King Fahd University Hospital Research Articles

Retinopathy of Prematurity in Neonatal Intensive Care Unit at King Fahd University Hospital, Eastern Province: Prevalence, Risk Factors, and pattern of severity Seven years’ experience.

Background Premature newborns are susceptible to retinopathy of prematurity (ROP), a vasoproliferative disease of the developing retinal vessels, which is a major cause of potentially avoidable blindness. Due to geographical variations in newborn care, geographic variations in the epidemiology of ROP have been observed internationally during the last several decades. There was a correlation between the severity of the condition and the number of prenatal, postnatal, and other risk factors. This study aimed to examine the incidence and risk factors associated with retinopathy of prematurity in preterm infants. Methods A retrospective review of preterm newborns evaluated for retinopathy of prematurity between January 2016 and December 2022 was carried out at King Fahd Hospital of the University (KFHU), Khobar, Saudi Arabia. Infants who fulfilled the screening criteria (GA < 34 or Birth Weight (WT) ≤ 1500 g) underwent the screening test, and the International Classification of Retinopathy of Prematurity was used to classify retinopathy of prematurity. Risk factors and demographic information regarding ROP were assessed. Statistical analysis was performed using SPSS (version 20) with a 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results Among the 200 preterm neonates that were evaluated and admitted to neonatal critical care units, 37% exhibited premature retinopathy, with 46.7% of those cases being in stage 1. The development of ROP was linked to gestational age, length of mechanical ventilation, septicemia, intraventricular hemorrhage, bronchopulmonary dysplasia, respiratory distress syndrome, and septicemia, according to univariate and multivariate logistic regression analyses. Conclusion The incidence of total retinopathy in premature infants in this population was 37%. Evaluating these risk factors during the screening of high-risk premature infants will help determine the appropriate timing of examinations and treatment.

Association between glycated hemoglobin and functional outcomes in patients with intracranial large artery atherosclerotic disease-related acute ischemic stroke: identifying the magic number.

This study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS). This retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis-those with HbA1c ≤6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors. A total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c ≤6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [p = <0.001, OR = 2.05, 95% confidence interval (CI) = 1.33-3.14]. The association between HbA1c >6.9% and unfavorable FOC was sustained even after adjusting for confounding factors (p = 0.008) and atherosclerosis risk factors (p = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications (p = 0.06, OR = 1.34, 95% CI = 1.02-1.77) and mortality (p = 0.07, OR = 1.42, 95% CI = 1.06-1.92) although these associations did not attain significant p-values. HbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c <7% should be the goal of physicians when managing patients at high risk of ICLAD.

Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review.

In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

Impact of hyperchloremia on inflammatory markers, serum creatinine, hemoglobin, and outcome in critically ill patients with COVID-19 infection.

Hyperchloremia has negative consequences, such as increased proinflammatory mediators, renal dysfunction, and mortality in patients with septic shock. However, data on the effects of hyperchloremia on COVID-19 infections are scarce. The study aimed to investigate the effects of hyperchloremia on inflammatory markers, serum creatinine, hemoglobin levels, and outcomes in critically ill COVID-19 patients. A retrospective review of all adult patients admitted to the ICU at King Fahd University Hospital with a moderate to severe COVID-19 infection from January 2020 to August 2021 was performed. Serum chloride levels, ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP), creatinine, and hemoglobin levels were collected on the first and third days of ICU admission. Demographic data, oxygen support modality, ICU length of stay (ICU LOS), renal replacement therapy (RRT), and deaths were collected. Of 420 patients, 255 were included; 97 (38%) had hyperchloremia, while 158 (62%) did not. Hyperchloremic patients had a higher percentage of increases in ferritin (54.6%), CRP (6.2%), and LDH (15.5%) between the first and third days of admission, compared to non-hyperchloremic patients (43.7%, 6.3%, and 5.7%, respectively). The decrease in hemoglobin levels was similar in both groups (p=0.103). There was a significant association between hyperchloremia and an increase in serum creatinine (p<0.0001). Sixty-six (68%) patients required endotracheal intubation in the hyperchloremic group (p=0.003). The mortality rate was significant in the hyperchloremic cohort (p=<0.0001). Hyperchloremia was significantly associated with increased risks of kidney injury, endotracheal intubation, and death. However, hyperchloremia was not associated with increased ferritin, CRP, or hemoglobin decreases in critically ill COVID-19 patients.

