Armed Forces Hospital Southern Region Research Articles

Impact of biological therapies on laboratory outcomes and FEV1 in patients with severe eosinophilic asthma with chronic rhinosinusitis: a real-life study from Saudi Arabia.

From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital-Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of 3 biological therapies (benralizumab, dupilumab, and omalizumab) in adults with SA and concomitant CRS in terms of FEV1 and laboratory parameters (serum IgE and eosinophilic counts). Eighty patients were enrolled, with a mean age of 46.68. There were 45 (56%) females and 35 (44%) males. There were significant improvements in FEV1 and laboratory parameters (serum IgE and eosinophilic counts) after 6 &12 months of biological therapies compared to pre-biological therapies (p<0.001, each). The response was different among different biological therapies. The improvements in FEV1, serum IgE, and eosinophilic counts were manifest with benralizumab and dupilumab but not with omalizumab. Results from the first study from two large Saudi Arabian tertiary centers for patients with severe asthma and chronic rhinosinusitis agree with and support those of worldwide real-life ones. One-year follow-up of patients with SA and CRS showed the effectiveness of benralizumab and dupilumab, but not omalizumab, regarding FEV1, serum IgE, and eosinophilic counts. Further prospective multicenter studies are warranted.

Prevalence of malignancy in thyroid nodules with AUS cytopathology: A retrospective cross-sectional study

ABSTRACT Background: Category III (AUS; Atypia of Undetermined Significance) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was established to describe thyroid nodule features that are neither benign nor cancerous. Objectives: This study aims to evaluate the rate of thyroid malignancy in patients diagnosed with AUS at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia. Method: The patients (508) diagnosed with AUS in their thyroid nodules underwent fine-needle aspiration cytology (FNAC). Data were collected through a chart-based approach, reviewing patients’ medical records and relevant information. Results: Among the cases, the majority were females (84.6%). Among the different age groups, individuals between 40 and 50 years had the highest prevalence of thyroid nodules (32.5%). Approximately 27% of patients exhibited tumor sizes larger than 4 cm. FNAC results revealed 16.5% benign, 26% AUS, and 22.4% follicular neoplasm cases. Histopathology indicated 54.1% of benign and 37.2% of malignant cases. Papillary carcinoma accounts for 80.4% of all malignant cases. A significant correlation was observed between FNAC and postoperative histopathology (P value &lt; 0.05). Hypoechoic nodules exhibited 33.9% of malignant cases, and calcification was observed in 25% of the cases. A significant association was found between malignancy and echogenicity and between malignancy and calcification (P value = 0.003 and 0.001, respectively). Conclusion: The findings of this study identify malignancy in thyroid nodules with AUS cytopathology, particularly in the Southern region of Saudi Arabia. The correlation between pre-surgery FNAC and postoperative histopathology supports FNAC’s diagnostic value. Additionally, echogenicity and calcification can potentially contribute to predicting nodule malignancy.

Outcomes of biological therapy in patients with severe asthma with chronic rhinosinusitis in Saudi Arabia: patients with nasal polyps versus those without nasal polyps

BackgroundThis study’s purposes were to evaluate the impact of biological therapies on outcomes in patients with severe asthma (SA) and chronic rhinosinusitis (CRS) and to compare these effects among those with NP (CRSwNP) versus those without NP (CRSsNP) in the “real-world” setting in Saudi Arabian patients.MethodsFrom March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital—Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of dupilumab therapy. Outcomes were assessed, including clinical outcomes, FEV1, and laboratory findings before and one year after dupilumab. Post-therapy effects were compared between CRSwNP and CRSsNP.ResultsFifty subjects were enrolled, with a mean age of 46.56. There were 27 (54%) females and 23(46%) males. Significant improvements in clinical parameters (frequency of asthma exacerbations and hospitalizations, the use of OCs, anosmia, SNOTT-22, and the ACT), FEV1, and laboratory ones (serum IgE and eosinophilic count) were observed 6 and 12 months after using dupilumab (p < 0.001), respectively. However, after 12 months of dupilumab therapy, there were no significant differences between those with and without NP with regards to clinical (anosmia, ACT, and OCs use), laboratory (eosinophilic count, serum IgE level) parameters, and FEV1%.ConclusionsPatients with CRS experienced significant improvements in clinical, FEV1, and laboratory outcomes after dupilumab therapy. However, these improvements were not maintained when comparing CRSwNP with CRSsNP. There were no significant differences between those with and without NP regarding ACT and OCs use or laboratory (eosinophilic count, serum IgE level) parameters. Further prospective multicenter studies are warranted.

