spread of the infection. Multiple extragastric complications, such as iron deficiency anaemia, immune thrombocytopenic purpura, vitamin B12 deficiency, diabetes mellitus, cardiovascular diseases, and certain neurological disorders, have also been linked to H. pylori infection. An awareness of H. pylori and associated health hazards is necessary to minimize or even eradicate the infection. Therefore, there is an urgent need to raise the standards for the currently employed diagnostic, eradication, alternative treatment strategies. In addition, a brief overview of traditional and cutting-edge approaches that have proven effective in identifying and managing H. pylori is needed. Based on the test and laboratory equipment available and patient clinical characteristics, the optimal diagnostic approach requires weighing several factors. The pathophysiology and pathogenic mechanisms of H. pylori should also be studied, focusing more on the infection-causing virulence factors of this bacterium. Accordingly, this review aims to demonstrate the various diagnostic, pathophysiological, therapeutic, and eradication tactics available for H. pylori, emphasizing both their advantages and disadvantages. Invasive methods (such as quick urease testing, biopsy, or culture) or noninvasive methods (such as breath tests, stool investigations, or serological tests) can be used. We also present the most recent worldwide recommendations along with scientific evidence for treating H. pylori. In addition to the current antibiotic regimens, alternative therapies may also be considered. It is imperative to eradicate the infections caused by H. pylori as soon as possible to prevent problems and the development of stomach cancer. In conclusion, significant advances have been made in identifying and treating H. pylori. To improve eradication rates, peptide mass fingerprinting can be used as a diagnostic tool, and vaccines can also eliminate the infection.

Paediatric career decision: a literature review of motivational factors.

Unless decision-makers for the future paediatric workforce are aware of different factors that influence the career choices of candidates, they may not be able to meet the needs of this major specialty. Paediatricians should be perceptive, effective communicators and endlessly patient with children. In this article, we conducted a thorough literature search to explore factors affecting career choices among undergraduate and postgraduate students who choose paediatrics or paediatric subspecialties. We assessed the similarities and differences in decision-making in paediatric, medicine, surgery and orthopaedic career contexts to help the candidates in ranking their career options. The authors found that both intrinsic and extrinsic factors shape the career choices of those seeking to work in paediatrics or paediatric subspecialties. A well-structured career development curriculum and clinical experience are considered the most important extrinsic factors, whereas personal characteristics of the candidate and career needs are considered the most important intrinsic factors. These factors may vary across specialties, and even between different subspecialties within the same major specialty. Some factors are considered very important, while others are deemed less so in comparison. The role of mentoring in career selection is crucial. It has been documented in a sizable body of literature that residents are inspired to pursue the careers of their mentors. Paediatrics is no exception. The decision to pursue a subspecialty training is complex and is affected by multiple factors. Those engaged in managing the workforce of the future in the field of paediatrics must familiarise themselves with the intrinsic and extrinsic factors that affect the candidates' career choices.

Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia.

Rheumatic fever (RF) is a common cause of acquired heart disease in children worldwide. It is a delayed, nonsuppurative, autoimmune phenomenon following pharyngitis, impetigo, or scarlet fever caused by group A ß-hemolytic streptococcal (GAS) infection. RF diagnosis is clinical and based on revised Jones criteria. The first version of the criteria was developed by T. Duckett Jones in 1944, then subsequently revised by the American Heart Association (AHA) in 1992 and 2015. However, RF remains a diagnostic challenge for clinicians because of the lack of specific clinical or laboratory findings. As a result, it has been difficult for some time to maintain a balance between over- and underdiagnosis of RF cases. The Jones criteria were revised in 2015 by the AHA, and the main modifications were as follows: the population was subdivided into moderate- to high-risk and low risk; the concept of subclinical carditis was introduced; and monoarthritis was included as a feature of musculoskeletal inflammation in the moderate- to high-risk population. This review will highlight the major changes in the AHA 2015 revised Jones criteria for pediatricians and general practitioners.

A rare cutaneous manifestation of Kawasaki disease.

Kawasaki disease (KD) is the second common vasculitis in childhood following Henoch-Schönlein purpura. The common skin manifestations in KD are polymorphic exanthema, epidermal desquamation, erythema of the palms and soles and edema over the extremities. Skin erythema at the Bacille-Calmette-Guérin (BCG) vaccination site has been reported frequently in patients with KD. Skin ulceration after BCG vaccination in a context of KD was also reported but not as a part of the disease manifestation. We report a 14-month-old child who presented with clinical criteria for KD and developed left forearm ulcer that did not respond to antimicrobial therapy but responded well to immunomodulatory therapy.

