King Khaled Hospital Research Articles

PCV60 PREVALENCE, RISK FACTORS, AND MANAGEMENT OF UNCONTROLLED HYPERTENSION AMONG DIABETIC PATIENTS: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

This research examines the prevalence of uncontrolled hypertension and associated risk factors among diabetic patients in Saudi Arabia. A hospital-based, cross-sectional study was used in diabetic patients with hypertension in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through medical records. Uncontrolled hypertension was defined as systolic blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension. Of 1,178 outpatient diabetic patients who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR=1.51, 95%CI: 1.031, 2.22), and obese (OR=2.39, 95%CI: 1.63, 3.504). The extent of uncontrolled hypertension among diabetic patients in the study sample was found to be high. Age, sex, and obesity are the most important factors for increased risk of uncontrolled hypertension.

Haemorrhagic stroke in Saudi adult male population and the ABO blood group distribution: a comparative analysis

Background: Globally stroke is leading cause of death and disability. According to WHO every year 15 million people get stroke and one third of these subjects die and about 5 million become permanently disabled. In SA smoking, diabetes, and hypertension are highly prevalent and since these factors are among ten major risk factors for stroke it puts Saudi population at higher risk of stroke. In current study we studied prevalence of hemorrhagic (HS) stroke and analyzed if there is any correlation between incidences of HS and ABO blood groups in Saudi population.Methods: Blood groups and other relevant data were collected for 2304 stroke patients registered at King Khaled hospital between 1/1/2008 to 1/6/2018. Statistical analysis was performed using Z calculator.Results: We saw 5.4-fold increase in prevalence of diabetes type 2 and 8.7 fold increase in prevalence of hypertension among HS patients as compared to control subjects. Prevalence of smoking was higher in both control and HS patients. 21.7% of stroke patients were HS patients. Distribution of A blood group was significantly higher in male HS patients. AB blood group showed statistically significant reduction in HS patients as compared to control group. Results were statistically significant at (p˂0.01). However, blood group B and O showed no significant differences between two groups.Conclusions: Results of our studies show a correlation between ABO and the incidences of hemorrhagic stroke in Saudi adult male population. Larger studies are needed to confirm these results.

Prevalence, risk factors, and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia. MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension. ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656). ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.

Use of electronic health records among Saudi and Non - Saudi health providers - a comparative study at a secondary hospital, Saudi Arabia.

Electronic Health Record (EHR) system is now considered the backbone of effective storage and retrieval of patient records in a healthcare setup. This study is an attempt to assess the knowledge, attitude and practice of healthcare professionals in the use of Electronic Health Record system in patient care. It was a comparative cross-sectional study, conducted among the clinicians working in King Khaled Hospital, Almajmaah, Saudi Arabia. The data was collected from 260 clinicians using systematic random sampling technique. A pre-validated questionnaire was used to gather the data. Nineteen items were graded based on the adaptability, usability and knowledge of the participants. The total duration of the study from conception to completion was 6 months. There were 146 (56.2%) Saudis and 114 (43.8%) non - Saudi participants. Knowledge of computer was slightly more among Saudis 134 (51.5%) than non - Saudis 104 (40.0%) (p>0.05). Saudis had an overall positive attitude toward using the EHR as compared to non-Saudis (p<0.001).Frequency of accessing computers daily was more among Non-Saudi practitioners 93 (35.8%) as compared to the Saudis 85 (32.7%) which was statistically significant (p<0.001). This study has attempted to correlate that clinician's adaptability with an electronic record system that requires prior expertise in the use of computers. It recommends further foray into researching barriers associated with slow uptake and positive attitudinal change among clinicians using the electronic health records system in healthcare facilities across Saudi Arabia.