REDUCTION BLOOD LOSS IN TKA: TRANEXAMIC ACID ARTHROPLASTY UNIT: ARMED FORCES HOSPITAL SOUTHERN REGION, KHAMIS MUSHAIT, KSA

Background:Total knee arthroplasty is the ideal surgical option for the management of severe pain in the arthritic knee.However, this surgery carries a high risk for blood loss due to the involvement of soft tissue and bone cuts in the knee region.Blood loss during Total Knee Replacement can lead toincreased morbidity, including longer stays in the hospital and delayed rehabilitation. Therefore, it is ideal to reduce the amount of bloodloss pre and post-operative. Tranexamic acidan anti-fibrinolytic agent has beenusedto achieve this goal with success. Aim:Our study is Cohort comparative study to compareefficacy of 1 Gram TXA with placebo group. Methods:This study was conducted at armed forces hospital southern region(AFHSR) on patients who performed primary total knee arthroplastyduring the period fromApril 2022 to December 2022 . The patients were simplerandomized into two groups those who received tranexamic acid and those who didnt. SPSS program version 23 was used to analyze the collected data a comparison was performed between the two groups. Results:The study included 50 patients who underwent total knee replacement Group one received tranexamic acid, and the Group Two didnt. The mean±SD of the total patients was 69.8 ±11.8 years, and regarding the two groups, there was no considerable difference between the two groups (P=0.2). There were significant differences between the two groups regarding gender (P=0.005) and dressing (P=0.002). There was no patient in the study who required a blood transfusion. Conclusion:TXA can be used for TKA patients to reduce blood loss postoperatively however, its impact on blood loss seems to be insignificant.

Association of Simple Febrile Seizure with Iron Deficiency Anemia in Children: A Case Control Study

Abstract: Background: Febrile seizure is an established entity in Pediatrics which characterizes with absence of any intracranial infection or metabolic disorders. Simple febrile seizure carries a favorable prognosis without any sequelae. Still, it emerges as the most common etiology of seizure till the age of five years. Iron deficiency anemia is a commonly witnessed micro-nutrient deficiency with a worldwide distribution. Objective: To establish relation of simple febrile seizure with iron deficiency anemia in paediatric population. Materials and Methods: Case-control study, conducted in Pediatric Medicine Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushayat, Kingdom of Saudi Arabia, from1st January 2022 to 30th June 2023. The 102 children, having age six months to five years, with a diagnosis of first simple febrile seizure were assessed. Likewise, the control group included 102 febrile children without convulsion. The hematological parameters evaluated for diagnosis of iron deficiency anemia included hemoglobin, mean corpuscular volume, serum ferritin, serum iron, total iron binding capacity &amp; red cell distribution width. Result: The mean age for first simple febrile seizure was 23 months. Acute respiratory infection was the most common etiology (80%). Iron deficiency anemia was identified in 17% of cases of simple febrile seizure, in contrary to 6% of cases with febrile illness without seizure, with odds ratio of 3.2. Conclusion: This study demonstrated that the children with iron deficiency anemia are at significantly higher risk of having febrile convulsions compare to control group with fever but without anemia. Keywords: Fever, Febrile seizure, Iron Deficiency anemia, Serum ferritin, Hemoglobin, Convulsion, Mean corpuscular hemoglobin.

