King Fahad Specialist Hospital Dammam Research Articles

Pediatric en bloc kidney transplant from donors

Most kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients. This study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital-Dammam from December 2014 to January 2018. Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes. The study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors' and recipients' mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1-year estimated glomerular filtration rate (eGFR) compared to the 1-week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5-year mark and during the last follow-up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months. In a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.

2231. Point Prevalence Survey on Antimicrobial Appropriateness in a Tertiary Care Hospital in Saudi Arabia

Abstract Background Antimicrobial resistance is a significant global health problem. Optimizing the use of antimicrobial agents is a key strategic objective for any antimicrobial stewardship program (ASP). In the literature, 9-64% of antimicrobials prescriptions were inappropriate the hospital setting. We aim to evaluate antimicrobial utilization practices and subsequently implement informed interventions to optimize antimicrobial use by conducting a point prevalence survey (PPS). Methods This is a single-center PPS at King Fahad Specialist Hospital-Dammam, Saudi Arabia. The hospital is specialized in Transplant, Oncology/hematology, and Neuroscience, with approximately 350 beds. All inpatient wards were conducted over one week period ward by ward. All inpatients on active antimicrobials were included. Data were collected from patients’ electronic medical records based on the WHO methodology for PPS on antibiotic use in hospitals. The outcome (appropriateness of antimicrobial treatment) included five elements: indication, duration, administration route, spectrum, and dosing. Assessments were made according to the local and international guidelines and the ASP team (Infectious diseases consultant and pharmacist). Results A total of 316 patients’ medical records were screened. Of whom 121 were included. Nineteen (16%) patients were pediatrics, and 102 (84%) were adults. Patients’ characteristics are presented in Table 1. A total of 207 systemic antimicrobials were recorded, 117/207 (57%) therapeutic and 90/207 (43%) prophylactic. The antimicrobials were inappropriate in 73 /207 (35%) antimicrobial orders that included 84 elements. Eleven out of the 73 orders have more than one inappropriate element. The main reasons were inappropriate indication 31/84 (37%), followed by the antimicrobial spectrum 21/84 (25%). Figure 1Table 1:Characteristics of patients receiving systemic antimicrobial treatment, n (%)Figure 1:Elements of antimicrobials inappropriateness Conclusion This point prevalence survey showed 35% of the antimicrobial prescription in the inpatient setting was inappropriate. The most common reasons were the indication followed by the spectrum and duration of antimicrobials. These findings provide valuable insight into stewardship's best approach and interventions to improve antimicrobials appropriateness. Disclosures All Authors: No reported disclosures

The Impact of Nurses Recognition, and Empowerment Related to Nurses Job Satisfaction at KFSH-D

Introduction: Nurses’ job satisfaction is referring to the level to which people feel that they are able to have an influence on their workplace. Nurse leaders should use a variety of empowerment strategies that are important to nurses’ job satisfaction. Meanwhile, meaningful recognition for nurses is considered a powerful tool to enhance nurses’ sense of self-efficacy especially facing an emotional challenge that may affect their wellbeing. Aim: The aim of the studies is to analyze the importance of nurses’ recognition, and empowerment towards nurses’ job satisfaction at KFSH-D. Method: This study takes the form of a quantitative research methodology, and descriptive-analytical technique. A questionnaire used to gather data from registered nurses employed at King Fahad Specialist Hospital-Dammam (KFSH-D) about the structural empowerment and nurses’ recognition program impact on their job satisfaction. Following the collection of data, the descriptive statistic used to describe the personal characteristics of the respondents, while inferential statistics used to determine the statistical relationship existing between independent variable job satisfaction and the structural empowerment and nurses’ recognition program among the registered nurses at KFSH-D as dependent variables. Recommendation: The researcher only focuses on the in-patient units, future studies, are recommended to focus on every dimension and category level of units. Apart from that, when looking into job satisfaction and empowerment, to be more specific, the researcher could investigate another dimension by comparing age, and clinical working experience which may provide a depth of understanding of the contribution perception of structural empowerment. Conclusion: The findings of the studies reveal recognition and empowerment are assets to make nurses stay and increase their level of job satisfaction and task assignments.

Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing.

The objective of this study was to determine the etiologies, outcomes, prognostic indicators and the role of genetic testing in children with acute liver failure (ALF). This retrospective study included 46 patients with pediatric acute liver failure (PALF) according to the PALF study group definition, admitted to King Fahad Specialist Hospital-Dammam, Saudi Arabia, between January 2014 and December 2021. Patients who survived with supportive therapy were designated as the recovery group, whereas those who died or underwent liver transplantation were designated as the death/transplant group. There were 26 (56.5%) patients in the recovery group and 20 (43.5%) patients in the death/transplant group. Four patients (8.7%) underwent liver transplantation. After indeterminate causes (45.6%), genetic-metabolic diseases and drug-induced liver injury (DILI) were the most common cause with 15.2 and 13%, respectively. Genetic testing had a high yield of (6/31) in identifying monogenic disease associated with ALF. Younger age, lower Glasgow Coma Scale and higher international normalized ratio (INR) on admission were predictors for poor prognosis. The death/transplant group had longer intensive care unit stay ( P < 0.001), and on admission they had more advanced hepatic encephalopathy ( P < 0.005), more prolonged prothrombin time ( P < 0.001), higher lactate ( P < 0.006), higher total and direct bilirubin ( P < 0.008) and ( P < 0.001), respectively. Genetic, metabolic and DILI causes constituted the most common cause of PALF after indeterminate causes. The use of genetic testing can improve diagnostic rates in special cases, but we could not assess the effect of genetic testing on prognosis. The overall survival rate in our study was 65.2%. Younger age, higher admission INR and lower Glasgow coma scale were indicators of poor prognosis.

Idiopathic Granulomatous Mastitis, Is It a Surgical Disease? Case Series and Literature Review

Idiopathic Granulomatous Mastitis (IGM) is an uncommon benign chronic inflammatory breast disease. It can mimic two frequent breast disorders, breast cancer and breast abscess. Although it is associated with certain risk factors, neither clinical presentation nor radiological findings are diagnostic. Histopathological evaluation plays a crucial role in the diagnosis of IGM and its treatment is controversial. We present two patients with IGM treated at King Fahad Specialist Hospital-Dammam, Saudi Arabia, over a period of 4 years. Both patients had different clinical presentations, and treatment courses. However, they both achieved remission of the disease eventually. We recommend that surgical management should be considered last in the treatment options, to avoid wound related chronic complications and poor cosmetic outcomes. The clinical presentation, diagnosis and management of IGM are discussed in this paper.

The Impact of COVID-19 Pandemic on Rehabilitation Services in a Tertiary Care Hospital in the Eastern Region of Saudi Arabia: A Single-Center Study.

ObjectiveIn this retrospective study, we aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on rehabilitation services including outpatient rehabilitation clinic visits, speech therapy, and occupational therapy and physiotherapy sessions.Materials and methodsThis was a retrospective, observational, single-center study, which included all patients who presented to the rehabilitation clinic at the King Fahad Specialist Hospital, Dammam (KFSHD) from January to August 2020 (study period), and they were matched with parallel groups from 2017 to 2019 (control period).ResultsA total number of 1,435 patient visits were recorded in the outpatient rehabilitation clinics during the study period as compared to the 1,496 patient visits during the control period. However, the number of patients seen by the speech therapists, physiotherapists, and occupational therapists significantly came down from 482, 963, and 171, respectively in the control period to 77, 218, and 130, respectively in the study period. The occupational therapy, physiotherapy, and speech therapy services were significantly affected during the COVID-19 pandemic.ConclusionsOur findings revealed the negative consequences of the COVID-19 pandemic on the outpatient rehabilitation services, which was reflected in the sharp decline in the number of patients who attended the rehabilitation clinics as well as in the reduced number of sessions. The rehabilitation facilities should be better prepared for such pandemics in the future to deliver appropriate and timely rehabilitation programs with a patient-centered approach.

Quality of Life and Morbidity after Endoscopic Endonasal Skull Base Surgeries Using the Sinonasal Outcomes Test (SNOT): A Tertiary Hospital Experience.