Assessing the Diagnostic Performance of CT in Suspected Urinary Stones: A Retrospective Analysis

Background Urinary stone disease is a common reason for emergency department (ED) visits, and a computed tomography scan of the kidneys, ureters, and bladder (CT-KUB) is frequently used for diagnosis. The objective of this study was to estimate the positive rate of CT-KUB and identify predictors of emergency interventions for patients with ureteric stones. Methods A retrospective study was conducted to investigate the positive rate of CT-KUB for urinary stone disease and to explore the factors that determine the need for emergency urologic interventions. The study population included adult patients who underwent CT-KUB to rule out urinary stones at King Fahd University Hospital. Results The study included 364 patients, of whom 245 (67.3%) were men and 119 (32.7%) were women. CT-KUB revealed stones in 243 (66.8%) patients, including 32.4% with renal stones and 54.4% with ureteric stones. Female patients were more likely to have normal results than male patients. Approximately 26.8% of patients with ureteric stones required emergency urologic intervention. Multivariable analysis found that the size and location of ureteric stones were independent predictors for emergency intervention. Patients with distal ureteric stones were 35% less likely to need emergency interventions than those with proximal stones. Conclusion The positive rate of CT-KUB was acceptable for patients with suspected urinary stone disease. Most demographic and clinical characteristics were not predictors for emergency interventions, but the size and location of ureteric stones and elevated creatinine levels were significantly associated.

Prevalence, electroclinical spectrum and effect on the outcome of non-convulsive status epilepticus in critically ill patients; the utility of routine electroencephalogram

ObjectivesTo highlight the importance of routine electroencephalogram (rEEG) in detecting non-convulsive status epilepticus (NCSE), describing the electroclinical spectrum and effect on outcome in critically ill patients with altered mental status (CIPAMS). MethodsThis retrospective study was conducted at King Fahd University Hospital. Clinical data and EEG recordings of CIPAMS to rule out NCSE were reviewed. All patients had at least 30 minutes of EEG recording. The Salzburg Consensus criteria (SCC) were applied to diagnose NCSE. The data analysis was performed using SPSS version 22.0. The chi-squared test was used to compare categorical variables such as etiologies, EEG findings, and functional outcomes. Multivariable analysis was performed to identify the predictors of unfavorable outcomes. ResultsA total of 323 CIPAMS referred to rule out NCSE were enrolled (mean age 57.8 ± 20 years). Nonconvulsive status epilepticus was diagnosed in 54 (16.7%) patients. A significant association was found between subtle clinical features and NCSE (P =< 0.01). Acute ischemic stroke (18.5%), sepsis (18.5%), and hypoxic brain injury (22.2%) were the main etiologies. The previous history of epilepsy was significantly associated with NCSE (P = 0.01). Acute stroke, cardiac arrest, mechanical ventilation, and NCSE were statistically associated with unfavorable outcomes. Nonconvulsive status epilepticus was an independent predictor of unfavorable outcomes (P = 0.02, OR = 2.75, CI = 1.16–6.48) during multivariable analysis. Sepsis was associated with higher mortality (P =< 0.01, OR = 2.4, CI = 1.4–4.0). SignificanceOur study findings suggest that the utility of rEEG in detecting NCSE in CIPAMS should not be underestimated. Important observations further indicate that repeating rEEG is advisable, as this would increase the likelihood of identifying NCSE. Thus, physicians should consider and repeat rEEG when evaluating CIPAMS in order to detect NCSE, which is an independent predictor of unfavorable outcomes. Nonetheless, further studies comparing rEEG and cEEG yields are required to augment the current understanding of the electroclinical spectrum and better describe NCSE in CIPAMS.

Development and Validation of the Sinonasal Outcome Test-12.

