King Abdulaziz Medical City-Riyadh Research Articles

Awareness, Concerns, and Protection Strategies Against Bloodborne Viruses Among Surgeons.

Background: Surgeons are at high risk of contracting infectious viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through exposure to patients’ blood. The purpose of this study was to assess the surgeons’ awareness of contracting bloodborne viruses. Methods: A cross-sectional study with a questionnaire distributed to 241 surgeons at King Abdulaziz Medical City - Riyadh (KAMC-R) during the period June 2017 through January 2018. Descriptive statistics were used to analyze data collected using Stata®, v14 (StataCorp LLC, College Station, Texas, USA). Categorical variables were analyzed using Pearson chi-square test. P-value of < 0.05 was considered significant.Results: A total of 241 surgeons answered the questionnaire, 179 (74.3%) surgeons were male and 62 (25.7%) were female. The mean age ± standard deviation (SD) of male surgeons was 35.8 ± 11.0 years while for females was 33.3 ± 9.1 years. The majority of our cohort were vaccinated for HBV (96% in males and 97% in females). Two-thirds of the study cohort did not know the conversion rate post-needlestick injury by HIV, HBV, and HCV. Two-thirds of the study cohort think there is a need for HIV screening before surgery. Mixed answers were received from the cohort when asked about their concern regarding contracting HIV infection from their patients; only one-third of the surgeons were extremely concerned. When asked about the risk of needlestick injury during treating patients positive for HBV, the majority of the surgeons said no. However, a significant difference between the female and male surgeons was found in which 12 of the 62 female surgeons answered yes (19.4%) compared to 11 of the 179 male surgeons (6.1%) (p = 0.002).Conclusion: The majority of our surgeons are vaccinated for HBV. However, female surgeons appear to be at higher risk of needlestick injury from HBV patients. This requires further investigation into the reasons for such high incidents. More education is needed about bloodborne viruses.

The prevalence and associated factors of viral hepatitis and cryptogenic related hepatocellular carcinoma at King Abdulaziz Medical city-Riyadh

Background: Worldwide, viral hepatitis is the major risk factor for HCC with hepatitis B (HBV) being more than hepatitis C (HCV). Saudi Arabia is one of the endemic areas of viral hepatitis. Cryptogenic HCC is thought to arias from unknown causes of liver cancers. Thus, the purpose of this study was to find the prevalence of viral and cryptogenic HCC in King Abdulaziz Medical City-Riyadh (KAMC-R).Methods: A retrospective chart review was performed for all HCC patients diagnosed between 2010 to 2017 at KAMC-R. Information regarding age, gender, comorbidity, alcohol consumption, serology tests, liver enzymes, body mass index, model for end-stage liver disease score, alpha-fetoprotein and Child-Turcotte-Pugh score were included. The Chi-square test was used to determine the differences between categorical data. A p&lt;0.05 was considered statistically significant.Results: Total of 294 patients with HCC charts were reviewed. HCV and HBV were found in 42.85% and 20.74% of the patients, respectively. Co-infection with HBV and HCV were reported in 1.7% whereas cryptogenic HCC was found in 32.65% of the patients. High BMI and DLP were noticeably higher in cryptogenic group (p=0.045 and p=0.022 respectively). Multiple lesions were noticed more in HCV group whereas single lesion was more in the cryptogenic group (p=0.0343). Also, large lesions (&gt;5 cm) were remarkably found more in cryptogenic HCC whereas small lesions were more in HCV group (p=0.006).Conclusions: Hepatitis C was the major risk factor associated with HCC, followed by Cryptogenic HCC. High BMI and DLP were common features of cryptogenic HCC.

