King Faisal Specialist Hospital And Research Center Research Articles

Investigating the Use of Simulated Patient Ratings in Objective Structured Clinical Examinations to Enhance Undergraduate Medical Assessments in Riyadh, Saudi Arabia.

Objective structured clinical examinations (OSCE) are the gold standard of clinical assessment, and are used to conduct undergraduate family medicine clinical assessment at King Faisal Specialist Hospital and Research Centre (KFSHRC). Some studies have suggested that simulated patient (SP) ratings could provide a better measure of empathy and communication skills than physician scores. The objective of this study is to further explore the effectiveness of simulated patient (SP) ratings inundergraduate OSCE assessments. The research employed a mixed-method approach. Three OSCE assessments for final-year students were selected. Both physicians and SPsevaluated each student, providing global ratings across four domains. The quantitative aspect involved comparing physician and SP scores and assessing correlation. The qualitative aspect involved interviewing SPs to establish what student behaviours led to higher or lower scores. Moderate correlation was found between physician ratings and SP ratings (r=0.53, p<0.01). Internal consistency of the SP ratings was lower than physician scores. SPs considered themselves to be patient advocates and were keen to give formative feedback. The ability of the trainee to truly listen was a major concern. Scoring for SPs was relatively holistic in nature. The results demonstrate that SP scores have slightly weaker reliability but are still relevant and offer a completely different perspective, enriching the assessment data. Assessment should take patientor SP perspectives into account, and not rely solely on the expert physician. Changing the assessment methods will lead to necessary changes in student approach to the OSCE and improve authenticity and validity.

Posterior reversible encephalopathy syndrome post stem cell transplantation in sickle cell disease: case series and literature review.

Posterior reversible encephalopathy syndrome (PRES) is a serious neurological syndrome that may develop following immunosuppressive therapy for stem cell transplantation (SCT). We report 8 patients with sickle cell disease (SCD) who developed PRES, which is likely to be related to immunosuppression. This is retrospective cohort analysis of the SCD registry at the King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Saudi Arabia. Inclusion criteria included all adults SCD patients who underwent SCT from 2011 until 2022. We explored all cases of PRES in patients with SCT. PRES was diagnosed with MRI imaging showing reversible vasogenic cerebral edema associated with neurological symptoms including severe headache, seizures, encephalopathy, delirium, and visual disturbances. During ten years follow-up (2011-2022) we found 8 patients with PRES (age range between 14 to 37 years at diagnosis) PRES occurred 8 to 124 days following SCT in 7 cases and one patient developed PRES 8 months prior to SCT. All patients were on immunosuppressive medications, including tacrolimus, cyclosporine, sirolimus and or mycophenolate mofetil. Headache, seizures, visual hallucinations, confusion, and drowsiness were the most common presenting symptoms. MRI showed abnormalities in the occipital, parietal and frontal lobes in most cases. Recovery was complete in all patients and no recurrences were noted. Two patients had graft versus host disease (GVHD). We compared risk factors for PRES among the 8 cases and 136 SCT in SCD patients who did not develop PRES. There was a significant association between PRES and imaging abnormalities, including previous bi-hemispheric infarctions (p = 0.001), and cerebral microbleeds (CBMs). PRES was strongly associated with presence (p = 0.006), size (p = 0.016) and number (p = 0.005) of CMBs. PRES can develop days to weeks following SCT in patients with SCD, and is associated with immunosuppressive therapy, previous bi-hemispheric infarctions and CMB. Prompt recognition and intervention leads to good recovery.

