Nawaf Mohammed Al-Dajani

BACKGROUND: COVID-19 pandemic has caused a major global health disruption. Pediatric presentations vary widely, particularly among children with differing immune status. OBJECTIVES: To compare the clinical presentation, disease course, and outcomes of immunocompetent versus immunocompromised pediatric patients with COVID-19 in a tertiary referral hospital in Jeddah, Saudi Arabia. DESIGN: Retrospective chart review SETTINGS: A tertiary center treating immunocompromised children including those with HIV, solid and hematologic malignancies, and solid organ or hematopoietic stem cell transplantation. PATIENTS AND METHODS: Records of 123 pediatric patients (P <.05. Immunocompromised status was defined as the presence of an underlying medical condition or treatment associated with clinically significant immune suppression MAIN OUTCOME MEASURES: Differences in symptoms, severity, clinical progression, and outcomes between immunocompetent and immunocompromised children. SAMPLE SIZE: 123 children RESULTS: Most patients were immunocompetent (93, 75.6%). Immunocompromised children primarily included post-transplant or oncology patients on chemotherapy. Fever was the most common presenting symptom (69, 56.1%), significantly more common in immunocompetent children ( P =.029). Immunocompromised children were more frequently admitted, mainly for non-COVID-related concerns (e.g., abnormal chest radiograph, febrile neutropenia, or hydration). Nearly all patients recovered without complications, and no significant difference in recovery rate was observed between groups ( P =.568). CONCLUSION: COVID-19 severity and recovery appeared similar between immunocompetent and immunocompromised pediatric patients in this cohort. However, the higher hospitalization rate observed among immunocompromised children likely reflects precautionary admission practices rather than increased disease severity. Findings should be interpreted cautiously given the small immunocompromised subgroup and heterogeneity of underlying conditions. Interpretation of these findings is limited by the retrospective design and relatively small sample size. Larger multicenter studies are required to confirm these observations.

BACKGROUND: Toxoplasmosis, an opportunistic intracellular protozoan infection caused by Toxoplasma gondii ( T. gondii ), and rubella, caused by the rubella virus (RV) are the two most common TORCH infections. OBJECTIVES: To evaluate seroprevalence of T. gondii and rubella infection among child bearing age women. DESIGN: Retrospective design SETTINGS: Multi-center study PATIENTS AND METHODS: The study included women of childbearing age living in the Western region of Saudi Arabia, who sought medical check-up in one of the governmental public hospitals. Electronic health records of eligible patients were reviewed during the period January 2017 to December 2021 from three major health care institutions. MAIN OUTCOME MEASURES: Seroprevalence of T. gondii and rubella infection among women of childbearing age in the Western region of Saudi Arabia. SAMPLE SIZE: 13 895 women were screened and 2117 women of childbearing age were eligible. RESULTS: Among the 2117 women, seropositive-antibodies-results for T. gondii were 148 (6.1%) for IgG antibodies anti-Toxo-IgG-antibodies, 16 (0.8%) for anti-Toxo-IgM-antibodies, and 14 (0.7%) for anti-Toxo-IgG and IgM-antibodies. Univariate analysis showed that the highest proportion of IgG+ women were recorded among 35–39 years of age followed by 25–29 years. The highest proportion of IgM+ was observed among 40–44 years old followed by 35–39 years. Among the women tested for rubella seroprevalence, 16 (0.8%) were IgM positive, 1346 (63.6%) were immune (IgG positive), and the remaining 755 (35.7%) were susceptible. Rubella immunity was moderately high (63.6%) but dropped significantly with increasing age. CONCLUSION: The seroprevalence of Toxoplasmosis in our study appears to be lower than the global average. Nevertheless, it highlights the need for targeted educational programs and public health initiatives with interventions to raise awareness in the community. Rubella immunity, while moderately high overall, showed a notable decline with increasing age, highlighting regular assessment of rubella vaccination programs in the country to ensure effective prevention and control of the disease. The study highlights the need for future research focusing on the epidemiologic trends of TORCH infections, given their broader implications on public health in Saudi Arabia. LIMITATIONS: The seroprevalence results were based on a small sample size living in the Western region of Saudi Arabia and may not reflect other regions in the country.

This case report details the fourth documented case of urinary tract infection caused by Kluyvera cryocrescens and the first in a neonate. Including a brief literature review on urinary tract infections associated with this organism, the report highlights the importance of considering uncommon pathogens in neonatal infections and the necessity of a thorough diagnostic approach to initiate appropriate antimicrobial treatment.

Introduction Umbilical venous catheters (UVCs) are standardly used for central venous access in acutely sick neonates. Complications associated with UVCs include thrombosis, infection, diffuse intravascular coagulopathy, arrhythmia, tamponade, and liver injury, many of which are related to misplacement of the catheters. Therefore, this study aimed to institute a policy of obtaining lateral and frontal radiographs to improve the determination of the UVC position. Methods We retrospectively reviewed UVC placement from 132 radiographs. We compared interpretations by different reviewers of frontal versus frontal and lateral chest radiographs for the most accurate determination of the UVC position. The reviewers completed questionnaires indicating their assessment of the catheter tip position, as well as the appropriate catheter manipulation required for optimal positioning. Their assessment was derived from frontal chest radiographs followed by frontal plus lateral view radiographs a week later. Results The reviewers (junior neonatology fellow, senior neonatology fellow, pediatric radiology fellow, and senior pediatric radiologist) revised their assessment with regard to the UVC positioning between frontal and frontal plus lateral radiographs in 24.6%, 22.7%, 19.6%, and 15.9% of cases, respectively, and indicated that the lateral view was helpful in 18%, 13.6%, 19.6%, and 31% of the cases, respectively. UVCs were placed appropriately at the first attempt in only 13.6% of the cases. Conclusion Correct initial placement of a UVC is uncommon. A lateral radiograph is beneficial in determining the UVC position. Hence, we suggest the inclusion of a lateral view along with the frontal chest radiograph for the evaluation of the UVC position if real-time ultrasound cannot be performed before UVC usage.

Introduction. Local data in Saudi Arabia regarding pediatric SARS-CoV-2 infection is limited. This study is aimed at adding insight regarding the effect of the novel coronavirus on pediatric patients by studying the presentation, laboratory parameters, and disposition of SARS-CoV-2-infected pediatric patients in one center in Jeddah, Saudi Arabia. Methodology. A retrospective study was conducted at the International Medical Center (IMC) in Jeddah, Saudi Arabia, to assess features of pediatric patients admitted with COVID-19 from April 2020 to September 2020. Results. A total of 43 patients were found to meet the study inclusion criteria. The most common presenting symptom was fever (53.5) in study participants followed by complaints of cough, runny nose, and shortness of breath (37.2). Lymphocytopenia was evident among 60 of those studied. Elevated C-Reactive Protein was remarkable in 24.9. More than half of those (53.5) studied required only supportive treatment. Conclusion. COVID-19 disease for the most part is mild in children with a varying clinical picture and nonspecific laboratory parameters. Further, large-scale national-based studies are needed to help in the early identification of pediatric cases at risk of complication due to COVID-19 infection hence providing proper and timely management, identifying population-specific disease pattern and perhaps targeted immunization.