Value of screening for vesicoureteral reflux in infants with antenatal hydronephrosis in king abdulaziz medical city-Riyadh

Background: Antenatal hydronephrosis (AHN) is diagnosed in 0.5%–1% of pregnancies. Hydronephrosis has many causes, but vesicoureteral reflux (VUR) remains an important cause, as it could lead to serious damage to the kidneys. Screening for VUR by voiding cystourethrogram (VCUG) is done in infants with congenital hydronephrosis to detect VUR that could lead to repeated urinary tract infections (UTIs). Objectives: The aim of the study was to investigate the value of VCUG as a screening tool for VUR in infants with various grades of hydronephrosis. Materials and Methods: This is a retrospective chart review for all infants with antenatal hydronephrosis between January 2010 and December 2015 at King Abdulaziz Medical City-Riyadh. Comparisons were made between hydronephrosis grades and VUR. Differences, therefore, were assessed for statistical significance using Chi-square test as appropriate. Analysis was performed using SPSS version 22. Results: During the study periods, 203 infants (75% of the study population) underwent VCUG. VUR was diagnosed in 21% of all infants who had VCUG. VUR was significantly higher in infants with high grade compared to low-grade hydronephrosis (30% versus 14.40%, P = 0.005). On the other hand, no significant difference found between high-grade hydronephrosis and low-grade hydronephrosis in the severity of VUR (P = 0.169). Meanwhile, high-grade hydronephrosis was significantly more associated with UTI 27.20% (25/92) than low-grade hydronephrosis 14.70% (26/177). Conclusion: Infants with antenatal hydronephrosis (HN) suffer greater morbidity as reflected by the increased incidence of VUR and UTI at follow-up. For high-grade HN, our recommendation clearly goes with the current practice for doing VCUG to all high-grade patients. On the other hand, the risk of VUR and UTI, although higher in infants with high-grade HN is still substantial in infants with low-grade HN. However, it is still controversial to do VCUG for them. Hence, we recommend further big researches about low-grade HN and VCUG to come up with clear conclusion for this HN group.

Psychological symptoms in adult Saudi Arabian cancer patients: prevalence and association with self-rated oral health.

BackgroundAlthough psychological symptoms and oral health status are associated with health management and outcomes among cancer patients, their association has not been assessed in Saudi Arabia. We aimed to assess the symptoms of depression, anxiety, and stress and their association with their oral health status, adjusting for sociodemographic and clinical factors.MethodsA self-reported study included 375 adult cancer patients who received outpatient healthcare services in the Oncology Department, King Abdulaziz Medical City-Riyadh, Saudi Arabia, between April 1 and August 31, 2017. We used the Arabic version of the Depression Anxiety Stress Scale to dichotomize a binary outcome for each. Oral health was evaluated by self-rating from “very good” to “bad”.ResultsA high prevalence of subjective depression, anxiety, and stress was found (44.8%, 52.5%, and 42.7%, respectively). Of the sample, 17.9% self-reported “bad” oral health, which is associated with a high risk of anxiety and stress, and its association remains significant after controlling for other factors (adjusted odds ratio=6.48 and 4.73, respectively). Being <60 years old, high level of formal education, low income, breast cancer, and lung cancer were associated with increased psychological symptoms.ConclusionEvery 6 in 10 cancer patients in this study reported at least one psychosocial symptom. The findings suggest that there exists an association between self-reported “bad” oral health and psychosocial symptoms. Being <60 years old, low income, high level of formal education, breast cancer, and lung cancer were associated with psychological symptoms. Routine psychological counseling and oral health screening in outpatient oncology clinics may improve psychological outcomes and cancer management.

A study of resident duty hours and burnout in a sample of Saudi residents

BackgroundWork hour restrictions in residency programs have been implemented over the last several decades in Europe, USA, and Canada. To best of our knowledge, there is no study of resident duty hours in the Kingdom of Saudi Arabia. In addition, few studies have looked at the prevalence of burnout amongst Saudi residents. The present study explored resident duty hours and burnout amongst residents in Saudi Arabia.MethodsA paper-based questionnaire was designed to survey resident duty hours in Saudi Arabia and was administered along with the Maslach Burnout Inventory. The questionnaires were administered to residents in medical and surgical residency programs at King Abdulaziz Medical City-Riyadh and two hospitals in Buraidah, Qassim Province.ResultsA total of 181 residents from the three hospitals participated in the survey. In terms of average number of work hours per week, 50% of all residents reported working 60–79 h while 30% reported working 80 or more hours per week. The prevalence of burnout was 81%. There was no association between higher number of working hours and the prevalence of burnout.ConclusionThis was the first study describing resident duty hours and exploring the relationship between duty hours and burnout in Saudi Arabia. Our main findings were that the majority of residents work 60 or more hours per week, and there was a very high degree of burnout amongst residents. A larger multi-centre study of resident duty hours and its effect on patient safety and resident well-being is needed to develop work hour regulations in Saudi Arabia. In addition, there is an urgent need to develop programs that address resident burnout.

