International Journal of Environmental Research and Public Health, Dec 9, 2020
Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health... more Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health. Our objective was to assess prevalence of depression, anxiety, and stress among the general population in Saudi Arabia during this pandemic. A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. Psychological impact was assessed using the Arabic version of Depression, Anxiety, and Stress Scale (DASS-21). A total of 1597 participants completed the survey. In total, 17.1% reported moderate to severe depressive symptoms; 10% reported moderate to severe anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, anxiety, and stress were significantly higher among females, younger respondents, and health care providers. Depression was higher among smokers, singles, and non-working respondents. Anxiety was higher among those reporting contacts with COVID-19 positive cases, previously quarantined and those with chronic health problems. Our findings reaffirm the importance of providing appropriate knowledge and specialized interventions to promote the mental well-being of the Saudi population, paying particular attention to high-risk groups.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (... more Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (ICUs) worldwide beyond their limits. To maintain efficient critical care services and to protect critical care staff, reengineering the ICU workflow became a necessity. The care of COVID-19 patients occurred in designated ICUs. High-efficiency particulate air filters were installed in rooms that did not have negative pressure. Non-ICU wards were used for care of critically ill patients. Handover between physicians, multidisciplinary rounds, and entry into the ICU were changed to avoid large gathering inside the units. Tiered staffing approach was used to maintain an adequate nurse-to-patient ratio. The care of non-COVID-19 patients took place in clean ICUs by a dedicated medical team to avoid cross contamination. As visitation was prohibited during the pandemic, communication with families of patients was done via advanced telecommunication methods such as videoconferencing. To protect ICU staff, appropriate donning and doffing of personal protective equipment were monitored and corrected by qualified personnel. Reuse or extended use of such equipment was carried out due to supply shortage.
Death is an assured inevitability event for all living beings of this cosmos. Based on the Americ... more Death is an assured inevitability event for all living beings of this cosmos. Based on the American Academy of Neurology (AAN) recommendations, clinical diagnosis of Brain Death (BD) includes multiple sequences of tests. The Apnea Test (AT) is a more significant procedure in diagnosing BD. Unfortunately, complications during this procedure can occur more frequently than documented, and its incidence is limited to case reports. However, most critical care physicians and Cardio-respiratory therapists consider an AT a principal method to confirm BD as it provides decisive information about the definitive loss of brainstem function. Here, we describe the execution of the AT procedure that transpired into extensive subcutaneous emphysema, tension pneumothorax, and pneumoperitoneum followed by pulseless electrical activity due to direct airway perforation by the supplemental oxygen catheter. In addition, we do a literature review on airway complications incidence and suggest methods to av...
A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thora... more A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture, accompanied by the herniation of abdominal visceral organs. We report a 47-year-old male construction worker who sustained a fall from a height of about 30 feet height. He presented with hypoxia initially and, after a primary survey, was found to have a traumatic rupture of the diaphragm with herniation of the stomach and abdominal contents, causing signs of obstructive shock. After adequate resuscitation in the Emergency Department, he was rushed to operating room. There, he suffered two very short pulseless electrical activity cardiac arrests. Therefore, an emergency anterolateral thoracotomy was done, and it was extended into laparoto...
Multidrug-resistant (MDR) Acinetobacter species are opportunistic pathogens that are clinically i... more Multidrug-resistant (MDR) Acinetobacter species are opportunistic pathogens that are clinically important, which causes severe infection during a prolonged stay in an Intensive Care Unit (ICU) of the hospital. In the present study, we screened clinical isolates of Acinetobacter species for its MDR nature from the ICU of a tertiary care centre at Abha, Saudi Arabia during the period of 2013-2017. Confirmed MDR Acinetobacter species clinical isolates were challenged against ethanolic extracts from mango kernel (Mangifera Indica L.) by classical disc diffusion method. In total, we characterized 124 MDR Acinetobacter isolates, out of which 62 (50%) were Acinetobacter baumannii (MDR-AB), 41 (33.1%) were Acinetobacter baumannii complex (MDR-ABC), 15 (12.1%) were Acinetobacter baumannii-haemolyticus (MDR-ABH), 3 (2.4%) were Acinetobacter haemolyticus (MDR-AH) and 3 (2.4%) were Acinetobacter iwoffii (MDR-AI). We observed that MDR-AB isolates were inhibited by ethanolic extract of M. indica ...
