Background: Human papillomavirus (HPV) is one of the leading causes of cervical and genital cancer in both genders. Purpose: To delineate parental attitude regarding HPV in Qatar. Methods: A cross-sectional study using a questionnaire was conducted at Sidra Medicine, Qatar. Results: A total of 334 questioners were completed. More than 60% of the parents were not aware that HPV can cause cervical and genital cancer. When asked about the level of comfort in giving their children a vaccine that would prevent them from getting genital cancer, 77% of the participants answered “very comfortable.” Interestingly, less than 4% of the parents stated that their children's primary care physicians ever mentioned that such a vaccine exists. When asked about the most preferable mode of receiving information regarding the HPV vaccine, 54% preferred the clinician's office, followed by 34% of whom preferred social media. In terms of the preferred age to receive the vaccine, 45% of the participants preferred to administer the vaccine to their children before they were mature enough to understand sexual relations, while 22% recommended vaccination right before marriage and 15% preferred to wait till they were grown up and decide for themselves. Furthermore, only 42% of the caregivers agreed that it is important to explain to their children that the vaccine can protect against some of the sexually transmitted infections. Finally, approximately 20% of the participants were not convinced about the HPV vaccine. Conclusion: A large proportion of parents residing in Qatar have a positive perception regarding the HPV vaccine. TheParents’ attitudes and perceptions are considered indispensable targets for community health intervention. We will share the result of our study with the ministry of public health in Qatar with a goal to incorporate the HPV vaccine in the National Immunization Schedule.

Objective: We aimed to describe the presentations and biochemical characteristics of sepsis-like syndrome (SLS) in infants aged <2 months who tested positive for SARS-CoV-2-in comparison to those in the same age group who were SARS-CoV-2-negative.Background: COVID-19 presents with a spectrum of manifestations, and children seem to have a favorable clinical course compared to other age groups. Limited data are available for symptomatic infants.Design: This was a case-controlled single-institution retrospective study on infants aged <2 months admitted with SLS between 1 April 2020 and 1 July 2020. These infants were divided into 2 groups: Group 1 (n = 41), infants with positive nasal/oropharyngeal swab polymerase chain reaction (PCR) results for SARS-CoV-2; and Group 2 (n = 40), infants with negative PCR results for SARS-CoV-2 (control group). Details between both groups were reviewed and analyzed.Outcome: The clinical and laboratory data for SARS-CoV-2 -positive infants who presented with SLS may differ from those for infants with SLS who tested negative for SARS-CoV-2.Results: Overall, 105 infants were admitted with clinical sepsis: 41 were SARS-CoV-2-positive, and 64 were negative. Fever was present in 90% of SARS-CoV-2-positive infants vs. 80% of the negative group. SARS-CoV-2-positive infants had a higher incidence of nasal congestion and cough (39 and 29%, respectively) compared to the SARS-CoV-2-negative group (20 and 3%, respectively) (P < 0.05). Poor feeding and hypoactivity occurred more frequently in the SARS-CoV-2-negative group (58 and 45%, respectively) than in the SARS-CoV-2-positive group (22 and 12%, respectively, P < 0.004). Sepsis workup, including lumbar puncture, was performed in 67% and partial septic workup was performed in 23% of the SARS-CoV-2-positive infants. Full sepsis workup was performed in 92% of the SARS-CoV-2-negative group. Cerebrospinal fluid (CSF) cultures were negative in 26/27SARS-CoV-2-positive infants (an infant had Klebsiella meningitis). All the SARS-CoV-2-negative infants had negative CSF cultures. Blood culture was negative in both groups. Urine culture showed bacterial growth in 9 infants with SARS-CoV-2-negative sepsis.Conclusions: Our study showed that respiratory symptoms (cough and nasal congestion) were more prominent in the SARS-CoV-2-positive group, while poor feeding and hypoactivity were reported more frequently in the negative group. However, the clinical differentiation between COVID-19 disease and sepsis in such age groups is difficult. Therefore, screening young infants with SLS for SARS-CoV-2- is necessary during this pandemic.

