King Fahd Specialist Hospital Research Articles

The Association between Vitamin D Status and Diabetic Complications in Type 2 Diabetic Patients

Diabetes can affect many different organs in the body and may lead to serious complications. Many studies related vitamin D deficiency to the occurrence Type 2 diabetes complications. However, the link between diabetic complications and vitamin D deficiency is under debate. Therefore this study aimed to evaluate the clinical relevance of vitamin D levels on diabetic complications. This retrospective cross-sectional study was conducted on 252 patients followed at King Fahd Specialist Hospital in Buraydah and King Saud Hospital in Unaizah, Saudi Arabia. The participants were divided into five groups: Non-diabetic group, diabetic without complications, diabetic nephropathy, diabetic peripheral neuropathy, and diabetic retinopathy. 78.3% of diabetic neuropathy showed vitamin D deficiency compared to diabetic nephropathy (75%), retinopathy (56.9%), and diabetics without complications (31.4%). Vitamin D deficiency was higher in diabetic patients with complications (69.8%) compared to those without complications (31.4%). Moreover 39.2% of diabetics without complications showed normal vitamin D level compared with 13.4% of diabetics with complications. The results showed that vitamin D deficiency was significantly associated with diabetic complications.

Trends and Outcome of Aggressive Fascial Space Infections.

Background: Odontogenic infections are common and self-limiting in most cases; however, they can lead to severe consequences, considerable morbidity and can even be fatal despite modern medical therapy. Patients and Methods: This retrospective study included patients with severe deep fascial space infections treated in the Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag Governorate, Egypt, and the Department of Oral and Maxillofacial Surgery, King Fahd Specialist Hospital (tertiary referral center), Burayda City, Qassim Province, Saudi Arabia, from June 2017 to June 2022. Results: This study included 296 patients, 161 (54.4%) males, 135 (45.6%) females. The fifth decade of life was the most common vulnerable age group. Forty-three percent of patients had diabetes mellitus, 26.6% were hypertensive, and 13.3% were on long-term steroid therapy. In 83% of patients, the offending tooth was identified but in 17% of patients no dental cause was identified. The lower third molar tooth was most commonly involved. Sixty-nine (23.3%) patients had submandibular space infections. Fifty-three (17.9%) patients had canine space infections. Thirty (10.1%) patients had submasseteric space infection. Twenty-eight (9.5%) patients had submental space infections. Twenty-three (7.8%) patients had combined infection of the submasseteric, submandibular, and pterygomandibular spaces, whereas 19 (6.4%) patients presented with Ludwig's angina. Conclusions: Odontogenic infections are common. The submandibular space is the most commonly affected single space. These infections could lead to lethal complications in immunocompromised patients, especially patients with diabetes mellitus. These infections require urgent surgical intervention to decrease hospital stays and avoid potentially lethal complications.

Emergency Physicians' Awareness of Medico-Legal Case Management: A Cross-Sectional Study from Saudi Arabia.

Emergency department physicians often encounter medico-legal cases when patients initially present to the hospital, and thus there is a strong need for them to have robust medico-legal management and reporting knowledge. To assess the awareness of emergency department physicians of two major hospitals in the Eastern Province of Saudi Arabia in managing medico-legal cases. This descriptive cross-sectional survey-based study included all adult and pediatric emergency physicians working at King Fahd Hospital of the University and King Fahd Specialist Hospital, two major government hospitals in the Eastern Province of Saudi Arabia. The questionnaire included questions about demographic information, the workload in the emergency department, previous medico-legal training, and information about physicians' perspectives regarding medico-legal situations. A total of 85 physicians completed the questionnaire, with most being Saudis (78.8%) and consultants (44.7%). Most participants (84.7%) immediately notified the police authority through the official procedure on suspicion of a case being criminal. However, only 28.2% of the participants were aware of how to complete the medico-legal report, and the majority (82.4%) had not received any specific training or attended specific courses in writing medico-legal reports. Most participants (91.8%) expressed the need for additional medico-legal case training programs, with continuous education (29.4%) being the preferred mode. In addition, 60% of the consultants were dissatisfied with the current medico-legal reporting and management workflow in their hospital. About half of the participants did not obtain photographs in medico-legal cases and did not know if their workplace provided a protocol for collecting evidentiary material such as clothes, swabs, bullets, remnants of foreign bodies, etc. The results of the present study indicate the necessity to consider periodical continuing medical education programs and workshops for emergency department physicians in the Eastern Province of Saudi Arabia to help them in appropriately handling medico-legal cases.