Exploring the status of treating chronic pain among elderly patients hospitalized in internal medicine wards in saudi arabia

The elderly population experience many health issues that range from emotional, psychological to physiological conditions. Previous studies reveal that chronic pain is among the major health issues affecting old people. The processes of managing chronic pain among the elderly have proven to be challenging practices since individuals exhibit different health complications in advanced age. Saudi Arabia is among the countries that have made progressive improvements to the approaches employed to address chronic pain. Thus, exploring the status of elderly patients experiencing chronic pain in three major hospitals in Saudi Arabia is an educational strategy to understand the situation both in the middle east and the rest of the world. The notable chronic ailments associated with the elderly in Saudi Arabia include diabetes, back pain, and depression. Several studies have shown that the systems for treating older adults that suffer from chronic pain in Saudi Arabia are effective. However, the treatment is not as smooth as the systems due to the complexities associated with old age. For instance, old people have memory problems, movement challenges, and concertation difficulties, among others. However, noting how different people experience and address chronic pain is imperative for understanding the magnitude of distress pain causes to the elderly. The study used the 20-item pain anxiety symptom scale (PASC) to asses chronic pain for 53 patients draw from King Fahad Hospital in Jeddah, Asir Central Hospital, and King Khaled hospital in Najran. The study revealed that chronic pain causes fear. Inability to think properly. Concertation problem and lack of sleep, among other issues. Apparently. The study borrows from other studies done outside Saudi Arabia to explore the issue problem in a broader spectrum. The understanding of chronic pain status is an inevitable exercise towards establishing effective pain management programs or systems.

An exploration of symptom burden and its management, in Saudi Arabian patients receiving haemodialysis, and their caregivers: a mixed methods study protocol

BackgroundGlobally 10% of the population worldwide are affected by chronic kidney disease (CKD), making it one of the most prevalent chronic diseases. Several studies have highlighted that the symptoms of CKD have a significant impact on patients. A number of symptoms, including fatigue and depression, are associated with poor patient health, increased risk of hospitalisation and mortality. Physical and emotional symptoms often remain under-recognised and largely untreated; however, patients often create a variety of self-management strategies to meet the challenges of these symptoms. There is a lack of knowledge regarding symptom burden and the experiences of patients receiving haemodialysis (HD) and their caregivers, particularly in Saudi Arabia, therefore, this study aims to explore symptom burden and its management amongst patients receiving HD in addition to caregiver burden.MethodA mixed methods, sequential, explanatory design consisting of two phases: phase 1 involves a cross-sectional study design with a planned convenience sample size of 141 patients who will be recruited from King Khaled hospital, Saudi Arabia. Thirty-two physical and psychological symptoms will be measured using the Chronic Kidney Disease-Symptom Burden Index (CKD-SBI). Additionally, 130 caregivers will complete the Arabic version of the Zarit Burden Interview (ZBI-22) to identify the level of burden in the caregivers of patients on maintenance HD. Phase 2 of the study is a qualitative descriptive design involving semi-structural interviews with 15 eligible patients currently receiving HD. The selection of participants for interviews will be based on the patients’ total CKD-SBI scores with five individuals recruited from the lowest, median and highest percentiles. Additionally, 15 caregivers of the patients to be interviewed, will also be recruited and interviewed.DiscussionThis study focuses on a wide number of physical and psychological symptoms experienced by patients receiving HD. It will also focus on the effective management strategies patients employ to help reduce their perceived symptoms. Burden in caregivers of patients receiving HD will also be explored. Furthermore, the association between symptom burden and caregiver burden will be investigated. Findings from this study will provide evidence to help health care providers to develop effective interventions to assess and manage symptoms in patients receiving HD.

Estimation of cancer risks during mammography procedure in Saudi Arabia.

The aims of the present work were to quantify radiation doses arises from patients' exposure in mammographic X-ray imaging procedures and to estimate the radiation induced cancer risk. Sixty patients were evaluated using a calibrated digital mammography unit at King Khaled Hospital and Prince Sultan Center, Alkharj, Saudi Arabia. The average patient age (years) was 44.4 ± 10 (26–69). The average and range of exposure parameters were 29.1 ± 1.9 (24.0–33.0) and 78.4 ± 17.5 (28.0–173.0) for X-ray tube potential (kVp) and current multiplied by the exposure time (s) (mAs), respectively. The MGD (mGy) per single projection for craniocaudal (CC), Medio lateral oblique (MLO) and lateromedial (LM) was 1.02 ± 0.2 (0.4–1.8), 1.1 ± 0.3 (0.5–1.8), 1.1 ± 0.3 (0.5–1.9) per procedure, in that order. The average cancer risk per projection is 177 per million procedures. The cancer risk is significant during multiple image acquisition. The study revealed that 80% of the procedures with normal findings. However, precise justification is required especially for young patients.

