National Guard Hospital Research Articles

Analysis of femoral fracture post motor vehicle accidents.

Objectives:To identify the prevalence of different types of femoral fractures post-motor vehicle accident (MVA) based on fracture location: proximal, middle and distal.Methods:A cross-sectional study of all femoral fracture post-MVA x-ray charts carried out at the National Guard Hospital, Riyadh, Kingdom of Saudi Arabia between November 2007 to December 2013.Results:Among the 471 patients reviewed, most fractures were in male (87%) compared with female (13%) victims, with breaks more in the right femur (56%) than the left femur (44%). As for location of the femur fracture, middle fractures (64%) exceeded proximal (26%) and distal fractures (10%). The most common age group was between 16-30 years, representing 56% of these fractures.Conclusion:Prevalence of the femur fracture location varies depending on gender, age, and other factors.

Reporting 4 Candida auris in National Guard Hospital, Riyadh/ Saudi Arabia

Reporting 4 Candida auris in National Guard Hospital, Riyadh/ Saudi Arabia

The impact of changing branded statins into generic drugs at the National Guard Hospital in Riyadh, Saudi Arabia

The impact of changing branded statins into generic drugs at the National Guard Hospital in Riyadh, Saudi Arabia

Blunt renal trauma in pediatric population.

Aims:This study aims to evaluate the magnitude and impact of renal trauma among pediatric population and to assess the effectiveness of conservative versus operative management.Subjects and Methods:All pediatric patients (age <18 years) with blunt renal trauma, who presented to King Khalid National Guard Hospital in Jeddah between January 2000 and December 2012, were retrospectively reviewed. Medical records were reviewed for demographics, mechanism of injury, length of hospital stay, grade of renal trauma, hematuria, renovascular injuries, associated nonrenal injuries, conservative versus operative management, renal outcomes, and complications.Results:Fifteen children with a blunt renal injury were identified, of which 14 met data inclusion criteria. The renal injury population had a mean age of 12.7 years (standard deviation 4.6) and was 85.7% male. The renal injuries were distributed as follows: Grade 1, n = 3 (21.4%); Grade 2, n = 3 (21.4%); Grade 3, n = 3 (21.4%); Grade 4, n = 3 (21.4%); and Grade 5, n = 2 (14.2%). Macroscopic hematuria was present in 64.3% of children. The median hospital length of stay was 13 days. Eleven children (78.5%) had traumatic injuries in multiple organs. Overall, 10 children (71.4%) were managed conservatively. Four children (28.5%) with high-grade trauma required operative intervention. Renovascular injuries were found in 4 cases (80%) of high-grade renal injuries.Conclusions:Conservative management of kidney injuries was highly successful in children with low-grade renal trauma. Furthermore, operative intervention in high-grade renal injuries proved to be successful and had good renal outcomes. Renal preservation was achieved in 92.8% of cases.

Second-generation self-inflating tissue expanders: a new dimension in tissue expansion

Objective To study the different uses of second-generation self-inflating tissue expanders regarding the advantages, disadvantages, and the rate of complications. Background Tissue expansion is a valuable technique in soft-tissue reconstruction. Osmotic expanders are self-inflating and obviate the need for repeated injections. They eliminate port-site problems and reduce the potential to introduce infection. The use of such expanders has become more common in recent years. Patients and methods The study included two parts: retrospective part from January to June 2017 and prospective part from August 2017 till January 2019. The study included 40 patients, admitted to the Plastic Surgery at El-Menoufyia University Hospital and Prince Mohammad Bin Abdulaziz National Guard Hospital – Madinah in Saudi Arabia. The patients had post-burn scars, alopecia, and large nevi. A total of 69 second-generation self-inflating tissue expanders were implanted from January 2017 till January 2019, with a follow-up period of 12 months. Results Of the patients, 30 patients were females and 10 were males. The indication was large scar in 30 cases, alopecia in five cases, and giant nevus in five cases. Extrusion occurred in 10 (14.4%) expanders, which occurred in six (15%) patients. The highest percentage of extrusion occurred in the scalp, in which six of 10 expanders extruded. Conclusion The study indicates that self-inflating expanders can be safely and effectively used for various plastic and reconstructive procedures especially in children. The fact that numerous painful and distressing filling sessions are obviated with these expanders is particularly beneficial for those children too young to understand and cooperate. Moreover, this approach minimizes the risk of infection and lowers costs.