Associated factors for oral health problems in a sample of Saudi cancer patients.

PurposeOral health in cancer patients was known to influence the quality of life. However, the knowledge of possible factors associated with oral health in cancer patients is seriously lacking in Saudi Arabia. In this study, we aimed to determine the burden of adverse oral health in cancer patients and identify the associated factors for oral health problems.Materials and methodsA cross-sectional study design was used to recruit a total of 375 cancer patients who attended oncology outpatient clinics at King Abdulaziz Medical City – Riyadh (KAMC-R) by using a consecutive sampling technique. A self-reporting questionnaire was used to collect the sociodemographic information, clinical symptoms, and lifestyle factors of cancer patients. Furthermore, depression, anxiety, and stress were assessed by using Depression Anxiety and Stress Scale. The authors assessed the oral health complaints based on seven common conditions (bleeding gums, toothache, mouth ulcers, bruxism, xerostomia, problems affecting speech, and satisfactory dietary intake). Unadjusted and adjusted risk ratios (aRR) and 95% CIs for the factors associated with the number of oral complaints experienced were computed using Poisson regression model.ResultsThe prevalence of oral health conditions experienced by cancer patients was 86.1% (95% CI: 82.2%–89.5%). Female sex (aRR=1.37, 95% CI: 1.05–1.78), low income (aRR=1.58, 95% CI: 1.23–2.04), smoking (aRR=1.29, 95% CI: 1.02–1.64), anxiety (aRR=1.75, 95% CI: 1.36–2.24), and stress (aRR=1.25, 95% CI: 1.00–1.55) were associated with increased risk of oral health problems in cancer patients (p≤0.05), whereas breast cancer patients experienced reduced risk (aRR=0.72, 95% CI: 0.56–0.93).ConclusionOur study highlighted the significant burden of oral health problems in Saudi cancer patients at KAMC-R and identified several key associated factors for oral health to aid healthcare practitioners in improving cancer management practices.

Quality and accuracy of electronic pre-anesthesia evaluation forms

Background and ObjectivePaper-based forms have been widely used to document patient health information for anesthesia; however, hospitals are now switching to electronic patient file documentation for anesthesia. The aim of this study is to compare the quality of paper-based and electronic pre-anesthesia assessment forms. MethodsThe research conducted in this study was quasi-experimental using a pretest–posttest design without a control group. The study was conducted at King Abdulaziz Medical City, Riyadh (KAMC-RD) during November 2015. Paper-based forms were converted into electronic forms, and the paper-based pre-anesthesia forms were used during the first two weeks of the data collection period while electronic forms were completed in the last two weeks. The quality of each (electronic vs. paper) was evaluated with respect to missing items, errors, and unreadable items. The sample size included all 15 anesthetists working in the pre-anesthesia clinic at KAMC-RD. The anesthetists completed 25 pre-anesthesia forms daily during a five-day week schedule. A total of 500 patient forms were completed during the study (250 paper-based and 250 electronic forms). Anesthetists’ satisfaction with the electronic pre-anesthesia form was also measured using a questionnaire. ResultsThe electronic form shows significantly higher quality in all assessment categories (missing items, errors, and unreadable items; X² (2, N = 500) = 171.64, p < 0.001). The satisfaction survey found 81.65% of the anesthetists were satisfied with the electronic pre-anesthesia form for all questions. ConclusionOur study demonstrates that the electronic pre-anesthesia form has better data quality, meets the expectations of anesthetists and aids to decrease missing key preoperative information. This type of approach is imperative for the safety of perioperative patients.

