No abstract

Vaccines have been vital in preventing and curbing the spread of SARS-CoV-2 infection. Adenoviral vector-based vaccines, namely the ChAdOx1-S vaccine (AstraZeneca, Cambridge, UK) and Ad26.COV2.S (Janssen; Johnson & Johnson, New Brunswick, NJ, USA), have been associated with a possibly fatal adverse event known as vaccine-induced thrombotic thrombocytopenia (VITT), wherein thrombi form in unusual sites, mainly the cerebral and splanchnic veins. With the female gender predominantly affected, patients present with headache, abdominal pain, neurological symptoms and fever. It is hypothesized that certain components of the vaccine, including the adenovirus vector, may trigger the formation of antibodies against platelet factor 4 (PF4). The antigen-antibody complexes that form thereafter then activate a cascade of reactions eventually leading to the consumptive coagulopathy. This pathogenesis closely resembles a well-understood complication of heparin, known as heparin-induced thrombocytopenia. The lab results in VITT are reflective of its proposed pathophysiology: low platelets, low fibrinogen and high D-dimer, in addition to elevated anti-PF4 titers are classic findings. Treatment mainly includes non-heparin anticoagulants, intravenous immune globulin (IVIG) and plasma exchange. There is some role for surgical intervention, such as mechanical thrombectomy. Mortality due to VITT is usually caused by cerebral hemorrhage. We describe a case of a 36-year-old female who presented with epigastric pain two weeks after receiving her first dose of the AstraZeneca vaccine, and upon workup, was subsequently found to have thrombosis of her right portal and right common iliac vein.

Total parenteral nutrition (TPN) is the intravenous delivery of nutrients and is commonly used in the Neonatal Intensive Care Unit (NICU). Hypersensitivity reactions to parenteral nutrition have seldom been described in the literature. Anaphylaxis is a potentially life-threatening emergency condition that can progress rapidly and involves multiple organ systems. We report a case of anaphylaxis due to TPN in a neonate with observed ultrasound findings during the acute episode never reported in the literature before.

Purpose: SARS-CoV-2 or COVID-19 virus was the culprit of the global pandemic that began in 2019. With alarming mortality rates reaching sky-high worldwide, the virus prompted the masses to switch to online working. However, this was not feasible for healthcare workers (HCWs) exposed to a higher-than-normal risk of acquiring COVID-19 infection. This study aims to observe the prevalence of COVID-19 positivity among the various areas of a healthcare facility in Saudi Arabia. Methods: A cross-sectional study of positive employees among all departments at a tertiary care hospital in Riyadh, Saudi Arabia, such as administration, capital projects/facilities, and healthcare. The study included all hospital employees-permanent staff, rotating physicians, and trainees-who tested positive for COVID-19 between March 20, 2020 and December 30, 2020. Results: It was found that HCWs had the most significant number of infected individuals with nursing staff being the predominant demographic. This was followed by the capital projects/facilities departments, of which the environmental services staff were the most infected. Conclusion: It is pertinent that strict protocols be taken by hospital management to limit the spread of future infectious diseases within hospital settings. This includes the provision of personal protective equipment (PPE) and adequate education on its proper usage, alongside regular surveillance of staff with regard to adherence and early detection of symptoms.