King Abdulaziz Medical City-Jeddah Research Articles

Sleep quality and psychological disorders in breast cancer female patients receiving radiotherapy at a tertiary oncology center in West Saudi Arabia.

Breast cancer is the most prevalent type of cancer among women worldwide. Many recently diagnosed and treated breast cancer patients complain about sleep disorders, depression, anxiety, stress, and fatigue. This study aimed to evaluate sleep quality among breast cancer patients and to assess its association with psychological disorders, and socio-demographic and clinical characteristics of patients. This cross-sectional study was conducted among women who received radiotherapy for breast cancer (stage 1-3) at King Abdul-Aziz Medical City-Jeddah from January to August 2021. Each participant completed a personal information form, the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the International Physical Activity Questionnaire (IPAQ). Clinical data were collected from the medical records to evaluate certain risk factors. Descriptive statistics were used for participant characteristics, and analyses of variance were used to assess associations between the qualitative variables. Fifty-six women with a mean age of 50.1years and an average of 10months after cancer diagnosis were included. Poor sleep quality was present in 58% of respondents. Symptomatic depression, anxiety, and stress were found in 34%, 32%, and 30% of women, respectively. Poor sleep quality was associated with depression (p = 0.031), anxiety (p = 0.03), and stress (p = 0.024) and was independently associated with hot flashes. In multivariate analysis, patients with depression or withcancer for more than 6months were less likely to have good sleep after controlling other variables (21.74 and 14.71 times, respectively). Poor sleep quality was present in 58% of women with breast cancer receiving radiotherapy and was significantly associated with depression, anxiety, stress, and hot flashes. Depression level and cancer duration were significant predictors of sleep quality. Early identification and proper management of psychological and sleep disorders are necessary to improve the quality of life and survival of breast cancer patients.

Renal outcomes in pediatric patients with sickle cell disease: a single center experience in Saudi Arabia.

Sickle cell nephropathy (SCN) is a significant complication of sickle cell disease (SCD) with an asymptomatic onset in childhood and potential progression to chronic kidney disease (CKD). The clinical findings of SCN include hyposthenuria, hematuria, proteinuria, hyperfiltration, and CKD. Data on renal manifestation among patients with SCD in Saudi Arabia is lacking. Therefore, this study aimed to evaluate renal outcomes in patients with SCD who visited a hematology clinic at the National Guard Hospital, Jeddah. We conducted a retrospective chart review of renal complications in patients with SCD who are within 0-14 years of age and on regular follow-ups at the pediatric hematology clinic in King Abdulaziz Medical City-Jeddah, Saudi Arabia. Among the 140 patients with SCD, 99 met the inclusion criteria. The median age at diagnosis was 18 (1-108) months. Two SCD phenotypes were observed, with 82 (83%) patients having sickle cell anemia (HbSS) and 17 (17%) having HbS/B+ thalassemia. Of the total patients, 92 (93%) were administered hydroxyurea (HU), with a median starting age of 48 (9-168) months. The most common renal complication observed during routine urinalysis was hematuria (38%), followed by proteinuria (11%). After stratifying the sample into four age groups (0-3 years old, 4-7 years old, 8-11 years old, and 12-14 years old), the mean glomerular filtration rate (GFR) values were 96.16, 101.36, 112.69, and 120.11 ml/min/1.73 m2 respectively. Renal imaging revealed abnormal findings in 27 (29%) patients. The most common abnormality observed on US was increased echogenicity (43%). SCN is a significant complication of SCD. In this study, we assessed the renal outcomes in pediatric patients with SCD. After analyzing the clinical findings of SCN, we concluded that the presence of renal complications in pediatric patients presented a progressive pattern.

Prevalence of Selective Serotonin Reuptake Inhibitor Use Among Pregnant Women From 2017 to 2020 in King Abdulaziz Medical City, Jeddah, Saudi Arabia: A Retrospective Study.