Utility of original and simplified pulmonary embolism severity indices in risk stratification of patients with pulmonary embolism: a study from Saudi Arabia

Abstract Background We aimed to report our experience using both the pulmonary embolism severity index (PESI) and its simplified form (s-PESI) score in evaluating patients with PE admitted at a large Saudi Arabian Hospital. Patients and methods This was a retrospective analysis where the adult (≥14 years old) patients admitted to the hospital of the Armed Forces Hospital Southern Region with the diagnosis of acute PE through 1 year were enrolled. The accuracy of both PESI and s-PESI was evaluated for mortality. Results Two hundred and twelve patients were enrolled. We encountered a significant relation only with the 90, 180 days, 1 year, and overall in-hospital mortality for low versus high-risk classification by the s-PESI score. There was neither a significant correlation between any-period mortality and classes of PESI score nor between low versus high-risk s-PESI score and 30-day mortality. The sensitivity of PESI and s-PESI in predicting mortality were 66.7 and 97.0%, respectively. The area under the curve of PESI and s-PESI were 0.611 (P=0.043), and 0.629 (P=0.005), respectively. Conclusion Besides being an easier tool for stratifying the risk of patients with PE, our data show that the s-PESI score is utilizable in Saudi Arabian patients with PE admitted at a large tertiary hospital. s-PESI and PESI have good potential to predict the prognosis of PE in terms of in-hospital mortality, with higher sensitivity, negative predictive value, and area under the curve for s-PESI versus PESI. There was a significant correlation between the s-PESI and the 90, 180 days, 1 year, and the overall in-hospital mortality. Further prospective multicenter studies are needed.

Clinical Features and Predictors of Mortality in Patients With Acute Pulmonary Embolism: A Retrospective Study From Southern Saudi Arabia.

We aimed to investigate the clinical characteristics, outcomes, and mortality predictors in patients with acute pulmonary embolism (PE). Adult patients who were admitted to the Armed Forces Hospital Southern Region, Khamis Mushait, a large tertiary hospital in Southern Saudi Arabia, with the diagnosis of acute PE were retrospectively examined for the predictors of one-year mortality. The overall in-hospital mortality was 15.6% among 212 patients. In univariate analysis, only age was significantly associated with increased early mortality, whereas age, obesity, presence of active malignancy, hypertension, use of thrombolytics, and Simplified Pulmonary Embolism Severity Index (sPESI) were significantly associated with increased late mortality. By use of binary logistic regression, the presence of obesity (HR 6.010, 95%CI 0.048-16.853, p=0.030), active malignancy (HR 3.040, 95%CI 1.147-8.059, p=0.025), and the use of thrombolytics (HR 8.074, 95%CI 2.719-23.977, p<0.001), were independently significant factors for late (overall) mortality, respectively. Among Saudi Arabian patients in the Southern Region, our data show that age is an independent factor for increased early and late mortality. The presence of obesity, active malignancy, and the use of thrombolytics, were independently significant factors for increased late (one-year) mortality. These factors should be taken into account for risk stratification and decisions on tailored management of patients with PE. Further prospective multicenter studies are needed.

Adrenal Incidentaloma Prevalence and Clinical Management- A Retrospective Study

This study aims to investigate the characteristics and prevalence of adrenal incidentalomas and subsequent clinical practice among patients in Armed Forces Hospital Southern Region -Saudi Arabia, 2021. An observational retrospective study was conducted in Armed Forces Hospital Southern Region -Saudi Arabia on the medical records of 383 consecutive patients. Patients with incidental adrenal tumors who underwent abdominal CT scans with intravenous contrast during the period from January 2013 and December 2021. A total of 300 patients were included in this study. However, the data were analyzed using statistical tests. The results revealed that most patients with adrenal incidentalomas were above 60 (53.3%%). The gender distribution was nearly equal, with 50.3% females and 49.7% males. Most observed tumors were unilateral (96.0%), while a small percentage was bilateral (4.0%). In terms of size, the majority were less than 1 cm (59.0%), followed by sizes greater than 4 cm (31.0%) and 1-4 cm (10.0%). Further analysis indicated that 49.3% were found to have functioning tumors, while 50.7% had non-functioning tumors. The specific types of functioning tumors included non-functioning adrenal adenoma (50.7%), pheochromocytoma (16.9%), Cushing’s syndrome (5.8%), and other functional tumor types (28.0%). Most of these patients were not referred to endocrine clinics. Adrenal incidentalomas are prevalent in the above-60 age group, with most tumors being non-functional. Further research into adrenal incidentalomas associated with diabetes and hypertension is required.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Utility of the 4C ISARIC mortality score in hospitalized COVID-19 patients at a large tertiary Saudi Arabian center.

