King Fahad Armed Forces Hospital Research Articles

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH).

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed thesatisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital.

Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting. A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process. A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%). The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.

Restless legs syndrome in multiple sclerosis patients: Prevalence, impact, and association with disease-modifying therapies in a Saudi Arabian pilot study.

Restless legs syndrome (RLS) emerges as a notable sleep disorder characterized by distressing sensations within the lower extremities. Its prevalence appears to be higher among patients afflicted with multiple sclerosis (MS) compared to the general population. Despite this observation, the understanding of the intricacies of RLS and its repercussions within the context of MS patients in Saudi Arabia remains limited. Employing a cross-sectional design, a comprehensive investigation was undertaken at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, spanning from November 2021 to March 2022. A cohort of 66 individuals diagnosed with MS was recruited and subjected to an assessment for RLS employing the revised diagnostic criteria outlined by the International Restless Legs Syndrome Study Group (IRLSSG). Furthermore, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleepiness Scale were employed to gage the extent of RLS's impact on sleep quality and daily functioning. The prevalence of RLS amidst the MS cohort was determined to be 30.4%. An observable association was discerned between RLS presence and higher scores on the Expanded Disability Status Scale (p<0.001), along with diminished sleep quality scores (p<0.001) and elevated fatigue scores based on IRLSSG criteria (p<0.001). Within the studied MS cases, 98.5% exhibited the relapsing-remitting subtype. Further investigation demonstrated that patients treated with Fingolimod or Ocrevus presented normal IRLSSG scores, whereas those undergoing Rituximab treatment manifested an even distribution between normal and moderate scores. Correspondingly, patients receiving interferons showcased 72.2% with normal scores and 27.8% with mild scores. Notably, a statistically significant variance in IRLSSG scores was observed when contrasting Fingolimod and Aubagio treatments (P<0.001). The presence of RLS as a comorbidity in MS patients within the Saudi Arabian context emerges as a significant finding, exerting a discernible detrimental influence on both disability status and sleep quality. This study underscores the need for further investigations aimed at unraveling the intricate pathophysiological underpinnings, identification of risk factors, and exploration of therapeutic modalities for RLS in this population. Furthermore, additional research endeavors are warranted to elucidate the diverse impact of various disease-modifying therapies on clinical outcomes.

Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery.

Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.

Screening for Allergic Contact Dermatitis Based on Pattern of Patch Test Results: A Retrospective Study

Abstract Background: Contact allergies are associated with morbidity worldwide. Purpose: To investigate the patterns of sensitization to contact allergens in a local population. Methods: A retrospective study investigated patch test reactivity among patients with a clinical diagnosis of contact dermatitis referred to the dermatology clinic at King Fahad Armed Forces Hospital, Jeddah, between January 2021 and January 2023. Pregnant women, immunosuppressed patients, and those receiving immunosuppressive therapy were excluded. Only 92 of 101 referred patients underwent patch testing after fulfilling requirements. The patch test was performed using a Thin-layer Rapid-Use Epicutaneous patch test containing 35 contact allergenic elements and one control (total = 36). Results: Among 92 patients, 35 (38%) were males, and 57 (62%) were females. Of these, 62 (67.4%) patients had a positive patch test and reacted to one or more allergens. The most common sensitizing allergens were p-phenylenediamine (PPD), gold sodium thiosulfate, and disperse blue 106, with equal positive reactions in 16 (25.8%) patients, followed by nickel sulfate in 13 (21%), p-tert-butylphenol formaldehyde resin in eight (13%), fragrance mix in 7 (10.8%), and epoxy resin in six (9.2%) patients. No significant sex differences were found among patients with contact dermatitis where notable patch test allergen reactivity was observed. Conclusion: Patch test reactivity to PPD, gold sodium thiosulfate, and disperse blue 106 was high. The pattern of contact allergy observed here highlights the need for large-scale investigations to identify local allergens for contact allergy and formulate policies for avoiding exposure.