Relationship Between Vitamin-D and Obesity in Pediatric Outpatients, at King Khalid General Hospital, Majmaah, Saudi Arabia

Background: In many countries, overweight and obesity are becoming a serious threat to the health of the population. Several studies have found a strong independent relationship between vitamin D levels and several metabolic complications of obesity. However, it is still not known if vitamin D deficiency is directly responsible in the pathogenesis of these complications or just a secondary consequence of obesity. With an increasing number of research studies, it is evident that improvement of Vitamin D status could lead to good health outcomes especially related to obesity. Aims: This study sought to find any possible association between body mass index (BMI) and serum level of vitamin D in 6-13-year-old children attending the outpatient department (OPD) at King Khaled Hospital, Majmaah, KSA. Settings and Design: This cross-sectional observational study was done on 86 children who were 6 to 13 years old attending the OPD from March 2016 to February 2017. Materials and Methods: Anthropometric indices (weight, height and waist circumference) were assessed by using identical instruments. The hematological profile of all study participants was also evaluated for biochemical parameters such as fasting blood sugar, insulin, total cholesterol (LDL, HDL, tri- glycerides). Results: This study revealed a high prevalence (83.7%) of vitamin D deficiency and insufficiency, with 50 (58.1%) children with vitamin D levels in the deficiency range (30 nmol/L). There were significant differences in vitamin D deficiency between male and female children; with females more deficient in Vitamin D than males. Vitamin D levels and BMI status were not significant between the vitamin D level and BMI; although there was significant inverse correlation between waist circumference and vitamin D levels. Conclusion: Vitamin D deficiency is common in children and is more prevalent in females as compared to males. There was a significant relationship between waist circumference and vitamin D. More exposure to sunlight and prescription Vitamin D pediatric supplements and/or food fortification is recommended.

The Patterns of Surgically Treated Thyroid Disease in Central Rural Region of Saudi Arabia

Objective: It is well recognized that incidence of thyroid disease is increasing in Saudi Arabia and varies in geographical areas of Saudi Arabia. This study was aiming to evaluate the patterns of thyroid pathology in Al Kharj region, which is a rural agricultural area in central Saudi Arabia with relatively large (3.1%) population. Methods: The retrospective study was designed covering period from 2012 to 2016, which include only patients, who received surgical treatment for the various thyroid pathologies. All data was collected from Department of Surgery at King Khaled Hospital (KKH), which is the university hospital, serving over 600,000 population of Al Kharj region. 92 thyroidectomies performed for various thyroid disorders where analyzed. Result: The incidence of thyroid disease for females in Al Kharj region was estimated as 2.7/100.000 of population per year comparing to males of 0.4/100.000 respectively. Female to male ratio of 6.7:1 was observed in relation to the overall thyroid pathologies. The mean age of all studied cases was 41.3 years ranging from 19 to 77 years. The majority of the thyroid diseases was in the age group 20-50 years (79.3%). Cancerous lesions were found in 35 cases (38%) and presented mainly as papillary or follicular carcinomas with the female to male ratio of 10.5:1. Theprevalence of thyroid cancer in Al Kharj region in current study was 1.1/100.000 of population per year for females and 0.1/ 100.000 of population per year for males respectively. Conclusion: This study showed that in central rural province of Saudi Arabia females are dominantly affected by thyroid pathologies. The female to male ratio requiring surgical intervention was higher in Al Kharj region compared to the other Saudi Arabian areas. Incidence of thyroid pathology and prevalence for thyroid cancer was significantly higher in females compare to male population.

Exploring family needs in neonatal and pediatric intensive care units at King Khaled Hospital- Jeddah

Exploring family needs in neonatal and pediatric intensive care units at King Khaled Hospital- Jeddah

Some epidemiological and serological studies on schistosomiasis in Najran area, Saudi Arabia

