Armed Forces Hospital Southern Region Research Articles

Knowledge, Attitudes and Practices of Women in the Southern Region of Saudi Arabia Regarding Cervical Cancer and the Pap Smear Test

Background:The main barrier for women to receive Papanicolaou (Pap) smear tests and immunization is lack of knowledge about the disease’s signs and symptoms, women’s attitudes toward prevention programs and cultural myths and beliefs. Therefore, the main objective of this study is to measure women’s knowledge, attitudes and practices about cervical cancer and the Pap smear test in the southern region of Saudi Arabia and to assess the findings in relation with women’s demographics. Methods:A cross sectional survey was conducted at the Armed Forces Hospital Southern Region Obstetrics and Gynecology Clinic using a self-administered questionnaire with a sample size of 255 women between the ages of 15 and 65 years. Results:Forty-three percent of the women in this region are aware of cervical cancer, but do not recognize its risk factors, implications, timing or main cause, which is Human papillomavirus (HPV). In fact, the primary source of information was obtained through social media. Only two women conducted Pap smear test and that was based on doctor’s referral, where women’s main reason from not conducting the test was feeling good and no need. Conclusions:There is a need, therefore, to create awareness programs for cervical cancer, its causes and risk factors, as well as its preventive measures for women in the southern region of Saudi Arabia.

The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

Objective: To endorse the impact of chewing gum on the intestinal functions’ restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD). Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748). Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p = .0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p = .0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use. Conclusion: Chewing gum, within 2 h postoperatively, is a simple, safe and well-tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries.

Patterns of Maxillofacial Fractures Associated with Assault Injury in Khamis Mushait City and Related Factors

Objective: The objective of this study was to explore the patterns of maxillofacial fractures associated with assaults among male patients in Khamis Mushait, Saudi Arabia. Methods: This study was a retrospective study conducted in Armed Forces Hospital Southern region(AFHSR) in Khamis Mushait City. The patients’ records were investigated and full-detailed records were included. Demographic data as well as type, location and cause of the maxillofacial fractures were obtained. Results: A total of 215 patients’ records were recruited for this study. Patients with age from 15 to 25 years were more than other age groups. Most of the patients were not Saudi citizens. About 68% of patients completed their primary school or were illiterates. Nearly half of the fractures (49%) were found in the dentoalveolar site. Mandible was more affected than maxilla. Left side was more affected than right side. Blunted injuries were more frequent among patients than penetrated injuries. Patients with age ≤ 35 years were more suspected to have fractures than those with older ages. Conclusion: Assault and violence can result in considerable maxillofacial traumas. Dentoalveolar fractures were the most common fractures. Young patients were more affected than elders. This problem should be taken as a general health problem and the actions should be taken to prevent further problems.

Analysis of Work-related Injuries among Health Care Workers in Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia

Introduction: Safety of healthcare workers (HCWs) is essential for patients safety. Despite of this fact, HCWs are at high risk of work-related injuries (WRI). Those injuries include falls, musculoskeletal disorders, needle stick injuries (NSIs) and workplace violence. These injuries have a negative impact on HCWs and reduces the quality of care. It is, therefore, important to analyze the occurrence of WRIs aiming the design of better targeted interventions to improve safety environment and work conditions in hospitals, which in turn, can improve the quality and outcomes of patient care. Methods: A retrospective study collected data about WRI reports available in the Armed Forces Hospital Southern Region (AFHSR). Injuries were NSIs that occurred during the period from January 2010 to June 2015 and workplace violence during the period from March 2014 to June 2015. Results: Total NSIs were 338 with a peak incidence of 85 (4.39%) during 2010, while the lowest incidence occurred during 2015 (n= 31, 1.12%). Regarding to workplace violence, 211 incidents Original Research Article Awaji and Alahmary; BJMMR, 15(4): 1-10, 2016; Article no.BJMMR.25056 2 were reported over the period of two years, and there was decreasing from 125 cases (4.73%) in 2014 to 86 cases (3.11%) in 2015. Discussion: The analysis showed that nurses had the highest rate of NSIs and workplace violence as compared to other HCWs. The highest rate of NSIs took place in dental, family and community medicine clinics which are usually crowded and had more activities, but emergency room and other clinics had the highest frequency of workplace violence. Conclusion: Needle stick injuries and workplace violence represent a major occupational challenge to HCWs in the hospital. To prevent those types of WRIs, there is a need for a system of environmental safety, continuous education, skills development, and infection control surveillance that is based on best available evidence of quality and safety best practices.

Burnout among middle-grade doctors of tertiary care hospital in Saudi Arabia.