Clinical Characteristics, Outcomes and Prognostic Factors for Critical Illness in Hospitalized COVID-19 Patients in Saudi Arabia: A Retrospective Cohort Study.

BackgroundA good understanding of the possible risk factors for coronavirus disease 19 (COVID‐19) severity could help clinicians in identifying patients who need prioritized treatment to prevent disease progression and adverse outcome. In the present study, we aimed to correlate clinical and laboratory characteristics of hospitalized COVID-19 patients to disease outcome in Saudi Arabia.Materials and MethodsThe present study included 199 COVID-19 patients admitted to King Fahd Specialist Hospital, Buraydah, Qassim, Saudi Arabia, from April to December 2020. Patients were followed-up until discharge either for recovery or death. Demographic data, clinical data and laboratory results were retrieved from electronic patient records.ResultsCritical COVID-19 cases showed higher mean of age and higher prevalence of co-morbid conditions. Fifty-five patients died during the observation period. Risk factors for in hospital death for COVID 19 patients were leukocytosis (OR 1.89, 95% CI 1.008–3.548, p = 0.081), lymphocytopenia (OR 2.152, 95% CI 1.079–4.295, p = 0.020), neutrophilia (OR 1.839, 95% CI 0.951–3.55, p = 0.047), thrombocytopenia (OR 2.152, 95% CI 0.852–5.430, p = 0.085), liver injury (OR 2.689, 95% CI 1.373–4.944, p = 0.003), acute kidney injury (OR 1.248, 95% CI 0.631–2.467 p = 0.319), pancreatic injury (OR 1.973, 95% CI 0.939–4.144, p = 0.056) and high D dimer (OR 2.635, 95% CI 0.747–9.287, p = 0.091).ConclusionClinical and laboratory data of COVID-19 patients may help understanding the pathogenesis of the disease and subsequently improve of the outcome of patients by determination of the associated risk factors and recognition of high risk group who are more liable for complications and in hospital death. The present study put an eye on some parameters (laboratory and clinical) that should be alarming signs that the patient is at high risk bad prognosis.

Sensitivity of DiaRem Scoring System in Predicting Type Two Diabetes Mellitus Resolution After Bariatric Surgery in Qassim Region.

Introduction: Type two diabetes mellitus (T2DM) remission has been observed as an additional benefit of bariatric surgery for morbidly obese diabetic patients. There are many scoring systems for identifying factors that predict diabetes remission; however, there is as yet no universally applicable scoring system.Aim: This study aims to test the sensitivity of the DiaRem scoring system for predicting the resolution of T2DM in morbidly obese patients who underwent bariatric surgery at King Fahad Specialist Hospital in Buraydah, Saudi Arabia.Methods: This was a non-randomized controlled trial conducted at King Fahd Specialist Hospital in Buraydah, Saudi Arabia. Visiting patients at first screening were enrolled based on eligibility criteria. Data were collected according to the given parameters such as gender, age, body mass index (BMI), duration of diabetes mellitus (DM), medications (insulin, oral antihyperglycemic agents, number of tablets if used, or no medications use), presence of comorbidities, such as hypertension and dyslipidemia, HbA1c level (before surgery and at third, sixth, and 12th months after surgery), and fasting blood glucose (FBG) level (before and after surgery).Results: A total of 96 diabetic patients were enrolled (35 males vs 61 females) with a mean age of 46.5 years. Laparoscopic sleeve gastrectomy was the most commonly performed surgery. The most common associated comorbidities were hypertension (50%) and hypothyroidism (14.6%). Results of the DiaRem scoring system showed 0-2 points in 15.6% patients, 3-7 points in 39.6% patients, 8-12 in 26% patients, 13-17 in 9.4% patients, and 18-22 in 9.4% patients. The lowest DiaRem score was associated with a higher value of BMI, shorter DM duration, and lower mean values of HbA1c and FBG post-surgery.Conclusion: Consistent with the literature, our results indicated that those with an increased BMI, shorter duration of DM, and lower values of HbA1c post-FBG had a greater chance of diabetes remission postoperatively.