Quality of life (QoL) questionnaires are widely used in clinical interviews to assess the impact of medical interventions or measure the outcomes of healthcare services. The main aim of such questionnaires is the subjective assessment of health status and its impact on QoL. This study aimed to develop an efficient, short sinonasal disease assessment instrument, the sinonasal outcomes test-12 (SNOT-12), and to compare it with the preexisting SNOT-22. This was a two-phase cross-sectional study. The study was performed between June 2019 and February 2020 using the electronic files of the ORL department outpatient clinics at King Fahd University Hospital, affiliated with Imam Abdulrahman Bin Faisal University. The study was performed in 2 phases: an item reduction phase, which resulted in an initial SNOT-12 scale, and a validation phase, using a comparative analysis of the initial SNOT-12 and the SNOT-22. The developed short-form SNOT-12 maintained the 4 latent factors extracted in EFA (nasal, Sleep/extra nasal, psychological, ear/facial). It strongly correlated with SNOT-22 (r = 0.973). It had good construct reliability (0.705-0.901) and validity and a higher discrimination power than the SNOT-22. The SNOT-12 is a short, valid, and reliable instrument that may prove useful for the initial screening and monitoring of patients with chronic rhinosinusitis.

Effect of high-intensity interval exercise on pain, disability, and autonomic balance in female patients with nonspecific chronic low back pain

Aim. to assess the impact of a 6-weeks high-intensity interval exercise (HIIE) regimen on pain, disability, as well as autonomic balance in women with nonspecific chronic low back pain (NSCLBP). Materials and methods. Eighty females with mild to moderate NSCLBP, with ages of 18-65 years, were recruited from the physiotherapy department at King Fahd University Hospital, AlKhobar. They were assigned randomly into the control group (n = 40), which received standard regular physiotherapy, or the experimental group (n = 40), which received HIIE as well as conventional regular physiotherapy. Pre- and post-intervention (after 6 weeks) assessments included pain intensity via Numerical Rating Scale (NRS), disability via Oswestry Disability Index (ODI), as well as autonomic balance via heart rate variability (HRV) parameters &amp; baroreceptor sensitivity (BRS) Both at rest and in reaction to an orthostatic challenge. Results. Both groups experienced significant improvements in pain and disability, with the HIIE group experiencing a higher improvement in both variables. For the HRV parameters after 6 weeks of intervention, the control group had a statistically significant reduction in high frequency (HF), and in response to the orthostatic challenge, a significantly higher rise in the normalized low frequency (LFnu) compared to the baseline. BRS showed a significant reduction and heart rate recovery was significantly faster post-intervention in the HIIE group in the 2nd and 3rd minutes, compared to the baseline values. Conclusions. HIIE can be a valuable addition to NSCLBP patients’ exercise routines in practice, since adding HIIE to standard physiotherapy resulted in more reduction in pain, disability compared to conventional physiotherapy alone, with enhanced autonomic regulation after six weeks of treatment.

The Pattern of Pediatric Acute Respiratory Distress Syndrome over 10 Years Period and Related Risk Factors of its Outcome Mortality

Background: Although paediatric acute respiratory distress syndrome (PARDS) is a common and devastating clinical syndrome that contributes to high morbidity and mortality, there is little known about its pattern and outcome mortality over time. Objective: This study aimed to determine the pattern of PARDS over a 10-year period and the risk factors for its outcome, mortality. Methods: This study was done at King Fahd University Hospital in Saudi Arabia using a retrospective study design involving children aged from &gt; 2 weeks to 14 years admitted to the PICU due to PARDS. Over the last ten years, data was extracted from their medical records. Results: The number of PICU admissions over the last ten years was 2317, the rate of PARDS amongst PICU admissions was 376/2317 (16.23%), and mortality amongst PARDS cases was 83/376 (22.07%). ER admission route, chronic liver disease, sepsis, fluid overload, the number of inotropes 3, and pneumonia mediastinum were significant predictors of mortality in PARDS (p 0.001). In addition, the mean PRISM III score, PICU admission days, and ventilation days were higher in the deceased than in the survivors of PARDS. In contrast, the mean PaO2/FIO2 and oxygen saturation indices were significantly lower among the deceased than the survivors (p 0.01). Conclusion: Although the rate of PARDS was alarming, the number of PARDS deaths was constant over the study period. Sepsis, ER admission route, comorbidities, fluid overload, a higher PRISM III score, longer PICU admission, and ventilation days increased the risk of PARDS mortality.

Risk Factors and Surgical Outcomes of Diabetic Foot in Diabetic Patients at King Fahad University Hospital.