Objective. To measure the awareness regarding the concepts of brain death and organ donation amon... more Objective. To measure the awareness regarding the concepts of brain death and organ donation among secondary school students within the age range of 12e18 years in the southern region of Saudi Arabia. Method. In the southern region of Saudi Arabia, 10 secondary schools were randomly chosen to participate in this study for which all the tree levels of secondary schools were visited and a written questionnaire was distributed to a randomly selected student from all 3 levels. The questionnaire was filled and completed anonymously and then analyzed. Results. Among the 649 students surveyed, 47.22% were aware of brain death and 53.78% did not know anything about organ donation. Further, among those who had heard about these terms, 60% had received the information from informal sources like their friends or through casual web surfing; only a few had received the information from formal sources like television and the radio. The students' understanding of concepts regarding the nature of death and the causes of brain death was, as expected, inadequate and inappropriate. The Islamic perspective on brain death and the knowledge about the Sharia ruling on organ donation was also poor. Regarding the students' knowledge about organ donation, 21.57% of the students knew that organs can be donated from a brain-dead person. 24.6% knew that only living persons can donate organs, while the rest (53.78%) were not aware about organ donation at all. Conclusion. The knowledge of and attitude toward brain death and organ donation are very poor among the young Saudi population, and have not evolved over a period of time. The information regarding the religious fatwas has not been transmitted to the level of the educational institutions.
R and accurate detection of hypoxemia is critical to prevent serious complications; morbidity and... more R and accurate detection of hypoxemia is critical to prevent serious complications; morbidity and mortality in many hospital settings, including the intensive care unit (ICU), emergency department, procedure suite, and operating room. However, oxygenation is difficult to assess on the basis of physical examination alone. For determining oxygen requirements, pulse oximetry has virtually replaced arterial blood gas sampling.
Saudi Journal of Kidney Diseases and Transplantation, 2016
The gap between demand and supply of organs continues. No country has found a concrete solution f... more The gap between demand and supply of organs continues. No country has found a concrete solution for tackling this problem. We attempted to evaluate the general information and attitude of university students in their primary basic science stage, when they did not receive special education regarding brain death and organ donation in Saudi Arabia. Since they were from different cities with different cultures and values, we believe that we could assess the educational needs of future doctors and paramedical staff, to help them gain enough competence for solving the concerns of the population at large. The present study is a secondary analysis of a survey conducted at the King Khalid University, Abha, Saudi Arabia, from March to May 2014, about the knowledge of and attitudes toward brain death, organ donation, and transplantation in a sample of university students. A total of 873 university students participated in the survey and 93% from the cohort had heard about brain death. Eighty-five percent got their information about brain death from the media. Seventy-three percent of the cohort had the impression that there is no difference between brain death and natural death. An organized educational program about all aspects of organ donation, particularly from deceased donors, seems necessary in the curriculum, which can be started at an early level and built up gradually to impart a gradual comprehensive knowledge on beliefs and practices about brain death, organ donation, and transplantation. The Saudi Center for Organ Transplantation in collaboration with other regional societies and regional professional organizations has to work together to achieve this long-term goal to save the precious lives of people, awaiting transplantation.
Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that prov... more Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO therapy has advanced significantly, complications like thrombosis and bleeding continue to be substantial, necessitating rapid transport of patients to the radiology suite to reveal crucial findings for further treatment plans or care. Even though the low flow rate for veno-arterial ECMO (VA-ECMO) support during contrast-enhanced CT is well known, the flow rate for veno-venous ECMO support during CT, especially computed tomography pulmonary angiography, is not well understood. Our case emphasizes that CTPA can be performed safely in trauma patients with ECMO runs and any suspected complications during ECMO runs may delay or worsen the clinical prognosis therefore immediate radiological verdicts ma...
A 24-year-old male polytrauma victim with associated maxillofacial injuries reported to our hospi... more A 24-year-old male polytrauma victim with associated maxillofacial injuries reported to our hospital. On arrival, his Glasgow coma scale (GCS) was 5, heart rate was 113 beats per minute, blood pressure was 153/80 mmHg, respiratory rate was 13 breaths per minute, and O 2 saturation was 86% on room air.
Background This study assessed the mobility levels among critically ill patients and the associat... more Background This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. Methods This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4–7 (at least active standing), 1–3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by ...
