National Guard Hospital Research Articles

Assessment of nurses’ workplace silence behaviour motives-: A cross-sectional study

ObjectivesThe motives that lead to nurses’ workplace silence behaviour are essential to understand, as the failure to voice their concerns and maintain silence may cause various adverse outcomes, including burnout, turnover, job dissatisfaction, low productivity, and mental and moral distress. This study aimed to identify the level and influencing motives of the workplace silence behaviour among nurses at the National Guard Hospital in Madinah. MethodsA descriptive cross-sectional survey was conducted in January and February 2023. The participants completed a questionnaire with two parts: the sociodemographic data form and the Workplace Silence Behavior Nursing Motives Scale. Data analysis was performed by descriptive statistics and the chi-square test. ResultsThe overall level for all workplace silence behavior motives is moderate (3.29 ± 0.69), with Avoidance Motives dimension receiving the highest scores (3.62 ± 0.75) and Organization-Oriented Motives dimension receiving the lowest (3.15 ± 0.86). Chi-square test showed that Saudi nationality (X2 = 0.015, P = 0.019) and monthly income (X2 = 0.045, P = 0.013) are factors in high-moderate levels of silence behaviour. ConclusionsThe overall level of workplace silence behaviour motives was found to be moderate, nurses have higher monthly salaries and non-Saudi nationals tend to have higher levels of workplace silence behaviour motives. The study results provide a reference for nursing managers to pay attention to nurses’ workplace silence behavior and take corresponding intervention measures.

The Incidence of Hypoglycemia and Its Risk Factors Among Diabetic Patients at Prince Mohammed bin Abdulaziz National Guard Hospital in Al-Madinah Al-Munawwarh, Saudi Arabia

Aims: This study aims to investigate the incidence rate and risk factors for hypoglycemia among individuals with type 1 (T1DM) and type 2 diabetes (T2DM) in Saudi Arabia receiving insulin treatment. Methods: A cross-sectional study was conducted at Prince Mohammed bin Abdulaziz National Guard Hospital in Al-Madinah Al-Munawarah, Saudi Arabia, from 2023 to 2024. The study included 255 diabetic patients aged 18 to 65 years who met the inclusion criteria. Data was collected using a validated questionnaire administered through phone calls, covering sociodemographic characteristics, diabetes type, medical history, hypoglycemia history, and compliance with treatment. Data analysis was performed using SPSS version 21, employing descriptive statistics and logistic regression analysis to identify significant risk factors. Results: Among the 255 participants, 55.3% reported experiencing hypoglycemia, with higher rates observed in patients with type 1 diabetes (100%) compared to type 2 diabetes (55.9%). The study identified significant associations between hypoglycemia and factors such as age, nationality, residence, marital status, and educational level. Additionally, wrong food diet, missing meals, and inadequate knowledge about diabetes management were common causes of hypoglycemic episodes. Most hypoglycemic events (92.5%) occurred outside of the hospital, with 18.6% classified as serious. Conclusions: The findings reveal a high incidence of hypoglycemia among diabetic patients in Saudi Arabia, with a substantial proportion of severe events occurring outside clinical settings. These results highlight the necessity for improved patient education and monitoring strategies to mitigate the risk of hypoglycemia.

Incidence and risk factors for recurrent laryngeal nerve injury after thyroid surgery

ObjectivesInjury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy.MethodsRetrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced.ResultsA total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months.ConclusionIn this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP.

Impact of an educational intervention on improving maternity nurses' knowledge and attitudes toward postpartum depression: a quasi-experimental study.