Diabetes mellitus affects a large number of the population worldwide. One of the most important complications is diabetic foot ulcers, which are debilitating to the patient and the health care system. To assess the risk factors leading to diabetic foot complications and the surgical outcome of management of patients affected by diabetic foot at King Fahd University Hospital. This is a retrospective case series study conducted at King Fahd University Hospital. The study included 52 patients who were admitted from the period 2007 to 2017 with cases of diabetic foot ulcers. The study includes a review of medical charts for diabetic foot patients including demographics, diabetic profile, associated comorbidities, clinical signs, laboratory investigations and surgical outcome. Our study shows thatdiabetic foot patients had comorbidities like hypertension at 69.2% and hyperlipidemia at 55.8%. Regarding the association between comorbidities and surgical outcomes, we did not find any significance. Furthermore, we found that patients with gangrene were more likely to undergo amputation. Patients who underwent amputation had hemoglobin A1c (HbA1c) of 10.3 ± 2.4% and random blood sugar (RBS) of 259 ±107 mg/dl, indicating poor diabetic control. Diabetic foot is the result of poor blood sugar control. Surgical intervention plays an important role in the management of diabetic foot. Depending on the presentation, patients may undergo surgical debridement, revascularization, or amputation. We found that patients who developed gangrene were more likely to undergo amputation.

Prevalence of Obesity and Cardiovascular Risk Factors Among Type 2 Diabetes Mellitus Patients in Al-Khobar, Saudi Arabia.

The prevalence of obesityhas grown significantly worldwide. It is considered a major cardiovascular risk factor among type II diabetes mellitus (T2DM) patients. The main objective of this study is to determine the prevalence of obesity in patients with T2DMat King Fahd University Hospital (KFUH), Al-Khobar, and to assess the relationship between T2DMand cardiovascular risk factors with body mass index (BMI) and waist to hip ratio (WHR). A retrospective, cross-sectional study, included T2DMpatients from the Internal Medicine departmentat KFHU. The investigators recorded patient demographics (age and gender), weight (kg), height (cm), body mass index (Kg/m2), waist and hip circumference (cm), smoking status, physical activity, blood pressure measurements (mmHg) and laboratory results of fasting blood glucose (FBG), glycated haemoglobin (HbA1c) and lipid profile. Among 346 patients, the prevalence of obesity and overweight was 62.4% and 27.2%, respectively. The relationship between BMI and demographic data including age and gender was statistically significant (P<0.05). The correlation between the BMI with cardiovascular risk factors including smoking, physical activity and WHR found to be statistically significant (P<0.05). Our study showed that obesity and overweight affect 89.6% of patients with T2DM. Therefore, it is important to take into consideration weight control strategies to effectively manage diabetic patients.

Prevalence of Microalbuminuria and Cardiovascular Risk Factors in Patients With Diabetes Mellitus Type-II in Al-Khobar, Kingdom of Saudi Arabia.

Background Type 2 diabetes mellitus (T2DM) is a common disorder worldwide. Impaired control of glucose levels predisposes to renal dysfunction, detected by a diagnosis of microalbuminuria. Several other risk factors have been identified in the development of microalbuminuria, such as hypertension, smoking, dyslipidemia, and obesity. Objective Assessment of microalbuminuria and cardiovascular risk factors in type-II diabetic patients who attended the outpatient clinic for the internal medicine department at King Fahd University Hospital, Al-Khobar. Methods A retrospective cross-sectional and an observational study included data from 2014 to 2022 collected from medical records. Patients with diabetes type-II and aged ≥18 years were included. The following were reviewed (age, sex, height, weight, body mass index, waist, hip, waist-hip ratio, systolic and diastolic blood pressure, smoking, sedentary lifestyle, diagnosis of dyslipidemia/hypertension, diabetes duration in years) and laboratory results (fasting blood glucose, HbA1C%, estimated glomerular filtration rate, serum creatinine, serum cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides). Microalbuminuria was measured by the urine albumin to creatinine ratio and was diagnosed if levels were 30-300 mg/g. Results Among 301 studied patients, the prevalence of microalbuminuria was found at 36.8%. The mean age was 57.8 ± 12.6 years, and females were 45%. The mean ± SD fasting blood glucose was 165.9 ± 71.9 mg/dL, while HbA1C% was 8.8 ± 5.6. Microalbuminuria was significantly associated with age, diabetes duration, systolic blood pressure, HbA1C%, fasting blood glucose, and triglyceride levels (p≤0.05). Conclusion Microalbuminuria in T2DM patients was high in this study, which emphasizes the need for early detection of microalbuminuria. The study suggests the need for effective diabetes control and the prevention of associated cardiovascular risk factors.

Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement.