Evolving Epidemiology of Pediatric Respiratory Syncytial Virus (RSV) Cases Around COVID-19 Pandemic: Impact and Clinical Insights, Retrospective Cohort Study

BackgroundThe burden of respiratory syncytial virus (RSV) in high-risk pediatric patients remains unclear. Therefore, this study aims to characterize pediatric RSV cases from January 2019 to December 2022 and assess the impact of the COVID-19 pandemic on RSV burden and RSV-related outcomes. In addition, examining factors influencing RSV-related hospitalization.MethodsThis is a retrospective study that included pediatric patients (aged 14 and below) who presented at King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh, Saudi Arabia with RSV infection identified using real-time reverse-transcriptase polymerase chain reaction assays. Statistical analyses were performed using STATA.ResultsA total of 885 RSV cases were reported; (56.05%) were males and (43.95%) were females with a median age of 24 months [interquartile range (IQR): 11–60]. 534 (60.34%) required hospitalization. As for RSV seasonality, there was a significant increase in RSV prevalence following the COVID-19 pandemic, escalating from 205 cases in 2019 to 425 cases in 2022. The increase in 2022 was evident in January and persisted from September to December, reaching its peak during the months of October (20.70% − 88 cases) and November (32.00% − 136 cases). About (27.12%) of RSV infected children were medically free patients. Symptomatic patients exhibited various clinical manifestations, with ventilation necessary in (13.11%) of cases. Further analysis revealed significant changes in RSV-related outcomes post-COVID-19, including a decrease in hospitalization rates, an increase in medically free patients, and a lower need for ventilation (p < 0.05). Notably, a significant proportion of RSV admissions occurred within the first 6 months of life, with (77.69%) in the age group of 0 to 5 months. In addition, previous RSV infection, prematurity, low birth weight, renal disease, congenital heart disease, endocrine/metabolic disease, neuro/neuromuscular diseases, and genetic disorders were positively associated with hospitalization (P < 0.05). Interestingly, asthma and bone marrow transplantation were negatively associated with hospitalization (P < 0.05). The mortality rate in this study is (2.37%) (21/885).ConclusionThis study provides a comprehensive understanding of the demographic and clinical factors influencing RSV outcomes, highlighting the impact of the COVID-19 pandemic and shedding light on potential risk factors for RSV-related hospitalization. The highest prevalence of RSV during (September to January), aligning with global patterns and emphasizing the importance of timing in preventive strategies.

A 3.5-year clinical experience with perampanel for refractory epilepsy.

This study aimed to evaluate the efficacy and tolerability of perampanel, which was used in a cohort of patients with refractory epilepsy for up to 3.5 years in a real-world setting in Saudi Arabia. Data from the medical records of patients treated with perampanel between March 13th, 2017, and September 6th, 2020, at neurology clinics at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh and Jeddah, Saudi Arabia, was collected. The Liverpool Adverse Events Profile (LAEP) scale was also used to measure the adverse effects of perampanel. Of the 75 included patients, 66.7% responded to perampanel at the last follow-up, including 22.7% seizure-free for at least the last six months, and 44% of patients responded with a ≥ 50% reduction in seizure frequency from baseline. The overall incidence of adverse effects that led to perampanel discontinuation was 13.3%; the most common adverse effect was aggressive behavior followed by sedation. Pre-existing psychiatric comorbidity was significantly associated with the incidence of psychiatric and behavioral adverse effects on perampanel (p = 0.0206). The mean score of LEAP was 40. The most frequently rated adverse effects in LEAP were "feelings of anger and aggression to others", "nervousness and/or agitation" and "sleepiness". The efficacy and tolerability of perampanel were dose-dependent. Dose 6 mg/day was the most frequently used dose that was taken by about one-third of patients at their last visit. Perampanel was effective as an adjunctive treatment for intractable seizures, with a responder rate of 66.7%. The long-term tolerability of perampanel was generally good. Aggressive behavior was the most common reason for perampanel discontinuation. Patients should be counseled and monitored for these adverse effects, particularly those with a history of previous psychiatric and behavioral problems.

A Comparison of Checklist and Domain-Based Ratings in the Assessment of Objective Structured Clinical Examination (OSCE) Performance.