Oral Hygiene Practice and Its Relation with Stress among the Adult Patient Visiting the National Guard Hospital and Military Hospital in Madinah

Oral Hygiene Practice and Its Relation with Stress among the Adult Patient Visiting the National Guard Hospital and Military Hospital in Madinah

Salmonella species causing hip septic arthritis

Salmonella infection has been associated with various presentations depending on the system that has been affected and Salmonella species that invaded the body. Usually present with gastroenteritis symptoms and bacteremia. Rare cases had been recorded that Salmonella causing septic arthritis. We are reporting a rare case of Salmonella causing septic hip arthritis. Case report of a 31-year-old lady, known case of: systemic lupus erythematosus, anti-phospholipid syndrome, chronic kidney disease from National Guard Hospital, Riyadh, Saudi Arabia, 2018. We found the possibility of Salmonella species that causes various diseases can cause septic hip arthritis. Salmonella gram-negative bacilli has been associated with broad spectrum of illnesses as gastroenteritis, typhoid fever and septicemia. In the developed countries Salmonella cause self-limiting diarrhea with risk of developing bacteremia. Rare cases reported as a case of Salmonella causing septic joint arthritis. Following the recommendations of treating Salmonella osteomyelitis would help eradicate the infection and decrease the relapse rate period.

How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method

BackgroundCancelation of same-day surgery is a common global problem, wasting valuable hospitals’ operating room (OR) times and imposing significant economic costs. There is limited evidence to support the association between frequency of same-day surgery cancelation and patient demographics, time-related variables, healthcare provider reasons for cancelation, and clinical procedures in Saudi Arabia. The aim of this study was to explore this relationship, providing an understanding of the local context.MethodsA retrospective cross-sectional study that retrieved medical records to examine the association between the frequency of same-day surgery cancelation and covariates including patient demographics, time-related variables, healthcare provider reason for cancelation, and clinical procedures. The data covered from January 2014 to December 2014 at King Fahad National Guard Hospital in Riyadh. We considered 440 patients that met the inclusion criteria for final analysis. The cancelation was regarded less frequent if a patient canceled once in the12 months and more frequent if a patient canceled two times or more in the same period. We used descriptive statistics to summarize data and employed a probit regression to estimate the association of frequency of same-day surgery cancelation and covariates via maximum likelihood method. King Abdullah International Medical Research Center granted the institutional approval.ResultsOur study suggests that while reasons of unavailability of OR time were associated with less frequent same-day surgery cancelation, scheduling issues were linked to more frequent cancelations, compared with reasons for patients being unwell on the day of surgery. Waiting time of more than six hours and morning sessions were associated with less frequent cancelations compared to shorter waiting time and afternoon sessions. Compared to general procedures, specialized clinical procedures were associated with cancelations that are more frequent. Further, female patients were more likely to have more cancelations. Finally, being married was associated with the less frequent cancelation of same-day surgery.ConclusionOur findings provide evidence of determinants of the frequency of same-day surgery cancelations. This study draws several important implications for hospitals, especially on optimal utilization of resources and minimization of same-day surgery cancellations. The study also offers several recommendations that we believe will spur future research.

PREVALENCE OF AND RISK FACTORS FOR DELAYED ONSET OF LACTATION IN SAUDI BREASTFEEDING WOMEN.

20Jan 2018 PREVALENCE OF AND RISK FACTORS FOR DELAYED ONSET OF LACTATION IN SAUDI BREASTFEEDING WOMEN. Faisal Al-Husayni , Mariann Al-Jehani , Afnan Malibari , Raghad Alawfi , Shahad Sarhan , Layan Khushaim , Bariah Drain , Mansour Qurashi , Loie Goronfolah and Mohammed Hasosah. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. College of Medicine, Ibn Sina National College for Health Science, National Guard Hospital, Jeddah, Saudi Arabia. Department of Neonatology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. Department of Pediatric Allergy and Immunology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. Department of Pediatric Gastroenterology, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia.

THE KNOWLEDGE, PERCEPTION AND ATTITUDES TOWARDS ORGAN DONATION AMONG GENERAL POPULATION - JEDDAH, SAUDI ARABIA.

22Jan 2018 THE KNOWLEDGE, PERCEPTION AND ATTITUDES TOWARDS ORGAN DONATION AMONG GENERAL POPULATION - JEDDAH, SAUDI ARABIA. Layan Khushaim , Roaa Al Ghamdi , Faisal Al-Husayni , Abdulaziz Al-Zahrani , Arshadullah Khan and Ahmed Al Zahrani. College of Medicine, Ibn Sina National College for Health Science, National Guard Hospital, Jeddah, Saudi Arabia. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia. Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, National Guard Hospital, Jeddah, Saudi Arabia.

Postpartum Depression among Saudi Women at National Guard Hospital and Alyamama Hospital in Riyadh in 2014 - 2015

Background: Postpartum Depression (PPD) is defined briefly as a “complication of birth where its reasons are differing from a carrier mother to mother”. Symptoms of PPD resemble those of any other depression disorders but PPD is characterized by the time of occurrence and period than any other depression. Objectives: This study aimed to estimate proportion of postpartum depression among Saudi women and identify the social and psychological factors that related to postpartum depression. Methods: The study included 150 postnatal females, selected randomly in (2014 -2015). The data collected through structured questionnaires. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Result: This study found that there was a strong statistical association between PPD and anxiety regarding baby's expenses (38.2%), PPD and having still births or babies born with health issues (62.6%). Also, in having PPD in a previous pregnancy (53.4%). In addition those who were having a history of depression associated with PPD (47.2%). Lastly, anxiety regarding baby's responsibilities had a border line association with PPD (69.9%). Also, we found that there was a strong associations between PPD and not receiving support from family or friends during pregnancy (35%), or from husbands during pregnancy (43.9%), not having husbands beside them during labor (55.3%), and not having a good marriage relationship (36.6%). Conclusion: PPD was associated with stillbirth, unhealthy baby, history of PPD depression, anxiety about baby's responsibility or expenses, lack of support from family or husband and bad marriage.

