Characteristics of First Cases of Coronavirus Disease 2019 and the Effort to Prevent the Early Spread of COVID-19 in Saudi Arabia

Satisfaction of Patients with Multiple Sclerosis Towards the Provision of Healthcare Services at a Tertiary Care Setting in Saudi Arabia

BACKGROUND

Multiple sclerosis (MS) is an autoimmune-mediated neurological disorder and the most frequent neurological disability in young adults. Assessing MS patient satisfaction with care is necessary to evaluate healthcare service quality and factors impacting it.

OBJECTIVES

We aimed to determine the satisfaction of patients with MS towards the provision of healthcare services, and the factors affecting their satisfaction.

METHODS

We conducted a cross-sectional survey from November 2022 to December 2022 at King Saud Medical City, Saudi Arabia. The study participants completed the CANHELP Lite27 questionnaire, which consists of 21 items.

RESULTS

A total of 300 patients with MS participated in this study. The majority were female (80%), with an average age of 31.6 years and a mean disease duration of 5.22 years. Overall, satisfaction was moderate (63.59 ± 14.54). Patients were most satisfied with general aspects of care (72.00 ± 16.46), doctor relationships (68.58 ± 14.88), and communication (67.72 ± 17.60), but less so with decision-making (64.98 ± 18.37) and illness management (59.60 ± 16.31). Correlation analysis revealed a negative association between disease duration and satisfaction across all domains (correlation coefficient ranged from -0.290 to -0.206, p < 0.01), while age showed no significant correlation (p > 0.05). Multiple linear regression identified age as positively influencing satisfaction, while longer disease duration had a negative impact. Higher education and marital status were associated with increased satisfaction, while employment status and having children showed mixed results.

CONCLUSIONS

This research uncovered significant insights regarding MS patient satisfaction within healthcare services. Despite moderate satisfaction levels overall, specific interventions are necessary to address shortcomings in decision-making and illness management. The negative correlation between disease duration and satisfaction across all domains underscores the evolving needs of MS patients over time. Future research could examine the effectiveness of illness management programs in improving MS patient satisfaction.

Pre-pandemic artificial MERS analog of polyfunctional SARS-CoV-2 S1/S2 furin cleavage site domain is unique among spike proteins of genus Betacoronavirus

OBJECTIVES

SARS-CoV-2 spike (S) glycoprotein furin cleavage site is a key determinant of SARS-CoV-2 virulence and COVID-19 pathogencity. Located at the S1/S2 junction, it is unique among sarbecoviruses but frequently found among betacoronaviruses. Recent evidence suggests that this site includes two additional functional motifs: a pat7 nuclear localization signal and two flanking O-glycosites. However, a systematic genus and subgenus analysis of spike protein sequences bearing this polyfunctional sequence domain has been missing.

DATA DESCRIPTION

Here we report comprehensive sequence data to demonstrate that among spike proteins of genus Betacoronavirus and outside of the SARS-CoV-2 clade a fully analogous S1/S2 domain was found in only one other virus: the artificial MERS infectious clone MERS-MA30, described already in 2017, which was rationally selected from serial passage in genetically humanized mice. As the evolutionarily closest betacoronaviruses outside of the SARS-CoV-2 clade lack all its three functional motifs, these data extend-beyond natural evolution and zoonosis-the current view on SARS-CoV-2 pre-pandemic origins by presenting the analogous S1/S2 MERS-MA30 sequence domain as a precise molecular blueprint for SARS-CoV-2.

The Child-Parent Relationship During the COVID-19 in Saudi Arabia

Background The COVID-19 pandemic psychologically affected children and their caregivers. On the other side, parents were adapting to new daily routines for work, education, and self-care in response to the current situation. Therefore, assessing the child-parent relationship during the quarantine period is a crucial issue. Objective This study aimed to measure the impact of quarantine during the COVID-19 period on the relationship between children and their parents in the western region of Saudi Arabia, mainly in Jeddah and other nearby cities. Methods A cross-sectional survey study was conducted from April to December 2020 in the western region of Saudi Arabia, primarily Jeddah and neighboring cities, during the COVID-19 quarantine and shortly after it was stopped. A validated survey (Child-Parent Relationship Scale (CPRS)) comprising socio-demographic characteristics, conflict, and closeness of the child-parent relationship was distributed to the respondents after being translated from English to Arabic. Statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). P-values less than 0.05 were considered statistically significant. Results The study included 361 parents with a mean (SD) age of 37.30 (7.77) years old. Most parents were mothers (77.9%, N=279), married (91.3%, N=326), lived with their children (98.3%, N=354), and had three or a lesser number of children (80%, N=287). The average time spent with children was significantly higher after the quarantine (12.96 hours) compared to before the quarantine (8 hours) (p<0.001). The number of hours spent with children before the quarantine was significantly higher for mothers than fathers (8.44 vs. 6.01 hours, respectively, p<0.001). There was a significant association between the mean difference in conflict scores before and after the quarantine and the age of parents (p=0.002), the gender of parents (p<0.001), and marital status (p=0.026). There was a significant correlation between mean differences in closeness scores before and after the quarantine and the gender of parents (p=0.038). Conclusion Our findings highlight the complex and varied effects of the pandemic on parent-child relationships. The results emphasize the need for support and interventions to address increased conflict and promote positive relationships between parents and children during challenging times.