Maternal mental health is a serious issue that affects both mothers and infants, necessitating increased knowledge and awareness among healthcare providers. This study assessed the effect of an educational intervention on maternity nurses' knowledge and attitudes towards postpartum depression (PPD) using a quasi-experimental pre/post-one-group design. The sample consisted of 120 maternity nurses recruited conveniently from different maternity departments at the Ministry of National Guard hospital. The study used two valid and reliable instruments: The Postpartum Depression Literacy Scale (PODLIS) by Mirsalimi et al. (2020) and the Attitudes Scale adapted from Kang et al. (2019). The participants, predominantly aged 30-39 with at least a bachelor's degree and holding SN1 nurse status, were mainly from Malaysia. The intervention significantly increased PPD knowledge in all domains, with the greatest improvement in risk factors and causes (10.09%). Positive associations existed between the pre-intervention attitude scale and professional help, recognition facilitation, and overall PPD knowledge (P < 0.05). Post-intervention, attitudes correlated positively with understanding risk factors and causes and facilitating recognition (P < 0.05). There were significant variations in the change of overall PPD knowledge based on the participants' nationality (P < 0.05), and attending a PPD workshop significantly affected the change of attitude (P < 0.05). The study concluded the beneficial effects of the educational intervention on both knowledge and attitudes regarding PPD among maternity nurses. Customized educational programs are essential for preparing healthcare professionals with the necessary competencies and comprehension to deal with PPD effectively.

Propofol vs Midazolam As the Initial Sedation Strategy for Mechanically Ventilated Patients: A Single-Center Experience From Saudi Arabia.

Background Propofol and midazolam are the most common sedative agents used in critical settings. Propofol and midazolam might have different mortality rates after sedation administration. Some studies mention that propofol is associated with a lower mortality rate than midazolam in mechanically ventilated patients, but other studies have contradicting results. This study aims to compare the 28-day mortality of propofol versus midazolam for patients undergoing mechanical ventilation in the National Guard Hospital Health Affairs (NGHA)-Western Region (WR). Methods A retrospective chart review was conducted at (NGHA-WR) from March 2016 to July 2022. The inclusion criteria were those mechanically ventilated patients aged 18 years or older who were admitted to ICU, where they were given either propofol or midazolam as the initial sedative agent. Those who signed DNR (Do Not Resuscitate) or were contraindicated to sedation, such as allergy, were excluded from the study. Data were retrospectively retrieved and obtained from the Hospital Information System (HIS-BestCare, Saudi-Korean Health Informatics Company, Riyadh, Saudi Arabia) and the Office of Data Intelligence. Results There is a significant difference between the type of sedation and the 28-day mortality rate. Midazolam was associated with higher rates of mortality - 104 (47.93%) when compared to propofol - three (14.29%). Also, patients who used midazolam had longer durations of ICU stay compared to propofol, with a mean number of 19.23 days vs 7.55 days, respectively. Conclusion There is a significant difference regarding the 28-day mortality between patients who were given propofol or midazolam as an initial sedative agent for mechanical ventilation ≥ 24 hours. Moreover, the use of propofol is associated with fewer days of being intubated or being in ICU when compared to midazolam.

Laboratory features and pharmacological management of early and late-onset primary Sjögren’s syndrome

BackgroundPrimary Sjögren’s Syndrome (pSS) is a systemic chronic autoimmune disorder that contributes to dry mouth (xerostomia) and eyes (xerophthalmia). It mainly affects females between 40 and 60 years old. So far, there is no treatment to cure SS; however, there is a list of medications that can ameliorate the symptoms. In addition, there has been no single test until now to detect pSS, but clinical and immunological investigations are applied as diagnostic tools. Therefore, this study aimed to explore the characteristics of pSS in Saudi patients based on the onset of the disease through laboratory findings and pharmaceutical management.MethodologyThis retrospective study examined diagnosed patients with pSS between 2018 and 2023 from the National Guard Hospital, Saudi Arabia. Data of pSS patients was categorized into two groups: early (under 40 years old) and late-onset (40 years old and above). Data on demographic information, mortality rate, and blood tests such as complete blood count (CBC), creatinine, erythrocyte sedimentation rate (ESR), and vitamin levels, in addition to prescribed medications, were collected from the patient’s medical record. Chi-square and t-tests were mainly used, and statistical significance was determined at a P-value less than 0.05.ResultsA total of 453 patients were included in the study, where the early-onset group comprised 136 and the late-onset group comprised 317 patients. The mean age of the early and late onset was 34.2 and 60.4, respectively. ESR was significantly higher in the early (46.3 mm/hr) and late-onset (49.8 mm/hr). The most common medication used by all pSS patients was hydroxychloroquine. However, artificial tears were mainly observed in the late-onset group. Other medications, such as pilocarpine, methotrexate, and azathioprine, were prescribed to pSS patients to a lesser extent.ConclusionThis study suggests that the onset of pSS could occur even before the age of 40 among Saudi citizens. Notably, elevated ESR levels appeared to be a feature of pSS, which was consistent with other previous findings. The variability of some medications between early-onset and late-onset pSS may indicate disease progression. However, further investigations are required to confirm this observation.