The Objective Structured Clinical Examination (OSCE) is the mainstay of clinical assessment in the final-year undergraduate Family Medicine clerkship at King Faisal Specialist Hospital and Research Centre (KFSHRC). The gold standard for OSCE assessment is the checklist rating, completed by physician examiners. Numerous studies have suggested that global or domain-based OSCE ratings may be a better indicator of competence than checklist ratings. The aim of this study was to examine the utility of domain-based OSCE ratings in the context of final-year, undergraduate, Family Medicine OSCE examinations in Riyadh, Saudi Arabia. This is akin to an exercise in quality improvement, as we continuously look for ways to improve our OSCE assessment processes. This study utilised a quantitative methodology. Three final year OSCE exams were chosen. Physicians rated each student using a checklist score and using a more holistic domain-based score. Physician checklist scores and physician domain-based scores were then compared, and correlation was assessed. We also looked at the internal consistency of the scoring methods. A significant correlation was found between checklist and domain-based scores by physicians for all exams (r=0.858, p<0.01), with a good internal consistency for these methodologies for all exams. The results demonstrate that both checklist and domain-based scores offer some benefit to the assessment, with a similar internal consistency and strong correlation. Domain-based ratings should be utilised for softer skills that are not easily assessed by checklists. There is clearly a need to rethink our OSCE assessment. The assessment should combine checklist and domain-based physician scores. As trainees become more experienced, checklist OSCE may penalise directness and efficiency, while domain-based ratings would offer a better appraisal of competence, and have been shown to be more sensitive to the level of training and expertise. Changing the assessment methods will lead to necessary changes in the student approach to the OSCE and improve authenticity and validity.

Observational cohort study of perinatal outcomes of women with COVID-19

BackgroundUnderstanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia. MethodsWe performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated. ResultsWe enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery. ConclusionsWe did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.

Identification of Activation Isotopes in a CS-30 Cyclotron Vault

A CS-30 cyclotron has been in operation at King Faisal Specialist Hospital and Research Center (KFSHRC) since 1982. The CS-30 cyclotron has been used to produce medical radioisotopes for positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some of the nuclear reactions of radionuclide production are associated with the intense release of a wide range of fast neutrons. In this work, we investigated the radionuclides produced from neutron interactions with the cyclotron facility walls. Activation isotopes were determined by performing gamma ray spectrometry utilizing a high-purity germanium (HPGe) detector. The major radionuclides found were 152Eu, 154Eu, 134Cs, 65Zn and 60Co. Activation isotope accumulation had increased the dose rate inside the facility. The surface dose rates were measured at all of the surrounding walls. The maximum surface dose rate was found to be 1.2 µSv/h, which is much lower than the permissible occupational exposure of 15 µSv/h based daily 5 work hours.

The risk of cancer in primary care patients with thrombocytosis: A retrospective observational study within a family medicine setting in Saudi Arabia.

An elevated platelet count, or thrombocytosis, is a risk factor for cancer. This study will highlight the importance of primary health care providers' awareness of the potential for malignancy in patients with thrombocytosis. To evaluate the prevalence of cancer among patients aged above 40 years with elevated platelet counts. The purpose of the study was to analyze the prevalence of cancer among patients aged above 40 years at King Faisal Specialist Hospital and Research Centre (KFSHRC) who had thrombocytosis and a platelet count above 450 × 109/L. A secondary objective was to examine whether primary care physicians were prompt in initiating investigation of these patients. This study's findings will help primary care physicians thoroughly investigate thrombocytosis and develop guidelines that can be applied in primary care settings. This study was an observational cohort study. The data used originated from the family medicine patient Records at KFSHRC. The data were collected from electronic records by searching all the patient consultations and laboratory results that were available. In total, 338 patients aged above 40 years had a platelet count above 450 × 109/L. Of these patients, 68 were men (20%) and 270 were women (80%). Cancer was diagnosed within two years of thrombocytosis in 7.8% of patients (n = 26), of whom 8 were men and 18 were women. It is necessary to enhance primary health care professionals' awareness of the need to investigate the prevalence of cancer in patients with thrombocytosis.