PurposeThe objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital’s (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting.MethodsThis is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018.FindingsThe response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores.Originality/ValueThe strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers’ perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.

Functional multigenic variations associated with hodgkin lymphoma

The current study aimed to describe genotypes associated with Hodgkin lymphoma (HL) in a cohort of Saudi and non-Saudi patients and discuss their possible susceptibility to HL. We studied clinical, histopathological, and laboratory findings of HL patients admitted over 12years duration, at King Fahd University Hospital, KSA. The genomic DNAs of HL patients (n=61) and normal control subjects (n=36) were extracted, and genotyping was performed using the Illumina human exome bead chip. Set of HL patients and set of normal controls were included in this study. A total of 35 DNA variants were found to be highly significant with the P-value <9.90×10-11 among 243345 exonic biomarkers and obeying the Hardy-Weinberg equilibrium. Nine, MEGF11-rs150945752 (P-value 1.20×10-12 ), CACNA1I- s58055559 (P-value 1.93×10-12 ), DECR2-rs146760080 (P-value 2.19×10-12 ), STAB1-rs143894786 (P-value 2.45×10-12 ), ZNF526-rs144433879 (P-value 2.76×10-12 ), CPLANE1-rs200612080 (P-value 3.77×10-12 ), DLK1-rs1058009 (P-value 5.95×10-12 ), RTN4RL2-rs61745214 (P-value 7.71×10-12 ), and PGRMC1-rs145582672 (P-value 8.56×10-12 ), exonic variants on chromosomes 15, 22, and 16 were highly associated with HL cases. THE HIGHLY SIGNIFICANT HAPLOTYPES AT CHROMOSOME 3: rs143894786G; rs149982219G with P-value=3.43×10-14 was found to be the risk haplotype for the HL patients. The opposite alleles at chromosome 3: rs143894786A; rs149982219G is protective with P-value=2.46×10-12 . Maximum number of SNPs at the chromosome 19: rs144433879C; rs181265966G; rs201144421C; rs145591797G; rs200560875G; rs77270337G (risk P-value=2.24×10-12 ) and its opposite allele rs144433879A; rs181265966A; rs201144421T; rs145591797A; rs200560875A; rs77270337A (protective P-value=2.60×10-9 ) were found to be associated haplotype with the HL and controls, respectively, in Saudi population. Our study concludes that the HL is genetically heterogeneous with multigene causation.

Prevalence of Medically Resistant Epilepsy in Saudi Arabia

Objectives: The objective of this study was to evaluate the prevalence of medically resistant epilepsy (MRE) in our hospital and to compare the prevalence with that in other populations. Methods: We retrospectively analyzed the data of patients who visited the epilepsy clinics at King Fahd University Hospital, Al-Khobar, Saudi Arabia between January 2017 and December 2018. This study included patients aged ≥14 years who had at least 2 unprovoked seizures 24 h apart. Patients who had provoked seizure(s), paroxysmal events, or syncope or had incomplete medical records were excluded. The definition and classification of the International League Against Epilepsy were used. Moreover, we searched the En­glish literature using PubMed and Google Scholar to compare the prevalence of MRE between our population and other populations. Results: In total, 1,151 patients were screened, and 751 patients were included in the final analysis. Of the 751 patients, 229 (male: 56.3%, female: 43.7%; mean age: 32.07 years, and standard deviation, 12.2 years) had MRE, with a cumulative prevalence of 30%. The etiology was as follows: unknown, 63.3% (n = 145); structural, 31.9% (n = 73); genetic, 3.1% (n = 7); and infectious, 1.7% (n = 4). None of the patients had metabolic or immune-related etiologies. Conclusion: The prevalence of MRE in our population (30%) is close to that in other populations (30–36.5%). Early identification of such patients is crucial to improve their management.

No evidence of disease activity-3 (NEDA-3) status in patients with relapsing remitting multiple sclerosis: Evidence from Saudi cohort receiving mainly Interferon.