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes among Pregnant Women: A Retrospective Cross-Sectional Study Design.

The escalating prevalence of obesity in women of reproductive age raises concerns about its impact on maternal and fetal health during pregnancy. This study aimed to thoroughly assess how obesity affects pregnancy and neonatal outcomes among Saudi pregnant women. In a retrospective cross-sectional study, we analyzed 8426 pregnant women who delivered at King Fahad National Guard Hospital in Riyadh in 2021. Of these, 3416 had obesity, and 341 of them, meeting the inclusion criteria, were selected. Maternal and neonatal outcomes were compiled using a structured questionnaire and extracted from the hospital's "Best Care" data-based registration system. The findings highlighted that 40.5% of pregnant women were classified as obese, with almost half falling into obesity class II based on BMI. Obesity correlated significantly with adverse maternal outcomes like gestational diabetes and increased rates of cesarean deliveries. Additionally, maternal obesity was linked to unfavorable fetal outcomes, including higher rates of newborn intensive care unit admissions, lower APGAR scores at 1 min, and a greater likelihood of macrosomia. This study underscores the important impact of maternal obesity on both maternal and fetal health during pregnancy. Addressing this high-risk condition demands targeted educational programs for women of reproductive age focusing on BMI control, dietary adjustments, and lifestyle modifications to mitigate obesity-related complications during pregnancy.

Predictors of forniceal rupture in patients with obstructing ureteral calculi: Analysis of multicenter data.

Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR.

The Safety Profile of Common COVID-19 Vaccines in Patients With Multiple Sclerosis.

Background and objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In light of the COVID-19 pandemic that emerged in late 2019, the World Health Organization (WHO) has endorsed mass immunization to enhance the population's immunity against the virus. However, certain concerns have been raised about the safety of COVID-19 vaccines among patients with autoimmune disorders, including those with multiple sclerosis (MS). Further research is required to address these concerns and to gain deeper insights into the possible complications of COVID-19 vaccines among MS patients. This study aimed to assess the side effects of COVID-19 vaccines among MS patients. Methods An observational cross-sectional study was conducted between May and November 2023 at the National Guard Hospital, Jeddah, Saudi Arabia. All MS patients enrolled in our local registry system and providedphone numbers were included in the study. A total of 208 MS patients were surveyed via phone interviews, and data were collected regarding their demographics, MS history, COVID-19 history, SARS-CoV-2 vaccination status, and their exposure to disease-modifying therapies (DMTs). All results were analyzed using Stata software. Statistical significance was set at a CI of 95% and a p-value <0.05. Results In our cohort, 128 (61.5%) patients had received three doses of the COVID-19 vaccine, while 68 (32.7%) had received two doses; four patients (2.0%) had received only one dose, five (2.4%) had not received the vaccine, and the number of doses was unknown for the remaining three patients (1.4%). The BNT162b2 mRNA COVID-19 Vaccine from Pfizer-BioNTech was the most commonly administered (n=136 patients, 66.0%),followed byChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca (n=47 patients, 22.8%), and mRNA-1273 SARS-CoV-2 Vaccine from Moderna (n=5 patients, 2.4%). Of note, 139 patients (69.5%) reported experiencing adverse events after receiving the vaccine, and the ChAdOx1 nCoV-19 Vaccine from Oxford-AstraZeneca was significantly associated with higher rates of side effects, in 87.8%of the patients. Conclusion A sizable proportion of MS patients experienced self-limiting side effects from exposure to the COVID-19 vaccine. The rates and incidence of side effects were similar to those encountered in the general population. None of the adverse effectsrecorded in our population of MS patients were serious or life-threatening. We recommend thatphysicians encourage patients with MS who have never received COVID-19 vaccinationto get promptly vaccinated as the risks of COVID-19 infectionfar outweigh the minor risks associated with COVID-19 vaccination.

Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia.

Background There is a lack of local studies on vitamin D deficiency in children with cancer. This study aims to estimate the prevalence of vitamin D deficiency in the pediatric oncology population at King Abdul-Aziz Medical City (KAMC) in Jeddah, addressing knowledge gaps for improved clinical practice and future research. Methods This retrospective observational studywas conducted from 2016 to 2021 at the pediatric oncology clinic in National Guard Hospital, Jeddah. The study focused on children aged 14 or younger at cancer diagnosis, data encompassed patient demographics, cancer details, and treatment information, including serum measurements of vitamin D (25(OH)D, calcium, phosphate, alkaline phosphatase). Vitamin D levels were categorized as deficient (<25 ng/ml), insufficient (25-49 ng/ml), sufficient (≥50- 125 ng/ml), or hypervitaminosis (>125 ng/ml), based on our center reference range and the validation of the assay. Results In this retrospective study of 155 pediatric oncology patients, the majority aged 0 to 10 years (78%), findings reveal a male preponderance (54.2%) and a more prevalent in patients with hematological malignancies (85%). Chemotherapy was administered to 98%, with 7% underwent radiotherapy, and 89% received steroids. Analysis of serum 25-OH vitamin D levels indicated an overall deficiency and insufficiency at diagnosis (63%) and post-therapy (43%). Age and gender had a significant influence on vitamin D levels at diagnosis, with older children and females exhibiting lower concentrations. However, these differences diminished by the end of therapy. Notably, hematological malignancy patients often presented insufficient vitamin D levels, while solid tumor patients frequently had sufficient levels. Clinical outcomes showed a high survival rate (90.7%), limited bone density assessments (18.1%), and a 14.2% prevalence of hypervitaminosis. Conclusion In summary, our study reveals that over two-thirds of pediatric oncology patients experience vitamin D deficiency and insufficiency at the time of diagnosis, particularly notable in females and older children. Notably, those with solid tumors exhibit higher baseline 25-OH vitamin D concentrations compared to counterparts with hematological malignancies. The findings underscore the importance of educating both patients and caregivers on supplementation and sun exposure to mitigate the prevalence of deficient and insufficient vitamin D levels in pediatric oncology cases.

Establishing the Kidney dIsease in the National guarD (KIND) registry: an opportunity for epidemiological and clinical research in Saudi Arabia.

In Saudi Arabia (SA), there has been an alarming increase in the prevalence of chronic kidney diseases (CKD) over the last three decades. Despite being one of the largest countries in the Middle East, renal conditions remain understudied, and there is limited data on their epidemiology and outcomes in SA. To document the experience of establishing a local renal registry assessing the epidemiology of CKD and identifying potential areas for improving the quality and delivery of care for CKD patients. This is a multi-center retrospective registry. Potential participants were identified through the ICD-10 codes from five hospitals serving the National Guard affiliates in SA. Patients aged ≥ 18 years treated in any National Guard hospital since 2010 for glomerulonephritis, CKD, or received hemodialysis, peritoneal dialysis, or renal transplantwere enrolled. Once enrolled in the registry, patients were followed to the last visit date. RedCap was used to create and host the online registry platform. A total of 2,912 patients were included, and more than half were younger than 60 years old. Two-thirds of the patients were overweight (25%) or obese (37%). Glomerulonephritis was diagnosed in 10% of the patients, and dialysis-dependent and kidney transplant patients accounted for 31.4% and 24.4%, respectively. Hypertension and diabetes mellitus were detected among 52% and 43% of the participants, respectively. Hemodialysis was the most prevalent dialysis method, with patients spending 3.6 ± 0.4 h per session to receive this treatment. One in every five participants had a kidney biopsy taken (21%). Several barriers and facilitators of the success of this registry were identified. The KIND registry provides much-needed information about CKD in Saudi Arabia and serves as a model for future projects investigating the natural history and progression of the spectrum of renal diseases. Logistic and financial challenges to the sustainability of registries are identified and discussed.

