Publications by authors named "Imran Khalid"

65 Publications

Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic.

Am J Hosp Palliat Care 2021 Sep 27;38(9):1159-1164. Epub 2021 May 27.

Consultant 66787King Faisal Specialist Hospital & Research Center, Jeddah & Staff Physician John D Dingell VA Medical Center, Detroit, MI, USA.

Background: Little is known about end-of-life care among Muslim patients, particularly during Coronavirus disease 2019 (COVID) pandemic, which we report here.

Methods: The clinical characteristics, end-of-life care and resuscitation status of Muslim patients who died in the ICU of our tertiary care hospital in year 2020 from COVID were compared to Non-COVID patients.

Results: There were 32 patients in COVID and 64 in the Non-COVID group. A major proportion, mainly of Non-COVID patients, already had a hospice eligible terminal disease at baseline (p=.002). COVID patients were admitted to the ICU sooner after hospitalization (2.2 vs. 17 days), had prolonged duration of mechanical ventilation (18.5 vs. 6 days) and longer ICU stay (24 vs. 8 days) than non-COVID patients, respectively (p<.001). Almost all patients were "Full Code" initially. However, status was eventually changed to 'do-not-attempt resuscitation' (DNAR) in about 60% of the cohort. COVID patients were made DNAR late in their ICU stay, predominantly in the last 24 hours of life (p=.04). Until the very end, patients in both groups were on tube feeds, underwent blood draws and imaging, required high dose vasopressors, with few limitations or withdrawal of therapies. Family members were usually not present at bedside at time of death. There was minimal involvement of chaplain and palliative care services.

Conclusions: Muslim COVID-19 patients had prolonged mechanical ventilation and ICU stay and a delayed decision to DNAR status than non-COVID Muslim patients. Limitation or withdrawal of therapy occurred infrequently. The utilization of chaplain and palliative care service needs improvement.
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http://dx.doi.org/10.1177/10499091211018657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160924PMC
September 2021

Test-based de-isolation in COVID-19 immunocompromised patients: Cycle threshold value versus SARS-CoV-2 viral culture.

Int J Infect Dis 2021 May 15;108:112-115. Epub 2021 May 15.

Special Infectious Agents Unit-BSL3, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.

Background: Immunocompromised patients with coronavirus disease 2019 (COVID-19) have prolonged infectious viral shedding for more than 20 days. A test-based approach is suggested for de-isolation of these patients.

Methods: The strategy was evaluated by comparing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (cycle threshold (Ct) values) and viral culture at the time of hospital discharge in a series of 13 COVID-19 patients: six immunocompetent and seven immunocompromised (five solid organ transplant patients, one lymphoma patient, and one hepatocellular carcinoma patient).

Results: Three of the 13 (23%) patients had positive viral cultures: one patient with lymphoma (on day 16) and two immunocompetent patients (on day 7 and day 11). Eighty percent of the patients had negative viral cultures and had a mean Ct value of 20.5. None of the solid organ transplant recipients had positive viral cultures.

Conclusions: The mean Ct value for negative viral cultures was 20.5 in this case series of immunocompromised patients. Unlike those with hematological malignancies, none of the solid organ transplant patients had positive viral cultures. Adopting the test-based approach for all immunocompromised patients may lead to prolonged quarantine. Large-scale studies in disease-specific populations are needed to determine whether a test-based approach versus a symptom-based approach or a combination is applicable for the de-isolation of various immunocompromised patients.
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http://dx.doi.org/10.1016/j.ijid.2021.05.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123529PMC
May 2021

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect.

Healthcare (Basel) 2021 Feb 18;9(2). Epub 2021 Feb 18.

Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia.

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects ( = 860, aged 41-80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A-control, Group B-test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2-4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired -test while the level of relationship was determined by Karl Pearson's test at a -value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21-30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.
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http://dx.doi.org/10.3390/healthcare9020226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922918PMC
February 2021

A Case of Rheumatoid Arthritis-Associated Interstitial Lung Disease - An Unfortunate Complication of Untreated Rheumatoid Arthritis!

Cureus 2020 Oct 21;12(10):e11074. Epub 2020 Oct 21.

Internal Medicine, Northwell Health, New York, USA.

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a rare extraarticular manifestation of the systemic autoimmune disease rheumatoid arthritis. RA-ILD is one of the leading causes of morbidity and mortality in patients with rheumatoid arthritis. It is more commonly seen in patients with risk factors, which include male sex, severe rheumatoid arthritis, and smoking. The presentation depends on the extent of the underlying pathology. Patients can remain asymptomatic for extended periods of time and progressively develop symptoms such as shortness of breath on exertion and a nonproductive cough. The diagnosis is made using a combination of clinical presentation, pulmonary function testing, and imaging. It is difficult for a practitioner to distinguish the presentation of interstitial lung disease from other causes and RA-ILD. However, it is extremely important to differentiate them due to the differences in management. The treatment usually involves a multidisciplinary team guided approach towards treating the underlying rheumatoid arthritis. Asymptomatic patients are managed by observation, while symptomatic patients are managed with glucocorticoids and immunosuppressants. Accurate and early treatment can lead to an improvement in a patient's symptoms and significantly improve their quality of life. We present an interesting case of a female with a long-standing history of rheumatoid arthritis not on any treatment presenting to the ED with exertional shortness of breath, dry cough, and abdominal distension.
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http://dx.doi.org/10.7759/cureus.11074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678764PMC
October 2020

Some valency oriented molecular invariants of certain networks.