Perinatal depression is a mental health disorder that is associated with feelings of hopelessness, despair, and lack of motivation. Its effects on pregnant women are not limited to hemorrhage and hypertension and may lead to maternal mortality. As a result, maternal antidepressant usage during pregnancy has rapidly increased in the United States. Selective serotonin reuptake inhibitors (SSRIs) are considered one of the most prescribed antidepressants. Thus, this study aims to measure the prevalence of SSRIuse during pregnancy. A retrospective cross-sectional study was carried out in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The population consisted of all pregnant women aged 18 or older from the period of January 2017 to December 2020 (N=13484). The sampling technique was non-probability consecutive sampling. The study included 13,484 pregnant women, and further analysis revealed that 62 (0.459%) were exposed to at least one type of antidepressant during pregnancy. Of these, 12 (19.35%) had used more than one class of antidepressants. The majority of the sample, comprising 39 (62.90%) women, were between 34 and 44 years old. Furthermore, SSRIs were found to be the most commonly used antidepressant (41, 66.13%). In addition, fluoxetine was the most frequently prescribed antidepressant, with 23 (37.10%) patients receiving this medication. The dosage did not exceed 20 mg for the majority of the patients on SSRIs. This study measured the prevalence and patterns of SSRIs and use of different antidepressant classes during pregnancy. After calculating the prevalence of each class of antidepressants among 62 pregnant women exposed to antidepressants, the analysis concluded that SSRIs are the most prescribed antidepressant during pregnancy. This study contributes to the growing body of literature on the use of antidepressants during pregnancy and highlights the need for ongoing research in this area.

Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients with Sickle Cell Disease in Saudi Arabia

Purpose: Sickle cell disease (SCD) is a common global hereditary hemoglobin disorder. One of the main treatments of sickle cell patients is the requirement of blood transfusions. Post transfusion alloimmunization of red blood cell antigens continue to be a major risk for SCD patients. The study objective is to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric SCD patients in our center and compare our results to published reports from the KSA, regional and some international countries.
 Methodology: A retrospective study drsign was adopted with record review of SCD patients at King AbdulAziz Medical City-Jeddah (KAMC-J) between 2008-2019 where blood samples were analyzed for alloimmunization using immunohematological techniques. Demographic characteristics and transfusion history were recorded. Data analysis was conducted by SPSS ver. 26. Data are summarized as frequency distribution and chi square test was used to check significance of the difference in the frequency of alloantibodies among subgroups. 
 Findings: Out of all examined sickle cell patients (n=112). Alloantibodies were detected in 21 patients (17.4%), and these were mostly single in 15 patients (71.4%) as anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other six patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibodies were significantly higher in patients who had been admitted to the hospital > 5 times annually, those who had an exchange blood transfusion, age groups > 3 years, and for those who received a larger number of blood units (p-value < 0.05).
 Recommendations: The consequences of red blood cell alloimmunization are highly significant and, therefore, extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fya, Fyb, Jka and Jkb antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion related complications. Our rate of alloimmunization post frequent blood transfusion is considered relatively low compared to other nations.

The Etiology, Diagnosis, and Management of Cerebrospinal Fluid Rhinorrhea: A Tertiary Center Experience.

Introduction The aim of the present study was to describe our institution's nine years of experience in the endoscopic endonasal management of cerebrospinal fluid (CSF) rhinorrhea and to discuss the causes, sites, and outcomes. Methodology The medical records of patients diagnosed with CSF rhinorrhea in King Abdulaziz Medical City-Jeddah (KAMC-J) between 2014 and 2023 were retrospectively reviewed, and all relevant information including body mass index, medical and surgical history, and postoperative outcomes were obtained. Results A total of 20 cases were included in the present study, sixteen (80%) of which were females and four (20%) were males. The mean age of participants was 42.59±13.9 years. Nine cases (45%) were spontaneous CSF rhinorrhea and 11 (55%) were traumatic; within the traumatic group, six cases (54%) were iatrogenic either following previous neurosurgery or functional endoscopic sinus surgery, while the remaining five cases were related to motor vehicle accidents. The mean body mass index for the spontaneous CSF leak was 32 Kg/m2, and 33 Kg/m2 for the traumatic leaks, no statistically significant difference was noted. The cribriform plate was the most common site of leakage (65%). A multilayer surgical technique using facia lata graft with nasoseptal flap was the most common choice for reconstruction with a first-attempt success rate approximating 90%. A recurrence was observed in two patients only. No major complications were reported. The average length of stay was nine days. Conclusion The endoscopic endonasal repair of CSF leak is a safe and reliable procedure and is associated with high success rates and low risk of complications. Therefore, it should be preferred as a first-line treatment for CSF rhinorrhea.

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit.

Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and includedthe education of healthcare workers on hand hygiene, disinfection of patients' surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each.

Assessment of Pre-existing Type 2 Diabetes Mellitus Prevalence and Risk Factors Among Colorectal Cancer Patients in King Abdulaziz Medical City, Jeddah.