Knowledge, attitude, and hesitancy towards human papillomavirus vaccine among parents attending primary health care centers in Al-Ahsa Region, Saudi Arabia

Objective: This study aimed to assess the knowledge, attitude, and hesitancy towards the Human papillomavirus (HPV) vaccine among parents attending Primary health care centers (PHCCs) in Saudi Arabia, Al-Ahsa region. Methods: An analytic and descriptive cross-sectional study was conducted including 383 parents who attended PHCCs in the Ministry of Health and National Guard Hospitals in the Al-Ahsa region. Results: A total of 460 parents from PHCCs in Al-Ahsa, Saudi Arabia, participated in this study. The majority were females (72.8%), and the highest age group was 36-45 years (48.5%). Knowledge about HPV was low, where 65.7% had no prior knowledge. Perceptions of HPV&amp;apos;s danger varied, with 55.7% being uncertain. Awareness of the HPV vaccine was limited (56.7% lacked information). Willingness to vaccinate children was mixed, where 37.4% were willing, 33.3% were unwilling, and 29.3% were undecided. Significant associations were found between higher income and better knowledge (p-value=

Factors Influencing Induction of Labor Success in Riyadh, Saudi Arabia.

The physiological process by which the fetus and placenta are delivered from the uterus and pass through the vaginal canal for delivery is known as labor. Induction of labor involves deliberately initiating labor before it occurs naturally, using medical interventions or techniques to stimulate contractions and initiate the birthing process. This study aimed to investigate the factors that influence the success of labor induction procedures in Riyadh, Saudi Arabia, from January to April 2023. Subject and Methods. This retrospective chart review was conducted at the National Guard Hospital in Riyadh, Saudi Arabia. Data were collected from the patient chart of those who underwent labor induction from January to April 2023. The collected data were tabulated and cleaned in MS Excel. Final data were transferred to SPSS for subsequent data analysis. Five hundred and thirty-one pregnant women were analyzed. 52.7% were aged 30 years or below. The most common indication of IOL was post-dated pregnancy (26.2%). 62% were normal deliveries, indicative of IOL success, while 31.1% were cesarean deliveries, indicative of IOL failure. In univariate analysis, women with lower gravidity (≤3) and who had received Propess were associated with cesarean delivery. In a multivariate regression analysis, women who received Prostin and increased parity were identified as the significant independent predictors of IOL success. IOL's success was dependent primarily on increasing parity and Prostin administration. However, lower gravidity (≤3) and Propess medication could lead to operative procedures among pregnant women. Hence, it is necessary to carefully assess the condition of pregnant women before directing them to IOL.

The outcomes of cardiopulmonary resuscitation and its prevalence in Al Madinah City, Saudi Arabia: a retrospective study