Introduction Endoscopic endonasal skull base surgery (EESBS) has been associated with a minimally invasive and effective approach for pathology of the anterior skull base and associated with less overall morbidity compared with open approaches. However, it is associated with its own potential morbidity related to surgical manipulation or resection of normal and noninflamed intranasal structures to gain adequate access. The assessment of sinonasal QOL (quality of life) postsurgery is therefore a vital aspect in follow-up of these patients. Objectives To assess quality of life and morbidity after endoscopic endonasal skull base surgery using the Sinonasal Outcomes Test (SNOT-22). Methodology. A single-center retrospective cross-sectional review with a sample of 80–100 patients undergoing endoscopic endonasal transsphenoidal surgery was conducted at the ENT and Neurosurgery departments of King Fahad Specialist Hospital-Dammam (KFSH-D) for a period of 10 years from March 2010 to March 2020. Data were collected through hospital records and database, as well as from patients through phone call interviews. Records were reviewed for diagnosis, demographic features, and 22-item Sinonasal Outcomes Test (SNOT-22) scores noted at three points in time: prior to procedure and after, at 3 months and 6 months. Results Within the study cohort comprising 96 patients, the mean age of the participants was 39.5 ± 12.1 years, and diagnostic typing before and after histopathological investigations revealed maximum pituitary adenomas (46.9%) closely followed by CSF-related ailments (41.7%). The changes in the mean and standard deviation of the total SNOT-22 scores postoperatively at the 3rd month (9.5 ± 5.4) and the 6th month (8.8 ± 5.2) were statistically significant (p < 0.001) when compared to the preoperative score (10.8 ± 5.1). Conclusion Although there was a predicted passivity of symptoms in the post-EESBS period, several significant positive outcomes were seen. The increase in discomfort in the sleep domains postsurgery is an issue to pursue and reason out. The overall SNOT-22 scores noted preoperatively and 3 and 6 months postoperatively showed statistically significant improvements in QOL with no long-term effects.

The Endonasal Endoscopic Management of Cerebrospinal Fluid Rhinorrhea.

IntroductionCerebrospinal fluid (CSF) rhinorrhea is the result of a bony defect at the skull base with disruption of the arachnoid, dura mater, and sinonasal mucosa that leads to an active CSF leak and flow of clear fluid from the nose. The endoscopic repair of CSF leaks and skull defects have been used by an increasing number of surgeons and is the standard of care for repairing CSF leaks.Materials and methodsWe conducted a retrospective study of all cases of CSF leaks managed via the endonasal endoscopic approach from 2010 to 2020 at a tertiary referral hospital of King Fahad Specialist Hospital, Dammam (KFSH-D).ResultsOver 10 years, 61 procedures were performed on a total of 56 patients (average age, 39.9 years) with 26 spontaneous CSF leaks and 30 traumatic CSF leaks. The leak sites were frontal bone in 14% of the cases, the roof of the ethmoid in 25%, the cribriform plate of ethmoid in 39%, and the walls of sphenoid sinus in 21%; multiple site defects were found in eight patients. The defect was localized by high-resolution computed tomography (CT) of the paranasal sinuses and skull base and magnetic resonance imaging (MRI) in all patients. CT cisternography, intrathecal fluorescein injection, and topical application of fluorescein dye were used in patients as required. A combination of free grafts and flaps materials were used in most patients. A middle and inferior turbinate graft was used in 12 patients, a septal cartilage graft in 18 patients, and a pedicled nasoseptal flap in 12 patients. The success rate was 92% after the first closure attempt. A recurrence of CSF leaks was observed in four patients. The mean hospitalization time was 6.5 days. The postoperative follow-up period ranged from one year to 10 years with a mean postoperative follow-up time of three years.ConclusionsThe endonasal endoscopic approach is the current standard of care for repairing most CSF leaks and skull base defects. We have had an excellent experience with endonasal endoscopic CSF leak repair, with high success rates and low morbidity. Our results support the effectiveness and safety of this technique and should encourage otolaryngologists to apply the procedure in cases of CSF leak.