Management of Dentigerous Cyst in Children and Adolescents

Background: The purpose of the present study was to evaluate the efficacy of marsupilization of dentigerous cyst in children and adolescents as a line of treatment and its role in involved teeth preservation, during the last three years in maxillofacial department, King Fahd specialist hospital, Qassim, Saudia Arabia. Methods: twelve patients with dentigerous cysts were included in this study, 7 males and 5 females. Age range was 9 – 15 years old. Follow up to one-year postoperatively, early and late radiological evaluation. Followed by orthodontic alignment of teeth if needed. Results: Marsupialization (decompression) is a reliable technique for management of dentigerous cysts in children and adolescents for cyst healing and involved tooth preservation, but it needs long periods of follow up, cooperative patient and sometimes orthodontic work up. Conclusions: Marsupialization of dentigerous cyst should be considered in children and young adults, especially in large cysts and when tooth preservation is desirable.

Prevalence and Significance of Pyuria in Chronic Kidney Disease Patients in Saudi Arabia.

Chronic kidney disease (CKD) is considered a major health problem, which poses a burden for health care systems worldwide. It has been estimated that 10% of the population worldwide have CKD; however, most of the cases are undiagnosed. If left untreated, CKD could lead to kidney failure, which highlights the importance of early diagnosis and treatment. Pyuria has been reported in CKD patients, and could be the result of several comorbidities, such as diabetes, or urinary tract infections (UTIs). A few studies have shown that pyuria is associated with the late stages of CKD. However, there are limited data on the prevalence of non-UTI (sterile) and UTI–pyuria in different CKD patient populations, and its association with the decline in kidney function and progression of CKD. In this retrospective study, we report the prevalence of pyuria (sterile and UTI) in 754 CKD patients of King Fahd Specialist Hospital, Buraydah, Saudi Arabia. Our data showed that 164/754 CKD patients (21.8%) had pyuria, whereas 590 patients (78.2%) presented with no pyuria. There was a significantly higher percentage of late-stage (stage 4) CKD patients in the pyuric group compared to the non-pyuric group (36.6% vs. 11.9%). In line with the previous data, proteinuria was detected in a significantly higher percentage of pyuric patients, in addition to significantly higher levels of serum creatinine and urea, compared to non-pyuric patients. Furthermore, 13.4% of the pyuric CKD patients had UTI, whereas 86.6% presented with sterile pyuria. E. coli was indicated as the causative agent in 45.5% of UTI patients. Our patient data analysis showed that a significantly higher percentage of UTI–pyuric CKD patients, than sterile pyuric patients (63.6% vs. 19.7%), had higher numbers of urinary white blood cells (>50/HPF, WBCs). The data also showed that a higher percentage of UTI–pyuric patients were late-stage CKD patients, compared to sterile pyuric patients (50% vs. 34.5%). Our findings indicate that a high level of pyuria could be considered as a marker for late-stage CKD, and that UTI is an important risk factor for the decline in kidney function and the progression to late-stage CKD. We believe that further studies are needed to correlate pyuria to kidney function, which could be helpful in monitoring the progression of CKD. Moreover, the management of comorbidities, such as diabetes and UTIs, which are risk factors for CKD and associated pyuria, could help to control the progression of CKD to the late stages.

Manifestations of renal system involvement in hospitalized patients with COVID-19 in Saudi Arabia.