Efficacy and safety of single pill combination of amlodipine and valsartan in hypertensive Saudi patients.

A significant global health issue that affects 25.5% of Saudi people is hypertension (HTN). According to international recommendations, most HTN patients require more than one therapy to reach their blood pressure targets (BP). Therefore, it would be preferable to utilize two medications from distinct classes separately or in a predetermined combination. According to recent studies, a single-pill combination (SPC) may be more efficient. This study evaluated the safety and tolerability of Amlodipine/Valsartan (Aml/Val) SPC in Saudi hypertensive patients, as well as the effectiveness of the medication. Observational research was done prospectively at the King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. The effectiveness of the treatment and the percentage of 159 hypertensive patients who achieved the target blood pressure values (140/90; 130/80 mmHg) among those with diabetes mellitus (DM), chronic kidney disease (CKD), other cardiovascular disorders, and responders were assessed from the beginning to the endpoint (week 23). According to the results, taking Aml/Val SPC significantly lowered all patients' baseline systolic and diastolic blood pressure readings by -17.97 and 8.58 mmHg, respectively. 43.4% of patients successfully met their BP therapeutic objectives by bringing their blood pressure levels back to normal, including 51.4% of patients under 65, 39.3% of patients with chronic kidney disease, and 26.2% of diabetic patients. Aml/Val 10/160 mg significantly lowers SBP, more than Aml/Val 5/160 mg (-13.32% vs. -9.00%, p<0.050). Vertigo (6.30%), respiratory tract infections (4.0%), and ankle edema (2.50%) were the most frequent adverse events. Aml/Val SPC therapy effectively lowered BP and had few side effects while being well-tolerated in people with hypertension.

The Molecular Characterization of Nosocomial Carbapenem-Resistant Klebsiella pneumoniae Co-Harboring blaNDM and blaOXA-48 in Jeddah

Carbapenem-resistant Klebsiella pneumoniae (CRKP)-associated infections have become a major concern and life-threatening worldwide. Understanding the epidemiology of CRKP using a reliable molecular technology can help to develop an effective infection control policies. In the western region of Saudi Arabia, there are no sufficient data on the prevalence of CRKP and its carbapenem-resistant determinants. Therefore, this study aimed to determine the molecular epidemiology of CRKP and identify the most common carbapenemase genes. In the current study, a total of 191 CRKP isolates were collected and obtained from clinical specimens of patients at King Fahad Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. All isolates that were resistant or intermediately susceptible to either of the carbapenem antimicrobials (imipenem, meropenem, or ertapenem) were included. All CRKP showed resistance to ceftazidime, cefepime, and piperacillin/tazobactam, whereas low (14%) and moderate (37.7%) levels of resistance were reported against tigecycline and colistin, respectively. The most common carbapenemase genes identified were blaOXA-48 (n = 157 [82.2%]), followed by blaNDM in 27 (14%) isolates. The blaVIM and blaKPC were reported in only one isolate each and no blaIMP producers were detected among all tested isolates. The high prevalence of OXA-48 among K. pneumoniae isolates reported in the current study may reflect that OXA-48 has become an endemic in Saudi Arabian hospitals. The second major finding was that the identification of CRKP co-harbors both blaNDM and blaOXA-48, and such isolates can be threating for healthcare societies (patients and healthcare workers) due to their high level of resistance to carbapenems. These results suggest that the use of molecular diagnostic methods and proper surveillance programs are required to monitor and control the spread of all multidrug-resistant (MDR) bacteria, including CRKP. Therefore, further research is recommended to expand the study and further analyze the genotyping of the most common clones of CRKP in other hospitals in the western regions of Saudi Arabia.