Factors influencing pharmacists' intentions to use Pharmacy Information Systems

The Pharmacy Information System (PIS) is a sub-system of the hospital information system, which is designed to assist pharmacists in safely managing the medication process. To maximize the benefits of PIS, it is important to assess its impact on pharmacists' workflow and medication management processes. The PIS was implemented at King Abdulaziz Medical City-Riyadh (KAMC-Riyadh) 15 years ago. However, its impact on the work of pharmacists has not been satisfactorily explored. Our study was conducted at the Pharmaceutical Care Department of KAMC-Riyadh, and the data were collected from the inpatient pharmacist staff through a survey-based questionnaire. The majority of PIS users reported having a favorable experience with the technology, and to most of the items related to functionality. The present study identified potential key factors; those that are likely to influence pharmacists' personal intentions for using PIS. However, extended use of PIS would require reducing the rate of demotivated users.

Phenotypic Profile of Kell Blood Group System among Saudi Donors at King Abdulaziz Medical City-Riyadh

Phenotypic Profile of Kell Blood Group System among Saudi Donors at King Abdulaziz Medical City-Riyadh

Determination of the frequency of the most immunogenic Rhesus antigens among Saudi donors in King Abdulaziz Medical City - Riyadh.

Background:The Rhesus (Rh) blood group system is one of the most polymorphic and immunogenic systems known in humans, because of its immunogenicity along with ABO grouping, RhD antigen testing was made mandatory before issuing a compatible blood. At present, there are five major antigens, i.e., D, C, E, c, and e in Rh blood group system.Aims:The aim of this study is to provide essential data about the distribution of the major Rh antigens and the most common phenotype among the Saudi population.Materials and Methods:This is a retrospective study to evaluate the Rh grouping and Rh sub-groups performed among some donors who donated blood or blood products at the department of donation center at King Abdulaziz Medical City Riyadh, Saudi Arabia from January 1, 2014 to December 31, 2014. Sample size included 600 donors. Donors are males and females and their ages are above 18 years.Results:The incidence of RhD was 84.8% and only 15.2% of samples were negative for D antigen. The Incidence of other Rh antigens C, E, c, and e were 62.3%, 23.5%, 74.3%, and 95.0%, respectively. The most common phenotype among RhD positive donors was DCcee (28.7%) and among RhD negative donors was dccee (13.7%). However, three donors (0.5%) were negative for antithetical antigens C and c.Conclusion:This study shows that there is a wide racial and geographical variation in the distribution of Rh antigens and phenotypes among study participants. The Rh blood group system has a vital role in population genetic study and in resolving medical legal issues and more importantly in transfusion medicine practice.

Characteristics and predictors of mortality of patients with hematologic malignancies requiring invasive mechanical ventilation.

RATIONALE:Acute respiratory failure (ARF) may complicate the course of hematologic malignancies (HMs). Our objective was to study the characteristics, outcomes and predictors of mortality of patients with HMs who required intubation for ARF.METHODS:This retrospective cohort study evaluated all patients with HMs who were admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City-Riyadh between 2008 and 2013 and required invasive mechanical ventilation. We noted their baseline characteristics, treatments and different outcomes. Multivariable logistic regression analysis was performed to evaluate predictors of hospital mortality.RESULTS:During the 6-year period, 190 patients with HMs were admitted to the ICU and 122 (64.2%) required intubation for ARF. These patients had mean age of 57.2 ± 19.3 years and Acute Physiology and Chronic Health Evaluation II score of 28.0 ± 7.8 and were predominantly males (63.4%). Lymphoma (44.3%) and acute leukemia (38.5%) were the most common hematologic malignancy. Noninvasive ventilation (NIV) was tried in 22 patients (18.0%) but failed. The code status was changed to “Do-Not-Resuscitate” for 39 patients (32.0%) during ICU stay. Hospital mortality was 70.5% and most deaths (81.4%) occurred in the ICU. The mortality of patients with “Do-Not-Resuscitate” status was 97.4%. On multivariable logistic regression analysis, male gender (odds ratio (OR), 6.74; 95% confidence interval (CI), 2.24–20.30), septic shock (OR, 6.61; 95% CI, 1.93–22.66) were independent mortality predictors. Remission status, non-NIV failure and chemotherapy during ICU stay were not associated with mortality.CONCLUSIONS:Patients with HMs requiring intubation had high mortality (70.5%). Male gender and presence of septic shock were independent predictors of mortality.