Comb Chem High Throughput Screen 2020 Oct 20. Epub 2020 Oct 20.

2 Center for Advanced Studies in Pure and Applied Mathematics, Bahauddin Zakariya University Multan 60800. Pakistan.

Background: The valency of an atom in a molecular structure is the number of its neighboring atoms. A large number of valency based molecular invariants have been conceived, which correlate certain physio-chemical properties like boiling point, stability, strain energy and many more of chemical compounds.

Objective: Our aim is to study the valency based molecular invariants for four hexa chemical structures, namely hexagonal network, honeycomb network, oxide network and silicate sheet network.

Method: We use the technique of atom-bonds partition according to the valences of atoms to find results.

Results: Exact values of valency-based molecular invariants, namely the Randić index, atom bond connectivity index, geometric arithmetic index, harmonic index, Zagreb indices, Zagreb polynomials, F-index and F-polynomial are found for four hexa chemical structures.
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http://dx.doi.org/10.2174/1386207323666201020145239DOI Listing
October 2020

Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial.

Intensive Care Med 2020 04 24;46(4):737-746. Epub 2020 Feb 24.

Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.

Purpose: We examined the association between surveillance for deep vein thrombosis (DVT) among medical-surgical critically ill patients by twice-weekly ultrasonography and 90-day all-cause mortality.

Methods: This was a pre-planned sub-study of the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (Clinicaltrials.gov: NCT02040103) that compared addition of intermittent pneumatic compression (IPC) to pharmacologic prophylaxis versus pharmacologic prophylaxis alone. The surveillance group included enrolled patients in the trial, while the non-surveillance group included eligible non-enrolled patients. Using logistic regression and Cox proportional hazards models, we examined the association of surveillance with the primary outcome of 90-day mortality. Secondary outcomes were DVT and pulmonary embolism (PE).

Results: The surveillance group consisted of 1682 patients and the non-surveillance group included 383 patients. Using Cox proportional hazards model with bootstrapping, surveillance was associated with a decrease in 90-day mortality (adjusted HR 0.75; 95% CI 0.57, 0.98). Surveillance was associated with earlier diagnosis of DVT [(median 4 days (IQR 2, 10) vs. 20 days (IQR 16, 22)] and PE [median 4 days (IQR 2.5, 5) vs. 7.5 days (IQR 6.1, 28.9)]. There was an increase in diagnosis of DVT (adjusted HR 5.49; 95% CI 2.92, 13.02) with no change in frequency in diagnosis of PE (adjusted HR 0.56; 95% CI 0.19, 1.91).

Conclusions: Twice-weekly surveillance ultrasonography was associated with an increase in DVT detection, reduction in diagnostic testing for non-lower limb DVT and PE, earlier diagnosis of DVT and PE, and lower 90-day mortality.

Trial Registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.
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http://dx.doi.org/10.1007/s00134-019-05899-1DOI Listing
April 2020

Comparative proteomic analysis of different stages of breast cancer tissues using ultra high performance liquid chromatography tandem mass spectrometer.

PLoS One 2020 16;15(1):e0227404. Epub 2020 Jan 16.

Analytical Biochemistry Research Centre (ABrC), Universiti Sains Malaysia, USM, Penang, Malaysia.

Background: Breast cancer is the fifth most prevalent cause of death among women worldwide. It is also one of the most common types of cancer among Malaysian women. This study aimed to characterize and differentiate the proteomics profiles of different stages of breast cancer and its matched adjacent normal tissues in Malaysian breast cancer patients. Also, this study aimed to construct a pertinent protein pathway involved in each stage of cancer.

Methods: In total, 80 samples of tumor and matched adjacent normal tissues were collected from breast cancer patients at Seberang Jaya Hospital (SJH) and Kepala Batas Hospital (KBH), both in Penang, Malaysia. The protein expression profiles of breast cancer and normal tissues were mapped by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The Gel-Eluted Liquid Fractionation Entrapment Electrophoresis (GELFREE) Technology System was used for the separation and fractionation of extracted proteins, which also were analyzed to maximize protein detection. The protein fractions were then analyzed by tandem mass spectrometry (LC-MS/MS) analysis using LC/MS LTQ-Orbitrap Fusion and Elite. This study identified the proteins contained within the tissue samples using de novo sequencing and database matching via PEAKS software. We performed two different pathway analyses, DAVID and STRING, in the sets of proteins from stage 2 and stage 3 breast cancer samples. The lists of molecules were generated by the REACTOME-FI plugin, part of the CYTOSCAPE tool, and linker nodes were added in order to generate a connected network. Then, pathway enrichment was obtained, and a graphical model was created to depict the participation of the input proteins as well as the linker nodes.

Results: This study identified 12 proteins that were detected in stage 2 tumor tissues, and 17 proteins that were detected in stage 3 tumor tissues, related to their normal counterparts. It also identified some proteins that were present in stage 2 but not stage 3 and vice versa. Based on these results, this study clarified unique proteins pathways involved in carcinogenesis within stage 2 and stage 3 breast cancers.

Conclusions: This study provided some useful insights about the proteins associated with breast cancer carcinogenesis and could establish an important foundation for future cancer-related discoveries using differential proteomics profiling. Beyond protein identification, this study considered the interaction, function, network, signaling pathway, and protein pathway involved in each profile. These results suggest that knowledge of protein expression, especially in stage 2 and stage 3 breast cancer, can provide important clues that may enable the discovery of novel biomarkers in carcinogenesis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227404PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964830PMC
May 2020

Detection and characterization of , a rare bacterial species of mutans streptococci from caries-active patients.