Summary Schistosomiasis is a major cause of morbidity and mortality and has been estimated to infect over 200 million people. Diagnosis of schistosomiasis by detection of specific antibodies is likely to be more sensitive than the traditional method of diagnosis by detection of eggs in stool or urine. Therefore the present study was the first attempt to highlight the seroepidemiology of schistosomiasis among the general population of Najran City, southern of Saudi Arabia, as well as to achieve the performance of the diagnostic tests used. A total of 180 participants attending King Khaled hospital in Najran Province, Saudi Arabia, over a one year period, from September 2013 to September 2014 were screened for the presence of Schistosoma antibody in their blood serum using an indirect hemagglutination assay (IHA). Specific immunoglobulin (Ig) G antibody was evaluated using an enzyme-linked immunosorbent assay (ELISA). Out of the 180 samples of sera tested using IHA, 32 (20 %) were found to be positive with a titer ranging from 1:160 to 1:1280, while 42(23.2 %) revealed Schistosoma IgG. A positive relationship was found between the seroprevalence of schistosomiasis and age of tested participants, especially in the age group of 20-40 years old. Additionally, prevalence of infection was more in males (36 %) than females (7.5 %), and showed statistical significance (P &lt; 0.001). Similarly, there was significant association between the presence of Schistosoma antibodies and the nationality of residence, and education of participants (P &lt; 0.05). The current investigation reveals an alarmingly high prevalence of schistosomiasis among participants in Najran, southern region of Saudi Arabia and this supports an urgent need to re-evaluate the current control measures and implement an integrated, targeted and effective schistosomiasis control measures.

Nystagmus in laurence-moon-biedl syndrome.

Introduction. Laurence-Moon-Biedl (LMB) syndrome is a rare autosomal-recessive ciliopathy with manifold symptomatology. The cardinal clinical features include retinitis pigmentosa, obesity, intellectual delay, polydactyly/syndactyly, and hypogenitalism. In this paper, the authors report on three siblings with Laurence-Moon-Biedl syndrome associated with a probable pseudocycloid form of congenital nystagmus. Methods. This was a case study conducted at King Khaled Hospital. Results. The authors assert that the nystagmus in Laurence-Moon-Biedl syndrome is essentially similar to idiopathic motor-defect nystagmus and the nystagmus seen in optic nerve hypoplasia, ocular albinism, and bilateral opacities of the ocular media. Conclusion. The data support the previous hypothesis that there is a common brain stem motor abnormality in sensory-defect and motor-defect nystagmus.

Genetic association between the HLA-G 14-bp insertion/deletion polymorphism and the recurrent spontaneous abortions in Saudi Arabian women.

The non-classical class I human leukocyte antigen (HLA)-G molecule was found to be predominately expressed in the extravillous cytotrophoblasts at the fetal-maternal interface during pregnancy. This molecule is critically important for successful implantation during human pregnancy. The polymorphic insertion-deletion (indel) 14-base pair (bp) site localized at the 3' untranslated region was associated with HLA-G mRNA stability and isoform alternative splicing patterns, and thus may influence HLA-G function during pregnancy. We studied the association between the 14-bp indel polymorphism (rs16375) at the 3' untranslated region with recurrent spontaneous abortions in a Saudi population living in Riyadh. A group of 64 women with 2-11 successive abortions were included in this study. The control group included 62 women without reported abortions and at least 2 pregnancies, all visiting the King Khaled Hospital in Riyadh. The 14-bp indel was genotyped in the case and control groups. The frequency of the genotype +14/+14 was slightly higher in women with recurrent spontaneous abortions, but no significant differences were observed in the distribution of alleles and genotypes.

Pattern of Acute Poisoning in Al Majmaah Region, Saudi Arabia

Background: Acute poisoning is a common situation in emergency departments all over the world. It may cause severe complications and death. Treatment of these cases requires great medical care and significant costs. There are many differences with respect to the pattern and cause of acute poisoning between geographical regions, even within the same country. Objective: This study was carried out to assess the pattern of acute poisoning with drugs, chemicals and natural toxins in both adults and children in Al Majmaah region, Saudi Arabia. Methods: The study was conducted at King Khaled Hospital in Al Majmaah region. The medical records of cases who were admitted due to acute poisoning from January 2009 to December 2012 were reviewed retrospectively. Results: This study included 591 acute poisoned cases presented to ED. There were 79.4% more than 12 years old and 20.6% under 12 years old. .Number of males with toxic exposure was 435 while that of females was 156. Animal envenomation contributed to most of these cases. Unfortunately, other data of these cases could not be followed as 422 cases were observed and discharged from ED. Of them 188 were observed, received no treatment and discharged from ED. The other 234 cases were treated and discharged from ED. The medical record of 169 cases who were admitted to pediatric and internal medicine department could be retrieved and studied completely. There were 5.6% infants, 74.4% between 1–6 years old, 20% between 6-12 years old, 15.2% between 12-18 years old, 83.5 between 18-60 years old and 1.3% more than 60 years old. Pharmaceutical drugs and household products were the main causes of poisoning in cases under 12 years old ( 84.4%) while, animal envenomation; mainly scorpion stings contributed to most cases over 12 years old (62%). Conclusion: Accidental poisoning is still a significant cause of morbidity. Regarding the high prevalence of pharmaceutical drug and household products poisoning in children, implementation of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers is recommended. Improving proper and complete medical record-keeping is also suggested for a better information access.