The Business Case for Magnet® in an International Hospital.

There is a growing interest outside the United States in obtaining Magnet accreditation. King Fahad Specialist Hospital-Dammam became the 1st Ministry of Health hospital in the Kingdom of Saudi Arabia to be recognized as a Magnet-accredited institution. Understanding the return on investment of Magnet accreditation is important and speaks to the value of Magnet for international hospitals. Data from a peer hospital will aid nurse executives when presenting the business case for Magnet accreditation.

The Merit of Image Guidance in Endoscopic Frontal Sinus Surgery.

The introduction of image guidance navigation system in endoscopic sinus surgeries has been highly advocated in the recent past era. Ever since its introduction in the 1980s and 1990s in Germany it has been asserted that the image-guided navigation enhances surgical outcomes and diminished perioperative morbidities. The objective of this study is to reflect the experience of our institute with the image guidance navigation system in the frontal sinus endoscopic surgeries, specifically due to its constricted anatomy and proximity to vital structures. Retrospective chart review was performed for all image guided endoscopic frontal sinus procedures Performed at a tertiary referral center of King Fahad Specialist Hospital Dammam during the period from 2010 to 2019. A total of 450 endoscopic sinus and skull base procedures were performed using different image guidance systems. Out of the 450 cases, 231 cases were indicated for frontal sinus involvement. The fundamentals of anatomical knowledge are essential for the success of any surgery including image-guided surgeries. Utilization of image-guidance in endoscopic frontal surgeries assists in portraying the way to targeted frontal disease. It aids in localizing vital structures in distorted anatomy thus avoiding undesirable complications.

MRI Evaluation of Global Developmental Delay: A Retrospective Study

Introduction: Global developmental delay (GDD) is defined as a significant delay in one or more developmental domains. Aims and Objectives: To study the prevalence of normal and abnormal magnetic resonance imaging (MRI) in pediatric patients presenting with GDD, and how abnormal MRI helps in the diagnosis of children with GDD. Materials and Methods: This was a retrospective observational study conducted at the King Fahad Specialist Hospital Dammam. MRI of the brain was conducted on 170 patients who were referred by the Pediatric Neurology Department between February 2016 and April 2018. Results: Normal MRI findings were seen in 45.3% and 54.7% had abnormal findings. The ventricles and white matter, mainly the corpus callosum, were the most commonly affected anatomical structures. In 15 (16%) patients, MRI enabled a direct diagnosis, and in 22 (23.6%) MRI suggested a diagnosis which was confirmed by further investigation. Conclusion: The clinical diagnosis of GDD should not be the end point, but rather a springboard for an effective search for causal factors. MRI is the best investigation with a high yield in such patients.

Invasive Fungal Rhinosinusitis in Pediatric Populations; a Tertiary Hospital Experience

Fungal infection is a well-known and a common cause of sinusitis. Fungal sinusitis is classified into two main categories based on histopathological invasion as: invasive and non-invasive, the invasive form includes acute, chronic, and chronic granulomatous, while the non-invasive include: fungal ball, saprophytic fungal infestation, eosinophilic fungal sinusitis and allergic fungal sinusitis. Usually, Invasive fungal sinusitis is encountered in immunocompromised patients. However, there are many reports which have described these cases with immunocompetent individuals. The purpose of this review article is to summarize our long experience with pediatric patients diagnosed with invasive fungal sinusitis managed at a tertiary referral hospital at King Fahad Specialist Hospital Dammam, KSA and discuss the management and determine the variables that impact the outcome.

Identifying pattern in global developmental delay children: A retrospective study at King Fahad specialist hospital, Dammam (Saudi Arabia).