The prevalence of urinary tract infection, or urosepsis following transrectal ultrasound-guided prostate biopsy in a subset of the Saudi population and patterns of susceptibility to flouroquinolones.

Objectives:To study the prevalence of urinary tract infections (UTI), or sepsis secondary to trans-rectal ultrasound-guided (TRUS) biopsy of the prostate, the pathogens involved, and patterns of antibiotic resistance in a cohort of patients.Methods:This is a descriptive study of a consecutive cohort of patients who underwent elective TRUS biopsy at King Abdulaziz Medical City Riyadh, Saudi Arabia between January 2012 and December 2014. All patients who underwent the TRUS guided prostate biopsy were prescribed the standard prophylactic antibiotics. Variables included were patients’ demographics, type of antibiotic prophylaxis, results of biopsy, the rate of UTI, and urosepsis with the type of pathogen(s) involved and its/their antimicrobial sensitivity.Results:Simple descriptive statistics were used in a total of 139 consecutive patients. Urosepsis requiring hospital admission was encountered in 7 (5%) patients and uncomplicated UTI was observed in 4 (2.8%). The most common pathogens were Escherichia coli (90.1%) and Klebsiella pneumoniae (9.1%). Resistance to the routinely used prophylaxis (ciprofloxacin) was observed in 10 of these patients (90.9%).Conclusion:This showed an increase in the rate of infectious complications after TRUS prostate biopsy. Ciprofloxacin resistance was found in 90.9% of patients with no sepsis.

Viral hepatitis (A, B and C) and Human Immunodeficiency Virus (HIV) co-infection Seroprevlance in a Tertiary Care Hospital in Saudi Arabia

Background/Objectives: Viral hepatitis is still causing a great undesirable impact on the health systems worldwide as a major etiological agent of liver diseases and chronic evolution affecting millions of people, especially among HIV-infected patients. This study was carried out to determine the prevalence of viral hepatitis among HIV-infected patients in a tertiary care hospital in Saudi Arabia. Material/methods: Retrospective study was conducted among all of HIV seropositive patients in King Abdulaziz Medical City-Riyadh from January 2005 to November 2015, data was collected and recorded form patients’ charts, electronic health record system and HIV data base for age, gender, nationality, CD4 count, hepatitis A virus (HAV) serology, hepatitis B virus (HBV) serology and hepatitis C virus (HCV) serology. Results: A total of 22/61 patients out of 61 HIV infected patients involved in this study were positive for hepatitis (A,B and C) serology (36.1%),15/61 patients were positive for HBV serology (24.6%), 3/61 patients were positive for HCV serology (4.9%) and 8/61 patients were positive for HAV serology (13.1%). 7/61 patients were positive for HBV surface antigen (HBsAg) (11.5%), 8/61 patients were positive for HBV surface and core antibodies with negative HBsAg (13.1%), 1/61 patient was positive for HBV/HCV serology (1.6%) and 3/61 patients were positive for HAV/HBV serology (4.9%). Conclusions: One third of our HIV positive patients were found to be suffering from viral hepatitis, this significant prevalence in HIV infected patients in SA would encourage health care workers to do a routine surveillance for viral hepatitis in all new HIV positive cases.