Diabetes mellitus (DM) and cancer are recognized as non-communicable chronic disorderswhich are among the top ten causes of death globally. In Saudi Arabia, the prevalence of type 2 DM(T2DM) and colorectal cancer (CRC) is alarmingly high. Both T2DM and CRC share common risk factors. In this study, we aim to assess the prevalence of pre-existing T2DM among CRC Saudi patients. In this cross-sectional study, data were collected from the medical records of 275 Saudi adult patients with CRC from 2009 to 2018 at King Abdulaziz Medical City, Jeddah (KAMC-J). Participants had a mean age of 57.0 years, standard deviation (SD) of 13.0, and were mostly males (60.00%) and Saudi (100.0%). Participants had a mean BMI of 26.42 (7.35) kg/m2. The prevalence of pre-existing T2DM in this study was 40.80%. 15.8% of participants were overweight and obese (BMI>30), respectively. The average age of diabetics and non-diabetics was 63.6 (10.64) and 52.73 (12.43), respectively. Diabetic patients are significantly older than non-diabetic patients (p<0.001). The average BMI for diabetics was 26.96 (7.26) kg/m2, whereas the average BMI for non-diabetics was 25.93 (7.48) kg/m2. No significant differences were found between the two groups. This study provides new insight into the high prevalence of pre-existing T2DM in CRC patientsin Saudi Arabia. In particular, the age of diagnosis of CRC in diabetic patients was significantly higher than in non-diabetics.

Quality of Life and Needs Assessment of Cancer Patients’ Caregivers in the Saudi Culture

Background: Cancer is a chronic health condition that requires long-term treatment and care. Diagnosis of cancer is a family crisis that has a bad impact on patients and their caregivers, which can worsen the quality of life of the entire family members. It would be relevant to highlight the changes in the quality of life among cancer patients' caregivers within the Saudi culture to strengthen their involvement in the plan of treating cancer patients.Objective: To assess the needs and quality of life of Saudi cancer patients' caregivers by using the World Health Organization quality of life questionnaire WHOQOL-BREF and the Family Inventory of Needs (FIN) questionnaire for family caregivers.Materials and methods: Of 376 caregivers invited to participate, 270 (72%) accepted and completed the questionnaire. The study was carried out in outpatient clinics and oncology inpatient wards of Princess Noorah Oncology Center in King Abdul-Aziz Medical City Jeddah, Saudi Arabia.Results: The study found that 53 % of Saudi caregivers reported a good quality of life in the following domains: psychological, social relationship, and environment. On the other hand, the lower quality of life scores were stated for the physical health domain in almost two third of participants (67 %). Poor quality of life was reported among the male caregivers of the older age group who had a lower level of education and had a short term of caring (fewer than 12 months). Regarding the need assessment, most of the 20 needs items were rated important and were related to patient care. Whereas, the least important needs were related to the caregivers' health.Conclusion:There was a significant association between quality of life scores and the demographic characteristics of the caregivers, addressing these factors in addition to the assessment of the caregivers' needs during medical care will provide holistically care for the patients and their caregivers to increase their quality of life.

COVID-19 ONLINE CROSS-TRAINING PROGRAM

Background:The need for continuity in medical education with the advent of COVID -19, has been highlighted in light of the current global pandemic situation. As the risks posed by COVID -19 must be balanced against the need to care for patients and protect health care workers, cross-training of various health care professions is now more important than ever. In response to the global pandemic and in line with current practice, the Ministry of National Security, King Abdul-Aziz Medical City-Jeddah, has established a cross-training working task force comprising medical educational specialists from various specialtiesto develop an educational platform that includes up-to-date learning resources to provide healthcare professionals with the knowledge they need to treat critical, suspected, and confirmed COVID -19 patients.The main objective of this manuscript is to describe and discuss the implementation process of the cross-training modules. In addition, the manuscript aims to address the knowledge gap related to COVID -19 management by measuring the perceptions of medical students and healthcare professionals. Methods:A qualitative, descriptive study was conducted in the King Abdul-Aziz Medical City (KAMC) National Guard using the COVID -19 cross-training e-learning platform. The training participants were primarily physicians, then health care workers, students and interns from different universities (KSAU-HS) to be able to treat COVID -19 patients in different areas. This platform was equipped with all the necessary functions to create e-learning training courses. The content of the educational material was to be delivered using two main teaching methods: (1) Virtual learning modules consisting of basic and advanced courses. (2) Simulation-based instruction, consisting of computer-based and simulation manikin-based courses. First, a needs assessment survey was distributed to approximately 150 medical students and health professionals. Then, another self-assessment survey was distributed to approximately 1000 participants. Results: In the needs assessment survey, the majority of participants (22.3%) were from the Department of Internal Medicine. In the feedback survey, the majority of participants were from the Department of Nursing (15.7%). Overall, participants consider the Cross-Training Module/Unit Content &amp; Structure to be adequate in terms of its purpose (P 0.908) results also indicate that participants are satisfied with the provisions (P 0.374) and that the Cross-Training was relevant and helpful to the circumscribed and included professions (P 0.731). Conclusion: As synthesis research, this study revealed the perceptions of health professionals and medical students regarding the implementation of an e-learning strategy for cross-training as a teaching tool. Participants indicated that the training program was most helpful because the course materials were strongly tailored to their areas of expertise.