The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) 4C mortality score has been used before as a valuable tool for predicting mortality in COVID-19 patients. We aimed to address the utility of the 4C score in a well-defined Saudi population with COVID-19 admitted to a large tertiary referral hospital in Saudi Arabia. A retrospective study was conducted that included all adults COVID‑19 patients admitted to the Armed Forces Hospital Southern Region (AFHSR), between January 2021 and September 2022. The receiver operating characteristic (ROC) curve depicted the diagnostic performance of the 4C Score for mortality prediction. A total of 1,853 patients were enrolled. The ROC curve of the 4C score had an area under the curve of 0.73 (95% CI: 0.702-0.758), p<0.001. The sensitivity and specificity with scores >8 were 80% and 58%, respectively, the positive and negative predictive values were 28% and 93%, respectively. Three hundred and sixteen (17.1%), 638 (34.4%), 814 (43.9%), and 85 (4.6%) patients had low, intermediate, high, and very high values, respectively. There were significant differences between survivors and non-survivors with regard to all variables used in the calculation of the 4C score. Multivariable logistic regression analysis revealed that all components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Our data support previous international and Saudi studies that the 4C mortality score is a reliable tool with good sensitivity and specificity in the mortality prediction of COVID-19 patients. All components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Within the 4C score, odds ratios increased proportionately with an increase in the score value. Future multi-center prospective studies are warranted.

Impact of viral co-infection on clinical outcomes and mortality of COVID-19 patients: a study from Saudi Arabia.

In COVID-19 patients undetected co-infections may have severe clinical implications associated with prolonged hospitalization, ICU admission, and mortality. Therefore, we aimed to investigate the impact of viral coinfections on the outcomes of hospitalized patients with COVID-19 in a large tertiary Saudi Arabian Hospital. A total of 178 adult patients with confirmed SARS-CoV-2 who were hospitalized at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia, from March 1st to June 30th 2022, were enrolled. Real-time PCR for the detection of viral co‑infections was carried out. Cases (SARS-CoV-2 with viral coinfections) and control (SARS-CoV-2 mono-infection) groups were compared. 12/178 (7%) of enrolled COVID-19 patients had viral coinfections. 82/178 (46%) of patients were males. 58% of patients had comorbidities. During the study period, 4/12 (33%) and 21/166 (13%) cases and control patients died, p=0.047, respectively. Duration of hospitalization was the only significant independent factor associated with SARS-CoV-2 coinfections, OR 1.140, 95% CI 1.020-1.274, p=0.021. The findings of this study from a large tertiary Saudi Arabian Center revealed a prevalence of 7% for SARS-CoV-2 viral coinfections. SARS-CoV-2 coinfected patients had a significantly prolonged duration of hospitalization and higher mortality than those with SARS-CoV-2 alone. Future studies are needed.

The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience

To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P=.0001), higher body mass index (P=.0001), and history of hypertension (P=.0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P=.0322) with a history of ischemic heart disease (P=.06) and higher creatinine baseline (P=.08) presenting with dyspnea (P=.0174), and acute allograft dysfunction (P=.002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P=.017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.

Depression and Associated Risk Factors Among Type 2 Diabetic Patients: A Cross Sectional Study on a Convenience Sample from the Diabetic Center, Khamis Mushait; Saudi Arabia.