Clinical Presentation, Management, and Outcomes of Coronavirus Disease 2019 Infection in Children on Active Therapy for Cancer and Posthematopoietic Stem Cell Transplantation: Experience from a Tertiary Care Center

BACKGROUND:

Coronavirus disease 2019 (COVID-19), is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). Limited data on presentation, management and outcomes of COVID-19 in children with cancer and post-hematopoietic stem cell transplantation (HSCT) from Saudi Arabia is available.

AIM:

The primary aim of the study is to evaluate and describe presenting signs, symptoms, and severity of COVID 19 infection in pediatric patients with cancer and post HSCT, whereas the secondary aims are to assess COVID-19 management strategies and to assess outcomes in terms of treatment delays and mortality.

METHOD:

Retrospective study in children ≤ 14 years of age, who are on-active therapy for cancer or post-HSCT during the period March 2020 to July 2022.

RESULTS:

A total 45 cases with confirmed COVID-19 infection reported in children with cancer and post-HSCT. There were 29 male (64%) and 16 female (36%) cases, and median age of 7 years (1–14 yrs.) at the time of COVID-19 confirmed diagnosis was observed. Acute lymphoblastic leukemia, is the major diagnosis in 18 cases (40%) and all patients on active treatment course with majority of the cases being symptomatic, 78% (n = 35), with fever being the most common reason in 28 cases (80%). Main management was through home isolation in 78%, while hospitalization required in 12 % (10). Primary disease treatment remained uninterrupted in 56% (26), while treatment delays observed in 19 patients (42%). All patients in our study had smooth and complete recovery form COVID-19 infection. At a mean follow-up of 12.0 months (2.0–25.7 months), no morbidities or mortality to report.

CONCLUSION:

Our experience shows mild clinical symptoms and less severe disease course, which is comparable to international experience. Cancer treatment delays emerged as the only major impact, with no impact on the primary cancer progression or relapse at a two-year follow-up seen. Multi-institutional observational studies may enable evaluation of disease-free survival in larger cohort and could address long COVID symptoms in children.

Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.

Oral Manifestations Associated with COVID-19 Infection: A Cross-Sectional Study of Recovered Iraqi Patients

Aims

The aim of this study was to determine prevalence of oral manifestations related to COVID-19 infection among a sample of recovered patients in the Basrah province of Iraq. Methodology. This cross-sectional study included a total of 574 individuals from Basrah city, Iraq (196 males and 378 females), who had been previously infected with COVID-19. A questionnaire was developed and used to record the demographic data, medical history, severity of respiratory infection followed by hospitalization along with oral signs and symptoms that occurred during the COVID-19 infection and their persistence after recovery.

Results

Oral manifestations were reported in 88.3% of the studied sample. The most common oral manifestation was ageusia (66.8%), followed by dry mouth (59%), gustatory changes (46%), dysphagia (40.5%), burning sensation (20.8%), oral ulceration (14.5%), and gingival bleeding (3.3%). The findings suggested that ageusia was the only symptom that persisted following recovery from the COVID-19 infection. The results showed a significant statistical correlation between the incidence of oral manifestations and the severity of COVID-19 infection followed by hospitalization. A significant correlation was also found between the age groups and COVID-19 oral manifestations, whereas no significant statistical relationship was observed between gender, smoking, and systemic diseases.

Conclusions

COVID-19 infection has considerable impacts on the oral cavity and salivary glands and after recovery from the infection, some patients continue to complain of ageusia for several months. There is a positive correlation between the incidence of oral signs and symptoms associated with COVID-19 infection and the severity of the infection.

Relationship between the government implemented protective measures for coronavirus disease 2019 (COVID-19) during the pandemic and the understanding of religious evidence in Muslim community: A cross-sectional study from Saudi Arabia

BACKGROUND

Coronavirus disease 2019 (COVID-19), which has swept across the Middle East has ignited religious tensions. Although the implementation of effective preventive measures is the best way to control the spread of COVID-19, in such countries as Saudi Arabia, these restrictions have sometimes been viewed as violations of religious practice. The present study explores the reasons for ignoring the authorities' recommendations, and the inability of the authorities to create a sense of inclusion in the protective measures they introduce against the COVID-19 outbreak.