International Journal of Environmental Research and Public Health, Dec 9, 2020
Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health... more Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health. Our objective was to assess prevalence of depression, anxiety, and stress among the general population in Saudi Arabia during this pandemic. A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. Psychological impact was assessed using the Arabic version of Depression, Anxiety, and Stress Scale (DASS-21). A total of 1597 participants completed the survey. In total, 17.1% reported moderate to severe depressive symptoms; 10% reported moderate to severe anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, anxiety, and stress were significantly higher among females, younger respondents, and health care providers. Depression was higher among smokers, singles, and non-working respondents. Anxiety was higher among those reporting contacts with COVID-19 positive cases, previously quarantined and those with chronic health problems. Our findings reaffirm the importance of providing appropriate knowledge and specialized interventions to promote the mental well-being of the Saudi population, paying particular attention to high-risk groups.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (... more Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (ICUs) worldwide beyond their limits. To maintain efficient critical care services and to protect critical care staff, reengineering the ICU workflow became a necessity. The care of COVID-19 patients occurred in designated ICUs. High-efficiency particulate air filters were installed in rooms that did not have negative pressure. Non-ICU wards were used for care of critically ill patients. Handover between physicians, multidisciplinary rounds, and entry into the ICU were changed to avoid large gathering inside the units. Tiered staffing approach was used to maintain an adequate nurse-to-patient ratio. The care of non-COVID-19 patients took place in clean ICUs by a dedicated medical team to avoid cross contamination. As visitation was prohibited during the pandemic, communication with families of patients was done via advanced telecommunication methods such as videoconferencing. To protect ICU staff, appropriate donning and doffing of personal protective equipment were monitored and corrected by qualified personnel. Reuse or extended use of such equipment was carried out due to supply shortage.
Death is an assured inevitability event for all living beings of this cosmos. Based on the Americ... more Death is an assured inevitability event for all living beings of this cosmos. Based on the American Academy of Neurology (AAN) recommendations, clinical diagnosis of Brain Death (BD) includes multiple sequences of tests. The Apnea Test (AT) is a more significant procedure in diagnosing BD. Unfortunately, complications during this procedure can occur more frequently than documented, and its incidence is limited to case reports. However, most critical care physicians and Cardio-respiratory therapists consider an AT a principal method to confirm BD as it provides decisive information about the definitive loss of brainstem function. Here, we describe the execution of the AT procedure that transpired into extensive subcutaneous emphysema, tension pneumothorax, and pneumoperitoneum followed by pulseless electrical activity due to direct airway perforation by the supplemental oxygen catheter. In addition, we do a literature review on airway complications incidence and suggest methods to av...
A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thora... more A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture, accompanied by the herniation of abdominal visceral organs. We report a 47-year-old male construction worker who sustained a fall from a height of about 30 feet height. He presented with hypoxia initially and, after a primary survey, was found to have a traumatic rupture of the diaphragm with herniation of the stomach and abdominal contents, causing signs of obstructive shock. After adequate resuscitation in the Emergency Department, he was rushed to operating room. There, he suffered two very short pulseless electrical activity cardiac arrests. Therefore, an emergency anterolateral thoracotomy was done, and it was extended into laparoto...
Multidrug-resistant (MDR) Acinetobacter species are opportunistic pathogens that are clinically i... more Multidrug-resistant (MDR) Acinetobacter species are opportunistic pathogens that are clinically important, which causes severe infection during a prolonged stay in an Intensive Care Unit (ICU) of the hospital. In the present study, we screened clinical isolates of Acinetobacter species for its MDR nature from the ICU of a tertiary care centre at Abha, Saudi Arabia during the period of 2013-2017. Confirmed MDR Acinetobacter species clinical isolates were challenged against ethanolic extracts from mango kernel (Mangifera Indica L.) by classical disc diffusion method. In total, we characterized 124 MDR Acinetobacter isolates, out of which 62 (50%) were Acinetobacter baumannii (MDR-AB), 41 (33.1%) were Acinetobacter baumannii complex (MDR-ABC), 15 (12.1%) were Acinetobacter baumannii-haemolyticus (MDR-ABH), 3 (2.4%) were Acinetobacter haemolyticus (MDR-AH) and 3 (2.4%) were Acinetobacter iwoffii (MDR-AI). We observed that MDR-AB isolates were inhibited by ethanolic extract of M. indica ...