Indian J Dent Res 2019 Jul-Aug;30(4):579-582

Department of Biotechnology, Krupanidhi Degree College; Nucleobase Life Sciences Research Laboratory, Bengaluru, Karnataka, India.

Background: The oral bacteria, mutans streptococci (MS), are an etiological agent of dental caries. Of MS, Streptococcus downei are rarely isolated bacteria.

Aim: The aim of this study was to isolate and characterize S. downei from caries-active subjects.

Materials And Methods: In all, 65 dental plaque samples were collected from dental caries-active subjects. All the isolates were further identified and characterized using 16S rDNA sequencing, biochemical tests, antibiogram, and minimum inhibitory concentration (MIC).

Results: Five isolates have been identified as S. downei using 16S rDNA sequencing. Phylogenetic analysis showed that S. downei was closely related to S. sobrinus. The biotype traits of these five isolates were IV (n = 3), V (n = 1), and variants (n = 2). The study proposed one new biotype, classified as biotype VIII for the variant strain. The antibiogram tests revealed that all the strains of S. downei were susceptible to all the antibiotics used in the study with higher sensitivity to penicillin and ampicillin. The MIC of ampicillin and erythromycin against S. downei was 0.047 and 0.39 μg/mL, respectively.

Conclusion: The study reports the prevalence of S. downei in caries-active subjects and recommends further investigations to determine its role in the disease.
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http://dx.doi.org/10.4103/ijdr.IJDR_400_17DOI Listing
November 2019

Recognition of Antibiotic Resistance in Spontaneous Bacterial Peritonitis Caused by Escherichia coli in Liver Cirrhotic Patients in Civil Hospital Karachi.

Cureus 2019 Jul 31;11(7):e5284. Epub 2019 Jul 31.

Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK.

Introduction Spontaneous bacterial peritonitis (SBP) is the most common life-threatening infection in patients with ascites due to liver cirrhosis. The infection is most commonly caused by the bacterium Escherichia coli, commonly referred to as E. coli. Over the past few years, the incidence of antimicrobial resistance against E. coli has risen drastically, leading to increased morbidity and mortality. Methods This cross-sectional study was conducted to determine the pattern of resistance using variations of antibiotics against E. coli, to prevent its empirical usage and initiate an appropriate target antibiotic therapy. The data were collected from May 2017 to October 2017 and included a total of 184 patients. The patients had previously been diagnosed with chronic liver disease and had presented with E. coli-induced SBP in the medicine wards at Civil Hospital, Karachi, which is the largest tertiary care hospital in the city. All participants underwent diagnostic paracentesis, and the ascitic fluid samples were sent to labs for culture and sensitivity to antibiotics. Results The sample population consisted of 184 participants, of which two-thirds (63.6%; n=117/184) of the population consisted of males. The mean age of the participants was 47.6±10.7 years. More than half of the patients had hepatitis C (54.9%; n=101/184) while the remaining were diagnosed with hepatitis B (45.1%; n=83/184). The ascitic fluid showed varying percentages of resistance for drugs, with no resistance to imipenem and meropenem while ciprofloxacin showed the highest resistance in eradicating the bacterium, E. coli. Additionally, a statistical correlation was tested between drug resistance and factors like age, gender, duration of liver disease, and duration of ascites. Ciprofloxacin and tetracycline showed a positive correlation between the resistance of these drugs and the age, gender, and duration of chronic liver disease in the participants while trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, and piperacillin/tazobactam showed a positive association with the duration of ascites. Conclusion A rapid diligent intervention of cirrhotic patients with complicated ascites is crucial to alleviate patient mortality. Due to the rising bacterial resistance, primarily, epidemiological patterns should be assessed and analyzed in our regional hospitals, and then, antibiotics should be prescribed meticulously.
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http://dx.doi.org/10.7759/cureus.5284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764645PMC
July 2019

Borescope: A frugal tool for capturing cleft palatal surgeries.

J Plast Reconstr Aesthet Surg 2019 Sep 22;72(9):1576-1606. Epub 2019 May 22.

Department of Oral & Maxillofacial Surgery, College Of Dentistry King Khalid University, Guraiger, Abha 62529, Saudi Arabia.

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http://dx.doi.org/10.1016/j.bjps.2019.05.019DOI Listing
September 2019

Gastric Tuberculosis.

J Coll Physicians Surg Pak 2019 Jun;29(6):S20-S22

Medical Student, Dow Medical College, Dr. Ruth K.M. Pfau, Civil Hospital, Karachi, Pakistan.

Gastric tuberculosis is a very rare disease posing a diagnostic challenge to physicians, pathologists and radiologists. It usually occurs in females aged 25 to 45 years. Symptoms include epigastric pain, vomiting, fever, weight loss, upper gastrointestinal (GI) bleed and gastric outlet obstruction. High index of suspicion and endoscopic or endoscopic ultrasound guided biopsies may help in making an early diagnosis, particularly in patients with non-healing gastric ulcers. We report a case of gastric tuberculosis in a 55-year male, who presented with persistent vomiting, epigastric pain and significant weight loss. His upper GI endoscopy finding with histopathology results favoured the diagnosis of gastric tuberculosis. He was successfully treated with antituberculous regimen.
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http://dx.doi.org/10.29271/jcpsp.2019.06.S20DOI Listing
June 2019

Knowledge and Attitude about Basic Life Support and Emergency Medical Services amongst Healthcare Interns in University Hospitals: A Cross-Sectional Study.

