Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Materials Challenges in Reconstruction of Historical Projects: A Case Study of the Old Riwaq Project

Nowadays, the focus on sustainable materials with high specifications has become a necessity in certain important construction projects. These materials play an essential role and constitute the foundation stone in the sustainability of these projects in addition to their impact on the execution time. Many studies have discussed the challenges faced by these materials and their negative impact on the execution period of construction projects. However, these studies are still scarce in the reconstruction projects, especially the historical ones, which are based mainly on the sustainability of the materials used, which are represented by the historical elements that maintain the ancient shape of the building. The aim of this research is to highlight the materials-related challenges of historical reconstruction projects which negatively affect the planned duration of implementation. This study was conducted on the Old Riwaq project, which is the historical part of the Mataf Expansion project in the city of Mecca, Saudi Arabia. It is considered one of the most important reconstruction historical projects that have been recently carried out in the Middle East. In order to achieve this goal, 15 interviews were held with the engineers working in this project and specialists in these types of historical projects. The results show a group of different challenges that follow the reconstruction stages of the historical building. These challenges are: challenges related to the first stage which is the documentation and dismantling stage (two challenges), challenges related to the second stage which is the workshops stage (three challenges), and challenges related to the third stage which is the new designs and mockup stage (three challenges). Finally, the identification of sustainable materials challenges should be considered an urgent necessity, in order to overcome or reduce their negative effects in future projects, especially in relation to project durations

Patients’ Perception toward Medical Students’ Involvement in Their Surgical Care: Single Center Study

Objectives. To investigate patients’ perception regarding medical students’ role in the operating theatre. Methods. A cross-sectional study was conducted on a randomly selected sample at King Abdulaziz University Hospital. Results. 131 participated in this study. 77 of the participants were females and 50 participants were males. 46.4% think that it was important for the future doctors to be in theater during surgery. 60.2% thought that medical students only observed surgeons in the theatre and 39% thought that medical students performed minor procedures in the theatre. Conclusion. Patients underestimated the importance of medical students’ attendance and involvement in theatre compared to bedside teaching and outpatient clinics. Patients believed that medical students should obtain their consent prior to observing them in the theatre

Delay Factors Management and Ranking for Reconstruction and Rehabilitation Projects Based on the Relative Importance Index (RII)

In recent decades, the construction industry has developed rapidly. Delay was and remains one of the most important challenges negatively affecting not only this industry but also the economy and sustainable development. This study aims to conduct a comprehensive analysis of the delay factors in reconstruction projects because of the vital importance of these types of projects. This is the first attempt to conduct such an analysis for reconstruction projects in particular, and it is a continuation of the previous case study, which was considered one of the most important reconstruction projects in the Middle East region. The previous study focused on determining the types of delay factors used in this project. It is necessary to carry out advance in-depth analysis to sort the delay factors based on their effect on the project plan. In order to achieve the study goal, 93 questionnaires were distributed by hand to experts working on the project: some of them working the day shift, and the others working the night shift. The questionnaire results were analyzed and delay factors were sorted in descending order according to the relative importance index (RII). The three main factors affecting the overall reconstruction project duration were site restrictions and conditions, electrical and mechanical rerouting works, and design buildability and adjustment

Delay Factors in Reconstruction Projects: A Case Study of Mataf Expansion Project

Delays in construction projects are a common phenomenon throughout the industry. This problem has many negative impacts on the time, cost, and sustainability of the projects. Many studies were conducted to identify the main causes of this delay in new construction projects in different regions but very few studies have focused on finding an explanation for the causes of delay in major reconstruction projects that have great religious and cultural sustainability. This paper examines the factors that contributed to work delays in one of the most major reconstruction projects that took place recently in the Middle East, which is namely the Mataf Expansion Project in the city of Mecca, Saudi Arabia. Fourteen interviews were conducted with project managers, construction managers, and senior site engineers to identify the factors that they encountered and led to the delay in the reconstruction activities of this project. Some of the findings were consistent and similar to most other causes of delay that are associated with new construction projects. However, interestingly, this research has discovered the existence of other unavoidable factors that caused a delay and should be considered for any similar reconstruction projects. The results showed that these factors could be divided into two groups: the first one is related to the demolition phase (five factors) and the second group is related to construction works (nine factors). In addition, it has been observed that the building material during the reconstruction is considered one of the major delaying factors. Finally, these 14 delay factors should be carefully considered to assure the sustainability of the main object’s function during the reconstruction activities

The perception of otolaryngology: Head and neck surgery speciality among physicians at a tertiary care hospital

Objective: To assess the awareness of physicians at King Abdulaziz University Hospital (KAUH), a tertiary care centre in Jeddah, Saudi Arabia, about the scope of practice of otolaryngologist (OTL) - head and neck surgeons. Furthermore, to identify diseases of the head and neck in which physicians may underestimate the role of OTLs. Study Design: Cross-sectional analysis. Background: The scope of practice of ear, nose and throat surgeons has impressively widened to include many subspecialities such as head and neck surgery (HNS). Encountering diseases that used to be or could be handled by other surgical specialities may cause confusion among physicians. This confusion may extend to mislead some physicians while referring. Methods: A total of 336 questionnaires were distributed to physicians at KAUH. The questionnaire targeted consultants, specialists and residents of different departments. The survey asked the responders which specialty they believed was the expert in managing certain clinical conditions related to OTLs. The respondents were allowed to choose one or more speciality for each question. Results: One hundred and seventeen questionnaires of the total 336 were analysed with a response rate of 34.8%. The analysis showed that 94.9% of the respondents believed that OTLs were experienced in dealing with pharyngeal lesions. Regarding hoarseness, 96% of the physicians thought that it was a symptom managed by OTLs. About 94% of the respondents chose OTLs as experts in managing patients with a foreign body ingestion. Almost 89% (88.9%) thought that OTLs were the physicians who perform tracheostomies. However, regarding cold or flu and oral lesions, OTLs only scored 68.4% and 64.1%, respectively. Conclusion: The study revealed the awareness of physicians at KAUH in regards to the extent of services provided by OTL-HNS as not fully satisfactory. It is our job as OTLs to raise awareness of our speciality among colleagues of other departments