Abstract TP57: Effects Of Vitamin D Level On Stroke Clinical Severity - A Retrospective Study In Saudi Arabia.

Authors: Faisal Alamri, Seraj Makkawi, Hussain Alqahtani, Amer Alali, Abdullah Alharbi, Maan almaghrabi, Nouf Alghamdi, Esra Aldabbagh, Yahya Samman, Omar Albaradie, Anhar Bawashkhah, Saeed Alghamdi, Muhammad Alsalmi. Background (objectives): Stroke is the most common neurological condition globally, with significant rates of mortality and disability. Many studies focused on vitamin D as a risk factor, but only a limited number of studies focused on vitamin D as a predictor of stroke severity. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity. Methodology: A retrospective cohort study was conducted in 2021 in King Abdulaziz Medical City-Jeddah, Saudi Arabia. 774 ischemic stroke patients were screened over the last five years. However, the study enrolled only 372 patients who have their vitamin D baseline level measured. The National Institute of Health Stroke Scale (NIHSS) was assessed at admission to predict stroke clinical severity. The association between vitamin D level and stroke severity was assessed using multivariate logistic regression model. Results: Out of 372 participants, 11% , 22.1%, 66.9% had normal, insufficient, and deficient 25(OH)D serum levels, respectively. The mean age was 68.8 ±12.4 years, and 52.2% were male. The majority of patients (66,9%) had moderate NIHSS. The correlation coefficient test showed a significant inverse relationship between 25(OH)D serum level and NIHSS score (r=-0.117 p-value 0.024). After adjustment of the potential covariates, the study found that the relationship between deficient 25(OH)D serum level and NIHSS score has further strengthened with an OR (CI) for severe NIHSS 3.8 (1.2-4.7) P-value =0.001. Conclusion: Our finding adds to the evidence that vitamin D is a predictor of stroke clinical severity at admission. Limitation: The limitations of this study should be mentioned, NIHSS was calculated using admission notes only.

Rapid implementation of telemedicine in Neurology during the COVID-19 pandemic

Telemedicine is defined as the remote medical practice of delivering healthcare services to the underserved using information and communication technology. It encompasses a wide range of medical activities, including diagnosis, treatment, disease prevention, and education. The coronavirus disease of 2019 (COVID-19) pandemic has caused significant social dislocation, negative economic impact, and a major change in medical practice in Saudi Arabia. Telemedicine has rapidly moved to the frontline of healthcare practice due to the demand for prevention and mitigation strategies. It has been encouraged and facilitated with huge government support. Herein, we describe the virtual clinical practice of the neurology department at King Abdulaziz Medical City-Jeddah in response to the COVID-19 pandemic. This narrative review is an urgent call to improve the perception and knowledge of both medical personnel and patients concerning telemedicine and to support the utilization of advanced information and communication technology.

Maternal and Neonatal Complications Resulting From Vacuum-Assisted and Normal Vaginal Deliveries.