A Single Center Experience: Short Term CD4 Count Monitoring and Rate of Opportunistic Infections in Human Immunodeficiency Virus (HIV) Infected Patients

Background/Objectives: CD4 cell count is a key measure of Human immunodeficiency virus (HIV) disease progression and for the risk of developing a life-threatening opportunistic infections (OIs). We designed this study to assess and monitor CD4 count at baseline and response to antiretroviral therapy (ART) at 6 and 12 months and to know the prevalence of OIs among all adult with HIV-infection in a tertiary care hospital in Saudi Arabia (SA). Material/methods: Retrospective study was conducted with a total of 61 HIV seropositive patients attended at King Abdulaziz Medical City-Riyadh from January 2005 to November 2015, data was collected and recorded form patients’ charts, electronic health record system and HIV database for age, gender, nationality, CD4 count at baseline for all patients and at 6 months and 12 months for patients receiving ART and OIs. Flow cytometry was used for absolute CD4 count measurement. Identification of all causative microorganisms of OIs was performed by the standard microbiologic methods with clinical correlation. Results: Majority, 46/61(75.4%) of study participants were male patients. The mean age of participants was 44.39 with std of +/- 13.375 years. Mean baseline CD4 count for all study participants was 285.28 with std of +/- 306.333 cells/μL. Distribution of baseline CD4 count for all patients was, DC4 count less than 200 cells/μL were 34/61(55.7%), CD4 count from 200-500 cells/μL were 13/61(21.3%) and CD4 count more than 500 cells/μL were 14/61(23.0%). A total of 30/61 patients (49.2%) were not receiving ART and 31/61 patients (51.8%) were receiving ART. A total of 22/61 (36.1%) OIs were observed from the study participants. Commonly observed OIs were Cytomegalovirus (CMV) 14/61 (23.0%) (Positive IgG and IgM antibodies, pp65 antigen and PCR without clinical correlation), Tuberculosis 4/61(6.6%), pneumocystis pneumonia 2/61(3.3%) Toxoplasmosis 2/61(3.3%), Syphilis 2/61(3.3), varicella zoster virus (VZV) 1/61(1.6%), herpes simplex virus (HSV) 1/61 (1.6%). Conclusions: Half of HIV-infected patients 55.7% in this study were severely immunocompromised at the time of HIV diagnosis. Half of patients receiving ART were nonadherence to medications and 21% of patients had a poor immunologic response after one year of adherence to ART. One-third of our HIV-positive patients were infected with one or more OIs.

Attitude of Saudi Arabian adults towards consanguineous marriage.

Background: Research on the attitudes of Saudi adults towards consanguinity is scarce. The study aimed to explore the attitudes towards consanguinity and its associations with socio-demographic characteristics in a sample of Saudi adults. Methods: A cross-sectional study was conducted using a self-administered questionnaire. A total of 386 outpatient waiting-area attendees at King Abdul-Aziz Medical City-Riyadh were included. Participants were asked about their socio-demographic characteristics, attitude towards consanguinity and the reasons behind this. Results: The positive attitude towards consanguinity among the study respondents was 48.1% with 95% confidence interval (42.91–53.33%). Social and traditional culture (59.9%) were found to be the predominant reasons for favoring consanguinity in Saudi Arabia. Evidence against a positive attitude towards consanguinity was noted in respondents who received medical information about consanguinity versus those who had not received medical information (42.3% vs. 57%, p-value = 0.008). According to the multivariate logistic model, the odds of a positive attitude towards consanguinity were 2 times higher for males (adjusted odds ratio [aOR]: 2.2; 95% CI: 1.147, 4.290) and 4.1 times higher in respondents in consanguineous marriages (aOR: 4.1; 95% CI: 2.350, 7.156). The odds of a positive attitude towards consanguinity were 50% less in respondents who received health information on consanguinity compared to those who had not received health information about consanguinity (aOR: 0.50; 95% CI: 0.253, 0.863). Conclusion: One in every two Saudi adults favors consanguinity however, Saudi men and women differ in their attitudes towards consanguinity. Receiving health information on consanguinity was associated with a negative attitude towards this practice.