Objectives: This study aimed to investigate cardiopulmonary resuscitation (CPR) outcomes, analyze influencing factors, and assess its prevalence within the studied population. Methods: This retrospective study included all patients aged &amp;ge; 18 years who experienced cardiac arrest and were resuscitated at Prince Mohammed Bin Abdulaziz National Guard Hospital (PMBA-NGH), Al Madinah, Saudi Arabia, between 2016 and 2022. Data were obtained from electronic medical records and CPR sheets following Utstein-style recommendations. Results: A total of 244 cases were enrolled in this study, and its prevalence was 5.1 cardiac arrest cases per 1000 hospital admissions. The overall survival rate was found to be 35.7%. Certain factors correlated with higher mortality included being intubated before cardiac arrest, intensive care unit (ICU) admission, history of cerebrovascular accident (CVA), abnormal vital signs and consciousness level before cardiac arrest, as well as utilized vasopressors, mechanical ventilation during CPR, and receiving 3-4 defibrillator shocks. Conversely, a higher survival rate was observed in hepatic insufficiency patients, those with a shockable initial rhythm, shorter CPR duration, and receiving 1-2 defibrillator shocks. Conclusion: This study identified several factors influencing CPR outcomes, with a prevalence of 5.1 cardiac arrest cases per 1000 admissions, and an overall survival rate of 35.7%. Continued research and advancement of CPR strategies are crucial for optimizing outcomes in cardiac arrest patients.

Renal outcomes in pediatric patients with sickle cell disease: a single center experience in Saudi Arabia.

Sickle cell nephropathy (SCN) is a significant complication of sickle cell disease (SCD) with an asymptomatic onset in childhood and potential progression to chronic kidney disease (CKD). The clinical findings of SCN include hyposthenuria, hematuria, proteinuria, hyperfiltration, and CKD. Data on renal manifestation among patients with SCD in Saudi Arabia is lacking. Therefore, this study aimed to evaluate renal outcomes in patients with SCD who visited a hematology clinic at the National Guard Hospital, Jeddah. We conducted a retrospective chart review of renal complications in patients with SCD who are within 0-14 years of age and on regular follow-ups at the pediatric hematology clinic in King Abdulaziz Medical City-Jeddah, Saudi Arabia. Among the 140 patients with SCD, 99 met the inclusion criteria. The median age at diagnosis was 18 (1-108) months. Two SCD phenotypes were observed, with 82 (83%) patients having sickle cell anemia (HbSS) and 17 (17%) having HbS/B+ thalassemia. Of the total patients, 92 (93%) were administered hydroxyurea (HU), with a median starting age of 48 (9-168) months. The most common renal complication observed during routine urinalysis was hematuria (38%), followed by proteinuria (11%). After stratifying the sample into four age groups (0-3 years old, 4-7 years old, 8-11 years old, and 12-14 years old), the mean glomerular filtration rate (GFR) values were 96.16, 101.36, 112.69, and 120.11 ml/min/1.73 m2 respectively. Renal imaging revealed abnormal findings in 27 (29%) patients. The most common abnormality observed on US was increased echogenicity (43%). SCN is a significant complication of SCD. In this study, we assessed the renal outcomes in pediatric patients with SCD. After analyzing the clinical findings of SCN, we concluded that the presence of renal complications in pediatric patients presented a progressive pattern.

EVALUATION AND IMPLIMENTATION OF A COMMERCIAL QUALITY CONTROL PRODUCT TO MONITOR SERUM INDICES DETECTION IN DAILY ROUTINE USE

Abstract Introduction/Objective Clinical Chemistry analyzers measure serum indices of each sample. Serum indices affect patient result. Yet there is no current common practice of monitoring the Instruments ability to measure serum indices using a commercial QC product. In this study, we focused on such Q.C. product evaluation. Methods/Case Report We evaluated the implementation of daily routine use of serum indices QC. We used a commercially available Bio-Rad (Hercules, California, United States) LiquichekTM Serum Indices QC material on Abbott (Abbott Park, Illinois, United States) Architect c8000 Chemistry analyzers in National Guard Hospital, Jeddah, Saudi Arabia. We run the QC twice a day in three Instruments for Two months. Data transferred to Bio-Rad Unity Real Time, a QC data management software. Mean, standard deviation and coefficient of variation calculated for each Instrument. Results (if a Case Study enter NA) A total of 1,296 data points were collected. The QC performed well with a precision of % CV ≤ 1.97% Hemolysis, ≤ 2.67% Icterus and ≤ 6.80% Lipemia. The three instruments performed with a slightly different mean. No “out of control” situations observed. TAT was not affected. To mimic a possible day-to-day Lab scenario, the saline bottle used as HIL reagent was deliberately contaminated using a few drops of whole blood to study the effect of gross hemolysis reagent contamination on HIL readings. The commercial HIL quality control detected the problem. Its performance showed increase in Hemolysis, slight decrease in Icterus and a slight increase in Lipemia readings. Conclusion Bio-Rad Liquichek Serum Indices QC is easy to use with a long shelf life. It helps to monitor the instrument’s ability to detect the sample integrity. Results can be compared to peer group unlike the home brewed QC. Peer group comparison helps to monitor and troubleshoot any bias or shift from the peer group and brings benefit to the total QC process.