The Effect of Phototherapy on Serum Calcium and Magnesium Level in Newborns Gestational Age 36 Weeks and Above

Objective: To investigate the phototherapy effect on serum calcium and magnesium levels of children with gestational age 36 weeks or above.&#x0D; Study Design: Cross-sectional analytical study.&#x0D; Place and Duration of Study: Department of Pediatric, King Fahad Armed Forces Hospital, Jeddah from Jan to Sep 2019.&#x0D; Methodology: Total of 200 participants were recruited into the study after obtaining informed consent. Patients’ characteristics were obtained from medical record file. Their mothers were interviewed. Before phototherapy, laboratory investigations were done. Phototherapy was performed with conventional method 410-417mm wave length was maintained and patients was kept at distance of 20cm. After phototherapy completion, laboratory investigations were repeated and difference was noted.&#x0D; Results: Out of 200 patients, 54% were males and 46% were females. Average age of patients was 1.85 ± 0.96 days with range 0-5 days. Decrease in calcium and magnesium levels was observed in 64 (32%) and 49 (24.5%) patients respectively following phototherapy completion. There was statistically significant mean difference in calcium and magnesium levels after phototherapy and bilirubin was also significantly decreased.&#x0D; Conclusion: Decrease was observed in calcium and magnesium levels following phototherapy. Phototherapy may lead to decrease levels of calcium and magnesium, hence frequent assay warranted. Further investigations should be conducted inour region enrolling only neonates to confirm phototherapy induced hypocalcaemia and hypomagnesaemia.

Pre and post operative physiotherapy in foot and ankle surgery: role, impact, and importance

Background: The foot and ankle injuries require surgery to be fixed. The success of surgeries, in this case, is associated with appropriate physiotherapy before and after the surgery. The education, skills, capabilities, and expertise that physiotherapists possess are extremely beneficial to injuries to maximize their success. The expertise and competency of physiotherapists enable them to design functional rehabilitation regimens for these patients. The main objective of the study is to investigate the role, impact, and significance of pre- and post-operative physiotherapy in foot and ankle surgery.Methods: The current cross-sectional, and descriptive study conducted to 120 (n=120) patients with foot and/or ankle surgery before and after the physiotherapy between September 2019 to February 2022, from five hospitals, King Fahad General Hospital (KFHJ) in Jeddah, King Abdullah Medical City (KAMC) in Makkah, King Fahad Armed Forces Hospital (KFAFH) in Jeddah, International Medical Center Hospital (IMC) in Jeddah, and Al-Noor Hospital in Makkah. The descriptive survey data was collected depended on questionnaire reports based on patient-reported outcomes measurement information system (PROMIS) physical function and pain interference scales.Results: The results found the pain was interfered with patient daily activities (70.5%) and where unable to concentrate (69.8%), while 68.8% of them were unable to enjoy life. The results clearly indicated that most of the patients are unable to walk at normal speed (66.7%). Additionally, a considerable number of the patients had problems hiking or moving smoothly (60.8%).Conclusions: The average data suggests that improvement in physical performance and discomfort plateaus at around 4 months after surgery, with only minor changes occurring after this time point in the future. So, the patients have the biggest change in function and discomfort during the first 4 months following surgery on average.

The Influence of Preoperative Thyroid Gland Volume On Intraoperative Time and Postoperative Complications for Total Thyroidectomy Patients