Emerg Med Int 2019 3;2019:9342892. Epub 2019 Mar 3.

Assistant professor, Department of Oral and Maxillofacial Surgery, King Khalid University, College of Dentistry, Abha, Saudi Arabia.

Background: Road traffic accident and sudden cardiac arrest are one of the most leading causes of death in KSA. Basic life support (BLS) is lifesaving intervention as a premedical facility. Adequate knowledge and awareness about BLS and CPR are mandatory for healthcare students.

Objective: The objective of the present study is to assess the knowledge, awareness and attitude towards BLS among healthcare interns in different university hospitals across Saudi Arabia. s. A total of 865 health interns attending the health colleges (Medicine, Dentistry, Nursing, Pharmacy) in the University Hospitals across KSA participated in the study. A self-explanatory questionnaire, comprising of 15 questions, was designed for the study. All the hypotheses were formulated using two-tailed alternatives against each null hypothesis.

Result: Out of 865 subjects, 698 completed the survey with a response rate of (80.69%). The male to female sex ratio in the entire group of respondents was 1.44:1.00. Mean score about the awareness and knowledge of BLS and other emergency services among the participants was 2.74±1.02 and 4.02±1.56 respectively. Female participants revealed significantly higher awareness score than male (-value<0.05). Medical interns showed higher awareness level compared to rest of all the faculty interns (-value<0.01). There was no significant difference in the attitude of interns among the different faculties. 60 to 70% of interns had recommended to include BLS training in the university curriculum.

Conclusion: Among the participants of the study, overall awareness score was average, whereas the knowledge score was below average. Further, the participants showed a positive attitude toward BLS training. An optimistic decision should be considered on the inclusion of Basic Life Support procedures in the university curriculum.
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http://dx.doi.org/10.1155/2019/9342892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420992PMC
March 2019

Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis.

N Engl J Med 2019 04 18;380(14):1305-1315. Epub 2019 Feb 18.

From the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (Y.M.A., S.J.A., S.A.I.A., A.A.-D.), the Departments of Intensive Care (Y.M.A., S.J.A., S.A.I.A., A.A.-D.) and Emergency Medicine, (S.J.A.), Ministry of National Guard Health Affairs, Military Medical Services, Ministry of Defense (Y. Mandourah), the Department of Intensive Care Services, Prince Sultan Military Medical City (G.A.A.), the Department of Pulmonary and Critical Care Medicine, King Fahad Medical City (M.A., H.L.), Critical Care Medicine Department, King Faisal Specialist Hospital and Research Center (H.H.), and the Department of Biostatistics and Bioinformatics (J.J.) and Research Office (L.Y.A.), King Abdullah International Medical Research Center (Y.M.A., S.J.A., S.A.I.A., A.A.-D.), Riyadh, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Intensive Care Department, Ministry of National Guard Health Affairs (F.A.-H.), and Critical Care Section, Department of Medicine, King Faisal Specialist Hospital and Research Center (I.K.), Jeddah, the Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University (M.S.A.), Dammam, the Department of Critical Care Medicine, King Khalid University, Asir Central Hospital (A.A.B.), Abha, and King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Intensive Care Division, Department of Medicine, King Abdulaziz Hospital (A.A.A.), Al Ahsa - all in Saudi Arabia; St. Michael's Hospital, Li Ka Shing Knowledge Institute (K.E.A.B.), the Department of Medicine, Sinai Health System (S.M.), and Interdepartmental Division of Critical Care Medicine, University of Toronto (K.E.A.B, S.M.) - all in Toronto; the George Institute for Global Health (S.F.), the Department of Intensive Care Medicine, Centre for Applied Medical Research, St. Vincent's Hospital (H.B.), and the University of New South Wales, Sydney (S.F., H.B.), and Intensive Care Department, Gosford Hospital, Gosford, NSW (A.G.) - all in Australia; and the Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow (Z.A.), and Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon (Y. Mehta) - both in India.

Background: Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain.

Methods: We randomly assigned patients who were considered adults according to the local standards at the participating sites (≥14, ≥16, or ≥18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group). The primary outcome was incident (i.e., new) proximal lower-limb deep-vein thrombosis, as detected on twice-weekly lower-limb ultrasonography after the third calendar day since randomization until ICU discharge, death, attainment of full mobility, or trial day 28, whichever occurred first.

Results: A total of 2003 patients underwent randomization - 991 were assigned to the pneumatic compression group and 1012 to the control group. Intermittent pneumatic compression was applied for a median of 22 hours (interquartile range, 21 to 23) daily for a median of 7 days (interquartile range, 4 to 13). The primary outcome occurred in 37 of 957 patients (3.9%) in the pneumatic compression group and in 41 of 985 patients (4.2%) in the control group (relative risk, 0.93; 95% confidence interval [CI], 0.60 to 1.44; P = 0.74). Venous thromboembolism (pulmonary embolism or any lower-limb deep-vein thrombosis) occurred in 103 of 991 patients (10.4%) in the pneumatic compression group and in 95 of 1012 patients (9.4%) in the control group (relative risk, 1.11; 95% CI, 0.85 to 1.44), and death from any cause at 90 days occurred in 258 of 990 patients (26.1%) and 270 of 1011 patients (26.7%), respectively (relative risk, 0.98; 95% CI, 0.84 to 1.13).