BackgroundAlthough COVID-19 is an acute disease that usually resolves rapidly in most cases, the disease can be fatal and has a mortality rate of about 1% to 56%. Alveolar injury and respiratory failure are the main causes of death in patients with COVID 19. In addition, the effect of the disease on other organs is not fully understood. Renal system affection has been reported in patients with COVID 19 and is associated with a higher rate of diverse outcomes, including mortality. Therefore, in the present work, we reported the clinical characteristics and laboratory data of hospitalized patients with COVID-19 and analyzed the manifestations that indicated renal system involvement and their impact on clinical outcomes.Materials and methodsThis was an observational retrospective study conducted at King Fahd Specialist Hospital, Buraydah, Saudi Arabia. All patients with COVID-19 who were admitted to this Hospital from April to December 2020 were included in the study. The patients’ findings at presentation were recorded. Demographic data and laboratory results (hematuria, proteinuria, urinary sediment cast and pus cell presence, and kidney function tests) were retrieved from electronic patient records.ResultsOne hundred and ninety-three patients with confirmed COVID 19 were included in the study. Dipstick examinations of all urine samples showed proteinuria and hematuria in 53.9% and 22.3% of patients, respectively, whereas microscopic examination revealed the presence of pus and brown muddy granular casts in 33.7% and 12.4% of samples, respectively. Acute kidney injury was reported in 23.3% of patients. A multivariable analysis demonstrated that hematuria was associated with acute kidney injury (AKI) (OR, 2.4; 95% CI, 1.2–4.9; P = 0.001), ICU admission (OR, 3.789; 95% CI, 1.913–7.505; P = 0.003), and mortality (OR, 8.084; 95% CI, 3.756–17.397; P = 0.002). Conversely, proteinuria was less significantly associated with the risk of AKI (OR, 1.56; 95% CI, 1.91–7.50; P = 0.003), ICU admission (OR, 2.493; 95% CI, 1.25–4.72; P = 0.001), and mortality (OR, 2.764; 95% CI, 1.368–5.121; P = 0.003). Patients with AKI had a higher probability for mortality than did those without AKI (OR, 14.208; 95% CI, 6.434–31.375; P = 0.003).ConclusionThe manifestations of the involvement of the renal system are not uncommon in COVID-19. These manifestations included proteinuria, hematuria, and AKI and were usually associated with a poor prognosis, including high incidences of both ICU admission and mortality.

High Dose Chemotherapy (HDCT) With Autologous Stem Cell Transplantation (ASCT) in Children with Solid and Central Nervous System (CNS) Tumors, a Single Centre Experience

Objectives: The Primary aim of this study is to assess the outcome of children with solid and CNS tumors who underwent HDCT and ASCT at King Fahad Specialist Hospital in Dammam, secondarily we aim to compare our local results with national and international outcomes, Identify the toxicities, and complications of this modality of treatment, and identify the outcome in term of overall survival and relapse and mortality rates. Design: This is a retrospective cross-sectional study of all the pediatric patients below sixteen-year-old who diagnosed with solid tumor or central nervous system tumor and treated by high dose chemotherapy and autologous stem cell transplantation in king Fahd specialist hospital in Dammam, pediatric hematology/ oncology department between 1st November 2011 and 29th February 2020, our study included 33 cases. Setting: It is a single center study at King Fahad Specialist Hospital in Dammam which is 400 beds tertiary referral hospital with 27 beds pediatric oncology Ward, 4 beds bone marrow transplant and 18 bed pediatric oncology day care services. Methods and Results: After obtaining the IRB approval, all data and information of patients were retrieved from patients’ hard files and electronic medical records. Data analysis were done by using Statistical Package for the Social Sciences (SPSS) program version and stored in the Redcap system for confidentiality. Results: Within our study period we diagnosed 33 cases who diagnosed with solid tumor or central nervous system malignancies and treated by high dose chemotherapy and autologous stem cell transplantation in king Fahd specialist hospital in Dammam, the overall survival was 66% with both the relapse rate and mortality rate were 33%. Conclusion: In summary, despite being a single-center experience and relatively small sample size, yet we believe that our study showed that the approach of using HDCT followed by APBSCT for managing children with advanced malignant solid tumors is safe and effective with the best results obtained in those with complete remission status before that approach. A prospective study will be more suitable to evaluate whether HDCT with autoi?½??PBSCT will significantly impact the outcomes in the treatment of children with advanced malignant solid tumors. a serious international collaboration is crucial to design randomized trials aiming to address these expensive and high morbidity procedures in treating childhood advanced solid malignant tumors.

Infant Leukemia, Single-Center Eight Years' Experience

Objectives: The aim of this study is to evaluate the clinical course, laboratory findings and treatment outcomes of the infant patients diagnosed with leukemia treated in our center. Design: This is a retrospective study of all the patients below one year old who diagnosed with leukemia and treated in King Fahd specialist hospital in Dammam, pediatric hematology/ oncology department between 1st January 2011 and 1st December 2018, our study included 14 cases. Setting: It is a single center study at King Fahad Specialist Hospital in Dammam which is 400 beds tertiary referral hospital with 27 beds pediatric oncology Ward, 2 beds bone marrow transplant and 18 bed pediatric oncology day care services. Methods and Results: All data and information of patients including laboratory results were retrieved from patients’ files and electronic medical records. Data analysis was done by using Statistical Package for the Social Sciences (SPSS) program version. Results: Within our study period we diagnosed 13 cases with infantile leukemia out of 202 cases of childhood leukemia in 8 years period (incidence of 6.4%) with overall survival of 61.5%. Conclusion: The incidence of ALL in infants is significantly lower than in other groups of children it tends to be presented with aggressive clinical features at diagnosis, including hyper leukocytosis, massive organomegaly, and central nervous system (CNS) involvement. The management particularly challenging, the outcome is inferior with tendency towards refractory course and increased relapse rates. In our study the survival rate was 61.5% which is minor better than what was reported in some centers for theses group of patients probably masked by the small number of patients in our study. More studies with larger patient numbers are needed to reevaluate HSCT's eligibility criteria in this group of patients, in addition to studying some new strategies such as CAR-T cell, targeted therapies, improving conditioning regimens, and maximize the supportive care should all be considered to improve the prognosis.