The Effect of Diabetes Mellitus on Cardiac Remodeling and Overall Clinical Outcomes in Patients With Acute Myocardial Infarction: A Single-Center Retrospective Study in Saudi Arabia.

Diabetes mellitus (DM) is a major chronic condition that is considered a strong indicator of poor cardiovascular outcomes, such as recurrent infarction and heart failure (HF), in individuals with acute myocardial infarction (AMI). However, the concept of left ventricular remodeling (LVR)following AMI in DM patients is not well understood and studied in Saudi Arabia. Thus, the aim of this study is to assess the association between LVR and DM in patients presenting with ST-elevation myocardial infarction (STEMI) who had reperfusion therapy with optimal medical therapy after percutaneous coronary intervention (PCI). In this retrospective cohort study, 171 patients diagnosed with AMI who visited King Faisal Cardiac Center in King Abdulaziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia, were chosen via the convenience sampling method. The study included patients with AMI who received echocardiograms upon admission and during a follow-up period of six to 12 months. The patients were divided into two groups based on their diabetic status: diabetic (DM) and non-diabetic (non-DM). To collect the data, trained medical students supervised by the principal investigator used the patients' medical records. The study showed that DM patients were more likely to have a history of hypertension, dyslipidemia, smoking, and stress hyperglycemia and had a higher hospitalization rate compared to the non-DM group. Although there was no statistically significant difference (p=0.253), both groups had a higher incidence of the left main trunk and/or left anterior descending artery affected. Regarding the echocardiographic finding, there were no significant differences between the two groups in terms of left ventricular ejection fraction, left ventricular internal diameter at end-diastole, left ventricular internal diameter at end-systole, and interventricular septum thickness. This paper suggests that there is no significant correlation between DM and non-DM patients in terms of LVR after AMI. However, DM patients had a statistically significant increased risk of developing HF and valvular heart disease compared to non-DM patients after AMI.

Idiopathic Intussusception in Infants and Children: Different Outcomes in Relation to Interventions.

Background Intussusception is a pediatric emergency causing bowel obstruction that can progress to gangrene or perforation. Patients usually present with vomiting, abdominal discomfort or pain, or rectal bleeding. Specialized infant and child care is important to detect and manage such cases. Methodology This retrospective, cross-sectional study analyzed 45 cases of idiopathic pediatric intussusception presented to and managed by specialized pediatric healthcare services over 12 years. The medical records of children who presented with idiopathic intussusception from January 2010 to December 2022 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia were reviewed. The data obtained included age, sex, clinical presentation, symptom duration, diagnostic investigations, mode of treatment, length of hospital stay, and outcomes. Results A total of 45 children were included (25 male, 20 female). The median age was 10 months ranging between five and eight months. The majority presented with abdominal pain or colic (78%), vomiting (76%), and rectal bleeding (47%). The diagnosis was done by an ultrasound preceded by pneumatic enema reduction that was successful in 33 (80%) children. Only four (9%) children underwent surgery as initial management. Ileocolic intussusception (73%) was the most prevalent, followed by colicolic (18%) and ilioiliac (10%). Among the children who underwent surgical reduction, 11 (92%) underwent laparotomy reduction. In total, 11 children underwent surgical reduction as well as an appendectomy, and four children required bowel resection. Only two children developed perforation, and recurrence occurred in two other children. The mean duration of symptoms before presentation was 46.73 hours, and the mean hospital stay was 3.4 days for all cases. Rectal bleeding was a predicting factor for surgical reduction. Conclusions Ileocolic was the most common site of intussusception. Abdominal pain, vomiting, and rectal bleeding were frequently seen on presentation. In addition, surgical reduction was associated with rectal bleeding. However, pneumatic reduction was successful in 80% of the cases. Unlike the previous study, this study reports fewer children requiring surgical intervention as well as lower hospital stay duration. Thus, this study emphasizes the importance of specialized pediatric services to enhance outcomes.