Conclusions: Among critically ill patients who were receiving pharmacologic thromboprophylaxis, adjunctive intermittent pneumatic compression did not result in a significantly lower incidence of proximal lower-limb deep-vein thrombosis than pharmacologic thromboprophylaxis alone. (Funded by King Abdulaziz City for Science and Technology and King Abdullah International Medical Research Center; PREVENT ClinicalTrials.gov number, NCT02040103; Current Controlled Trials number, ISRCTN44653506.).
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http://dx.doi.org/10.1056/NEJMoa1816150DOI Listing
April 2019

Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients: A study protocol and statistical analysis plan.

Medicine (Baltimore) 2018 Sep;97(36):e12258

Intensive Care Department, College of Medicine-Riyadh, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia Interdepartmental Division of Critical Care Medicine, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada Department of Intensive Care, College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah Intensive Care and Emergency Medicine Departments, College of Medicine-Riyadh, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center Department of Pulmonary & Critical Care Medicine King Fahad Medical City, King Saud Bin Abdulaziz University for Health Sciences Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh Department of Critical Care Medicinem, King Khalid University, Asir Central Hospital, Abha Department of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, Dammam Critical Care Section, Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India Department of Pulmonary & Critical Care Medicine, King Fahad Medical City, Riyadh Intensive Care and Pulmonary Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Al Ahsa Department Biostatistics and Bioinformatics Research Office, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.

Objective: Surveillance ultrasounds in critically ill patients detect many deep venous thrombi (DVTs) that would otherwise go unnoticed. However, the impact of surveillance for DVT on mortality among critically ill patients remains unclear.

Design: We are conducting a multicenter, multinational randomized controlled trial that examines the effectiveness of adjunct intermittent pneumatic compression use with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on the incidence of proximal lower extremity DVT in critically ill patients (the PREVENT trial). Enrolled patients undergo twice weekly surveillance ultrasounds of the lower extremities as part of the study procedures. We plan to compare enrolled patients who have surveillance ultrasounds to patients who meet the eligibility criteria but are not enrolled (eligible non-enrolled patients) and only who will have ultrasounds performed at the clinical team's discretion. We hypothesize that twice-weekly ultrasound surveillance for DVT in critically ill patients who are receiving thromboprophylaxis will have more DVTs detected, and consequently, fewer pulmonary emboli and lower all-cause 90-day mortality.

Discussion: We developed a detailed a priori plan to guide the analysis of the proposed study and enhance the validity of its results.
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http://dx.doi.org/10.1097/MD.0000000000012258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133421PMC
September 2018

The BRCA1 and BRCA2 Genes in Early-Onset Breast Cancer Patients.

Adv Exp Med Biol 2020 ;1292:1-12

Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia.

Approximately 5-10% of breast cancers are attributable to genetic susceptibility. Mutations in the BRCA1 and BRCA2 genes are the best known genetic factors to date. The goal of this study was to determine the structure and distribution of haplotypes of the BRCA1 and BRCA2 genes in early-onset breast cancer patients. We enrolled 70 patients diagnosed with early-onset breast cancer. A total of 21 SNPs (11 on BRCA1 and 10 on BRCA2) and 1 dinucleotide deletion on BRCA1 were genotyped using nested allele-specific PCR methods. Linkage disequilibrium (LD) analysis was conducted, and haplotypes were deduced from the genotype data. Two tightly linked LD blocks were observed on each of the BRCA1 and BRCA2 genes. Variant-free haplotypes (TAT-AG for BRCA1 and ATA-AAT for BRCA2) were observed at a frequency of more than 50% on each gene along with variable frequencies of derived haplotypes. The variant 3'-subhaplotype CGC displayed strong LD with 5'-subhaplotypes GA, AA, and GG on BRCA1 gene. Haplotypes ATA-AGT, ATC-AAT, and ATA-AAC were the variant haplotypes frequent on BRCA2 gene. Although the clinical significance of these derived haplotypes has not yet been established, it is expected that some of these haplotypes, especially the less frequent subhaplotypes, eventually will be shown to be indicative of a predisposition to early-onset breast cancer.
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http://dx.doi.org/10.1007/5584_2018_147DOI Listing
January 2021

Statistical analysis plan for the Pneumatic CompREssion for PreVENting Venous Thromboembolism (PREVENT) trial: a study protocol for a randomized controlled trial.

Trials 2018 Mar 15;19(1):182. Epub 2018 Mar 15.

King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.

Background: The Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial evaluates the effect of adjunctive intermittent pneumatic compression (IPC) with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on venous thromboembolism (VTE) in critically ill adults.

Methods/design: In this multicenter randomized trial, critically ill patients receiving pharmacologic thromboprophylaxis will be randomized to an IPC or a no IPC (control) group. The primary outcome is "incident" proximal lower-extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the lower-extremity ultrasonography will be blinded to intervention allocation, whereas the patients and treating team will be unblinded. The trial has 80% power to detect a 3% absolute risk reduction in the rate of proximal DVT from 7% to 4%.

Discussion: Consistent with international guidelines, we have developed a detailed plan to guide the analysis of the PREVENT trial. This plan specifies the statistical methods for the evaluation of primary and secondary outcomes, and defines covariates for adjusted analyses a priori. Application of this statistical analysis plan to the PREVENT trial will facilitate unbiased analyses of clinical data.

Trial Registration: ClinicalTrials.gov , ID: NCT02040103 . Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506 . Registered on 30 October 2013.
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http://dx.doi.org/10.1186/s13063-018-2534-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856363PMC
March 2018

Isolation and Typing of and from Caries-active Subjects.