Methicillin-resistant Staphylococcus aureus development in intensive care patients. A case-control study.

Objectives:To determine the factors associated with the development of methicillin-resistant Staphylococcus aureus (MRSA), hospital stay and mortality, and early versus late MRSA infection.Methods:Cases (n=44) were intensive care unit (ICU) patients admitted to King Fahd Specialist Hospital, Al-Qassim, Saudi Arabia between 2015 and 2019 who developed MRSA during their hospital stay. Controls (n=48) were patients from the same place and period who did not develop MRSA. Data were abstracted from hospital records.Results:Admission with sepsis (case: 46% vs. control: 2%, p<0.001) and having at least one comorbid condition (case: 95% vs. control: 46%, p<0.001) were significantly associated with the development of MRSA. Age (mean ± SD: case: 65±18, control: 64±18, p=0.7) and gender (% male, case: 52%, control: 56%, p=0.70) were not associated with the development of MRSA. Approximately 73% of all MRSA cases developed within the first 2 weeks of admission. Among the early cases, 44% died during their ICU stay; the corresponding percentage among the late cases was 42% (p=0.69). There was no difference between early and late MRSA cases in terms of non-sepsis admissions (50% vs. 67%, p=0.32) or comorbid status (at least one: 97% vs. 92%, p=0.17).Conclusion:Sepsis and comorbid conditions were significant risk factors for MRSA development among hospital patients.

Comparing the use of Arabic decision aid to usual care. A multicenter randomized controlled trial for Arabic speaking metastatic colorectal cancer patients in Saudi Arabia.

Objectives:To evaluate the effect of decision aids (DAs) for metastatic colorectal cancer (mCRC) patients in the Arabic language.Methods:A multi-centered randomized control trial was used to evaluate the effect of Arabic DA use with usual care for mCRC patients compared to usual care alone. Patients were recruited from 4 main oncology centers in Saudi Arabia King Fahad Medical City, Riyadh; King Khalid University Hospital, Riyadh; King Saud Medical City, Riyadh; and King Fahd Specialist Hospital, Dammam, Saudi Arabia, between March 2016 and October 2018. The final follow up was in April 2019. The study measured patient understanding of prognosis, treatment options, and the level of the patient’s anxiety.Results:Ninety-two patients were included in the analysis; 51 in the intervention group. A small proportion of both (DA with usual care and usual care) understood that mCRC was incurable (8% and 5%) of the 2 groups, respectively. There was no significant difference between groups in anxiety level; however, a time effect both initially and after one month was significantly higher than at 6 month.Conclusion:The study shows that a higher level of patient’s baseline understanding lowered anxiety levels over time. Decision aids group presented low levels of anxiety over time than those provided the usual care. We recommend using Arabic DA in the oncology centers dealing with mCRC patients, aiming to empower patients in decision making.

Prevalence of Canine Impaction among Saudi Population at Al Qassim Area in the Kingdom of Saudi Arabia