Objective: To determine the influence of preoperative thyroid gland volume on intraoperative time and postoperative complications for total thyroidectomy patients in a militaty tertiary hospital. Design: A cross-sectional analysis for data collected retrospectively from 106 consecutive patients who underwent thyroid surgery for various thyroid diseases at King Fahad Armed Forces Hospital in Saudi Arabia, between January 2015 and December 2019. Methods: A total of 106 patients (96 Female = 90.6% and 10 males = 9.4 %). Thyroid gland volumes were calculated preoperatively using ellipsoid model. FNA was done per American thyroid association guidelines. The patients underwent total thyroidectomy for benign and malignant thyroid conditions. The intraoperative time was measured starting from the skin incision till wound closure. Patients were followed for perioperative complications. The intraoperative time was correlated with preoperative ultrasonographic sizes of the thyroid glands. Independent sample t-Test done to compare mean US volumes in patients with complications and patients without complications. Results: The average thyroid gland volume was 43.48 ml the largest volume was 189.454 ml and the lowest volume was 1.46 ml. The average intraoperative time was 2 hours with longest time was 4 hours in a case with thyroid gland volume of 159.9 ml and the shortest intraoperative time was 1 hour and 1 minute in a case with thyroid gland volume of 58.44 ml. Total number of complications was 14 =13.2%. 1 case (0.9%) of expanding hematoma which required surgical drainage on a patient with thyroid gland volume of 34.59 ml, 7 cases (6.6%) of permanent hypocalcemia observed on patients with thyroid gland volumes of (9.16,14.21,19.81, 31.4, 37.57, 53.8, 159 ml). 4 cases (3.8%) of transient unilateral vocal fold immobility observed in patients with thyroid gland volumes of (11.55, 12.94, 26.98, 74.81ml) and 2 cases (1.9 %) of transient bilateral vocal folds immobility observed in patients with thyroid gland volumes of (60.53, 82.99 ml). Conclusion: The larger preoperative thyroid gland volume the longer operative time. Preoperative thyroid gland volume showed no significant influence on perioperative complications. Hence reviewing preoperative ultrasonographic thyroid gland volume may help the surgeon and operative staff preparations for larger cases.

Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia.

Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study in Saudi Arabia to evaluate the outcomes of tracheostomy in intubated COVID-19 patients. This is a retrospective, observational cohort study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia and King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. The findings of the study revealed that seventy-one patients with COVID-19 underwent tracheotomy between 1 March 2020 and 31 October 2020. The average period between intubation and tracheostomy was 9.97 days. Hypertension, diabetes, lung disease and obesity (BMI > 30) were significant risk factors of mortality. The overall 30-day mortality rate was 38.4%.

Role of fine needle aspiration in malignant parotid tumors at a single-center experience: A retrospective cohort study

BackgroundParotid gland tumors are mostly benign with good prognosis. On the other hand, malignant tumors of the parotid gland often have poor prognosis and metastasize. Mucoepidermoid carcinoma is the most common cancer in the parotid gland accounting for nearly 40–50% of the cases. Therefore, it is important to define the role of fine needle aspiration in differentiating between different types of parotid malignancies. MethodThis is a retrospective chart review study that was done on 49 consecutive patients who underwent parotid surgeries in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, between Jan 2003 and Feb 2020. The records of 49 patients were obtained, fine needle aspiration and pathology reports were reviewed to define the role of fine needle aspiration in diagnosing malignant parotid tumors by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. ResultsRetrospective analysis of 39 cases revealed that there was one case which was diagnosed for cancer was missed by fine needle aspiration. Meanwhile, six cases were diagnosed as malignant lesions using both fine needle aspiration and histopathology. Furthermore, 30 cases were determined benign based on fine needle aspiration and histopathology. The sensitivity of fine needle aspiration for detecting malignancy was 85.7%, specificity was 93.8%. positive predictive value of 75% and negative predictive value of 96.7%. ConclusionFine needle aspiration is highly sensitive and specific for parotid tumors. We support the role of pre-operative FNA for all parotid tumors as its accurate in differentiating between benign and malignant lesions.

The Impact of a Pre-Dialysis Educational Program on the Mode of Renal Replacement Therapy in a Saudi Hospital: A Retrospective Cohort Study.