Objective. To measure the awareness regarding the concepts of brain death and organ donation amon... more Objective. To measure the awareness regarding the concepts of brain death and organ donation among secondary school students within the age range of 12e18 years in the southern region of Saudi Arabia. Method. In the southern region of Saudi Arabia, 10 secondary schools were randomly chosen to participate in this study for which all the tree levels of secondary schools were visited and a written questionnaire was distributed to a randomly selected student from all 3 levels. The questionnaire was filled and completed anonymously and then analyzed. Results. Among the 649 students surveyed, 47.22% were aware of brain death and 53.78% did not know anything about organ donation. Further, among those who had heard about these terms, 60% had received the information from informal sources like their friends or through casual web surfing; only a few had received the information from formal sources like television and the radio. The students' understanding of concepts regarding the nature of death and the causes of brain death was, as expected, inadequate and inappropriate. The Islamic perspective on brain death and the knowledge about the Sharia ruling on organ donation was also poor. Regarding the students' knowledge about organ donation, 21.57% of the students knew that organs can be donated from a brain-dead person. 24.6% knew that only living persons can donate organs, while the rest (53.78%) were not aware about organ donation at all. Conclusion. The knowledge of and attitude toward brain death and organ donation are very poor among the young Saudi population, and have not evolved over a period of time. The information regarding the religious fatwas has not been transmitted to the level of the educational institutions.
R and accurate detection of hypoxemia is critical to prevent serious complications; morbidity and... more R and accurate detection of hypoxemia is critical to prevent serious complications; morbidity and mortality in many hospital settings, including the intensive care unit (ICU), emergency department, procedure suite, and operating room. However, oxygenation is difficult to assess on the basis of physical examination alone. For determining oxygen requirements, pulse oximetry has virtually replaced arterial blood gas sampling.
Saudi Journal of Kidney Diseases and Transplantation, 2016
The gap between demand and supply of organs continues. No country has found a concrete solution f... more The gap between demand and supply of organs continues. No country has found a concrete solution for tackling this problem. We attempted to evaluate the general information and attitude of university students in their primary basic science stage, when they did not receive special education regarding brain death and organ donation in Saudi Arabia. Since they were from different cities with different cultures and values, we believe that we could assess the educational needs of future doctors and paramedical staff, to help them gain enough competence for solving the concerns of the population at large. The present study is a secondary analysis of a survey conducted at the King Khalid University, Abha, Saudi Arabia, from March to May 2014, about the knowledge of and attitudes toward brain death, organ donation, and transplantation in a sample of university students. A total of 873 university students participated in the survey and 93% from the cohort had heard about brain death. Eighty-five percent got their information about brain death from the media. Seventy-three percent of the cohort had the impression that there is no difference between brain death and natural death. An organized educational program about all aspects of organ donation, particularly from deceased donors, seems necessary in the curriculum, which can be started at an early level and built up gradually to impart a gradual comprehensive knowledge on beliefs and practices about brain death, organ donation, and transplantation. The Saudi Center for Organ Transplantation in collaboration with other regional societies and regional professional organizations has to work together to achieve this long-term goal to save the precious lives of people, awaiting transplantation.
Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that prov... more Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO therapy has advanced significantly, complications like thrombosis and bleeding continue to be substantial, necessitating rapid transport of patients to the radiology suite to reveal crucial findings for further treatment plans or care. Even though the low flow rate for veno-arterial ECMO (VA-ECMO) support during contrast-enhanced CT is well known, the flow rate for veno-venous ECMO support during CT, especially computed tomography pulmonary angiography, is not well understood. Our case emphasizes that CTPA can be performed safely in trauma patients with ECMO runs and any suspected complications during ECMO runs may delay or worsen the clinical prognosis therefore immediate radiological verdicts ma...
A 24-year-old male polytrauma victim with associated maxillofacial injuries reported to our hospi... more A 24-year-old male polytrauma victim with associated maxillofacial injuries reported to our hospital. On arrival, his Glasgow coma scale (GCS) was 5, heart rate was 113 beats per minute, blood pressure was 153/80 mmHg, respiratory rate was 13 breaths per minute, and O 2 saturation was 86% on room air.
Background This study assessed the mobility levels among critically ill patients and the associat... more Background This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. Methods This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4–7 (at least active standing), 1–3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by ...
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