MATERIALS AND METHODS

A cross-sectional community-based study was conducted in Saudi Arabia and data were collected from 922 participants. The questionnaire contained 17 questions on personal characteristics, compliance with governmental protective measures, and participants' understanding of religious evidence. The SPSS was used for data analysis. Categorical data was presented as frequencies and percentages. Chi-square test was used to determine the association between people's compliance to the protective measures and their understanding of religious evidence.

RESULTS

The age of the study participants ranged between 17 to 68 years with a mean age of 43.9 (±12.69) years. About half of the participants reported always complying to Mosque precautions (49.9%) and keeping distance (53.7%). However, only 34.3% participants always maintained social distancing while visiting relatives; about 25.2% often kept a social distance. We found that an adequate understanding of religious principles was significantly associated with accepted overall commitment, and inadequate understanding was significantly associated with lack of commitment. An adequate understanding of religious principles was significantly associated with a positive attitude toward future commitment and inadequate understanding was significantly associated with a negative attitude.

CONCLUSION

We recommend that the Ministry of Health in Saudi Arabia solicits the support of religious scholars to give a proper explanation of the religious evidence and eliminate misconceptions to promote compliance with the protective measures.

Assessing knowledge of herbal medicine course for dental students

BACKGROUND

The aims of this article are to assess dental students' knowledge about herbal medicine usage and the potential benefits and side effects, and to conduct a short course about herbal medicine.

METHODS

All fourth-year pre-doctoral students were invited to participate in a herbal medicine course as a test while the sixth-year students were the control group. A survey was tested for validity and reliability. It comprised of 16 multiple choice questions was given before the course and one month after the course. The sum score of knowledge for each participant was calcuated based on the ability to identify the use of herbs in dentistry with high-quality evidence (correct answer) or total answer for periodontal disease and caries.

RESULTS

The response rate for completing the study was 112 fourth-year students (73.7%) and 64 sixth-year students (39.0%). More than half of the participants (52.5%) were unsure about the importance of herbal medicine in dentistry. However, the majority also stated that the most common herbs used in dentistry were clove (62.9%), followed by curcuma turmeric (54.7%) and meswak (43.0%). The fourth-year students displayed evidence of a higher overall knowledge score after the course in herbal medicine related to periodontal disease in total and correct answers (mean 4.48 ± 4.13, 3.73 ± 3.31, respectively) compared to before the course (mean 0.84 ± 1.23, 0.74 ± 1.16, respectively) (p-value < 0.001). The post-course periodontal disease total and correct answers were statistically significant between fourth- and sixth-year students.

CONCLUSION

Herbal medicine has a potential positive impact on dentistry. However, these effects are not fully investigated and received full attention in academic institute. This short educational program related to medicinal herbs can improve the knowledge of dental students. This will help increase the awareness about the use and potential side effects of herbal medicine in the dental field.

An Assessment of the Knowledge, Perception, and Willingness to Use Telepharmacy Services Among the General Public in the Kingdom of Saudi Arabia

Background and objective At the height of the coronavirus disease 2019 (COVID-19) pandemic, numerous strategies were introduced by the authorities to contain the spread of the virus, which significantly affected people's lives and impeded their mobility. As the general public was unable to leave their dwellings, many digitalized pharmacist-led services were initiated to meet the public's needs for pharmaceutical care. The aim of this study was to ascertain the knowledge, perception, and willingness to utilize telepharmacy services and the determinants associated with these services among the general public in the Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional survey involving participants recruited from the Saudi general public was conducted by using a validated questionnaire. We collected information regarding participants' demographics, as well as knowledge, perception, and willingness toward telepharmacy. The results were analyzed via descriptive statistics. The Mann-Whitney U Test was applied to assess the associations between knowledge, perception, willingness, and demographic variables regarding the utilization of telepharmacy services. Results A total of 273 Saudi citizens participated in the study; 71% (n=193) of them were aware of telepharmacy services. Many respondents showed a positive perception towards telepharmacy services and 83% (n=227) of the total participants showed their willingness to use telepharmacy services in the future. A significant association was identified between education, gender, and the knowledge of the participants regarding telepharmacy services. The demographic characteristics such as age, gender, and education, were not associated with the participants' perception regarding telepharmacy services. However, gender was significantly associated with the willingness to use telepharmacy services in the future. Conclusions Many participants had a fair knowledge and positive perception of telepharmacy services. More than two-thirds of the participants showed their willingness to utilize telepharmacy services in the future. However, further measures should be implemented involving strategies to increase the knowledge about telepharmacy by targeting the less educated among the Saudi population and those with limited access to technology.