Background: One of the most reported dental problems is a tooth impaction which is defined as the infraosseous position of the tooth after the estimated time of eruption [1]. Thus, the most notable tooth impaction is canine impaction which is a frequently encountered clinical problem. Aim: This study aimed to determine the prevalence of impacted canines among Saudi people from the 5-year period of 2013-2018 in Al Qassim area in the KSA. Methodology: A retrospective research designed was utilized in the study. A retrospective study simply means to “look back” in the past and usually done by obtaining data from medical records of the targeted population with common characteristics [2]. Results: This 5-year study covered year 2013 to 2018. In this study, there were 1500 who seek dental health in King Fahd Specialist Hospital. Thus, out of these clients, only 89 were identified with cases of impacted canine using the OPG with a prevalence rate of 5.9 %. In addition, it was found that out of 89 patients identified, the patients have impacted canines in different locations: maxillary, mandible, right side and left side. It was found that there were 187 impacted teeth in different locations among 89 clients affected. There were 48 cases (25.7%) of impacted canines on the right side while 64 cases (34.2%) were reported on the left side of the total group. Moreover, impacted maxillary canine were 68 cases (36.4%) and mandibular impacted canine were only 7 cases (3.7%) of the total group. Conclusion: The early detection and treatment approach of impacted canines among affected individuals is vital in order to prevent different problems that may arise during impaction of canine teeth. Awareness, early detection, proper diagnostic test and multiple treatment approaches are needed to prevent different sequelae due to canine impaction.

The Use of Computed Tomography in the Diagnosis of Fatty Liver and Abdominal Fat Distribution among a Saudi Population

BACKGROUND:The pandemic of obesity is striking heavily worldwide and particularly among the affluent Gulf States where it is expected to continue to rise along with its complications.AIM:To examine the link between liver fat infiltration and abdominal fat amount using plain computer-assisted tomography (CT).METHODS:Fifty patients visiting the obesity clinic of “King Fahd Specialist Hospital” or Dr Suliman Alhabeeb Hospital between January 2015 and April 2016 were included. Liver and splenic attenuation dimensions were undertaken with three hepatic regions of interests (ROIs) and two ROIs from the spleen. The liver attenuation indices (LAIs) that were measured liver parenchymal attenuation (CTLP), liver/splenic attenuation ratio (LS ratio)and the (3) difference between liver and splenic attenuation (LS dif) and based on this LS dif The patients were grouped as LS dif greater or less than 5. Abdominal fat was evaluated utilising a 3 mm chop CT scan starting from the umbilicus; then computed by a workstation. The abdominal fat was classified as total fat (TF) and the sub-compartments of visceral adipose (fat) (VF), and subcutaneous fat (SF).RESULTS:Twenty-six of the participants were males. The mean (SD) of the age and BMI was 48 (14.9) years and 32.05 (8.3) kg/m2 respectively. The BMI and body Wt had a moderate negative correlation with the liver attenuation indices CTLP, LS ratio, LS diff (r = -0.417, -0.277, -0.312 and 0.435, -0.297, -0.0297), respectively. A very strong negative correlation between fatty liver, LS ratio and CTLP was found (-0.709, -0.575) respectively.CONCLUSION:Plain computed tomography can reliably be used as a survey device for fatty liver disease.

Outreach and Partnership Oncology Center Program Model in Eastern Province, Dammam, Saudi Arabia (Out-East)

The overall goal of King Fahd Specialist Hospital Oncology center outreach program is to bring cancer care delivery to individuals in their own communities, thereby generating a broadly applicable evidence base that contributes to improved patient outcomes and a reduction in cancer disparities through establishment of clearly defined and progressively implemented policy of evidence-based practices, utilizing local resources through a transfer of knowledge and management responsibilities to local healthcare professionals.

Retrospective Observational Study on Multiple Myeloma Cases Admitted to Kfsh – Dammam Between 1st of June 2006 till the End of December 2013

Introduction: Multiple myeloma (MM) is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. It accounts for approximately 1 percent of all cancers and slightly more than 10 percent of hematologic malignancies in the United States. There is a scarcity on the information of myeloma in the kingdom of Saudi Arabia.Hence was this observational study from a single center in Dammam, Saudi Arabia. Method:Retrospective chart review of consecutive patients Diagnosed with Multiple myeloma in the period between 1st of May 2006 until end of December 2013 at King Fahd Specialist Hospital in Dammam (KFSHD). Purpose:to describe the presenting characteristics of MM patients in our region, treatment patterns prescribed with the outcome of therapy that include progression free survival and overall survival. Result:63 patients with multiple myeloma were diagnosed and treated during this period. The percentage of patients with ECOG (≥2) is 52.3 % . 60 % of the patients had stage III international staging system (ISS). Only 17.4% received Triple agents as primary therapy as most of our patients received duplet therapy. 46% received High Dose therapy and Autologous stem cell transplantation. the PFS was 41.1 % and the OS of 69.1% at 95 months. Conclusion:Our results showed that we had rather younger patient population with a median age of 60 compared to the average western myeloma patient population. Despite the relatively young age those patients unfortunately had relatively poor performance status and high ISS stage which correlate with worse clinical outcome. However, the response to therapy and the outcome of our patients were superior to the outcome of any cohort of patients with similar disease characteristic. This observation worth further studying which could be due to an unknown disease or treatment related factors that might affect positively the patient’s outcome. DisclosuresNo relevant conflicts of interest to declare.

