King Abdulaziz Medical City-Riyadh Research Articles

Determination of the most common morphological patterns of anemia among Saudi anemic patients attending King Abdul-aziz Medical City-Riyadh

Background: Anemia is a medical condition in which the red blood cells (RBCs) count and hemoglobin (Hb) are less than the normal range. The main causes of anemia are a decrease in RBCs, their destruction and decrease of Hb synthesis. A useful method for diagnosis and classification of anemias is based on the morphological appearance of RBCs on an ideal stained blood smear. The main terms used in such classification are normocytic normochromic, microcytic hypochromic and macrocytic anemia. Aim: The aim of this study is to determine the most common morphological pattern of anemia in Saudi anemic patients who were admitted at King Abdul-aziz Medical City-Riyadh. Materials and Methods : Retrospectively we evaluated the results of complete blood count (CBC) and peripheral blood picture (PBP) of all anemic patients attending during the year 2013 (from 1 st January to 31 st December). Results: Participants in this study included 150 patients (13 infants, 27 children, 12 youths, 52 adults and 46 old). The gender distribution showed 70 males and 80 females. The results of CBC and PBP showed that 113 (75.3%), 36 (24%) and 1 (0.7%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anemia respectively. Conclusion: The normocytic normochromic pattern of anemia is highly frequent among this sample of Saudi patients while the macrocytic pattern of anemia is the lowest. According to gender groups microcytic hypochromic pattern of anemia is more common among females; malnutrition, increase of blood loss due to pregnancy or menstruation, and lack of iron absorption are the main causes, while the normocytic normochromic is highly frequent among males, which are mainly due to blood loss or chronic diseases.

Frequency and clinical significance of respiratory isolates of non-tuberculous mycobacteria in Riyadh, Saudi Arabia.

The prevalence of pulmonary non-tuberculous mycobacteria (NTM) disease is increasing worldwide. The aim of this study was to assess the frequency and clinical significance of NTM isolated from respiratory specimens at King Abdul-Aziz Medical City-Riyadh, Saudi Arabia. The medical records of all patients who had at least one respiratory specimen that was positive for growth of NTM between 2006 and 2012 were retrospectively reviewed. The clinical significance of the isolates was determined using the diagnostic criteria for NTM disease published by the American Thoracic Society (ATS). A total of 380 respiratory specimens with positive culture for NTM from 142 patients were identified. Forty patients (28%) had definite pulmonary NTM disease with a mean (± standard deviation) age of 54 ± 16 years, 58% were male and 50% had had underlying chronic lung disease. Mycobacterium avium complex (MAC) (n = 19, 48%) and Mycobacterium abscessus (n = 10, 25%) were the most commonly encountered NTM. The clinical manifestations of NTM lung disease are non-specific, with symptoms indistinguishable from pulmonary tuberculosis (TB). The most common radiological features of NTM lung disease were nodular bronchiectasis (45%) and fibrocavitary lesions (40%). Twenty-eight percent of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. MAC and M. abscessus were the most encountered NTM isolated species that caused NTM lung disease in our population, which is a rate similar to many previous studies.

Prevalence of portopulmonary hypertension among liver transplant candidates in a region highly endemic for viral hepatitis

Portopulmonary hypertension (POPH) is rarely encountered in the setting of end-stage liver disease (ESLD) and, if severe, may preclude patients from undergoing liver transplantation. The aim of the present study was to determine the prevalence of POPH in the setting of ESLD for patients who were referred to King Abdulaziz Medical City-Riyadh (Riyadh, Saudi Arabia) for assessment for liver transplantation. The medical records of all patients evaluated for liver transplantation between 1993 and 2009 were retrospectively reviewed. Pulmonary hypertension (PH) was defined as an echocardiographically estimated right ventricular systolic pressure ≥40 mmHg and a mean pulmonary arterial pressure >25 mmHg measured using right heart catheterization. A total of 542 consecutive subjects with ESLD who underwent assessment for liver transplantation were identified; however, medical records for 18 were missing. The final cohort, therefore, consisted of 524 subjects with a mean (±SD) age of 49±13.9 years, 60% were male, and 70% had viral hepatitis. PH was detected by echocardiography in 64 (12%) of the 524 subjects. Hemodynamic data obtained from intraoperative right heart catheterization or as part of the pre-transplantation evaluation were available for 248 subjects, including 57 of the 64 who had echocardiographically defined PH. PH was confirmed in 30 subjects and ruled out in 27, and only 4 (0.76%) subjects fulfilled the criteria for POPH. The prevalence of POPH determined in the present study was lower than previously reported. Further prospective research is needed to confirm this finding and to explore possible clinical, genetic, and environmental factors that contribute to the low prevalence of POPH in regions highly endemic for viral hepatitis.