The Magnitude and Effects of Early Integration of Palliative Care Into Oncology Service Among Adult Advanced Cancer Patients at a Tertiary Care Hospital.

BackgroundPalliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer.ObjectivesTo investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia.Subjects and methodsA retrospective cohort study was conducted at KFSHRC. It included advanced cancer patients who died between January 1, 2019 and Jun 30, 2020. The dependent variable of primary interest is the timing of PC consultation and the timing of PC referral. The independent variables included age, sex, marital status, nationality, date of death, types of cancer, Eastern Cooperative Oncology Group (ECOG), palliative performance status (PPS), palliative prognostic index (PPI), code status (do not resuscitate [DNR]), the severity of symptoms (assessed by the Edmonton Symptom Assessment System - Revised [ESAS-r]), referral to home health care (HHC), referral to long-term care (LTC), referral to interdisciplinary team (IDT), length of survival after the first PC consultation, length of survival after the referral to the PC service, length of hospital stay, frequency of emergency room (ER) visits and hospital admission in the last year before death, and involvement in bereavement with advanced care planning (ACP) services.ResultsOf the 210 advanced cancer patients, 109 (51.9%) were male, and their ages ranged between 18 and 90 years. More than half of patients (56.7%) had a history of PC consultation. Among them, PC consultation was described as late in 60.5% of patients. Concerning the timing of palliative care referral among advanced cancer patients, it was too late and much too late among 25.7% and 58.1% of them, respectively. Patients who visited ER more frequently (≥3 times) (p=0.014) and those who referred to HHC (p=0.005) were more likely to consult PC early compared to their counterparts. Length of survival was significantly higher among patients who reported early PC consultation compared to those without PC consultation and those with late PC consultation, p<0.001. Referral to PC for both transfer of care and symptom management was associated with earlier PC consultation, p=0.021. Patients who were admitted to the hospital three times or more were less likely to be much too late referred to PC services, p=0.046. Also, patients who were not referred to long-term care or home health care were more likely to be referred to PC services much too late, p<0.001. Among 28.8% of patients whose PPS ranged between 30% and 50% compared to 14.9% of those whose PPS ranged between 10% and 20% expressed too late referral time to PC, p=0.040.ConclusionIn a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.

Assessment of oral health and care in head and neck oncology patients in King Faisal Specialist Hospital and Research Center-Jeddah

ObjectivesTo assess oral hygiene indices, dental status, and oral health practices among head and neck cancer patients at King Faisal Specialist Hospital and Research Center (KFSHRC)-Jeddah. Materials and MethodsThe charts of 117 patients with head and neck cancer were reviewed to identify the decayed/missing/filled teeth (DMFT) index, calculus index (CI), gingival index (MGI), and oral hygiene index. The type of cancer, other systemic diseases, and sex data were extracted from the records and analyzed using SPSS statistical software for descriptive statistics, Student’s t-test, analysis of variance (ANOVA), and Spearman correlation statistical analyses. ResultsThe total mean DMFT index was 14.33. The significant caries index (SiC) for the studied sample was 25.87. Men had a mean DMFT of 14.11 (SD 9.8). The mean DMFT index for women was 14.63 (SD 9.7). The DMFT score for patients with systemic disease was 17.47 (SD 9.9). Patients with no other diseases had a mean DMFT score of 12.82 (SD 9.3). The DMFT index was not significantly different between men and women (p = 0.925). One-way ANOVA (F = 1.729) revealed no significant difference (p = 0.110) between DMFT scores according to the location of the cancer. DMFT with systemic disease showed no significant difference (p = 0.6) in comparison to patients without systemic disease.The Spearman rho statistic revealed no correlation between the DMFT score and CI (p = 0.383). ConclusionsThe total DMFT score was 14.33. The total SiC was 25.87. The DMFT scores of men and women were not significantly different. Cancer location and presence or absence of systemic diseases did not affect the DMFT score. The DMFT score and CI were not correlated, but a correlation was found between the DMFT score and MGI and the oral hygiene index.