Contemp Clin Dent 2017 Oct-Dec;8(4):587-593

Department of Microbiology, M.R. Government Arts College, Mannargudi, Tamil Nadu, India.

Background: and are main etiological agents of dental caries.

Aim: The aim of the study was to isolate, identify, characterize, and determine the minimum inhibitory concentration (MIC) of and from caries-active subjects.

Materials And Methods: Sixty-five plaque samples were collected from caries-active subjects aged between 35 and 44 years, processed and cultured on mitis salivarius bacitracin agar. All the bacterial isolates were subjected to morphotyping and the suspected colonies were identified by 16S rDNA sequencing. The and strains were characterized by biotyping and phylogenetic analysis. The MIC of ampicillin and erythromycin was determined by microtiter plate method.

Results: Of the study population, 41 isolates displayed typical colony morphologies of and . The 16S rDNA sequencing results revealed that 36 isolates were and 5 isolates were . The biotyping of these isolates demonstrated three biotypes, namely, biotype I ( = 35), biotype III ( = 1), and biotype IV ( = 2). However, 3 isolates exhibited variant biotypes. The phylogenetic analysis revealed that the clinical strains of and clustered independently along with respective reference strains. The average MIC of ampicillin and erythromycin against and was 0.047 μg/ml and 0.39 μg/ml, respectively.

Conclusion: The 16S rDNA sequencing was an impeccable method for and identification when compared with morphotyping and biotyping methods. The study also suggested that nonspecific bacteria might be involved in caries formation.
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http://dx.doi.org/10.4103/ccd.ccd_610_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754980PMC
January 2018

First Detection and Characterization of from Caries Active Subject.

J Clin Diagn Res 2017 Jul 1;11(7):DM01-DM03. Epub 2017 Jul 1.

Research Associate, Department of Life Sciences, Nucleobase Life Sciences Research Laboratory and Associate Professor, Department of Biotechnology, Krupanidhi Degree College Bengaluru, Karnataka, India.

Introduction: Mutans streptococci (MS) are a group of oral bacteria generally regarded as the principal agents in the pathogenesis of dental caries.

Aim: The study aimed was characterize based on phylogenetic analysis and phenotypic methods from Caries Active Subject.

Materials And Methods: While sequencing MS species which were isolated from 65 caries active subjects, one strain of was detected. Dental plaque samples were processed and cultured on mitis salivarius bacitracin agar. was characterized using phylogenetic analysis, colony morphology characterization and biotyping.

Results: Among the study population, one strain designated as H14 was identified as by 16S rDNA sequencing. Morphologically, could not differentiate from other species of MS. H14 demonstrated biotype II biochemical characteristics of MS. The phylogenetic analysis showed is closely related to .

Conclusion: The study concludes that can inhabit the human oral cavity and therefore further investigations are warranted to determine its role in caries.
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http://dx.doi.org/10.7860/JCDR/2017/25903.10316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583906PMC
July 2017

Recovery from the Middle East respiratory syndrome is associated with antibody and T-cell responses.

Sci Immunol 2017 Aug 4;2(14). Epub 2017 Aug 4.

State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, China.

The Middle East respiratory syndrome coronavirus (MERS-CoV) causes a highly lethal pneumonia. MERS was recently identified as a candidate for vaccine development, but most efforts focus on antibody responses, which are often transient after CoV infections. CoV-specific T cells are generally long-lived, but the virus-specific T cell response has not been addressed in MERS patients. We obtained peripheral blood mononuclear cells and/or sera from 21 MERS survivors. We detected MERS-CoV-specific CD4 and CD8 T cell responses in all MERS survivors and demonstrated functionality by measuring cytokine expression after peptide stimulation. Neutralizing (PRNT) antibody titers measured in vitro predicted serum protective ability in infected mice and correlated with CD4 but not CD8 T cell responses; patients with higher PRNT and CD4 T cell responses had longer intensive care unit stays and prolonged virus shedding and required ventilation. Survivors with undetectable MERS-CoV-specific antibody responses mounted CD8 T cell responses comparable with those of the whole cohort. There were no correlations between age, disease severity, comorbidities, and virus-specific CD8 T cell responses. In conclusion, measurements of MERS-CoV-specific T cell responses may be useful for predicting prognosis, monitoring vaccine efficacy, and identifying MERS patients with mild disease in epidemiological studies and will complement virus-specific antibody measurements.
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http://dx.doi.org/10.1126/sciimmunol.aan5393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576145PMC
August 2017

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units.

Ann Thorac Med 2017 Jan-Mar;12(1):11-16

Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.
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http://dx.doi.org/10.4103/1817-1737.197765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264166PMC
February 2017

Alzheimer and vascular dementia in the elderly patients.

Pak J Med Sci 2016 Sep-Oct;32(5):1286-1290

Taha Sheikh, MBBS. Final year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.

Objectives: To find out the frequency of Alzheimer's and Vascular dementia in the elderly patients.

Methods: This cross sectional descriptive study was conducted in Department of Medicine, Ziauddin Hospital Karachi from 1 October 2013 to 31 March 2014. Patients with symptoms of dementia for more than 6 months duration, and Mini Mental State Examination score <24 were included in this study. Patients who fell in category of dementia were assessed for duration of symptoms. Patients underwent CT scan of brain. Patients with generalized atrophy of brain on CT scanning of brain were labeled as Alzheimer's dementia, while patients with ischemic or hemorrhagic stroke on CT scan of brain were labeled as vascular dementia.