Clinical outcome of familial hypercholesterolemia (FH) at King Abdulaziz Medical City, Riyadh-A 20 year experience

Familial Hypercholesterolemia (FH), is a well recognized risk factor for premature atherosclerosis and increased cardiovascular mortality. Prevalence of FH and FHrelated cardiovascular adverse clinical outcomes in the Saudi population are unknown. The aim of this study is to evaluate; epidemiological aspects, current management practices and clinical outcomes of FH over a 20-year-period, in King Abdulaziz medical city-Riyadh (KAMC-R). This is a retrospective, chart review study that includes patients of both genders and all ages, who have been clinically diagnosed as FH or have had significantly elevated cholesterol level, after excluding secondary causes of hypercholesterolemia. Potential study candidates between January 1990 and December 2010 were identified through hospital information system and laboratory database. Study population was limited to a subgroup of patients who have an LDL-C ⩾10 mmol/l as a potential homozygous phenotype, representing the highest risk population who deserves special medical attention. A set of predetermined demographic, clinical and laboratory variables were meticulously extracted from paper charts and electronic medical records. Out of 1227 discharge diagnosis of FH and 29,196 laboratory database candidates of LDL-C >4 mmol/l, 31 subjects met the study criteria. All patients are Saudi Nationals with mean age of 23 years and 52% being males. Xanthoma was documented in 87% with mean baseline LDL-C of 16.5 mmol/l and latest available mean LDL-C of 14 mmol/l. Statins were used in 94%, while longterm apheresis therapy was performed for 2 individuals (7%) and none of the study population underwent liver transplantation. Ten (32%) patients with mean age of 21 years underwent cardiac surgical interventions in form of CABG, mostly in combination with different valve replacement procedures. Seven patients (23%) were either documented to be dead or lost to follow up. The demographic distribution, clinical features and laboratory parameters are highly suggestive of Homozygous FH in the majority of study population. This large number of potential Homozygous FH in a small Saudi community is highly suggestive of increased prevalence of FH in the Saudi population at large as compared to the western countries. The reported adverse clinical outcomes in conjunction with persistently elevated LDL-C level may reflect the substandard lipid lowering strategies being delivered to this population. National FH registry and comprehensive FH management program are strongly recommended for urgent implementation.

Perception of Physicians Regarding the Prevalence of Unprofessional Behavior among Their Colleagues in a Tertiary Care Hospital in Saudi Arabia

To estimate the perception of physicians regarding the prevalence of certain unprofessional behaviors done by physicians as estimated by physicians themselves at a tertiary care center in Saudi Arabia. A cross sectional survey conducted at King Abdul-Aziz Medical City Riyadh, Saudi Arabia. 154 physicians from five specialties: emergency medicine, family medicine, internal medicine, obstetrics and gynecology and surgery in the period from 21 st January 2008 to 20 th February 2008 participated in the study. Self-administered survey containing eleven case scenarios, each is followed by a question to estimate the perception of prevalence of the unprofessional behavior. Response rate was 82 %. The estimated prevalence of the selected unprofessional behaviors was 25.6% in crude terms. The highest was breaking patient confidentiality (50%). The lowest was lack of sexual virtue (3%). Other unprofessional behaviors studied were: behaviors related to altruism, communications skills, relations with pharmaceutical companies, evidenced-based management, respect of colleagues, primacy of patient care, honesty with patients, private work and teamwork . Getting older showed significant decrease in perception of the prevalence of unprofessional behaviors. The study showed high estimated perception of prevalence of some unprofessional behaviors among physicians as perceived by physicians themselves. These findings in confirmed on a larger size samples and more representative, could be considered as a health system and medical education problem that needs serious attention at higher level in the medical profession. Further study concerning the assessment of medical professionalism is warranted