BackgroundStudies had confirmed that diabetic patients have a greater risk for developing depression. Our objectives were to estimate the prevalence and predictors of depression among type 2 diabetic patients.MethodsA cross-sectional study at the Diabetic Center, Armed Forces Hospital-Southern Region (AFHSR), Khamis Mushait was conducted in the period from March to June 2017. The study includes a convenience sample of type 2 diabetic patients. Self-administered questionnaires were utilized. It consists of personal characteristics, diabetes-related information’s, and the Arabic version of the Patient Health Questionnaire (PHQ-9). Proper statistical analyses were done to assess the significance of the correlates with p ≤ 0.05 considered significant.ResultsThe study included 350 diabetic patients out of 410 with a response rate of 85.4%. Their age ranged between 28 and 100 years with a mean ±SD of 61.4±13 years. The prevalence of depression among them was 36.6%. Logistic regression revealed that patients older than 50 years were at lower risk for developing depression as compared to those aged between 28 and 40 years OR and 95% CI were 0.21 (0.08–0.57), 0.30 (0.12–0.78) and 0.33 (0.12–0.91) for patients in the age groups 51–60, 61–70 and > 70 years, respectively. Diabetic patients with thyroid dysfunction, neuropathy, those treated with insulin, and noncompliant patients were at double risk for developing depression compared to their counterparts (OR = 2.26, 95% CI = 1.20–4.27, p = 0.012); (OR = 2.35, 95% CI = 1.22–4.53, p = 0.011); (OR = 1.92, 95% CI = 1.08–3.40, p = 0.026); (AOR = 2.14, 95% CI = 1.01–4.53, p = 0.047) respectively.ConclusionAlmost one third of type 2 diabetic patients were depressed. Younger patients, having comorbid thyroid disorders or neuropathy, those treated with insulin and noncompliant patients were at higher risk for developing depression. Proper screening and treatment of depression is a crucial part of the health care management of diabetic people.

The prevalence and outcome of Stenotrophomonas maltophilia bacteraemia over a 5 year period at tertiary care in Saudi Arabia

Objective: To identify bacteraemia of Stenotrophomonas maltophilia, susceptibilities, and which antibiotic was used. Methods: A record-based retrospective study was conducted on those who were admitted to Armed Forces Hospital Southern Region – Khamis Mushet, Saudi Arabia, during the period from January 2017 until January 2021 and who had positive blood culture for Stenotrophomonas maltophilia during admission. Results: We collected data from 34 patients with mean age of 65.4 years old (SD=19.9). Moreover, we found that 73.5 % of the patients were males. Intubation was reported among 61.8 % of the patients with mean duration of 12.6 days. Moreover, tracheostomy was reported in 35.3 % of the patients with mean duration of 52.5 days. Single antibiotic regimen was applied in 67.6 % of cases while two- antibiotics regimen was applied in 32.4 % of them. Ceftazidime was used in 55.9 % of the patients, levofloxacin was used only in 23.5 % of the patients and trimeth/sulfa was used in 41.2 % of the patients. According to susceptibility tests, ceftazidime showedthe highest level of resistance (27.3 %) and trimeth/sulfa showed the highest level of sensitivity Conclusion: We found that our drug of choice is trimeth/Sulfa when considering treatment of positive patients with S. maltophilia. Stenotrophomonas incidence is common in patients with comorbidities than the normal population. Keywords: Stenotrophomonas maltophilia bacteraemia, prevalence, outcome

Association between vitamin D status and subclinical hypothyroidism

Abstract Aims and Objectives: The purpose of this study is to investigate the relation between Vitamin D levels and sub-clinical hypothyroidism and the effect of Vitamin D supplementation on treatment outcome. Design: A retrospective cohort file-based study. Method: In this study, the relation between Vitamin D level and subclinical hypothyroidism and the effect of Vitamin D supplementation on patients with subclinical hypothyroidism were evaluated where 30 patients were diagnosed with subclinical hypothyroidism followed up in Armed forces hospital southern region, KSA was included through electronic files revision. Results: The mean age was 41.6 +/- 12.4 years among the study group. Twenty-seven patients (90%) had their thyroid function test normalized after Vitamin D correction, while the rest had their TSH level improved from the baseline level. The presence of thyroid peroxidase antibodies (TPO) antibodies was found to be inversely related to TSH level after correction of Vitamin D level, and all patients who were negative for TPO 19 (100%) had their Thyroid Stimulating Hormone (TSH) level normalized after Vitamin D correction. In comparison, 3 (27.3%) of TPO-positive patients had subclinical hypothyroidism despite vitamin D correction. Conclusion: Vitamin D deficiency is inversely related to TSH, and TPO status and correction of Vitamin D deficiency in patients with subclinical hypothyroidism can normalize the thyroid function. Further studies are needed to establish the relationship between Vitamin D deficiency and subclinical hypothyroidism.

