A CROSS SECTIONAL STUDY ON ESTIMATING THE PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATIONS AMONG ELDERLY PATIENTS ADMITTED TO KING ABDUL-AZIZ MEDICAL CITY EMERGENCY CARE CENTER

Introduction: Medication management in elderly patients is truly a challenge for all health care professionals. Age-related changes, poly-pharmacy, and co-morbidities are factors for Potentially Inappropriate Medications [PIMs] prescribing that will increase the risk of Adverse Drug Events [ADEs]. STOPP [Screening Tool of Older Persons’ Prescriptions] criteria are the most updated screening tool for detecting PIMs in elderly patients. Objectives: To estimate the proportion of potentially inappropriate medications among the elderly visiting Emergency Care Center [ECC] at King Abdul-Aziz Medical City – Central Region [KAMC-CR]. Methods: Prospective cross-sectional study has been approved by the Institutional Review Board. The study includes 300 patients, conducted over two months from October-November 2014 at an ECC in KAMC-CR. The inclusion criteria: elderly more than 60 years old, patients from both gender and have polypharmacy [more than 4 medications] prescription. Exclusion criteria: patients who are non-eligible to be treated in KAMC-CR, and who don’t have medications history in KAMC-CR pharmacy computer system. The data were collected from the hospital electronic system and patients’ charts. The statistical analysis was completed using the Statistical Package for the Social Sciences [SPSS] 19.0 software. Results will be reported in terms of frequency, percent, and p-value. Results: 1200 patients who were admitted in ECC at KAMC-CR conducted over two months from October-November 2014. As a result, our study consisted of 300 patients [male 54% female 46%], the majority of patients were between 60-79 years old. PPIs are prescribed to 206 out of 300 patients. The results showed that the most frequent prescriptions resulting in PIPs by STOPP criteria were the PPI [20%], duplicated drug class prescriptions and long-term opiates in those with recurrent falls [11.7%] and vasodilator drugs with postural hypotension [11.4%]. Conclusion: > Poly-pharmacy was independently associated with PIMs especially in patients aged over 65. > These findings have significant implications that will help us identify areas of improvement in the overall medical care of geriatric patients and focus on avoiding inappropriate drug use, reduce unnecessary medication, drug interactions and related adverse events. > Comparing with other international findings, our institutions need to pay more attention to prescribing in the elderly population. Keywords: STOPP, Polypharmacy, PIMs, Elderly, ADE

Mental health outcomes amongst health care workers during COVID 19 pandemic in Saudi Arabia

Objectives: The study aimed to assess the mental health outcomes and associated factors among health care workers during COVID 19 in Saudi Arabia.Design, Setting, and Participants: We conducted a cross-sectional survey of health care workers from tertiary care and ministry of health Centers across the Central, Eastern, and Western regions of Saudi Arabia. There were 1,130 participants in the survey, and we collected demographic and mental health measurements from the participants.Primary Outcomes and Measures: The magnitude of symptoms of depression, anxiety, and insomnia was measured using the original version of 9-item patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder scale (GAD-7), and 7-item insomnia severity index (ISI). We use the multiple logistic regression analysis to identify the associated risk factors of individual outcomes.Results: The scores on the PHQ-9 showed that the largest proportion of health care workers (76.93%) experienced only normal to mild depression (50.83 and 26.1%, respectively). The scores on the GAD-7 showed that the largest proportion of health care workers (78.88%) experienced minimal to mild anxiety (50.41 and 28.47%, respectively). The scores on the ISI showed that the largest proportion of health care workers (85.83%) experienced absence to subthreshold insomnia (57.08 and 28.75%, respectively). The risk factors for depression in health care workers were Saudi, living with family, working from an isolated room at home and frontline worker. For anxiety, being female was risk factor and for insomnia, being frontline worker was risk factor.Conclusion: It was observed that the symptoms of depression, anxiety, and insomnia were reported in a lower proportion of health care workers in our study. The participants who were female, frontline workers, Saudi, living with family, and working from home in isolated rooms were predisposed to developing psychological disorders

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Incidence and Clinical Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with COVID-19: A Multicenter Cohort Study

Atrial fibrillation (Afib) can contribute to a significant increase in mortality and morbidity in critically ill patients. Thus, our study aims to investigate the incidence and clinical outcomes associated with the new-onset Afib in critically ill patients with COVID-19. A multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care units (ICUs) from March, 2020 to July, 2021. Patients were categorized into two groups (new-onset Afib vs control). The primary outcome was the in-hospital mortality. Other outcomes were secondary, such as mechanical ventilation (MV) duration, 30-day mortality, ICU length of stay (LOS), hospital LOS, and complications during stay. After propensity score matching (3:1 ratio), 400 patients were included in the final analysis. Patients who developed new-onset Afib had higher odds of in-hospital mortality (OR 2.76; 95% CI: 1.49-5.11, P  =   .001). However, there was no significant differences in the 30-day mortality. The MV duration, ICU LOS, and hospital LOS were longer in patients who developed new-onset Afib (beta coefficient 0.52; 95% CI: 0.28-0.77; P  < .0001,beta coefficient 0.29; 95% CI: 0.12-0.46; P  < .001, and beta coefficient 0.35; 95% CI: 0.18-0.52; P  < .0001; respectively). Moreover, the control group had significantly lower odds of major bleeding, liver injury, and respiratory failure that required MV. New-onset Afib is a common complication among critically ill patients with COVID-19 that might be associated with poor clinical outcomes; further studies are needed to confirm these findings

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

COVID-19 Host Genetics Initiative. A first update on mapping the human genetic architecture of COVID-19

The COVID-19 pandemic continues to pose a major public health threat, especially in countries with low vaccination rates. To better understand the biological underpinnings of SARS-CoV-2 infection and COVID-19 severity, we formed the COVID-19 Host Genetics Initiative1. Here we present a genome-wide association study meta-analysis of up to 125,584 cases and over 2.5 million control individuals across 60 studies from 25 countries, adding 11 genome-wide significant loci compared with those previously identified2. Genes at new loci, including SFTPD, MUC5B and ACE2, reveal compelling insights regarding disease susceptibility and severity.</p