BackgroundNo evidence of disease activity (NEDA) is a composite surrogate assessing the responsiveness to various disease-modifying treatments (DMTs) in patients with relapsing and remitting multiple sclerosis (RRMS), addressing clinical as well as radiological disease activity. Despite the rising prevalence of multiple sclerosis in Saudi Arabia (SA), there is a lack of evidence focusing on this important aspect in the management of RRMS. This study aimed to identify the prevalence of NEDA-3 status achievement in patients with RRMS on DMTs (mainly the interferon) and to describe the factors affecting its attainment. MethodThis was a retrospective, cross-sectional study carried out at King Fahd University Hospital after obtaining institutional ethical approval. The electronic records of 119 patients diagnosed with RRMS were reviewed. Clinical manifestations at initial presentation, relapse after starting treatment, disability progression, and development of new lesions on follow-up magnetic resonance imaging were all documented to assess NEDA-3 status. Data were analyzed using Statistical Package for Social Sciences, version 22. ResultsNEDA-3 status was achieved in 41 (33.6%) patients. The female-to-male ratio for all patients was 1.5:1. Interferon (IFN) was the most commonly prescribed DMT. NEDA-3 status was achieved in 30.9% of patients receiving IFN. Mean baseline Expanded Disability Status Scale in patients who did not achieve NEDA-3 was 2.8±1.8. Patients with ataxia (P = <0.001), sphincter disturbances (P=0.002) and infra-tentorial brain lesions (P=0.03) were less likely to achieve NEDA-3 status. Involvement of pyramidal, cerebellar and more than one system at initial presentation was more frequent in patients who could not achieve NEDA-3 status (P=0.002) ConclusionLess than one third of total patients on IFN as DMT could achieve NEDA-3 status in our cohort of patients which is in agreement with the literature published in the West. We could not properly asses NEDA-3 status for other DMTs in our center due to the very small sample size of patients on these DMTs, and recommend future studies including larger number of patients on DMTs other than IFN. Significant differences were identified between the two groups of patients with respect to attainment of NEDA-3 status, which requires further verification by multicenter prospective studies.

Correlation of prognostic and predictive indicators in breast cancer patients from the eastern province of Saudi Arabia.

Objectives:To highlight and correlate demographic and histopathological features of breast cancer along with prognostic and predictive biomarkers, in Saudi patients from the Eastern Province and compare it to a cohort of non-Saudi patients.Methods:In a retrospective study between January 1998 and December 2017, data were collected from the medical records of breast cancer patients who were admitted at King Fahd University Hospital (KFHU), Dammam, Saudi Arabia. The information included demographic, histopathological, and immunohistochemical findings.Results:Out of 482 breast cancer patients, 60% (n=286) were Saudis, and 40% (n=196) were non-Saudis. Data showed a wide age distribution; however, most cases (80%) were seen in the third through fifth decades, with a median age at diagnosis of 51 ±12 years. Over years, breast cancer in Saudi patients was increasingly seen at a younger age (p=0.003). While tumors were increasingly detected at earlier stages (p=0.003); however, stage III & IV tumors (p=0.033) and human epidermal growth factor receptor-2 overexpressed tumors (p=0.035) were more frequently seen at a younger age. Interestingly, these associations were not significant in non-Saudi patients.Conclusion:Although, the current findings might help future studies to identify variables that could lead to better management of breast cancer in this region; however, a wider investigation including other centers in the eastern province is needed.

The Effectiveness of the Joint Commission International Accreditation in Improving Quality at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach.

IntroductionSaudi Arabia has one of the highest numbers of health organizations accredited by the Joint Commission International. This study aimed to measure this process’s effectiveness in improving quality at King Fahd Hospital of the University in Khobar, Saudi Arabia. Additionally, the study investigated health providers’ perceptions of this process.Materials and MethodsThis research utilized a convergent parallel mixed method. For the quantitative analysis, an interrupted time series was conducted to assess the changes in a total of 12 quality outcomes pre- and post-accreditation. Thematic analysis was utilized to collect and analyze qualitative data from hospital employees and health providers.ResultsThe quantitative results indicated that pursuing accreditation positively impacted nine out of 12 outcomes. The improved outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients, the percentage of critical lab reporting, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations, and the rate of patient falls. The qualitative analysis suggested that the accreditation process was perceived positively by participants. Nevertheless, participants also highlighted some of the drawbacks of this process, including: the potential bias in observation-based key performance indicators, the focus on improving process without enhancing the hospital structure, and the increased workload.ConclusionInternational accreditation had a positive impact on quality and was received positively by providers. However, several issues need to be addressed by hospital administrators in future accreditation cycles. According to participants, the most notable issue during the first two accreditation cycles was the increased workload and paperwork, which can potentially distract from patient care.