Pediatric Medulloblastoma: A Study from Western Region of Saudi Arabia

Objective: Medulloblastoma is the most common malignant brain tumors in children worldwide. It is little known about the characteristics associated with medulloblastoma and the outcome in Saudi Arabia. Therefore, the study was conducted to understand the current status and what should be done for future. Methods: A retrospective chart review of all children (<14 years) who have been diagnosed and managed with medulloblastoma at King Faisal specialist hospital and research center (KFSHRC) in Jeddah, Saudi Arabia from 2011 to 2017. Important epidemiological and clinical Data have been collected and analyzed through descriptive statistics to understand the clinical characteristics and treatment outcomes. In addition, Kaplan-Meier survival analysis was conducted to generate EFS and OS. Results: The obtained results of OS of 73.7% with suggested that lower age (Age ≤ 3), high risk, positive metastasis at presentation, partial resection remained vital and contributed to lower overall survival rate among the patients with P value as follow: (P: 3 years (P<0.001) was the major factor for better survival. Conclusion: As per the observation, the estimated outcome of total cohort was OS 73.7% and EFS 54.8% which are comparable to the developed countries. The age of > 3 years and the complete surgical excision are emerging as the most significant factors affecting OS (80.5%, 88.7%) and EFS (61.2%, 70%). Average risk and negative metastasis had significant OS with p value of 0.04, 0.02 respectively. This study provides an important clue in understanding the importance of the demographic, clinical, and treatment modalities in understanding the prognosis of medulloblastoma. This report will serve as an important resource from Kingdom of Saudi Arabia regarding medulloblastoma survival.

Truncating mutations in YIF1B cause a progressive encephalopathy with various degrees of mixed movement disorder, microcephaly, and epilepsy.

We are grateful to the patient families for their participation. This research was conducted through intramural funds (RAC# 2120022, 2180004, 2110006) provided by King Faisal Specialist Hospital and Research Centre (KFSHRC). We would like to thank National Plan for Science, Technology and Innovation program under King Abdulaziz City for Science and Technology (NSTIP/KACST) for supporting NK and DC. We thank the King Salman Center for Disability Research for generous funds for NK. We thank the KFSHRC Genotyping and Sequencing Core Facilities at Genetics Department, Research Advisory Council Committees, Saudi Human Genome Program and Purchasing Department (Mr. Faisal Al Otaibi) for facilitating and expediting our requests. The research by STA was supported by funding from King Abdullah University of Science and Technology (KAUST) through the Award No. FCC1/1976-25 form the Office of Sponsored Research. TSB is supported by the Netherlands Organization for Scientific Research (ZonMW Veni, Grant 91617021), a Brain & Behavior Research Foundation NARSAD Young Investigator Grant, an Erasmus MC Fellowship 2017 and Erasmus MC Human Disease Model Award 2018.

The effectiveness of a tele-intensive care unit implementation at a secondary hospital in Eastern Saudi Arabia

Background: Tele-intensive care units (tele-ICUs) are promising medical solutions for improving critical care quality, enhancing access to health care, and increasing the productivity of intensivists. King Faisal Specialist Hospital and Research Center (KFSHRC) initiated a tele-ICU implementation in Saudi Arabia during 2009/2010, with the aim of creating 28 tele-ICU-connected hospitals throughout the region by 2014. However, the effect of tele-ICUs on patient outcomes remains unclear. This study assessed the effectiveness of a tele-ICU intervention program on patient outcomes. Methods: A retrospective pre-post study was performed in an adult medical-surgical ICU at a secondary hospital in Eastern Saudi Arabia. Tele-intensivists were located at the KFSHRC. The sample comprised adult patients (≥12 years, as per hospital policy) admitted to the ICU. Patients were allocated into pre-intervention (January 1 to April 29, 2012) and post-intervention (May 1 to August 31, 2012) groups; each group had 178 patients. The tele-ICU was implemented on April 30, 2012. Results: According to a Mann–Whitney U-test, the groups did not differ on length of stay (LOS) (U=16097.50, p=0.78). Medians and interquartile ranges in length of stay for both groups were 2 days. Regarding mortality, 10 (5.6%) pre-intervention patients died, while 12 (6.7%) post-intervention patients died. This difference was not significant (p=0.51). Conclusions: The tele-ICU program did not appear to impact patient outcomes in terms of mortality or LOS.