Evaluation of the Cutting Seton Technique in Treating High Anal Fistula.

Objectives Fistula-in-ano is a common condition that negatively affects the quality of life of its sufferers. A high anal fistula poses a significant challenge for surgeons due to its proximity to the anorectal ring and the potential risk of incontinence rather than recurrence. Many modalities have been used in a justified search for a satisfactory cure for the condition, but the seton remains a mainstay of surgical treatment. Therefore, the rationale of this study is to assess the outcome of treating a high anal fistula using the cutting seton technique in a hospital in Al Madinah, Saudi Arabia. The evaluation is intended through a retrospective analysis of patients' outcomes, comparing its effectiveness to similar articles. Methods This is a retrospective study that includes 50 patients with high anal fistulas who were treated with a cutting seton at the National Guard Hospital over a four-year period (2019-2022). Information obtained from medical records included clinical and demographic data. The data collected during the study was compiled and statistically analyzed using the SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). A p-value of <0.05 was considered statistically significant. Results A total of 50 patients with high anal fistula treated with a cutting seton were included: 82% were males and 18% were females, with 66% below 45 years of age. Approximately 92% had inter-sphincteric fistulas, and only 28% had a recurrent fistula. Almost all patients (98%) had an MRI done before surgery. Around 70% of patients were completely cured, 26% had minor complications, 8% of the operated patients experienced mild incontinence, and only one recurrence (2%). Conclusion The cutting seton is still a valid modality in treating patients with a high anal fistula, as it is considerably safe, effective, and yields good outcomes. Standard preoperative assessment and thorough surgical techniques are cornerstones for achieving a satisfactory outcome.

Proton pump inhibitor prescribing patterns and utilization: A retrospective chart review analysis

IntroductionProton pump inhibitors (PPIs) show a high level of efficacy and a high safety profile, and they have been increasingly prescribed in recent years. However, recent pharmacoepidemiological evidence has shown that PPI use has been associated with health risks and complications. ObjectivesThis study aimed to assess the prescribing patterns of proton pump inhibitors and the prevalence of potential drug–drug interactions (DDIs) among patients who use PPIs. MethodThis was a retrospective analysis of electronic health records from the Ministry of National Guard Hospitals in Riyadh from January 2019 to June 2022. All adult patients who used PPIs were included to assess the prescribing patterns and drug utilization, including the number of prescriptions, duration of prescriptions, number of doses, and prescription indications. Potential DDIs were assessed based on concurrent use, which is defined as taking an interacting drug parallel to PPIs. The assessment includes complete or partial overlapping, with at least one day of overlapping. ResultsThe total number of PPI prescriptions was 80,365 for a total of 9,930 patients with a mean age of 67.5. The majority of PPIs were prescribed in high doses (74%), without reporting appropriate indications (95%), and 17% were prescribed for long-term use. A total of 24,575 (33.6%) potential DDIs with PPIs were found. ConclusionThe results showed that the majority of the PPI prescriptions were made with a high number of doses, without reporting appropriate indications, with some having potential DDIs. This might result in exposing patients to an increasing number of health risks. The findings highlight the importance of implementing a stewardship program for PPI prescription with periodic reassessments of patients’ needs for these medications.