BackgroundOperative vaginal delivery is a procedure that is performed using forceps or vacuum to extract an infant from the birth canal. It has many indications, one of which is prolonged second stage of labor. Although rare, vacuum extraction (VE) can lead to various neonatal and maternal complications. The objective of this study was to compare the rates of different neonatal and maternal complications between vacuum-assisted deliveries and spontaneous vaginal deliveries.MethodsThis is a retrospective cohort study that was conducted in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The data were collected from the Labor and Delivery Unit at KAMC-J. A total of 745 samples was included (586 delivered spontaneously and 157 delivered by VE). Analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 27.0.ResultsThe median age was 30 years (IQR=36-34). Of all deliveries, vacuum was used in 21.1%. Perineal tear was the most frequent maternal complication (20.9%), while caput succedaneum was the commonest neonatal complication (11.8%). Post-partum hemorrhage was significantly higher among vacuum deliveries (RR=18.8; 95% CI: 5.5-64.15), as well as cephalohematoma (RR=28.9; 95% CI: 8.79-95.04) and caput succedaneum (RR=18.6; 95% CI: 10.99-31.49). The first-minute Apgar score was lower with VE (p < 0.001), and higher perineal tear degrees were reported with VE (p < 0.001).ConclusionThe rates of maternal and neonatal complications were significantly higher among vacuum-assisted deliveries. The most serious neonatal complication was subgaleal hematoma, which is considered life-threatening. Further research is recommended to investigate subgaleal hematoma risk factors.

Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia

BackgroundPediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia. Patients' demographics and risk factors associated with sepsis-related mortality were also investigated.MethodsA retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).ResultsOf the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30–9.93) and 9.27 (95% confidence interval: 1.28–67.29), respectively.ConclusionsThe incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance.

Common Complications of Cesarean Section During the Year 2017 in King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Cesarean section (CS) is one of the most well-known major obstetrics surgeries and one of the oldest operations in the area of abdominal surgery. It is used for the purpose of delivering the newborn and the placenta through the abdominal wall incision (laparotomy) as well as Uterine incision (hysterotomy), followed by suture of the uterus and abdominal wall layers. Most common maternal complications internationally, according to literature were bleeding and wound infection. Most common fetal complications according to the literature were depressed Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, low blood pH and ICU admissions. The aim of this study is to determine the most common CS complications among all the deliveries at King Abdulaziz Medical City (KAMC) in Jeddah in 2017 and to estimate maternal and fetal complication rates following CS. Comparing the rate of complication between residents and non-residents physicians performing a CS was tested as a secondary outcome. To the best of our knowledge, this is a novel research in this medical center at KAMC Jeddah that will aid in quality improvement in both clinical services and training activities of residents. The maternal and fetal complication rates were assessed in a cross-sectional chart review study. In order for this method to be achieved, a secondary data collection sheet was constructed to collect all eligible patient health records. This literature review was based on estimating the rate of CS complications for the mothers and their neonates that founded approximately 7% and 6%, respectively, where the procedure was either performed electively or emergently within the period of 1 January to 31 December 2017. Also, all patients with medical and surgical conditions were included while intrauterine fetal death was excluded. The most common maternal complications documented in our population were bleeding and wound extension, while the most common fetal complications were low APGAR score and NICU admissions. No statistical significance was found in either complications in terms of the correlation between demographical factors, maternal health conditions and gravida status. As for the secondary objective, the association between operator level of training and rate of complications revealed a higher percentage rate of maternal and fetal complications among consultants, which were 6.2% and 8.2%, respectively, mainly because the number and complexity of their cases in comparison to cases held by residents and others.

Managing Type 1 Diabetes among Saudi adults on insulin pump therapy during the COVID-19 lockdown

Background and aimsThe coronavirus disease 2019 (COVID-19) pandemic has affected people’s lives including patients with type 1 diabetes mellitus (T1DM). We aimed to investigate the impact of the COVID-19 lockdown on psychological status, self-management behaviors, and diabetes care maintenance among Saudi adults with T1DM using insulin pump therapy. MethodsThis cross-sectional study used a web survey to collect data on Saudi adults with T1DM who were treated in the specialized insulin pump clinic at King Abdulaziz Medical City-Jeddah, Saudi Arabia. We used the Patient Health Questionnaire-9 and General Anxiety Disorder-7 scales to measure depression and anxiety. ResultsOf the 70 patients who received the survey, 65 completed it. Overall, 23.1% and 29.2% of the patients reported moderate to severe and mild depression, respectively; 18.5% and 24.6% reported moderate to severe and mild anxiety, respectively. Compared with pre-lockdown, adherence to a healthy diet and regular physical activity decreased in 67.7% and 41.5% of the patients, respectively. Most patients maintained their adherence to insulin pump behaviors; frequent self-monitoring of blood glucose increased in 47% of glucometer users. Most patients benefited from phone visits or virtual education sessions, but 66.2% of the patients reported difficulty obtaining at least one type of insulin pump supply. ConclusionsPromoting self-management behaviors and psychological wellbeing of patients with T1DM using insulin pump therapy is crucial during a lockdown. Telemedicine is a useful alternative to in-person appointments, but strategies to ensure that patients have access to adequate resources during lockdown must be developed.