Juvenile idiopathic arthritis in multiplex families: longitudinal follow-up.

To describe the physical, social, educational and employment status and clinical outcomes of patients with juvenile idiopathic arthritis (JIA) from multiplex families. All familial JIA patients were treated and had regular follow-up between 1990 and 2015 at King Faisal Specialist Hospital and Research Center (KFSH-RC), Riyadh, were included. Demographic data, disease duration, active arthritis and articular and extra-articular damage at last follow-up visit were reviewed. Additionally, social, educational and employment history were obtained via personal or phone interviews. Twenty-three patients (20 females) belonging to 10 families were included. The mean age was 14.6 (±9) years with mean disease duration of 11.4 (±9) years and mean follow-up duration of 10.5 (±6). Fourteen patients had systemic JIA while eight patients had polyarticular subtype, and one patient had psoriatic arthritis. All patients received concomitant treatment. Twenty-one patients commenced biologic agents; treatment switched to another agent in all of them because of inadequate response. Most patients had progressive disease course. Twelve patients had active polyarthritis and 22 patients showed evidence of articular damage. All patients had raised inflammatory markers. Eighteen patients had short stature and 11 patients had delayed puberty. Two patients had lower limb lymphedema and one patient had a single kidney with refractory hypertension. Three patients underwent hip arthroplasty. Seventeen patients had satisfactory educational achievement and four patients were in employment. Two patients died due to infection. Our results showed the largest familial clusters of JIA in the Middle East. Patients with familial JIA had refractory disease with progressive disease course.

Beyond the Language Barrier 'Speak', 'See', 'Help Me'

Introduction: King Faisal Specialist Hospital and Research Center (KFSHRC) workforce is composed of close to 67 different nationalities. Diversity in the nursing workforce is unique in the hospital reason being the expatriates outnumber the Saudi nationals. Staff from different backgrounds provides a different perspective to the clinical care ensuring the hospital standards and policies are adhered to. In the Intensive Care Unit (ICU), when these new nurses arrive, their grasp of Arabic is limited. It is essential that nurses understand the language of their patients. In intensive care setting, patient’s condition is critical and highly specialized nursing care is paramount to the safety of the patient. It poses a challenge for non-Arabic speaking nurses to overcome the language barriers, to ensure high quality care is provided to the patient, maintain patient satisfaction and confidentiality. Therefore, communication tool kit is developed to overcome the language barrier. The tool kit is an educational instrument for non-Arabic speakers by expediting learning most frequent terms and words in Arabic. Aim: The purpose of this study is to focus on the importance of implementing a communication toolkit to enhance the communication between the nurse and the patient. Moreover, this study attempted to evaluate the efficacy of this communication tool prepared for non-Arabic health care providers. Method: Descriptive Quantitative pre and post-test study design was used. This study included all adult intensive care units and non-Arabic speaking nurses from KFSHRC in Riyadh. The pre and post questionnaire was developed by a panel of experts working in the ICU. The communication toolkit was created by direct care staff nurses working alongside the multidisciplinary team to address communication barriers. Baseline assessment was conducted which highlighted the common words and culturally appropriate images used by the Arabic patients. After the approval of the ethics and research board the study was conducted. Recruitment of the participants was performed on a voluntarily basis. On the basis of the sample size, 95 percent level of confidence, 73 participants were recruited. The communication toolkit was distributed for the duration of three months. Follow up was performed by the investigators after three a months’ time frame. Results: The results of the study showed that 90 percent of the nurses did not study Arabic prior to their arrival in the hospital. 72 nurses completed the pre and post questionnaires. Majority of the nurses were from Asian countries and few were from Western countries. Most of the nurses were using interpreters to overcome the language barrier. With regards to the questionnaire 94 percent of the nurses viewed that this toolkit will overcome their language difficulties. 19 percent used the toolkit daily, 55 percent used it twice per week and 16 percent used once per month. In regards to the efficacy 83 percent stated that this toolkit is a good mode of communication with the patients. 50 percent of the nurse highlighted the need for Arabic classes. Conclusion: This study highlights the need for the toolkit to improve the language barriers. Most of the nurses have suggested Arabic classes, access to electronic devices and need for interpreters to overcome the language barrier. The toolkit is important and is to be made available in all areas of the organization.