Global developmental delay (GDD) and intellectual disability are relatively common in pediatric neurology conditions. A retrospective study was designed to analyze risk factors and clinical features in children with GDD at our hospital. No previous data is available on GDD from Saudi Arabia. This study was conducted at king Fahad specialist hospital Dammam (KFSHD) of 134 GDD children (82, 61% males, 52, 39% females), (age 1-9 years). They were assessed by using Griffith Mental Development Scales for (0-2) years and 3-8 years old in locomotors, personal/social, communication, eye & hand co-ordination, performance and practical reasoning. Patients with ASD and non-cooperative behavior were excluded. 75% had developmental delay since birth while 84% had no problem during pregnancy. 22% had birth weight below 2.5 kg. 56% had epilepsy and 57 % had interfamily marriages. 51% were diagnosed cases in the present study. 40% had genetic cause, 25% had metabolic problem, 58% had neuroradiology abnormality and 45% had EEG abnormalities. There a variety of delays in development (speech and language variant, global delay, and the motor variant) noted and are commonly seen in a clinical practice in KFSHD. Longitudinal research beginning in early development will help to understand the developmental domains and neurological comorbidities in these children at high risk for neurodevelopmental disorders.

Clinical profile and outcome of patients with myasthenia gravis, post-thymectomy versus non-thymectomy. A 10-year retrospective study in a tertiary care hospital

To study the clinical profile and outcome of post-thymectomy versus non-thymectomy in patients diagnosed with Myasthenia Gravis followed at King Fahad Specialist Hospital-Dammam, Saudi Arabia. A retrospective, observational study was conducted in a tertiary care hospital in Dammam, Saudi Arabia. Data from 75 patients’ files diagnosed with myasthenia gravis across ten years, between January 2008 to December 2018, were analyzed by Statistical Package for Social Sciences (SPSS). All patients were above the age of 16 years. Fifty-five patients are female (74%), and 20 patients are male (26%). At diagnosis, the majority of the patients had a generalized type (66.6%), and ocular/oculobulbar accounts for 33.4%. Using the Myasthenia Gravis Foundation of America (MGFA) classification, 44 % of patients fell under Class 3. Acetylcholine receptor (AchR) antibody was positive in 50 patients (66.7%), and antiMUSK antibody was positive in 14 patients (18.7%). The most common thymic histopathology was normal (57.3%) followed by follicular hyperplasia (18.7%) and thymoma (13.3%). Thymoma was only found in patients with AchR antibody positive. Thymectomy was done for 39 patients (52%). Patients who underwent thymectomy achieved stable and pharmacological remission more than non-thymectomy patients (p-value <0.000). No significant difference in the clinical outcome was found between patients taking Azathioprine versus Mycophenolate. Thymectomy appears to provide a high rate of stable remission as compared to non-thymectomy. Moreover, Mycophenolate seems to be as effective as Azathioprine in the long term therapy of Myasthenia Gravis.

Local experience in Saudi Arabia of selective internal radiation therapy with yttrium-90 microspheres for the treatment of unresectable liver tumours

AbstractAim:To assess local experience in Saudi Arabia of the effectiveness and tolerability of selective internal radiation therapy (SIRT) in patients with liver tumours.Materials and methods:In a retrospective study, patients with unresectable liver tumours treated with yttrium-90-labelled resin microspheres (SIR-Spheres®, Sirtex, Australia) at the King Fahad Specialist Hospital Dammam (KFSHD) were followed up for at least 12 months, or until death. Data were extracted from medical records. The primary outcome measure was overall survival (OS). Tumour response was recorded using the modified Response Evaluation Criteria in Solid Tumors (mRECIST): tumour control (TC) was defined as the proportion of patients with stable disease (SD), partial response (PR) and complete response (CR).Results:A total of 30 patients (21 males, 9 females) with hepatocellular carcinoma (76⋅7%), metastatic colorectal cancer (13⋅3%), cholangiocarcinoma (6⋅7%) or carcinoid tumour (3⋅3%) were evaluated. Mean OS was 16⋅98 months. Eighty-five percent of patients showed TC, 35% had SD, 15% a PR and 35% a CR. No severe complications were observed. Four deaths were considered unrelated to treatment.Findings:In this cohort, SIRT showed similar efficacy to that in other studies, with an acceptable tolerability profile. SIRT appears a feasible procedure for liver tumour treatment in the KFSHD.