BackgroundSelf-care and peritoneal dialysis (PD) benefits have been underutilized in patients with end-stage renal disease (ESRD). The pre-dialysis education program (PDEP) has been generally introduced as an acceptable tool in increasing the rates of PD and has been reportedly recommended for ESRD patients as part of the introduced care. We aim to study the effect of PDEP on ESRD and whether they would prefer PD of center-based hemodialysis (HD).MethodsThis is a retrospective cohort study that was done at King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia, in the dialysis center. Data were collected on patients and included demographics, preference of renal replacement therapy modality, and other possible factors that may affect patient choices such as educational level, economic status, and age.ResultsA total of 213 ESRD patients that met our criteria were included, with a total of 75 patients receiving PDEP. Out of those who received the PDEP, 57.3% and 42.7% of patients decided to perform HD and PD, respectively. There was a significant impact of PDEP on reducing HD choice [OR (95% CI) = 0.11 (0.05-0.24); P-value < 0.001]. Infections did not occur in 50.5% of the included patients while 45.8%, 3.3%, and 0.5% had central line-associated bloodstream infection (CLABSI), other infections, and peritonitis, respectively. Most of the PD patients (81.8%) did not have an infection as compared to 42.3% of the HD patients. HD was also associated with increased admission days [OR (95% CI) = 1.27 (1.07-1.51); P-value = 0.007].ConclusionWe found that PDEP positively impacted the rate of PD while PD was associated with favorable outcomes and lower infection rates, emphasizing the importance of an educational program.

Juggling Between Paperwork and Patient Care: How Residents View Their Time Division in Clinical Training?

Objective: The objective of this study was to explore residents’ perception of time they spend on clinical data and patient care. Methods: A cross-sectional study, utilizing a validated questionnaire was conducted in July 2019 at the King Fahad Armed Forces Hospital, Jeddah after gaining ethical approval. Link to the online survey designed on Google forms was shared through Facebook, WhatsApp, and Email. The questionnaire consisted of 21 items to assess different variables like direct patient care, documentation requirements, and complete patient interaction. Results: Out of 150 participants, the response rate was 111 (74%). Of 111 participants, regarding clinical documentation, 105 (95%) felt that it has become excessive, and 93 (84%) agreed that it compromises patient time. In addition, 87 (78%) residents felt rushed all the time and 82 (74%) said that they are frustrated with data entry. On the educational value of clinical documentation, 90 (81%) of residents agreed that it has little or no influence. Furthermore, 92 (83%) agreed that it negatively impacts the time available for teaching other junior residents. Conclusion: We conclude that: although residents wish to provide quality care to their patients, many of them felt that data entry has become excessive and it is negatively affecting their clinical training.

Clinical, Radiological, and Histopathological Patterns of Allergic Fungal Sinusitis: A Single-Center Retrospective Study.

ObjectivesTo explore the clinical, pathological, and imaging characteristics of allergic fungal sinusitis (AFS) and to analyze the correlation of disease duration with imaging and histopathology findings.MethodsWe reviewed all cases of AFS managed at the otorhinolaryngology department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Demographic and clinical features were collected, as well as imaging and histopathological findings, which were analyzed by time from onset.ResultsForty-six patients were diagnosed AFS, representing 11.8% of total sinusitis cases; 25 (54.3%) were female, with mean (SD) age=33.57 (11.76). Patients presented with multiple symptoms of chronic rhinosinusitis (43, 93.5%), chronic headache (14, 30.4%), and hyposmia (2, 4.3%), and 36 (78.3%) were diagnosed late (≥5 years after onset). AFS involved all four sinuses in 32 (69.6%) patients and was bilateral in >53.5% of infected sinuses. Imaging showed increased intrasinus attenuation (88.2%-95.3%), complete opacification (74.4%-85.3%), sinus expansion (35.3%-51.2%), remodeling (20.6%-37.2%), wall thinning (41.2%-58.1%), and involvement of adjacent soft tissue (11.8%-25.6%), depending on the sinus type. Histology evidenced eosinophilic mucin (45.7%), eosinophils (91.3%), fungal hyphae (93.5%), and Charcot-Leyden crystals (6.5%). Patients who were diagnosed late had a higher percentage of imaging and pathological lesions, principally, the expansion and wall thinning of involved sinuses (p<0.050).ConclusionAFS represents a significant proportion of chronic sinusitis cases treated in the otorhinolaryngology department and is often diagnosed late with extensive forms. Major efforts should be made to improve the early diagnosis and management of such disease, including raising awareness about this entity among general practitioners and family physicians to enhance clinical suspicion and detection rate.