Results: Four hundred twenty two patients were included in this study. There were 232 (54.98 %) male and 190 (45.02 %) were female. The mean age ± SD of the patients was 72.58±5.34 years (95% CI: 72.07 to 73.09), similarly average duration of symptoms was 10.14±2.85 months. About 18.96% of patients were illiterate, 32.23% were matric, 28.44% were intermediate and 20.33% were graduate and post graduate. Hypertension and diabetes were the commonest co-morbid i.e. 81.3% and 73.7%, hyperlipedimia and smoking were 38.2% and 45% respectively. Frequency of Alzheimer's disease and vascular dementia in the elderly was observed in 3.79% (16/422) and 2.61% (11/422) cases.

Conclusion: A good number of patients, 27 out of 422, in this hospital based study were suffering from Alzheimer's disease and vascular dementia. Early detection and prompt treatment can reduce the burden of the disease in our population.
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http://dx.doi.org/10.12669/pjms.325.10792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103150PMC
November 2016

Frequency of Non-Alcoholic Steatohepatitis on Histopathology in Patients of Type 2 Diabetes Mellitus with Duration of More than 5 Years.

J Coll Physicians Surg Pak 2016 Aug;26(8):643-6

Dow Medical College, Civil Hospital Karachi, DUHS Karachi.

Objective: To determine the frequency of non-alcoholic steatohepatitis (NASH) on histopathology in patients of type 2 diabetes mellitus with duration of more than 5 years.

Study Design: Descriptive, cross-sectional study.

Place And Duration Of Study: Department of Medicine, Dow Medical College, Civil Hospital, Karachi, from November 2013 to April 2014.

Methodology: Patients with type 2 diabetes mellitus of more than 5 years duration having raised alanine transaminases level and fatty liver on ultrasonography were selected. Informed consent was obtained and liver biopsy was performed in all patients by experienced physician of Civil Hospital Karachi. All samples of biopsy were sent for histopathology. Those patients with hepatitis B, C and D and steatosis like alcoholic and hypertriglyceridemia were excluded from the study. Descriptive statistics were calculated on SPSS version 17.

Results: Out of the 262 cases, 56.49% (148/262) showed non-alcoholic steatohepatitis on the basis of histopathology. The mean age of the patients was 50.72 ±8.48 years. Median (interquartile) duration of diabetes mellitus of the cases was 9 years (15 - 4). Out of 148 NASH cases, 56.1% (83/148) were males and 43.9% (65/148) were females.

Conclusion: Nonalcoholic steatohepatitis is an increasingly important and unrecognised spectrum of chronic liver disease associated with high prevalence of diabetes that is often overlooked and diagnosed with complications. So early recognition of these patients can prevent further complications.
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http://dx.doi.org/2395DOI Listing
August 2016

Frequency of Hyperthermia in Acute Ischemic Stroke Patients Visiting a Tertiary Care Hospital.

J Coll Physicians Surg Pak 2016 Jun;26(6):490-3

Department of Medicine, Civil Hospital, Dow University Health Sciences (DUHS), Karachi.

Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country.

Study Design: Cross-sectional, observational study.

Place And Duration Of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013.

Methodology: Patients aged ≥18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA).

Results: Atotal of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5%) were males and 45 (42.5%) females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. Atotal of 17 (16%) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26% developed hyperthermia compared to 7.1% in patients of ≥60 years of age (p=0.008). On gender stratification, among male patients, 14.8% developed hyperthermia compared to 17.8% in female patients (p=0.43).

Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia.
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http://dx.doi.org/2348DOI Listing
June 2016

Antibody Response and Disease Severity in Healthcare Worker MERS Survivors.

Emerg Infect Dis 2016 06;22(6)

We studied antibody response in 9 healthcare workers in Jeddah, Saudi Arabia, who survived Middle East respiratory syndrome, by using serial ELISA and indirect immunofluorescence assay testing. Among patients who had experienced severe pneumonia, antibody was detected for >18 months after infection. Antibody longevity was more variable in patients who had experienced milder disease.
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http://dx.doi.org/10.3201/eid2206.160010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880093PMC
June 2016

Patient characteristics infected with Middle East respiratory syndrome coronavirus infection in a tertiary hospital.

Ann Thorac Med 2016 Apr-Jun;11(2):128-31

King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

Background: In April 2014, a surge in cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was seen in Jeddah, Saudi Arabia. The aim of this study is to describe the demographic and clinical features, laboratory and radiological findings of MERS-CoV patients identified during this outbreak in a single tertiary hospital.

Methods: All laboratory-confirmed MERS-CoV cases who presented to King Faisal Specialist Hospital from March 1, 2014, to May 30, 2014, were identified. Patients' charts were reviewed for demographic information, comorbidities, clinical presentations, and outcomes.

Results: A total of 39 patients with confirmed MERS-CoV infection were identified. Twenty-one were male (54%), aged 40 ± 19 years and included 3 (8%) pediatric patients (<18-year-old). 16 (41%) patients were health care workers. Twenty-one (53%) patients were previously healthy whereas eighteen (47%) had at least one comorbidity. The predominant comorbidities included hypertension (31%), diabetes (26%), respiratory (23%), and renal disease (18%). Thirty patients (81%) were symptomatic at presentation, fever (69%) being the most common complaint. The overall mortality rate was 28%. In univariate analysis, older age, hypertension, and chronic kidney disease were associated with mortality.