Isolated sphenoid inflammatory diseases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Isolated sphenoid inflammatory disease is a rare clinical condition among patients with paranasal sinus disease, reported incidence ranged between 1-3%. The most common symptoms of isolated sphenoid inflammatory lesions are headache, ophtalmological and nasal symptoms. Delayed diagnosis may occur due to its nonspecific symptoms. The disease requires appropriate and good imaging technique for diagnosis. The objective of the study was to discuss different pathologies of isolated sphenoid inflammatory lesions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; From 2008 to 2017, we performed surgery on 27 patients with isolated sphenoid inflammatory diseases. The presenting signs and symptoms, radiological studies, operative findings, and clinical outcomes were retrospectively reviewed and analyzed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 27 cases were identified at tertiary hospital of King Fahad Specialist Hospital Dammam. 12 bacterial sphenoid sinusitis, 4 allergic fungal sinusitis, 4 fungal balls, 2 invasive fungal sinusitis, 3 pediatric (2 sphenoid sinusitis and 1 allergic fungal sinusitis), 1 mucocele and 1 mycopyocele were noticed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Isolated sphenoid inflammatory disease is rare, with comprehensive history taking, complete physical examination, appropriate endoscopic examination and advanced imaging studies will give appropriate clinical diagnosis. Histopathologyand microbiology is important for definite diagnosis.&lt;/p&gt;

New-onset diabetes after transplantation among renal transplant recipients at a new transplant center; King Fahad Specialist Hospital-Dammam, Saudi Arabia.

New-onset diabetes after transplant (NODAT) has been reported to occur in 4%-25% of renal transplant recipients. Its development has also been shown to be associated with an adverse impact on patient survival and an increased risk of graft rejection and graft loss, as well as an increased incidence of infectious complications. The study aims to describe the incidence of NODAT and its important risk factors in a single center. We conducted a retrospective analysis of data from all kidney transplant recipients in our center, transplanted between September 2008 and May 2013. Out of 311 patients, 77 had diabetes mellitus (DM) before transplantation and were excluded, leaving 234 patients as the study population. NODAT was diagnosed based on the WHO definition for DM: any two readings of fasting blood sugar >7 mmol/L or random blood sugar >11 or the use of hypoglycemic medications after 1st posttransplant month. The mean age of the study patients was 36 years ± 14 years; 55.5% were male, 69% had living-related transplant, 31% had deceased donor transplant, 98% were on tacrolimus-based immunosuppression regimen, 2% on cyclosporine and all patients were on the steroid-based regimen. The 1 and 5-year cumulative incidence of NODAT was 14.1% and 27.5%, respectively. The median duration to onset of NODAT was 2.5 months. The body mass index of >30 kg/m2 and age >60 years at the time of transplant were significantly associated with the occurrence of NODAT. Our finding of incidence was not different from what has been reported in the literature. Larger prospective and multicenter studies are needed.

New mutations of EpCAM gene for tufting enteropathy in Saudi Arabia

Background/Aim:Tufting enteropathy (TE) is a rare cause of congenital intractable diarrhea in children. It often results in an irreversible intestinal failure and total parenteral nutrition (TPN) dependency; eventually, intestinal transplantation may be necessary. Data on TE from the Middle East are scarce; therefore, our aim of conducting this study was to clarify the clinical, histopathologic, and molecular features of TE in Saudi children.Patients and Methods:This was a retrospective chart review of four children with TE who presented between January 2011 and December 2013 to King Fahad Specialist Hospital-Dammam (KFSH-D). The diagnosis of TE was suspected based on characteristic histopathologic intestinal biopsy findings and confirmed by EpCAM gene testing.Results:Molecular testing identified two novel mutations in the EpCAM gene in our patients. These mutations were associated with severe phenotype of the disease characterized by very early onset (median of 2 weeks of life), TPN dependency, and death during early childhood. Two patients died due to central line-related complications. Two patients were referred for intestinal transplantation due to loss of intravenous access in one and progressive liver disease in the other.Conclusion:Mutations in EpCAM gene in Saudi children are characterized by severe phenotype and poor outcome.