Knowledge of first aid management of epistaxis among medical interns attending King Fahad Armed Forces Hospital in Saudi Arabia

Aim: The aim of this study is to explore the knowledge of medical interns about first aid in the management of epistaxis. Materials and Methods: An anonymous, cross-sectional, and validated survey-based study was conducted in January 2020 at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Results: A total of 57 medical interns responded to the survey. The vast majority of survey respondents were male (78.9%) and single (80.7%). Around 57.9% of the respondents declared that epistaxis is regarded as one of the emergency situations. A sum of 71.9% of medical interns correctly identified “finger nail trauma” as the most common cause of epistaxis. In addition, while 71.9% of medical interns correctly answered, “sitting with head tilted forward” as the proper management position for a patient with epistaxis, only 52.6% of medical interns correctly answered, “pinching the lower cartilaginous part of the nose” as the primary measure to stop epistaxis. When medical interns were asked about what to do if the patient continued to bleed from the nose in the emergency room after the primary measures had been done, only 50.9% of medical interns correctly answered with “refer the patient to an otolaryngologist to take further care.” Using two-tailed Chi-square test, there were no differences in the percentages of correct answers among the surveyed medical interns according to gender (P > 0.05). With regard to the sources of information about first aid in the management of epistaxis, the top selected source by medical interns was “self-taught” (52%), followed by “medical textbooks” (19%). Conclusion: The surveyed interns had unsatisfactory knowledge about epistaxis first aid. There is a pressing need to establish solid curricular, extracurricular, and institutional measures to increase the intern's awareness of first aid knowledge in the management of epistaxis.

Incidence and risk factors of inadvertent parathyroidectomy during thyroid surgery: A single-center retrospective study

Context: Thyroidectomy is considered a relatively safe surgery with morbidity of <5% when undertaken by experienced surgeons. Inadvertent parathyroidectomy (IP) means pathology report has found parathyroid tissue in the thyroid specimen, and it was reported to range from 2.9% to 31%. Aims: The aim of this study is to measure the incidence rate and to evaluate the significant relationship between risk factors and IP during thyroid surgery. Settings and Design: A retrospective chart review study was carried out in King Fahad Armed Forces Hospital, Jeddah, between June 2015 and December 2019. Subjects and Methods: All consecutive patients undergoing unilateral or bilateral thyroidectomy were enrolled in this study. Histopathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid disease, and these were compared to patients with no parathyroidectomy in terms of gender, pathological features, re-operation, Hashimoto thyroiditis, extrathyroidal extension, and central neck dissection. Statistical Analysis Used: Statistical analysis was carried out using the Statistical Package for the Social Sciences. Results: Retrospective analysis of 181 consecutive thyroidectomy cases reveals that 34 (18.7%) patients had IP. Significant risk factors for IP included extra-thyroid extension (P = 0.008), total thyroidectomy (P = 0.017), and Hashimoto thyroiditis (P = 0.021). Other risk factors, including gender, malignancy, central neck dissection, and re-operation, were not statistically significant in this study. Conclusions: IP during thyroid surgery is not uncommon (18.7%). Total thyroidectomy, hashimoto thyroiditis, and extrathyroidal extension of the tumor were found to be significant risk factors. We recommend more meticulous intra-operative identification of parathyroid glands, particularly for patients with these risk factors.