Stroke Prevention Therapy and Prevalence of Risk Factors Among Patients With Atrial Fibrillation at King Fahad University Hospital in Al Khobar: A Retrospective, Single-Center Study.

BackgroundAtrial fibrillation is the most common cardiac arrhythmia in clinical practice. It represents a significant health impact as it is greatly associated with increased risk of mortality and morbidity, most importantly stroke and systemic thromboembolism. AimThis study aims to determine the risk factors of atrial fibrillation, to identify stroke and bleeding risk factors among patients with atrial fibrillation, to assess the trend of stroke prevention management and the influence of CHA2DS2-VASc and HAS-BLED scores on choosing the treatment.MethodsThis study was performed using all the medical records of 395 patients with Atrial fibrillation who were admitted between 2011-2019 at King Fahd University Hospital, Al-Khobar, Saudi Arabia. The review process included demographic data of the patients and the calculation of stroke and bleeding risk by CHA2DS2-VASc and HAS-BLED scores.ResultsThe median age of the population was 72 years old. Hypertension was the most common risk factor for atrial fibrillation (78.2%), followed by diabetes mellitus (61.0%), dyslipidemia (60.0%), coronary artery disease (41.0%), myocardial infarction (18.7%), and congestive heart failure (29.4%). Regarding the management, (42.5%) of the patients were on a combination of both anticoagulants and antiplatelet therapy, while (33.2%) were on anticoagulant therapy only, (17.5%) were on antiplatelets only, and (5.8%) were not on medication. The increased use of anticoagulants and combined therapy was related to the percentage of a high-risk group of thromboembolic events reaching up to (34.5%) and (45.7%), respectively, which is statistically significant. Moreover, the prescription of warfarin declined in the last five years of our study, while the use of non-vitamin K antagonist oral anticoagulants increased.ConclusionAtrial fibrillation is more prevalent in females, hypertension was the most common risk factor for atrial fibrillation, followed by diabetes mellitus, and dyslipidemia. Most of the studied population was categorized as a high risk of stroke and bleeding according to CHA2DS2-VASc and HAS- BLED scores. The majority of the atrial fibrillation patient were taking anticoagulants and combined treatment as a stroke prevention therapy. Non-vitamin K antagonist oral anticoagulant prescription increased over warfarin in recent years.

Prevalence of diabetic peripheral neuropathy among type II diabetic patients in King Fahd University Hospital, Khobar, Kingdom of Saudi Arabia

ABSTRACT Background: Diabetic peripheral neuropathies (DPN) are a common complication of diabetes mellitus (DM). DPN can be either painless or painful. General objective: To determine the prevalence of DPN among DM type II patients at King Fahd University Hospital (KFUH), Al-Khobar, Kingdom of Saudi Arabia (KSA). Specific objectives: To see the association between the prevalence of DPN and patient demographics and body mass index (BMI). To assess the relationship between the prevalence of DPN and DM type II and duration of disease. To provide awareness and education of DPN by pamphlets to the recruited diabetic patients at KFUH, Al-Khobar, KSA. Methods: questionnaire-based cross-sectional study, recruited DM type II patients from the internal medicine outpatient clinics at KFUH, Khobar, KSA. The investigators recorded patients’ demographics (age, sex, and nationality), height, weight, and BMI, diabetes duration in years and laboratory results of fasting blood glucose (FBG), Hemoglobin A1C and the Michigan Neuropathy Screening Instrument (MNSI) has been applied. Results: among 187 recruited patients with type II DM, the prevalence of DPN was 37.4%. The mean age range of the sample was 56.4 ± 11.2 years. Females to males were 62.6% vs 37.4%. Saudis represented a great proportion of the participants constituting nearly 95.2%. The mean BMI of patients was 33.6 ± 7.08 kg/m2. The mean FBG was 161.4 ± 62.9 mg/dL while the mean value of HbA1c was 8.11%±1.63%. HbA1c levels were significantly associated with DPN. Duration of DM of more than 1 year and FBG levels were significant predictors for patients to have DPN. Other socio-demographic variables such as age, gender, nationality, and BMI levels were not significantly associated with DPN. Conclusion: DPN affects 37.4% of type II diabetic patients at King Fahd University Hospital in Saudi Arabia. Approximately 60% of patients were not aware of the importance of daily foot care. Thus, foot care pamphlets were distributed to patients.