Burnout Syndrome is a mental condition caused by chronic exposure to work related stress and is identified by the presence of any of the three distinct elements of emotional exhaustion, depersonalization and lack of personal accomplishment. Middle grade doctors are the backbone of any tertiary care hospital / medical institution, partaking in unscheduled and inpatient care. The aim of this study was to assess the presence of burnout syndrome in the middle grade doctors in a tertiary care hospital in Saudi Arabia. The study was conducted at the Armed Forces Hospital Southern Region, Khamis Mushyt, from August to October 2012 in departments with at least fifty inpatient admissions per month and with at least five middle grade (Resident, Registrar and Senior Registrar) doctors. The departments were Obstetrics and Gynecology, Internal Medicine, Pediatrics, Emergency, General Surgery and Nephrology. This was a cross sectional descriptive and analytical study using the Maslach Burnout Inventory-Health Services Survey and a self-reported stressor-identifying questionnaire to ascertain possible precursors of, or contributing factors to, Burnout Syndrome. A total of 96 proformas/questionnaires were collected anonymously to maintain confidentiality and burnout syndrome was identified in as high as 88.5% of the respondents with high emotional exhaustion in 68.8%, high depersonalization in 63.6% and low personal accomplishment in 38.5%. The authors concluded that burnout syndrome is high among the middle-grade doctors in this medical facility and that urgent steps are needed to address this problem to ensure that these physicians remain physically and mentally healthy.

Histopathologic profile of esophageal atresia and tracheoesophageal fistula

Purpose Few reports are available in the literature on the histology of the congenital atretic esophagus in humans. Histologic abnormalities including congenital esophageal stenosis (CES) may contribute toward the abnormal esophageal motility after successful repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF). The main aim of this study is to document the histopathologic profile in cases of EA. Methods One hundred and nineteen surgical specimens were collected from 69 consecutive EA patients who underwent surgical repair at the Aseer Central Hospital, Abha, and Armed Forces Hospital Southern Region, Saudi Arabia, from May 1999 through May 2009. This included 62 cases with EA and distal TEF, five cases of pure EA, and two cases of N-type TEF. Samples from tips of the upper pouch (UP), lower pouch (LP), and mid portion of the TEF were preserved in 10% formalin, sectioned, and stained with hematoxylin and eosin. Results The combined three elements of tracheobronchial tissue were observed in only three LP specimens. Gastrictype mucosa was seen in one UP and one LP specimen. Except for one N-type fistula, all sections showed fullthickness muscle coats. Distortion of muscles by fibrosis was most commonly seen in the UP. The muscle layer in the LP was more commonly distorted by glands with or without cartilage. Fourteen samples (10.8%) showed a histological picture consistent with CES. Conclusion Glands in the submucosa may be abnormal innumber and type, and may extend to different esophageal coats. Muscle distortion by fibrosis, glands, or cartilage and associated CES may contribute toward esophageal dysmotility and stricture after surgery. Cutting the TEF B3–5mm distal to its origin from the trachea is adequate histologically for primary anastomosis of the atretic esophagus. The histological changes associated with the TEF need to be revised. Keywords : congenital esophageal stenosis, esophageal atresia, esophageal dysmotility, histopathology

Luteal phase support may improve pregnancy outcomes during intrauterine insemination cycles

Objectives To determine the impact of luteal phase support with vaginal progesterone on pregnancy outcomes in infertile couples undergoing intrauterine insemination when recombinant follicle-stimulating hormone was used for ovulation induction. Study design This prospective randomized study was undertaken at the Infertility Unit, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia, and included 71 patients with either primary or secondary infertility who met the inclusion criteria. All 71 patients underwent intrauterine insemination. Thirty-seven were randomized to start with a supported cycle and 34 started with an unsupported cycle. In supported cycles, patients received vaginal progesterone once daily from the day after insemination for 14 days. No progesterone was given during unsupported cycles. For the second cycle, crossover occurred such that women who initially had a supported cycle underwent an unsupported cycle, and vice versa. The cycle types were alternated until the end of the study. The main outcome measures were clinical pregnancy rates and livebirth rates per cycle and per patient. Results In total, 132 supported cycles and 126 unsupported cycles were performed successfully. The clinical pregnancy rate per patient was higher for supported than unsupported cycles (54.92% vs. 35.21%, respectively; p = 0.016), but the per-cycle difference was not significant (29.54% vs. 19.84%, respectively; p = 0.07). Twenty-five pregnancies in supported cycles and seven pregnancies in unsupported cycles resulted in live births. When these rates were compared per cycle and per patient, significant differences were detected between the cycle types (18.9% and 35.2% vs. 5.5% and 9.8%; p = 0.001 and <0.001, respectively). Conclusion Luteal phase support with vaginal progesterone improved the success of intrauterine insemination cycles when recombinant follicle-stimulating hormone was used for ovulation induction. Condensation Luteal phase support may improve pregnancy outcomes during intrauterine insemination cycles, but large multicentre, placebo-controlled, double-blind trials are needed.