Objective To describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in a MERS-CoV referral hospital during the peak months of the pandemic. Design A single-center case series of hospitalized individuals with confirmed SARS-CoV-2 infections in King Saud University Medical City (KSUMC), an academic tertiary care hospital in Riyadh, KSA. Clinical and biochemical markers were documented. Risks for ventilatory support, intensive care unit (ICU) admission, and death are presented. Results Out of 12,688 individuals tested for SARS-CoV-2 by RT-PCR, 2,683 (21%) were positive for COVID-19. Of the latter, 605 (22%) patients required hospitalization with a median age of 55 years, and 368 (61%) were male. The most common comorbidities were hypertension (43%) and diabetes (42%). Most patients presented with fever (66%), dyspnea (65%), cough (61%), elevated IL-6 (93.5%), D-dimer (90.1%), CRP (86.1%), and lymphopenia (41.7%). No MERS-CoV co-infection was detected. Overall 91 patients (15%) died, risk factors associated with mortality were age of 65 years or older OR 2.29 [CI 1.43–3.67], presence of two or more comorbidities OR 3.17 [CI 2.00–5.02], symptoms duration of seven days or less OR 3.189 [CI (1.64 – 6.19]) lymphopenia OR 3.388 [CI 2.10–5.44], high CRP OR 2.85 [CI 1.1–7.32], high AST OR 2.95 [CI 1.77–4.90], high creatinine OR 3.71 [CI 2.30–5.99], and high troponin-I OR 2.84 [CI 1.33–6.05]. Conclusion There is a significant increase in severe cases of COVID-19. Mortality was associated with older age, shorter symptom duration, high CRP, low lymphocyte count, and end-organ damage.

Background Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. Methods This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. Results Out of 16,947 individuals tested in KSUMC, 3,480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure < 90 mmHg in the first 24 hours of presentation, lymphocyte count <1 × 10 9 /L and aspartate transaminase level > 37 units/L in the first 48 hours of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. Conclusion Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48 hours of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.

Objectives: To identify pulmonary tuberculosis (PTB) delayed inpatient diagnosis duration and contributing factors in an academic center in Saudi Arabia (SA). Methods: Retrospective review of all cultureconfirmed PTB cases between May 2015 and April 2019. The outcomes were the timing between admission and suspicion of PTB or isolation to either: early group (within 24 hours of admission) and late group (24 hours after admission). Original Article Results: Forty-nine cases were included with a median age of 49 years; a third of them were above 65 years of age. Most patients were of Saudi nationality and male. Approximately 38% of the cases were in the delayed group, half of them were smear-positive, with an average delay of 5.5 days. This was significant with: age above 65 years (odds ratio [OR]=8.93, 95% confidence interval [CI]=2.22-35.95) presence of non-respiratory symptoms (OR=5.6, 95% CI=1.56-19.98), malignancy (OR=13.38, 95% CI=1.46-122.71), chronic medical problems (OR=4.90, 95% CI=1.31-18.32), missed chest x-ray findings (OR= 48, 95% CI=8.63-266.88) or procalcitonin level above 0.5 ng/mL (OR=12, 95% CI=1.58-91.08). Conclusion: Physicians in SA need to have a low threshold for PTB consideration in elderly patients or those with a history of malignancy. A careful review of the initial chest x-ray might help to overcome missing cases of PTB.

Opioids are drugs that are used to manage wide range of chronic painful diseases. They are classified as broadspectrum analgesics. They are frequently prescribed to manage cancer and chronic pain, post-operative pain among certain other conditions. However, there is a well-known phenomenon of psychological addiction that can develop with the use of opioids leading to prolonged use, abuse and misuse which undermines their clinical efficacy associated with their use. Although in some conditions long-term opioid therapy is needed. According to clinical recommendations, long-term opioid therapy involves taking opioids every day for more than three months. The criteria for defining long-term opioid therapy in clinical settings and research, however, vary. Certain conditions are associated with its long-term use including impaired cognitive effects, sedation, constipation, nausea, vomiting, physical dependence, tolerance, and respiratory depression which are quite common with the opioid treatment. Clinical concerns regarding addiction may hinder appropriate prescribing, resulting in insufficient pain management. Delay in stomach emptying, hyperalgesia, immunologic and hormonal abnormalities, muscular rigidity, and myoclonus are examples of less prevalent effects reported with long-term opioid use. Opioid induced constipation is commonly reported in long-term use and may get severe enough to necessitate stopping the opioids and cause underdosing and insufficient analgesia. Respiratory and sleep disorders also frequently observed in longterm users of opioids. Also, incidence of new episode of depression is quite commonly linked to the chronic use of opioid. The purpose of this research is to review the available information about common conditions associated with long term opioid usage.

Background: In Saudi Arabia, cataract is considered the major cause of blindness as 55% of the total cases are caused by cataract. Moreover, 35.5% of visual loss is caused due to cataract making it the second leading cause of visual loss. Therefore, the aim of the study was to determine the outcome of visual acuity after paediatric cataract surgery. Methods: The preferred reporting items for systematic review and meta-analysis (PRISMA) were used in this systematic review. Cochrane handbook guidelines were used for all aspects of this study. It includes published and unpublished studies with different study designs. Such studies were found from databases including Google Scholar, Medline, PSYCHInfo, Embase Google, and Cochrane library, from their inception through the second week of March 2022 without any language restriction and identified all RCTs related to the results of visual acuity after Cataract Surgery in children. We used the following search keywords: ‘‘visual’’, ‘‘visual acuity’’, ‘‘cataract’’, ‘‘childhood blindness’’, ‘‘visual impairment’’, ‘‘amblyopia’’, ‘‘cataract surgery’’ and ‘‘pediatric cataract surgery’’ and ‘‘randomized controlled trial’’. In addition, we manually reviewed the references of a few journals to uncover more works that might be linked. Result: All RCTs connected to outcomes of visual acuity after pediatric cataract surgery were found using a total 376 articles from the electronic databases PubMed, Embase, PSYCHInfo, and the Cochrane Library, which were searched without language barriers from their inception. "Visual", "visual acuity", "cataract", "childhood blindness", "visual impairment", "amblyopia", "cataract surgery", and "pediatric cataract surgery" and "randomized controlled trial" were some of the search keywords. In addition, the references of a few journals were searched to find more potentially relevant studies. Due to redundancy, 92 articles were excluded from the total of 376. A total of 167 articles were reviewed, with 108 being rejected following a preliminary review. There were 59 full-text papers reviewed for eligibility, and 7 of them met the inclusion requirements, with all of the selected articles being of high quality. The parameters of the trials differed greatly in terms of treatment length and population investigated. Conclusion: According to the findings, most pediatric cataracts are inherited. Cataract extraction with Intraocular Lens (IOL) implantation with primary posterior capsulectomy and anterior vitrectomy (PPC+ AV) is the preferred method for pediatric cataract therapy. Active case discovery, parent counseling, and clear referral paths, are required to address cataract blindness. There may be a refractory surprise after the surgery in pediatric cataract instances, most often due to incorrect measuring, as the youngsters will be uncooperative for precise measurement or under the anesthetic influence. The surgery should be done in a fully equipped unit with qualified cooperative staff, and various techniques might be necessary to improve follow-up after the surgery. Keywords: visual acuity, cataract, childhood blindness, visual impairment, blindness