Evaluation of probable specific immunotoxic effects of cigarette smoking in smokers

Tobacco smoking is one of the most potent and prevalent addictive habits, influencing the behavior of human beings for over four centuries. It is not surprising that immunological studies on the effect of cigarette smoking on the human immune system are rather rare. This cross-sectional, parallel group study was performed at the King Khaled Hospital between May and November 2010. Thirty current smokers (16 males and 14 females), aged 18–41years were included. The level of IFN-γ, IgG and IgM in serum along with the T-lymphocyte subset (CD4+, CD8+ and CD16+) percentage was assessed. Systemic exposure to nicotine was assessed by a radioimmunoassay (RIA) with a double antibody for cotinine. The results revealed a decrease in the total leukocyte count, decrease in the CD4+ levels with a significant decrease of CD4+/CD8+ ratio along with a decrease in natural killer CD16+ level of both groups of cigarette smokers and a significant decrease in the IgG level and increase in the IFN-γ level. The findings suggest that CD4+, CD8+, CD16+, IgG, IgM and IFN-γ are sensitive to the cumulative chronic effect of smoking because they can affect both innate and adaptive immunity and may serve as a potential immuno-biomarker for active smoking. The current review underlines the importance of smoking prevention and eradication not only for its ordinary disorders but also for its autoimmune disorders as well.

Bruxism Associated with Anoxic Encephalopathy: Successful Treatment with Baclofen

Introduction. Bruxism is a movement disorder characterized by grinding and clenching of the teeth. Etiology of bruxism can be divided into three groups: psychosocial factors, peripheral factors, and pathophysiological factors. Methods. The clinical investigation was conducted at King Khaled Hospital in Hail, Saudi Arabia, in 2012. Results. A 16-year-old Saudi female was brought to the hospital in a comatose state and with generalized convulsive seizures secondary to acute anoxic encephalopathy. In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen). Conclusion. Our data support the hypothesis that bruxism emanates from imbalance or dysregulation of the neurotransmitter system. Larger scale studies will be needed to confirm this hypothesis.

AGENESIS OF THE POSTERIOR PART OF CORPUS CALLOSUM IN SANJAD-SAKATI SYNDROME (CASE REPORT AND A REVIEW OF ARTICLES)

IntroductionSanjad-Sakati syndrome (SSS) was first described in the Middle-East in children of consanguineous parents. It is a rare autosomal recessive disorder known also as Middle-East syndrome, Richardson-Kirk syndrome or hypoparathyroidism-retardation-dysmorphism...

Tuberculosis in Saudi Arabia: Initial and secondary drug resistance among indigenous and non-indigenous populations

Resistance to six anti-mycobacterial agents rifampicin, isoniazid, streptomycin, ethambutol, p-amino salicylic acid and cycloserine was studied. Variations in the resistance pattern among Saudi, non-Saudi and a stable National Guard King Khaled Hospital (NGKKH) population were investigated. A high percentage of relapse cases, 21 %, was recorded. Among the NGKKH population this figure was much lower, 9.9%. Resistance to rifampicin alone was high at 7.2% followed by streptomycin 3.3%, isoniazid 1.8%, p-amino salicylic 1.2% and cycloserine 0.8%. Resistance to rifampicin alone was higher among ‘new’ cases whilst combined resistance to two or more drugs was seen more often in ‘old’ patients. Resistance was seen more frequently among non-Saudis, both ‘old’ and ‘new’. An unusual finding was the prevalence of rifampicin resistance among non-pulmonary isolates.

Size at Birth in Najran, Saudi Arabia

ABSTRACT The number of live births at King Khaled Hospital in Najran was 1,436 during a one-year period. The age of the mothers ranged between 14 and 47 years. The lowest abortion and stillbirth ra...