Low Representation of ETV6-RUNX1 Fusion Oncogene in Pediatric Acute Lymphoblastic Leukemia Patients from Saudi Arabia and Strong Association with Clinical Response to Day-14 of Remission Induction Therapy

Abstract:Introduction: t(12; 21) leading to ETV6-RUNX1 fusion oncogene is associated with better prognosis and excellent treatment outcome in pediatric ALL (pALL) patients have good prognosis as compared to other genetic abnormalities1. Accordingly, frequency of ETV6-RUNX1 has a huge implication in treatment strategies of pALL in a given population. Different ethnic groups from various geographical regions have different frequencies of ETV6-RUNX1 ranging from 10% (Southeast Asia) to 33% (Australia) 2,3. Therefore, aim of this study was to determine ETV6-RUNX1 status of Saudi Arabian pALL patients and its association with clinical parameters and early remission.Patients & Methods: Pediatric Acute Lymphoblastic Leukemia (pALL) patients at King Abdulaziz Medical City represent pure Saudi Arabian population. Clinical parameters and ETV6-RUNX1 status (using FISH technique) of pALL patients attending Pediatric Oncology Clinic, King Abdulaziz Medical City Riyadh from 2006 to 2011 were studied using Vysis ETV6/RUNX1 DF FISH Probe Kit (Abbot Laboratories, Illinois, USA)4. CCG1991 protocol was used for standard risk patients while CCG1961 protocol was used for high risk patients. Number of blasts at day 14 and day 29 of the treatment were also calculated as a part of routine clinical follow-up.Comparison between ETV6-RUNX1 positive and negative groups done using chi-square test or Fisher's exact test. All Statistical analysis was performed using SAS version 9.2 (SAS Institute, Inc., Cary, NC).Results: Out of 54 patients, 33 were male and 21 were females (ration1.57:1). B- and T-cell lineage was found in 47 (87%) and 7 (13%) patients respectively. Only 5 (9.3%) patients with ETV6-RUNX1 positive while 49(80.7%) were ETV6-RUNX1 negative. All ETV6-RUNX1 patients (100%) were of B-cell lineage and 80% (4/5) were in 3-7 year age group. None of ETV6-RUNX11 patients had ≥5% blasts (no remission) at Day 14 as compared to 9% patients from ETV6-RUNX1 negative group (Table 1).Discussion: Frequency of ETV6-RUNX1 positive patients (less than 10%) in our pALL patients is much lower than reported in most of the European countries, North America, Australia and Japan while it is in accordance with ETV6-RUNX1 frequencies from Egypt (11.6%), Pakistan (10%), and India (5-7%) 2,3,5,6. This diversity in frequencies of ETV6-RUNX1 among pALL can be attributed to level of industrialization and/or westernized lifestyle. Moreover, ethnic differences in frequencies of this and other prognostically important genetic abnormalities can have a significant bearing on global pediatric ALL management strategies7 which necessitates further large scale studies in this regard.

Symptoms and risk for obstructive sleep apnea among sample of Saudi Arabian adults

The aim of this study was to determine the risk and symptoms for obstructive sleep apnea (OSA) among Saudi Arabian adults. This cross-sectional survey among healthy participants was conducted at King Abdulaziz Medical City-Riyadh (KAMC-R). The Berlin Questionnaire (BQ) was used to assess the risk of OSA, and Epworth Sleepiness Scale (ESS) was used to measure excessive daytime sleepiness (EDS) as a manifestation of OSA in participants. The total number of participants was 2095, mean age of the sample was 42.3 (±15.5) years and 848 (40.7%) were females. Using BQ, 31.9% of the participants were classified as high risk for OSA (33.4% among females and 31.1% among males). The risk for OSA increased with age: 19.4% among the young group (≤29 years), 35.2% among the middle-aged (30–59 years), and 41% among the elderly (≥60 years). The risk of symptomatic OSA by combining both BQ and ESS was 7.8% and increased with age (5.5% among the young group, 8.5% among the middle-aged, and 9.7% among the elderly), but there was no difference between gender (8% among females vs. 7.7% among males). This study showed that the risk for OSA is very high, is equal in both genders and it increases with age and obesity.