Impact of Mode of Delivery on the Survival Rate of Very Low Birth Weight Infants: A Single-Center Experience.

Introduction: Worldwide cesarean birth had increased over the past three decades and in the USA, the overall rate of cesarean birth has increased from 23.8% in 1989 to 31.9% in 2018. Moreover, the substantial increase of preterm infants delivered by cesarean section had reached anywhere from 45% to 72% for gestational age <33 weeks. There is a considerable debate on whether cesarean section confers a survival advantage for preterm infants. Published data on the relationship between mode of delivery and survival rate were inconsistent and there is a lack of large randomized controlled trials (RCTs) that have investigated this important clinical concern. Thus, the aim of this study is to evaluate the impact of cesarean section on the survival rate of very low birth weight (VLBW) infants.Methods: This was a retrospective cohort study of ≤32 weeks VLBW infants born alive and admitted to Neonatal Intensive Care Unit (NICU) at King Abdulaziz Medical City-Jeddah (KAMC-Jeddah) between January 1, 1994, and December 31, 2019. The primary outcome of interest was the survival rate to discharge of VLBW infants delivered by cesarean section compared to delivered vaginally. Relevant demographic and clinical variables were assessed and its association to survival to discharge of VLBW infants were analyzed.Results: Of the 1055 ≤32 weeks VLBW infants included in the study, 559 (53%) were delivered by cesarean section, and 496 (47%) were delivered vaginally. Cesarean delivery had increased from 44.2% to 66% between 1994-1998 and 2014-2019, respectively. The rise of cesarean delivery compared with the vaginal delivery was more profound for gestational age ≤26 weeks and birth weight ≤800 g. The VLBW infants delivered by cesarean section had a higher survival rate when compared to infants delivered vaginally (87.29% vs 71.77%, P<0.001). The survival advantage was statistically significant in extremely low birth weight (ELBW) infants (801-1000 g) and infants with birth weight ≤800 g, 86.73% vs 73.62%, P=0.018 and 58.02% vs 40.52, P=0.001, respectively. Moreover, VLBW infants ≤26 weeks gestational age delivered by cesarean section had a higher survival rate of 69.15% vs 44.5%, P<0.001.Conclusion: This study demonstrates that cesarean birth is associated with higher survival for VLBW infants with birth weight ≤800 g and ELBW infants and gestational age ≤26 weeks compared to vaginal birth.

Etiology of Pericardial Effusion and Outcomes Post Pericardiocentesis in the Western Region of Saudi Arabia: A Single-center Experience.

BackgroundPericardial effusion is the accumulation of blood or excess fluid in the cavity between the heart and the pericardium sac. Pericardial effusion can be caused by several etiologies, including malignant and non-malignant causes. Pericardiocentesis is the gold standard assessment method for pericardial effusion etiology. The aim of this study was to identify the long-term outcome of patients who presented with massive pericardial effusion and underwent pericardiocentesis at King Abdulaziz Medical City, Jeddah, a large tertiary hospital in the western part of Saudi Arabia.MethodsThis is a single-center retrospective cross-sectional study conducted at King Abdulaziz Medical City Jeddah, Saudi Arabia, between January 2013 to December 2018. Data were collected from patient’s charts; the clinical and echocardiographic findings, alongside with pericardial fluid analysis, were collected. Procedure and patients outcomes were obtained and reported.ResultsOf the 107 patients with pericardial effusion, 39 patients had moderate to severe pericardial effusion requiring pericardiocentesis. The mean age was 52 years, and 56.4% were females. The most common chronic disease was hypertension and the presence of metastasis. The most common cause of pericardial effusion was a malignancy. A majority of patients had severe pericardial effusion. Many patients had tamponade (69.6%). Patients with malignant pericardial effusion had a median survival of 54 days.ConclusionEtiologies of pericardial effusion requiring drainage depend on the population studied. Patients with malignant effusions have worse outcomes than non-malignant effusion. Pericardiocentesis is required to ascertain the cause and risk-stratify patients.

Survival rate of very low birth weight infants over a quarter century (1994-2019): A single-institution experience.