Assessment of knowledge and awareness regarding opioid overdose and toxicity among a sample of healthcare providers

Background: Knowledge and attitudes of healthcare providers regarding opioid toxicity are significant concerns. Objective: Investigate the knowledge, attitudes, awareness, and comfort level regarding overdosing among a sample of healthcare providers working at the Armed Forces Hospital Southern Region (AFHSR). Methods: Anonymous surveys were administered to AFHSR staff to assess attitude, knowledge, comfort level, and fear of consequences using a 5-point scale. Participants were AFHSR primary care physicians/internists, surgeons, physician assistants/advanced practice registered nurses, and pharmacists. Results: Healthcare providers demonstrated a lack of knowledge, awareness, and fear of the consequences associated with opioid use, overdose, and the indications and administration of naloxone. This study’s findings indicate that healthcare providers are hesitant to engage in discussions with patients about preventative measures for opioid overdose, with the majority believing that doing so will make no difference in preventing opioid overdose incidence. Additionally, a distinct difference in knowledge and perceptions of opioid abuse and toxicity was found between nurses and physicians. Further, the findings indicate a difference in knowledge and awareness regarding opioid overdose and toxicity between nurses and pharmacists.

Factors influencing referral delay of cancer patients to an oncology unit in the Southern Region of Saudi Arabia

Introduction: Cancer treatment and prognosis depend heavily on early detection. Survival in the early stages is excellent for almost all types of cancer. Unfortunately, in Saudi Arabia, a large number of cancer patients present with advanced disease, resulting in a poor prognosis. There are three levels of delay in the management of cancer patients. The first level is the time between the first cancer-related symptoms and the presentation to the health facility, the second level is from the presentation to the diagnosis, and the third level is between the diagnosis and the treatment. This study aims to determine if there is a delay, at what level and to study the factors causing such delays. Materials and methods: Two hundred cancer patients who presented to the Armed Forces Hospital Southern Region, Oncology Department, were interviewed from January 1st to June 30th, 2018. The interviews were conducted by trained physicians familiar with the questionnaire’s contents. The questionnaire consisted of four sections: a demographic section and three more sections to identify factors causing the delay at the three levels from the patients’ perspectives. All data were analyzed using the SPSS version 20.0. Results: The mean patient age was 63 years. A total of 112 patients were female and 88 were male. The most common cancer type was breast cancer (27.5%). Among the patients, 61% were illiterate and 25.5% had elementary school degrees, 86% expressed little or no general medical knowledge about cancer. More women than men paid attention to cancer symptoms (70% vs. 54%). 75% of the patients presented to the first health facility after 2 months from the first appearance of symptoms (level 1 delay). Only 2% of the patients presented within one week. 50% of the patients received a diagnosis after visiting two health facilities. All patients were diagnosed at hospitals. 40% of patients used alternative medicines, 70% of whom thought this was the cause of their delayed presentations. 67% had their diagnosis confirmed within one month (level 2 delay), and 66% started their definitive treatment within one month (level 3 delay). 75% of the patients blame themselves for the delay. Educational level (p = 0.03), knowledge about cancer (p &lt; 0.01), and the use of complementary and alternative medicines (CAM) (p = 0.01) were significantly associated with delayed presentation of patients to the health facility. Conclusion: There is a delay in the presentation of cancer patients (level 1) in the southern part of Saudi Arabia. Educational level, knowledge of cancer symptoms, and use of complementary and alternative medicines are the main causes. There were no delays in diagnosis and start of treatment (level 2,3).

Thyroglossal Duct Anomalies in Pediatric and Adult Population: A 10-Year Experience in a Tertiary Care Hospital