Severe Vitamin D Deficiency in Saudi Patients with Type 2 Diabetes Mellitus

Introduction It has been demonstrated that vitamin D deficiency is associated with type 2 diabetes mellitus (T2DM). We conducted a cross sectional study to investigate the prevalence severe vitamin D deficiency in patients with T2DM. Method A cross-sectional single centre study was conducted in 4053 patients with T2DM. Patients with T2DM attended the Diabetes Centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia between January 2018 and December 2018 were recruited. Results There were 4053 patients with T2DM, 1145 male and 2908 female (28 % vs.72% respectively). The mean age was 53.9 ±16.5 years. The mean and median 25-OHD concentrations were 57.8±30.5 and 51.9 respectively. Severe vitamin D deficiency (25-OHD&lt;25 nmol/l) was found in 1916 (9.5%). Moreover, severe vitamin D deficiency was not statistically significant more prevalent among females than males with male to female ratio 1:2.3 (70% vs. 30% respectively, p=0.6). In addition, severe vitamin D deficient patients were statistically significant younger than non-vitamin D deficient (48.0±16.7 vs. 54.6±16.3 respectively, p&lt;0.0001). Severe vitamin D deficient patients have statistically significant higher HbA1c than non-vitamin D deficient (8.3 ±2.3 vs. 7.6±1.9 respectively, p&lt;0.0001). The mean 25-OHD was upward as age advanced with highest frequency of vitamin D deficiency was found in the age group ≥60 years (27%) with males statistically significant most frequent than females in the age group ≥60 years (39 s, 22 respectively, p=0.003). Regression analysis of odd ratio of risk factors for patients with severe vitamin D deficiency showed that age and HbA1c were statistically significant associated with vitamin D deficiency. Conclusions The prevalence of severe vitamin D deficiency in patients with T2DM is low and that more females with T2DM are affected with vitamin D deficiency than males.

Effectiveness of a Training Course on Accuracy of Triaging of Pediatric Patients.

BACKGROUND:In the context of a new but busy Pediatric Emergency Department, the risk of missing patients who need more emergent care can be reduced by timely and accurate triaging. In the emergency department of King Fahad Armed Forces Hospital, the Canadian Triage and Acuity Scale had already been implemented, including the pediatric version (PaedCTAS). However, a common observation remained that critical patients did not always receive priority with subsequent delays in management. To improve this accuracy, a training course was administered to health care professionals responsible for triaging of pediatric patients.AIM:To determine the effectiveness of a training course on accuracy of triaging of Pediatric Patients.METHODS:A triage training course was conducted over two months, with patient encounter sheets reviewed before the course for 6 months and after the course for 12 months. Accuracy was calculated by comparing it to level as determined by two pediatric emergency physicians. Also, admission rates were used as a surrogate marker to also determine accuracy.RESULTS:A total of 31 053 patient sheets were reviewed. There was a considerable improvement in the correct determination of all triage levels, with accuracy ranging from 56.5% to 78.3% before the course, and reaching from 79.1% to 90.8% after the course with a statistically significant difference. Triaging errors still present were mainly in the form of down-triage.CONCLUSION:Our training course in triage has a significant impact on the accuracy of triaging of ill pediatric patients. Further improvement can be obtained by repeated courses and direct feedback with debriefing sessions on challenges to triage level determination.