The Use of Next-Generation Sequencing in the Identification of a Fastidious Pathogen: A Lesson From a Clinical Setup.

Clostridium haemolyticum is the causal agent of bacillary hemoglobinuria in cattle, goat, sheep, and ruminants. In this study, we report the first recorded human-infecting C. haemolyticum strain collected from an 18-year-old woman diagnosed with acute lymphoblastic leukemia. After failure of traditional techniques, only next-generation sequencing (NGS) technology in combination with bioinformatics, phylogenetic, and pathogenomics analyses revealed that our King Faisal Specialist Hospital and Research Center (KFSHRC) bacterial isolate belongs to C. haemolyticum species. KFSHRC isolate is composed of 1 chromosome and 4 plasmids. The total genome size is estimated to be 2.7 Mbp with a low GC content of 28.02%. Comparative pathogenomics analysis showed that C. haemolyticum KFSHRC isolate is a potential virulent pathogenic bacterium as it possesses the virulence factors necessary to establish an infection, acquire essential nutrients, resist antimicrobial agents, and tolerate hostile conditions both in the human host and in its surrounding environment. These factors are included in the main chromosome in addition to novel recombination of the plasmids, and they could be the reason for the incidence of that human infection. This work demonstrated the importance of using NGS in medical microbiology for pathogen identification. It also demonstrates the importance of sequencing more microbial samples and sharing this information in public databases to facilitate the identification of pathogenic microbes with better accuracy.

Depression in End-Stage Renal Disease Patients on Hemodialysis –A Single Center Experience in Saudi Arabia

1.1.Background: It is known that hemodialysis patients suffer multiple comorbidities; prevalence of depression is higher than general population however it's underestimated. Addressing the problem of depression in those patients will help in management that will lead to improvement in their quality of life. Based on that we screened for depression inhemodialysis patients at King Faisal Specialist Hospital and Research center (KFSHRC). 1.2.Design and Setting: A prospective cross-sectional study using validated Beck’s Depression Inventory (BDI) to identify the prevalence of depression in hemodialysis patients, we looked for the effect of different variables gender, age, marital status, dialysis vintage and renal transplant fitness status. 1.3.Methods: 79 patients were screened,67 patients met the inclusion, 32 were female. BDI scores were computed based on the patient responses to the questionnaire. 1.4.Results: 18 % of patients had a BDI score of >16 which is regarded as an indicator of moderate to severe depressive symptoms. BDI score of <16 among different categories assessed age, marital status, dialysis vintage, while patients who were deemed not transplantable ,female patients had (BDI score of 18%). 1.5.Conclusion: Prevalence of moderate to severe depression is high amonghemodialysis patients. There was no significant effect of different variables assessedage, marital status, dialysis vintage except in patients who were deemed not transplantable; where female patients predominated.

A Comparison of Drug Shortages in the Hospital Setting in the United States and Saudi Arabia: An Exploratory Analysis.