Conclusions: MERS-CoV presentation varies from asymptomatic infection to severe respiratory disease causing death. Future studies to identify the risk factors for worse outcome are needed.
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http://dx.doi.org/10.4103/1817-1737.180027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854059PMC
May 2016

Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak.

Clin Med Res 2016 Mar 4;14(1):7-14. Epub 2016 Feb 4.

King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.

Objective: Healthcare workers (HCWs) are at high risk of contracting Middle East respiratory syndrome coronavirus (MERS-CoV) during an epidemic. We explored the emotions, perceived stressors, and coping strategies of healthcare workers who worked during a MERS-CoV outbreak in our hospital.

Design: A cross-sectional descriptive survey design.

Setting: A tertiary care hospital.

Participants: HCWs (150) who worked in high risk areas during the April-May 2014 MERS-CoV outbreak that occurred in Jeddah, Saudi Arabia.

Methods: We developed and administered a "MERS-CoV staff questionnaire" to study participants. The questionnaire consisted of 5 sections with 72 questions. The sections evaluated hospital staffs emotions, perceived stressors, factors that reduced their stress, coping strategies, and motivators to work during future outbreaks. Responses were scored on a scale from 0-3. The varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate.

Results: Completed questionnaires were returned by 117 (78%) of the participants. The results had many unique elements. HCWs ethical obligation to their profession pushed them to continue with their jobs. The main sentiments centered upon fear of personal safety and well-being of colleagues and family. Positive attitudes in the workplace, clinical improvement of infected colleagues, and stoppage of disease transmission among HCWs after adopting strict protective measures alleviated their fear and drove them through the epidemic. They appreciated recognition of their efforts by hospital management and expected similar acknowledgment, infection control guidance, and equipment would entice them to work during future epidemics.

Conclusion: The MERS-CoV outbreak was a distressing time for our staff. Hospitals can enhance HCWs experiences during any future MERS-CoV outbreak by focusing on the above mentioned aspects.
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http://dx.doi.org/10.3121/cmr.2016.1303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851451PMC
March 2016

Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS.

Respir Care 2016 Mar 23;61(3):340-8. Epub 2015 Dec 23.

King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

Background: Data on the management, clinical course, and outcome of critical patients with Middle East Respiratory Syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients.

Methods: Subjects intubated for management of ARDS from Middle East Respiratory Syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated.

Results: Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median PaO2 /FIO2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon α-2a. Subjects had a critical ICU course and required neuromuscular blockade (n = 11; 79%), required rescue therapy for respiratory failure (n = 8; 57%), developed shock (n = 10; 71%), and required renal replacement therapy (n = 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y.

Conclusions: Middle East Respiratory Syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.
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http://dx.doi.org/10.4187/respcare.04325DOI Listing
March 2016

Idiopathic pulmonary fibrosis in Saudi Arabia: Demographic, clinical, and survival data from two tertiary care hospitals.

Ann Thorac Med 2014 Jul;9(3):168-72

King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.

Background: Idiopathic pulmonary fibrosis (IPF) is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia.

Methods: This was a retrospective study that looked at all the patients diagnosed with IPF between 2007 and 2012 at two tertiary care hospitals in Saudi Arabia. We collected the demographical, clinical, laboratory and radiological data from the patients' medical records. Medications administered and 1 year survival was also assessed.

Results: Between 2007and 2012, 134 IPF patients were identified. Their baseline characteristics (Mean ± SD) included: age 64 ± 13 years, body mass index 29 ± 8 kg/m(2), FEV1 56 ± 15 percent of predicted, FVC 53 ± 13 percent of predicted, FEV1/FVC 0.81 ± 0.09, total lung capacity 75 ± 13 percent of predicted, diffusing capacity of the lung for carbon monoxide 57 ± 15 percent of predicted, on home oxygen at presentation 71 (53%), mean ejection fraction 0.50 ± 0.07, mean pulmonary artery systolic pressure (via echocardiogram) 40 + 22 mmHg, presentation mean SpO292 ± 7%, presentation 6-min walk distance 338 ± 64 m and lowest SpO2 during 6-min walk test 88 ± 5%. Patients were predominantly female (56%), and 42% of patients had diabetes and were active smokers. The IPF patients' frequency of hospital admission (n = 99) was 2.4 ± 1.7 per year and duration of hospital stay (n = 99) was 17.4 ± 23.8 days. Overall 1 year survival in all IPF patients was good, 93% (124) patients remained alive after 1 year.

Conclusions: In Saudi Arabia, IPF patients tended to be slightly older and the disease progression was somewhat slower than reported IPF cohorts in other populations. They had frequent hospital admissions and a long hospital length of stay. The influence of genetics and co-morbid diseases on the incidence and outcome of IPF should be explored further.
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http://dx.doi.org/10.4103/1817-1737.134073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073575PMC
July 2014

Outcome of patients treated with noninvasive ventilation by a medical emergency team on the wards: scarce and probably secure and resourceful monitoring in select subjects--reply.

Respir Care 2014 May;59(5):e89-90

Division of Pulmonary, Critical Care & Sleep MedicineJohn D Dingell VA Medical CenterDetroit, MichiganandDepartment of MedicineKing Faisal Specialist Hospital & Research CentreJeddah, Saudi Arabia.

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http://dx.doi.org/10.4187/respcare.03355DOI Listing
May 2014

Reply: Compliance with central line insertion bundles in an intensive care unit.

Am J Infect Control 2014 May;42(5):582-3

Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.

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http://dx.doi.org/10.1016/j.ajic.2014.01.010DOI Listing
May 2014
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