Newborn infants with birth weight less than 1500 grams defining very low birth weight (VLBW) constitute 1.2-1.5% of total live births and 15-20% of all admissions to neonatal units. Advances in antenatal care, care at delivery, and neonatal practice over the past few decades, have substantially improved outcomes in VLBW infants, and reduced neonatal mortality. A retrospective single tertiary care center cohort study of VLBW infants with gestational age between 23-33 weeks admitted to the neonatal intensive care unit (NICU) in King Abdulaziz Medical City, Jeddah (KAMC-J) between January 1, 1994, and December 31, 2019 (26 years). The trends of survival of VLBW infants and major changes in clinical practice of premature care over a period of 26 years were evaluated. Over a period of 26 years, 1,247 VLBW infants were admitted to the NICU that represents 1.43% (1.25-1.83%) of total live births. 50.80% (n = 634) were male, whereas the 49.2% (n = 613) were female. Among them, 1013 (81.2%) were discharged home alive. There was a significant and progressive improvement in the survival rate of VLBW infants over a 26-year period from 66.83% in period 1 (1994 -1998) to 90.0 % in period 5 (2014 -2019), which represents a 34.67% total improvement rate. The improvement in survival rates was observed in all gestational ages between 23-33 weeks, particularly in infants weighing ≤750 grams and ≤1000 grams, and with gestational age between 23-27 weeks. Infants with a gestational age of ≤26 weeks and birth weight ≤750 grams delivered by cesarean section had a higher survival rate. Moreover, female infants with a gestational age of ≤26 weeks and birth weight ≤750 grams had a higher survival rate compared to males but not statistically significant. The survival rate of VLBW infants had improved significantly over the past 26 years (1994 -2019). This is attributed mainly to the improved survival of ELBW infants (<1000 grams) and gestational age of ≤26 weeks.

Cost Analysis of Clinical Compounding in Saudi Arabia: Antibiotic Pediatrics Formulations

International Journal of Pharmacology and Clinical Sciences,2019,8,3s,s7-s10.DOI:10.5530/ijpcs.2019.8.37Published:November 2019Type:Research ArticleAuthors:Yousef Ahmed Alomi, Malika Alhadab, Faiz Bahadig, Mohammad Jabir Al Harbi, Mona Lubbad, and Ebtesam Nazal Author(s) affiliations:Yousef Ahmed Alomi*, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia. Malika Alhadab, Head, Pharmacy Services, Alyamma Hopsital, Ministry of Health, Riyadh, Saudi Arabia. Faiz Bahadig, Informatics Pharmacist, Pharmaceutical Care Department, King Abdul-Aziz Medical, City-WR-Jeddah, Ministry of National Guard, Saudi Arabia. Mohammad Jabir Al Harbi, Neonatology and Pediatrics Clinical Pharmacist, Pharmaceutical Care Services, King Abdulaziz Medical City-Jeddah, Saudi Arabia, Ministry of National Guard-Health Affairs, Saudi Arabia. Mona Lubbad, Former Head, Extemporaneous Preparation Unit, Pharmacy services, Alyamma Hopsital, Ministry of Health, Riyadh, Saudi Arabia. Ebtesam Nazal, Head, Extemporaneous Preparation Unit, Pharmacy Services, Alyamma Hopsital, Ministry of Health, Riyadh, Saudi Arabia. Abstract:Objectives: The aim of this study to explore the cost analysis of selected pediatrics antibiotics formularies in the Kingdom of Saudi Arabia. Methods: It is a retrospective cost analysis of pediatrics formulations at 300-beds pediatrics and maternity hospital in Riyadh city, Saudi Arabia. The pharmacy section received the specific formulation from physician then the expert pharmacist applied the international standard of clinical compounding through providing to healthcare staff over eight hours per days for five days per a week. The pediatrics formulations consisted of selected four antibiotics (Nitrofurantoin, Oseltamivir, Chloroquine and Clindamycin). The analysis of the cost included the variable expenses included personal cost, material and supply cost, Costs fixed including direct cost, non-salary cost and overhead cost. The cost was derived from the Ministry of Health information database. All cost used US dollar currency. The study analyzed the cost of anti-hypertension pediatrics formulations through the Microsoft Excel sheet version 10th. Results: The estimated average total standard cost of pediatrics formulations per hour was (53.82 USD). The average estimated cost of Nitrofurantoin per each preparation was (14.13 USD) which consisted of standard cost (0.31 USD) and the direct cost was (13.82 USD). The average estimated cost of Oseltamivir per each preparation was (16.95 USD) which consisted of standard cost (0.33 USD) and the direct cost was (16.62 USD). The average estimated cost of Chloroquine per each preparation was (6.645 USD) which consisted of standard cost (4.36 USD) and the direct cost was (6.645 USD). The average estimated cost of Clindamycin per each preparation was (14.478 USD) which consisted of standard cost (2.018 USD) and the direct cost was (12.46 USD). Conclusion: There are varieties in the cost analysis between selected pediatric formulation and manufactured ready-made products. The pharmacist should select the cheapest one among them. The cost analysis of pediatrics formulation was used for health insurance coverage and to meet the updated pharmacy strategic plan and Saudi vision 2030 in the Kingdom of Saudi Arabia. Keywords:Antibiotic, Clinical, Compounding, Cost, Formulations, Ministry of Health, Pediatrics, Saudi ArabiaView:PDF (171.63 KB) PDFClick here to download the PDF file. Images Cost comparisons of the extemporaneous pediatrics formulation with ready made products.