E-governance role in raising the efficiency of performance within hospitals- King Fahd Specialist Hospital in Buraydah City-KSA

E-governance role in raising the efficiency of performance within hospitals- King Fahd Specialist Hospital in Buraydah City-KSA

On-the-Day of Surgery Cancellations of Elective Inpatient Surgeries in King Fahd Specialist Hospital in Dammam, Kingdom of Saudi Arabia

On-the-day of surgery, cancellations are used as indicators to measure the efficiency of operating room utilization. The study aimed to measure incidence of on-the-day of surgery cancellation of elective inpatient surgeries and to identify its reasons. A retrospective cohort study was conducted at King Fahd Specialist Hospital in Dammam, Kingdom of Saudi Arabia. Target population was cancelled elective inpatient operations on- the-day of surgery. Data were collected for the period from July 2007 till March 2008. Data were extracted from the statistics department where the number of scheduled elective surgeries and cancellations were available. Reasons of cancellations were extracted from the incident report and it was cross- checked with the cancellation forms of the operating theatre. Among 1789 scheduled elective surgeries, 196 (11.0%) were cancelled. Reasons of cancellations were hospital-related (57.7%); and patients' clinical (25.9%) and non-clinical (16.4%) causes. Avoidable reasons of cancellation were 74.1%. It was concluded that rate of cancellation was relatively high. Majority of cancellation reasons were hospital-related (administrative/ procedural) and patients' non- clinical reasons which were potentially avoidable. Accordingly, the hospital should improve communication channels at all levels and define a booking list to reduce rate of cancellation.

Human sperm can fertilize ova inside the Graafian follicles before ovulation

To report an incidental finding of fertilization of ova inside the ovarian follicles before ovulation. Case report. IVF Center, King Fahd Specialist Hospital, Buraidah, Al-Qassim, Saudi Arabia. One 31-year-old woman with 8 years of primary infertility. Long-protocol superovulation and ovum pickup (OPU). The retrieved nine oocytes were incubated and followed up closely. Three hours after OPU and only after decoronization of oocytes, sperm were seen attached to the zonae pellucidae of six mature oocytes. Three of them were showing signs of fertilization (two pronuclei). Neither conventional IVF nor intracytoplasmic sperm injection was done, and we decided to continue incubation and observation of all oocytes. From the nine total oocytes, fertilization was demonstrated in six with attached sperm, of which four divided. On day 2 after OPU, three embryos were transferred into the uterus. Human sperm can migrate and ascend through the female genital tract to get through the ovarian tissue. Moreover, under certain conditions, it can penetrate the wall of an intact ovarian follicle to reach the ovum and fertilize it just before ovulation.

Pattern of Congenital Heart Disease in the Southwestern Region of Saudi Arabia

The aim of this study was to assess the frequency of various forms of congenital heart disease (CHD) among affected children in the Southwestern region of Saudi Arabia. During the study period (July 1994 to June 1996), 608 children were referred to Asir Central Hospital as having CHD. All the children were evaluated by a pediatric cardiologist and had electrocardiogram and echocardiogram. Of the 608 patients, only 335, comprising 162 males and 173 females, had CHD. The male to female ratio was 0.9:1. The frequency of various forms of CHD was as follows: ventricular septal defect (VSD) 32.5%; patent ductus arteriosus 15.8%; atrial septal defect 10.4%; pulmonary stenosis 10.1%; atrioventricular septal defect and mitral valve prolapse, 3.6% each; aortic coarctation/interruption 3.3%; obstructive aortic valve lesions 2.7%; tetralogy of Fallot 4.5%; common ventricle 2.7%; pulmonary atresia (PA) with VSD 1.8%; D-transposition of the great arteries 1.5%; Ebstein anomaly 1.5%; and isolated PA 1.2%. Other lesions were extremely rare. The distribution in this study is similar to that reported in previous studies from other parts of the world, except for the lower incidence of obstructive aortic valve lesions.