A Study of Prevalence of Blood Group of Saudi Patients in King Abdulaziz Medical City-Riyadh

Background: Blood groups have been the subject of research because of the importance of blood transfusion in surgery as well as treatment of anemia and other hemorrhagic conditions. Blood groups and immune hematological problems of blood transfusion constitute an extremely interesting, but complex study area and their investigations have much to offer to hematology and immunohematology fields. Aim: The aim of our study is to provide essential data about the distribution of ABO and Rhesus blood groups among Saudi populations and to determine the ABO and Rh phenotype among patients who received blood or blood products in King Abdulaziz Medical City-Riyadh. Methods: For this purpose, we retrospectively evaluated the results of ABO grouping and Rh grouping performed among some patients who received blood or blood products at King Abdulaziz Medical City Riyadh during the year 2013. Results: Participants in this study included four hundred patients (100 children; 28 youths, 88 adults and 184 olds). The gender distribution showed 232 males and 168 females. ABO phenotypes result showed that blood group A is 27%, group B 22%, group AB 3%, and group O is 48%. The percentages of positive and negative Rh grouping phenotypes were 96% and 4%, respectively. Conclusion: In conclusion, our study shows that the blood group O is highly frequent among Saudi population, while the blood group AB is the lowest. Rh-negative phenotypes were not as frequent as Rh-positive.

Effect of age and gender in the prevalence of excessive daytime sleepiness among a sample of the Saudi population

The aim of this study is to assess whether the effect of gender on the excessive daytime sleepiness (EDS) is influenced by two confounders (age and hours of sleep per night). A cross-sectional study was conducted at King Abdulaziz Medical City-Riyadh (KAMC-R). A total of 2095 respondents answered a questionnaire that included questions regarding gender, age, hours of sleep per night, and daytime sleepiness using the Epworth Sleepiness Scale (ESS). The prevalence of EDS was 20.5% (females 22.2%, males 19.5%, p-value=0.136). The EDS did not differ between genders, age groups, or hours of sleep per night (<6 vs. ⩾6h). However, stratified statistical analysis shows that the prevalence of EDS did differ according to gender (25.3% in females, 19.0% in males, p-value=0.036) in respondents with shorter hours of sleep per night. EDS was strongly related to female gender and young age (ages⩽29years) in respondents with short hours of sleep. This study reveals that one out of five of the general Saudi population has EDS. The effect of gender on EDS appeared to be influenced by hours of sleep per night. High EDS strongly related to female gender with short hours of sleep.

Diagnostic Utility of QuantiFERON-TB Gold (QFT-G) in Active Pulmonary Tuberculosis.

Background:The utility of QuantiFERON-TB Gold In-Tube (QFT-G) test in the diagnosis of tuberculosis disease has been validated in high and low tuberculosis-prevalent (TB) countries. Aim: The aim of this study is to assess the performance of the QFT-G test in the diagnosis of tuberculosis disease among tuberculosis patients in an intermediate prevalent country.Setting and Design:A retrospective study at the King Abdulaziz Medical City-Riyadh (KAMC-R)Materials and Methods:We retrospectively reviewed all the patients with a diagnosis of pneumonia, including tuberculosis, admitted to KAMC-R between 1 January 2009 and 31 December 2013. We included only patients with an available result of the QFT-G test. A total of 142 tuberculosis cases and 226 pneumonia cases were studied, to assess the utility of the QFT-G test in diagnosing tuberculosis cases.Results:Among the tuberculosis (n = 142) cases, the QFT-G tested positive in 68.3%, negative in 23.2%, and indeterminate in 12 cases (8.5%). Of the 226 pneumonia cases, the QFT-G tested positive in only 20.4%, while a majority of 66.4% tested negative, with 30 cases (13.3%) being indeterminate. When we excluded 42 patients with indeterminate results, the QFT-G test achieved a sensitivity of 74.6% [95% CI: 66.09 to 81.65%] and specificity of 76.53 % [95% CI: 69.85 to 82.15%] in the diagnosis of tuberculosis cases.Conclusions:This study concludes that the QFT-G test is a useful tool for detecting tuberculosis disease when used as an adjunct tool for the diagnosis of active TB cases. It certainly cannot be used solely and indiscriminately, separate from other clinical and radiological information, in the diagnosis of active tuberculosis cases.