Introduction: Thyroglossal duct cyst is a well-recognized congenital midline neck swelling observed in early childhood and rarely in adults. It may reveal itself as a painless cyst, abscess, or as fistula. Several studies have been conducted across the world, but the literature is scarce on its presentation and complications in the Middle East. This indexing study aims to report a 10-year experience with thyroglossal duct cyst (TGDC) presentation, excision, and recurrence at a teaching hospital in Saudi Arabia (KSA). Methods: A retrospective chart review was conducted at the Armed Forces Hospital Southern Region, KSA from December 2008 to December 2018. Data were retrieved from the electronic medical record system of the hospital and validated with the histopathology records. A total of 48 patients diagnosed as TGDC, sinus or fistula were identified. Stata ver. 16.1 was used to analyze the data and results formulated using regression model and Pearson’s chi-square test. Results: The majority of our patients were female (60.4%), and the most common presentation was a midline neck swelling which moved with tongue protrusion. Surgical excision via Complete Sistrunk procedure was the operation of choice in 60.5% followed by excision of the cyst with tract and sinus tract. Previous infection and surgical history contributed to complications in our patients, but no association of age or gender was observed. Patients presenting with infected and discharging cysts were found to be much more likely to develop a recurrence (9 patients). Cysts deep to the hyoid showed more recurrence [n = 7 (78%)] compared to superficial cysts [n = 2 (22%)] and posterior and multi-tract lesions also showed significant recurrence. Conclusion: Despite being a common cause of neck swelling, thyroglossal duct cyst is often missed on physical exams. To reduce complications, timely diagnosis and treatment are necessary.

Incidence Rates of Breast Cancer by Age and Tumor Characteristics Among Saudi Women: Recent Trends.

Introduction and objectivesWith such a huge country as Saudi Arabia, it would be expected to have variations in the pattern and incidence of breast diseases. This study aims to determine the recent trends in breast cancer incidence rates by age and tumor characteristics among female patients treated in the Armed Forces Hospital Southern Region (AFHSR) from the period of January 2010 to December 2017.MethodsThis study is a retrospective chart review where all breast biopsy reports of female patients were seen between January 2010 and December 2017 at the AFHSR, Saudi Arabia, to observe the pattern of breast cancer as well as to calculate the incidence rates by age and tumor characteristics among the study subjects.ResultsOverall, the incidence rates of breast cancer among female patients ranged between three to eight confirmed cases of breast cancer for every 1000 patients for the period of 2010 to 2017, where the highest incidence rate was reported in the year of 2017. Additionally, two distinct patterns are observed in breast cancer trends, i.e., the most common type of cancer was ductal carcinoma with an incidence percentage of 81.80%, followed by lobular carcinoma (3.40%). There was no statistical evidence that the associated population means of age are significantly different from the type of tumor characteristics.ConclusionsIn this study, the average age for diagnosed women with invasive breast cancer is about 56 years of age while in situ is 51 years. Among women of all age groups, ductal carcinoma is the most common. There is also an increase in the incidence of breast cancer between 2016 to 2017, where the highest incidence rate was reported in the year 2017. Continued vigilance, mammographic screening, and patient education are needed to establish an early diagnosis and perform the optimal treatment.

Mental health awareness among adult attendees of Armed Forces Hospital Southern Region family and community center

Aim of Study:To assess mental health literacy among Saudi adults attending the Ahad Rufaidah extension of Armed Forces Hospitals, Southern Region, 2017.Methodology:Following a cross-sectional descriptive study design, 400 adult Saudi attendants of the Armed Forces Hospitals, Southern Region – Ahad Rufaidah extension were included in this study. An anonymous interview validated questionnaire was utilized for data collection. It included variables related to participants’ personal characteristics, knowledge assessment, and attitude regarding mental illness.Results:More than half of participants (55.3%) had poor knowledge regarding mental health, while 44.8% had satisfactory knowledge. Only 3.6% of participants had a positive attitude toward mentally ill persons, 43% were indifferent toward them, while 53.4% had a negative attitude toward them. Participants’ attitudes toward mental health differed significantly according to their knowledge grades (P < 0.001), with the majority of those with positive attitudes having satisfactory knowledge (93.5%) and most of those who had negative attitudes had poor knowledge (66.8%). Participants’ knowledge grades differed significantly according to their gender, with more satisfactory knowledge grades among males than females (50.8% and 22.4%, respectively, P < 0.001) and educational level, with more satisfactory knowledge grades among more educated participants (P = 0.002). Participants’ attitudes toward mentally ill persons differed significantly according to their gender (P = 0.013) and their educational level, with the highest percentage of positive attitude among university-educated participants (35.3%, P < 0.001).Conclusions:There is widespread mental health illiteracy among attendants in the Ahad Rufaidah extension of Armed Forces Hospitals, Southern Region. Their attitude toward mentally ill persons is rarely positive but largely negative or indifferent.