5. Newly developed atrial fibrillation in liver transplant patient with intravenous dexmedetomedine sedation

Introduction Atrial fibrillation (AF) is the commonest type of arrhythmias in common population and critically ill as well. Intensive care patients are vulnerable to develop AF due to numerous causing and risk factors during their illness. Drug-induced AF is a group of underestimated causes known to induce arrhythmias in severely ill patients one of these medications is. Dexmetedomedine (precedx™) one of relatively new sedative-analgesic is effectively used in mechanically ventilated patients and as a consequence recent critical care society recommendations claimed dexmedetomidine may be preferred over sedation with benzodiazepines. Case report We present a case report of newly developed resistant AF in post living-related liver transplant lady who received intravenous dexmedetomidine as recommended sedative to liberate her from the ventilator. Discussion Despite the presence of other clinical risk factors pertinent to the patient to develop AF which took place after starting dexmedetomidine, yet the resolution of AF had occurred subsequent to cessation of dexmedetomidine. Retrospective analysis of critical care department database of king Fahad specialist hospital Dammam from January 2011 till July 2014 up to revealed about 20% of patients received intravenous dexmedetomidine had experienced AF. In fact these results are higher than the reported information by the literature. Conclusion Intravenous dexmedetomidine (precedex™) is a common cause of AF in critically ill patients. This kind of side effect needs scrutinized assessment and follow up to find out the risk factors involved in its development especially in the era of increasing dexmedetomidine as a state-of-art recommended sedative agent in intensive care units and perioperative as well.

A Comparative Study of Piperacillin-Tazobactam With and Without Vancomycin as Empirical Therapy for Febrile Neutropenic Patients With Solid Tumor Malignancies.

BackgroundThe objective of this study was to evaluate the outcomes, mortality and toxicity associated with piperacillin-tazobactam (PT) and the addition of vancomycin (VM) to the empirical treatment of febrile neutropenic cancer patients.MethodA retrospective study on adult febrile neutropenic patients who were admitted between September 2008 and May 2013 with solid tumor malignancies was conducted at King Fahad Specialist Hospital Dammam, Saudi Arabia.ResultsOut of 86 febrile neutropenic patients, 60 patients were treated with PT group and 26 patients were with PT + VM group. The two groups were comparable in terms of outcome, mortality, nephrotoxicities and hepatotoxicities. The median duration of neutropenia in PT treatment group was 4 days (range 1 - 10) in the female and 7 days (range 1 - 13) in males while in PT + VM 6 days (range 1 - 5) in female and 7.5 days (range 1 - 6) in male with significance P = 0.007. There was no significant difference in terms of duration of fever and length of stay between the two treatment groups. There were no deaths reported during treatment in both groups. In PT, the microbial eradication was 27/40 (67.5%) patients (14/27 (51.9%) of female and 13/27 (48.1%) of male)), whereas it was 13/40 (32.5%) patients (9/13 (69.2%) of female and 4/13 (30.8%) of male)) in PT + VM group. Overall, there was no significant difference in terms of microbiological eradication between the two groups (OR: 1.22; 95% CI: 0.486 - 3.072; X2 stat: 0.182; P = 0.67). Response to therapy in clinically defined infections was higher 16/23 (69.56%) in PT treatment group than 7/23 (30.44%) in PT + VM group. But there was no significant difference between the two treatment groups in terms of clinically defined infections (OR: 1.013; 95% CI: 0.359 - 2.862; X2 stat: 0.001; P = 0.98). There was no significant difference in renal and liver functions between the two groups in terms of serum creatinine level and clearance, alkaline phosphate and alanine tranferase and gama glutamyl tranferase. The most commonly isolated organisms were Escherichais coli (eighteen isolates), Staphylococcus aureus (seven isolates), Streptococcus spp (six isolates) and Klebsiella pneumonia (four isolates). The overall success rate was similar in both treatment arms and treatment was well tolerated, with no severe adverse reactions reported.ConclusionAlthough the addition of VM might provide an additional value for coverage of gram-positive pathogens. This study demonstrates that there was no significant difference in terms of response rate in both treatment groups, which could be due to the low local methicillin-resistant Staphylococcus aureus (MRSA) rates and other resistant gram-positive organisms at our institution, stressing the importance of local antibiograms in developing empirical neutropenic fever protocols.