Drug shortages are a problem that has been growing in recent years. This problem has an impact on patient outcomes and public health. Most countries have been affected by a diversity of drug supply chain problems. To assess explanations for differences in drug shortages reported in the hospital setting in Saudi Arabia (SA) and the United States (US). Data were collected in May-June 2014 from Brigham and Women's Hospital (BWH) and from 2 Saudi hospitals: King Abdulaziz University Hospital (KAUH) and King Faisal Specialist Hospital and Research Centre (KFSHRC). Drugs were classified using the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system. The drug shortages among the hospitals were compared using descriptive statistics and a chi-square test. The percentage of the total number of active ingredients reported in shortage was higher in the US hospital setting (15.1%) than in the Saudi hospitals (10.3%) (p < .0001). KAUH reported the highest number of shortages (n = 133), followed by BWH (n = 42) and KFSHRC (n = 27). A significantly higher percentage of shortages involved injectable drugs in the US hospital setting (78.1%) than the Saudi hospitals (34.43%) (p ≤ .0001). Nervous system (17%) and alimentary tract and metabolism agents (15.7%) were the therapeutic areas with the higher number of reported shortages in the US and SA hospital settings, respectively. The number and characteristics of shortages varied by country and hospital. Several factors, including differences in hospital characteristics, number and type of drugs available, and procurement systems, may explain differences in reported shortages.

Clinical presentation of inflammatory bowel disease in Saudi children (Single centre experience).

Background and ObjectivesInflammatory bowel disease (IBD) includes Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC). IBD is a disorder characterized by chronic inflammation of the gastrointestinal tract with frequent relapse and remission courses. There is limited information regarding this disease in Saudi children, despite a rising worldwide incidence of IBD. We aim to study the clinical and demographic characteristics of Saudi children diagnosed with IBD at time of presentation. diagnosis, disease localization, and growth of pediatric IBD patients were compared with international data.Patients and methodsIn this retrospective study, charts of all children under the age of 14 years who were diagnosed with IBD and received follow-up at King Faisal Specialist Hospital and Research Centre (KFSHRC) from January 2001 to December 2011 were reviewed.ResultsSixty-six children were diagnosed with IBD; 36 (54.5%) had Crohn's disease (CD), 27 (41%) had ulcerative colitis (UC), and 3 (4.5%) had indeterminate colitis (IC). A male predominance was demonstrated in both CD (61%) and UC (56.6%). The mean age at diagnosis was 9.3, 7.3, and 7.5 years in CD, UC and IC, respectively. A positive family history was found in 19.7% of all patients. The most common presenting symptoms were diarrhea (89.4%), rectal bleeding (75.8%), and abdominal pain (62%). The most common site affected in CD was the ileocolonic region (41.6%) while pancolitis was predominant in UC (74.1%).ConclusionsCD is the most prevalent form of IBD in Saudi children. Male predominance and a high rate of growth failure were documented in children with CD. Clinical presentation, family history, and disease localization are comparable to international data.

Genetic counselors' scope of practice and challenges in genetic counseling services in Saudi Arabia.

Genetic counseling is an evolving field in Saudi Arabia. In 2015, genetic counseling was recognized as a Master's program by the Saudi Commission for Health Specialties. Our genetic counselors combine their knowledge of genetics, counseling theory and interpersonal communication to serve Saudi and non-Saudi patients affected with a range of genetic conditions and/or birth defects. Most patients are referred to the clinic from different clinics at King Faisal Specialist Hospital and Research Centre (KFSHRC) and outside of KFSHRC for various indications. Carrier testing and preventative reproduction options rank highly on the reasons for referral to our clinics.The Saudi population has unique customs and beliefs, such as consanguinity and the evil eye. Challenges that are routinely encountered in our genetic counseling clinics include, but are not limited to, preventative reproductive options and termination of pregnancy, manifesting carriers, stigmatization of women and approaches to complex molecular findings. Working with families from different backgrounds and beliefs undoubtedly requires professionals with a distinctive set of skills and a structured clinical setting. This review article presents the scope of genetic counseling practice and tackles some of the challenges faced in providing genetic counseling in Saudi Arabia.