Can identification badges be vectors of infection: Experience from a tertiary care center in Riyadh, Saudi Arabia.

BACKGROUND: Wearing identification badges is mandatory in many hospitals. Identification badges worn by healthcare workers may be contaminated with pathogens. OBJECTIVE: The objective of this study is to determine the levels and types of contamination on identification badges of healthcare workers at King Abdulaziz Medical City in Riyadh, Saudi Arabia. MATERIALS AND METHODS: This is a cross-sectional study of 200 healthcare workers at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A data collection form was handed to all the participants and swab cultures of their identification badges were taken. RESULTS: A total of 200 identification badges were sampled in this study. 37% were contaminated with pathogens. Coagulase-negative Staphylococcus was isolated from 70 badges (35%), and methicillin-sensitive Staphylococcus aureus from four badges (2%). Contamination was highest in physicians (45% compared to 14-32% in other healthcare workers). Males and females had similar contamination rates (39 and 36%, respectively). CONCLUSION: Identification badges worn by healthcare workers may be vectors of significant infection. We suggest more compliance of infection control measures in regards to disinfecting badges or personal belongings of healthcare workers.

Awareness, knowledge, and practices related to diabetic retinopathy among diabetic patients in primary healthcare centers at Riyadh, Saudi Arabia.

CONTEXT: Diabetic retinopathy (DR) is a microvascular complication for diabetes mellitus (DM), with around 35% of diabetic patients developing some form of DR. AIMS: This study assessed the awareness toward DR, practice of regular eye examination, and DM control among diabetic patients. SETTINGS AND DESIGN: This was a cross-sectional study among diabetics at two primary healthcare centers in Riyadh, Saudi Arabia, who were selected by convenience sampling. METHODS AND MATERIALS: The questionnaire contained sections for demography, knowledge, attitude, and practice toward DR, and compliance to DM treatment. The association of awareness about retinopathy with demographics was compared. STATISTICAL ANALYSIS USED: The association of awareness about retinopathy and education level with demographics and compliance with treatment were compared using Chi-square test. RESULTS: In total, 280 diabetic patients were included, 187 (67%) were males, mean age was 58.9 ± 10.1 years, and median duration of diabetes was 10 years. There was good awareness about DR, diabetes was well controlled in 170 (61%) patients, but less than half (45%) had their eyes checked within 1 year. Patients with education level of high school and above had higher awareness than those with no formal education (P < 0.001). Also, those with income level >10,000 SR had higher awareness than those with income ≤5,000 SR (P < 0.05). CONCLUSION: There was high awareness among the diabetic patients regarding DR but annual check-up was done in less than half of the patients. Improvement is required for scheduling annual eye examinations for the early detection of DR.

Public knowledge and awareness about Parkinson's disease in Saudi Arabia.

BACKGROUND: Parkinson's disease (PD) is one of the most prevalent neurologic disorders, leading to progressive disability that can be slowed but not stopped by treatment. It is characterized by tremors, slow movements, stiffness in arms and legs, and balance impairment. Despite advancement in treatment, diagnosis, and care of PD patients, lack of adequate knowledge and associated beliefs among the community might have a key role in limiting access to proper treatment and care. OBJECTIVES: To identify the level of awareness of our population regarding PD in terms of causes, signs, symptoms, and treatment. MATERIALS AND METHODS: A cross-sectional study was conducted on Saudis, who have active Twitter accounts. Data were collected through a previously validated questionnaire, which tests recognition of PD symptoms and general knowledge regarding PD. The questionnaire was translated into Arabic. Part 1 of the questionnaire is the demographic data collection sheet, Part 2 of the questionnaire tests recognition of PD symptoms, and Part 3 of the questionnaire tests general knowledge regarding PD. RESULTS: The questionnaire was administered to 3,050 members of the public, of which 2,609 questionnaires (86.20%) were included in the analysis. The tremor was the most widely recognized symptom (86.10%), and weight loss was the most recognized non-motor symptom (24%). Most respondents (56%) were able to identify imbalance as a symptom of PD, whereas only 4.10% of them were able to identify the reduced sense of smell as a symptom of PD. Motor symptoms were significantly better recognized (range 31.30%-86.10%) than non-motor symptoms (range 4.10%-24%). CONCLUSION: Educational campaigns may be appropriate to improve public awareness of PD and individual knowledge about PD symptoms and treatment.