World Health Organization (WHO) is encouraging reporting of children with Multisystem Inflammatory Syndrome (MIS-C) associated with SARS-CoV-2 infection for better understanding and management of the disease. This retrospective study included the first 15 pediatrics patient with a confirmed diagnosis of MIS-C associated with SARS-CoV-2 infection in the state of Qatar. We studied and analyzed their demographic data, clinical manifestations, laboratory tests, treatment, and outcome. A total of 15 children were studied (mean age 3.5 ± 2.7year). Recent severe acute respiratory syndrome coronavirus 2 infection was identified in all of them (100%). The majority of these patients had 4 or more systems involvement. Nine of the 15 presented with Kawasaki disease - picture and all had gastrointestinal symptoms (vomiting and diarrhea). Five required Pediatrics Intensive Care Unit (PICU) admission. Lab investigations revealed high D-Dimer, hyponatremia, and hypoalbuminemia in all. Low hemoglobin (Hb) , thrombocytopenia, and sterile pyuria occurred in 86.6%, 60% and 75% of them, respectively. Treatment with combined anti-inflammatory medications (intravenous immunoglobulin, corticosteroids) was used in along with immunomodulatory agents (Anakinra) in a selected group of refractory patients. No mortality happened. Our young children who presented with MIS-C related to SARS-CoV-2 infection had significantly higher Kawasaki-disease picture compared to other reports. One third of them required PICU admission but no mortality occurred.

Background: Effective communication among physicians and nurses in in-patient settings is associated with better patient care 1 , increased teamwork, and job satisfaction 2 , however, no literature has addressed the concern of the gap in perception of communication between physicians and nurses. 3 this study aims to explore the perceptions of physicians and nurses toward proper communication and collaboration before and after an intervention. The study period encompassed before and during the COVID-19 pandemic. Methods: A cross-sectional pilot survey was administered in September-November 2015 in pediatrics in-patient wards at Hamad Medical Corporation (Doha, Qatar) followed by a post-intervention program survey in November-December 2020. The interventions included establishing a multidisciplinary unit-based council involving physicians and nurses, and a communication skills course for physicians. The questionnaire included details of demographics, perceptions towards proper communication, and collaboration in daily clinical practice. Questions used a 3-point Likert scale. Result: 124 responses (66% physician/44% nurses) were obtained in 2015 and 83 responses (51% physician/49% nurses) in 2020. The physicians’ reported perceptions improved for nearly all survey questions, often in a statistically significant way, but it was not the case for their enjoyment of collaboration which was reduced by 10% points (p = 0.01) (Table 1). The enjoyment of collaborating with the other professions declined for the physicians (p = 0.01) whereas it improved for the nurses, but it was not statistically significant (p = 0.06). For the nurses, their perception improved across all items, but less often in a statistically significant manner. In general, nurses had higher levels of satisfaction regarding communication and team collaboration (Figure 1). Conclusions: Our study showed that physicians and nurses’ perceptions improved post-interventions. Nurses seemed to be more affected by the interventions. The biggest effect was in decision sharing as both had almost a similar improvement. Promoting communication and collaboration in a complex clinical environment is paramount. Interventions such as multidisciplinary rounds and adapting structured communication tools improve organizational culture.

Background : Due to the COVID-19 pandemic, all out-patients clinics shifted to telehealth visits 1 . However some patients still needed to be seen as face to face visit 2 , mostly through the new urgent referrals which were overbooked in the clinics due to the limited availability of slots 3 . The aim of this quality improvement project was to decrease the percentage of re-booked urgent referrals for in-person visits in the general paediatric clinics from 60% to 30% within 2 months. Methods: An intervention study started in October 2020 until present at the Out-patient Paediatric Department, Hamad General Hospital, Qatar. It included all general paediatric clinics, targeting urgent referrals. The intervention was to standardize the triaging process of urgent referrals (Figure 1) to guide the general paediatric team for booking patients to in-person visits within two weeks. Patients were contacted to confirm the date, time, and location of their visits. Results: A total of 48 overbooking referrals in 11 clinics were screened with an average of 3 patients per clinic. 69% of the referral were re-booked to the next clinics. Implementing the above intervention methods, the number of re-booked urgent referrals went down to 28% (1 patient/clinic) within a 2-month period (Figure 2). Conclusion : During the unprecedented time of the pandemic, patients still need to access healthcare services safely and in a timely manner. This study showed that using a standardized pathway, the target of decreasing the need to re-book urgent visits for in-person evaluations was achieved. Standardization reduces wastes in processes (Figure 1) and decreases variations that may lead to overutilization of the limited resources and negatively affects patient care. Continuous monitoring and evaluation of the outpatient referrals processes are critical in ensuring the delivery of high-quality care.