A comparison of the horizontal and vertical bitewing images in detecting approximal caries and interdental bone loss in posterior teeth: A diagnostic accuracy randomized cross over clinical trial

Background/purpose

Horizontal bitewing radiographs are widely and frequently used in dentistry and are very reliable in diagnosing proximal caries and interproximal alveolar bone level. However, it is challengeable in detecting interproximal root caries, horizontal and/or vertical alveolar bone loss, and furcation involvements. The aim of this article was to assess the accuracy of vertical bitewing images in the diagnosis of caries and alveolar bone level compared to the horizontal bitewing technique.

Materials and methods

Each one of the 20 patients had eight bitewing radiographs to get four horizontal bitewing (control) and four vertical bitewing (experimental) images for the same posterior area; a steel wire (3 mm) was used on the sensor plate to help measure the magnification later on. The radiographs were processed digitally and were evaluated for caries by two expert restorative specialists and for bone loss by two experienced periodontists. They were also compared to the "gold standard," which is using of both clinical and radiographic examination for diagnosis. They were blinded to each other during images evaluation.

Results

Of the 20-patient sample size, 70% were male and 30% were female, with a mean age of 29.9. The average number of radiographs taken to achieve four standard bitewing radiographs was 5.9 ± 1.7 for vertical bitewings and 5.3 ± 1.3 for horizontal bitewing radiograph. The measurements from the cementoenamel junction (CEJ) to the level of crestal bone didn't show a significant difference between the horizontal and vertical bitewing radiographs. The detection of furcation area in the molar teeth was much higher in the vertical bitewing (100%) compared to the horizontal bitewing (57.5%) (P < 0.0001). Conclusion: The vertical bitewing radiograph has the upper hand over the horizontal bitewing radiograph in the detection of furcation involvement, caries detection, and alveolar bone loss. Therefore, it is highly recommended to use vertical bitewing in caries and patients with periodontal disease rather than the conventional horizontal bitewing.

The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study

Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load. However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline. This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR was conducted and the value threshold cycle (Ct) for each sample was recorded. Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and non-smokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted.

Characteristics of Oral Manifestations in Symptomatic Non-Hospitalized COVID-19 Patients: A Cross-Sectional Study on a Sample of the Saudi Population

Purpose

Few case reports and letters to the editor have been published regarding oral signs and symptoms in COVID-19 patients. The aim of the study therefore is to investigate different types of oral manifestations in COVID-19 patients as well as their prevalence.

Patients and Methods

The study is a cross-sectional study from a single medical center. A convenience sample was taken from all patients who were COVID-19 confirmed, symptomatic, and non-hospitalized. Demographic information, medical and travel history, general symptoms, and clinical examination results of the oral cavity were collected.

Results

This study included a total of 109 patients. Loss of taste was the most common oral manifestation of COVID-19 (43.4%), followed by erythema/desquamated gingivitis and coated tongue (7.3% each) and ulcers/blisters (6.4%). Loss of taste was the only symptom persisting for 10 days. Oral manifestations appeared as a single symptom (79.3%), and dorsum of tongue was the most common oral location (72.4%).

Conclusion

Loss of taste was the most prevalent specific reported oral manifestation. Other nonspecific oral lesions/symptoms are controversial. It has been suggested that oral examinations of COVID-19 patients should be conducted as part of routine examinations to investigate any possible correlation between the disease and the oral cavity.

Infection Control Practices at the Dental Clinics in Jeddah, Saudi Arabia

Purpose

The aims of this study were to determine the rate of compliance of infection control and estimate the incidence of COVID-19 in dental clinics in Jeddah, Saudi Arabia.

Materials and Methods

This is an ecological correlational study of randomly sampled dental clinics in the city of Jeddah. The 32-question survey used in the study was constructed based on the infection control guidelines/protocols during the COVID-19 pandemic released by the ADA, CDC, and SMOH. A sample of clinics from a dental clinic list in Jeddah city, using a simple random technique.

Results

Fifty-three dental clinics consented to participate in our study, while ten refused. Most of the dental clinics checked their patients’ temperature (30.2%) and strictly required them to wear a surgical mask before entering the clinic (58.5%). Glove, gown, and face mask were the most common methods of infection control used during all dental procedures (98.1%, 96.2%, and 94.3%, respectively). Moreover, the incidence of COVID-19 was the highest among receptions/security (18.70%), followed by nurses (14.3%) and dentists (11.79%).

Conclusion

As the incidence of COVID-19 among dental staff will continue to increase in the future, it is highly recommended that infection control guidelines are followed in all dental clinics.