The Relationship between Serum Thyrotrophic and Components of Metabolic Syndrome

Background and objective: Metabolic syndrome (Meets) is a cluster of obesity, hyperglycemia, dyslipidemia and hypertension (HTN). Thyroid hormones play an important role in regulating energy homeostasis, carbohydrate, lipids and protein metabolism. Therefore the present study was an effort to investigate the influence of TSH levels in each component of patients with Meets in a population of Saudi Arabia. Design: We analyzed retrospectively 656 participants with MetS whom are between the ages 20 to 98 years. All patients were from the population of the Primary health centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. All data were collected on the basis of a review of electronic medical data. Patient who are pregnant were excluded. The reference range values of TSH 0.22-4.2 MIU/L, Free T4 12.0-22.0 pmol/L. TSH was divided into three groups; &lt;1.5, 1.5-2.5 and &gt;2.5-4.2. Metabolic risk factors were defined using the 2006 IDF criteria that define elevated triglyceride as ≥150 mg/dL (≥1.7 mmol/L) and reduced high density lipoprotein cholesterol (HDL) as &lt;40 mg/dL (&lt;1.03 mmol/L) for male and as &lt;50 mg/dL (&lt;1.29 mmol/L) for female. Elevated blood pressure was defined when the systolic blood pressure was ≥130 mm Hg and/or diastolic blood pressure was ≥85 mm Hg in addition to receiving any medication for HTN. Abnormal glucose metabolism was con¬sidered when HbA1c (≥5.7) or when patients were known to have type 2 diabetes mellitus (T2DM). The total number of cohort was separated on basis of age values into four groups: &lt;40 years, 40-49 years, 50-59 years and ≥60 years. Results: 656 subjects with MetS were included. There were 86 (13.1% ) male and 570 (86.9%) were female with mean age 55.6 ±12.7 with mean body mass index 32.8 ± 7.2 kg/m2 . HbA1c&gt;5.6 or T2DM, hypertension, triglyceride (≥1.7 mmol/l) and low HDL were present in 94 (14.3%), 354 (54.0%), 328 (50.2%) and 487 (74.2%) respectively. The mean TSH and FT4 values were 2.1 ±1.0 mIU/l and 15.4 ±3.1 pmol/l respectively. Patients with TSH (&gt;2.5-4.2) were non-significantly younger and have significantly higher BMI compared to patients with TSH (&lt;1.5) or TSH (1.5-2.5), 50.9 ±12.4 vs. 53.5 ±12.7 vs. 53.4 ±13.0 respectively, p=0.05 and 33.6 ± 8.2 vs. 31.7 ± 6.1 vs. 33.2 ± 7.0 respectively, p=0.01. Females compared to males were non-significantly predominant in patients with TSH (&gt;2.5-4.2) compared to patients with TSH (&lt;1.5) or TSH (1.5-2.5), 87.3 vs. 12.7%, 89.4 vs. 10.6% and 84.0 vs. 16.0%, p=0.2. Cases with HbA1c&gt;5.6 or T2DM were significantly more prevalent in patients with TSH (&gt;2.5-4.2) compared to TSH (&lt;1.5) or TSH (1.5-2.5), 18.8% vs. 13.9% vs. 10.0 respectively, p=0.03. Cases with HTN were significantly less prevalent in patients with TSH (&gt;2.5-4.2) compared to TSH (&lt;1.5) or TSH (1.5-2.5), 46.3% vs. 54.3% vs. 61.6 respectively, p=0.005. Cases with serum triglyceride (≥1.7 mmol/l) were significantly more prevalent in patients with TSH (&gt;2.5-4.2) compared to TSH (&lt;1.5) or TSH (1.5-2.5), 57.6% vs. 44.9% vs. 47.2 respectively, p=0.02. Cases with low HDL were significantly more prevalent in patients with TSH (&gt;2.5-4.2) compared to TSH (&lt;1.5) or TSH (1.5-2.5), 85.1% vs. 74.9% vs. 71.1 respectively, p=0.002. Higher prevalence of HbA1c&gt;5.6 or T2DM, low HDL , triglyceride (≥1.7 mmol/l) and HTN in patients with age 40-59 years compared to &lt;40 years or more than 60 years, p&lt;0.0001, p=0.4, p=0.02 and p=0.3 respectively. Conclusion: We found that an increase in serum TSH was positively correlated with components of metabolic syndrome and might be a risk factor for metabolic syndrome in Saudis. Further investigations are essential to further confirm the relationship between TSH and components of metabolic syndrome in Saudis as well as the underlying mechanism(s).