Stress Factors Impact on Pharmacist Job Satisfaction in Saudi Arabia

PTB Reports,2019,5,3,102-107.DOI:10.5530/PTB.2019.5.19Published:August 2019Type:Research ArticleAuthors:Yousef Ahmed Alomi, Faiz A. Bahadig Rph, Khurram Shahzad, Saima Qaism, Budoor Emad Aloumi, Bayan Ibrahim Alghuraybi, and Reem Saad Alsubaie Author(s) affiliations:Yousef Ahmed Alomi*, The Former General Manager of General Administration of Pharmaceutical Care, Former Head, National Clinical Pharmacy and Pharmacy Practice, Former Head, Pharmacy R&D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. Faiz A. Bahadig Rph, Informatics Pharmacist, Pharmaceutical Care Department, King Abdul-Aziz Medical, City-WR-Jeddah, Ministry of National Guard, SAUDI ARABIA. Khurram Shahzad, Senior Pharmacist, Pharmaceutical Care Department, King Abdul-Aziz Medical City-Jeddah, Ministry of National Guard, SAUDI ARABIA. Saima Qaism, Senior Pharmacist, Pharmaceutical Care Department, King Abdul-Aziz Medical City-Jeddah, Ministry of National Guard, SAUDI ARABIA. Budoor Emad Aloumi, Pharmacist, Pharmaceutical Care Services, Ministry of National Guard – Health Affairs. KAMC - Central Region, SAUDI ARABIA. Bayan Ibrahim Alghuraybi, Pharmacy Services, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. Reem Saad Alsubaie, Pharmacy Services, Prince Sultan Military Medical City, Riyadh, SAUDI ARABIA. Abstract:Purpose: To explore the stress factors impact of pharmacist job satisfaction in Saudi Arabia. Methods: It is a 4-months cross section survey of the stress factors impact of pharmacist job satisfaction in Saudi Arabia. The study consisted of 44 questions divided into two-part demographic information and the second part was the questions about stress related factors of pharmacy job. It included pharmacy management policies, pharmacy stress factors, pharmacy personal time, salary and benefits, pharmacy motivation factors, overall job satisfaction. The 5-points Likert response scale system closed ended questions were used. Results: The total responders were 242. Of those 214 (91.8 %) was Saudi and 33 (8.2%) was non-Saudi. The gender distribution 169 (70.7%) 55.8%) was male and 70 (29.3%) was female. The average pharmacist satisfaction score of pharmacy management policies factors was (3.53), personal pharmacy time was (3.14) and salary and benefits were (2.45) as explored in Table 4. The average score of pharmacy stress factors were (3.86) and the overall job satisfaction was (3.61) as explored in Table 5. The most pharmacy motivation factors found were the financial reward and salary advancement was 201 (87.01%), followed by the time needed for education and training was 144 (62.3%) and flexibility in work scheduling was 136 (58.87%) as explored in Table 6. Conclusion: The majority of pharmacists suffered from pharmacy salary and benefits and time demand for development and education. Those factors were essential of motivation factors related to the pharmacy job satisfaction in Saudi Arabia. Keywords:Factors, Job, Pharmacy, Satisfaction, Saudi Arabia, StressView:PDF (229.17 KB) PDF PDF Images The pharmacist’s motivations factors.