Prevalence and factors associated with depression among health care workers in National Guard Hospital in Riyadh, KSA

Background: Mental health disorder is common among working population worldwide and among health care-workers (HCWs) in particular. The prevalence of depression among HCWs varies significantly when taking in account different groups like among physician or among nursing staff or using different scales to assess depression. Methodology: A cross-sectional study was conducted on 300 HCWs of King Abdul Aziz Medical City in Riyadh, Saudi Arabia, using English version of the valid patient health questionnaire-9 questionnaire. Results: A 100% response rate was retained. The main outcome revealed that 4% of the HCWs had depression, as the initial diagnosis. Around 6.7% of them had the major depressive disorder, while 11.4% had symptoms of depression. The mean age was 28.4 (standard deviation 6.3). Depression was noted to be more prevalent during the first year of work. Socially, singles have a higher rate of depression than married. Conclusion: This study showed the prevalence of depression among HCWs which is quite common, but it was noted to be less prevalent when it was compared to the international studies in the same field. Further studies should be conducted to explore the magnitude and impact of mental illness among HCWs. Keywords: Depression, health care-worker, mental health, stress-induced depression.

Occurrence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) across the Gulf Corporation Council countries: Four years update.

The emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections has become a global issue of dire concerns. MERS-CoV infections have been identified in many countries all over the world whereas high level occurrences have been documented in the Middle East and Korea. MERS-CoV is mainly spreading across the geographical region of the Middle East, especially in the Arabian Peninsula, while some imported sporadic cases were reported from the Europe, North America, Africa, and lately Asia. The prevalence of MERS-CoV infections across the Gulf Corporation Council (GCC) countries still remains unclear. Therefore, the objective of the current study was to report the prevalence of MERS-CoV in the GCC countries and to also elucidate on its demographics in the Arabian Peninsula. To date, the World Health Organization (WHO) has reported 1,797 laboratory-confirmed cases of MERS-CoV infection since June 2012, involving 687 deaths in 27 different countries worldwide. Within a time span of 4 years from June 2012 to July 2016, we collect samples form MERS-CoV infected individuals from National Guard Hospital, Riyadh, and Ministry of health Saudi Arabia and other GCC countries. Our data comprise a total of 1550 cases (67.1% male and 32.9% female). The age-specific prevalence and distribution of MERS-CoV was as follow: <20 yrs (36 cases: 3.28%), 20–39 yrs (331 cases: 30.15%), 40–59 yrs (314 cases: 28.60%), and the highest-risk elderly group aged ≥60 yrs (417 cases: 37.98%). The case distribution among GCC countries was as follows: Saudi Arabia (1441 cases: 93%), Kuwait (4 cases: 0.3%), Bahrain (1 case: 0.1%), Oman (8 cases: 0.5%), Qatar (16 cases: 1.0%), and United Arab Emirates (80 cases: 5.2%). Thus, MERS-CoV was found to be more prevalent in Saudi Arabia especially in Riyadh, where 756 cases (52.4%) were the worst hit area of the country identified, followed by the western region Makkah where 298 cases (20.6%) were recorded. This prevalence update indicates that the Arabian Peninsula, particularly Saudi Arabia, is the hardest hit region regarding the emerging MERS-CoV infections worldwide. GCC countries including Saudi Arabia now have the infrastructure in place that allows physicians and scientific community to identify and immediately respond to the potential risks posed by new outbreaks of MERS-CoV infections in the region. Given the continuum of emergence and the large magnitude of the disease in our region, more studies will be required to bolster capabilities for timely detection and effective control and prevention of MERS-CoV in our region.

Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy.

The rules of quantitative measures such as parathyroid hormone (PTH) levels in the first hours following total thyroidectomy have since been validated repeatedly. Such measures play an integral rule in identifying patients at significant risk for hypocalcaemia and have allowed for earlier supplementation of these patients with calcium with or without vitamin D. A retrospective analysis was conducted of 40 consecutive patients with well differentiated thyroid cancer (WDTC) who underwent total thyroidectomy without central neck dissection (CND) as an initial surgery and no comorbidity at King Abdulaziz Medical City (National Guard hospital), between July 2011 and July 2012. A blood testing protocol was applied for all patients that measured serum calcium PTH at 6 hours postoperatively. Following total thyroidectomy, women were found to experience transient hypocalcaemia in 12.5% of cases (4/32), whereas no men cases encountered this postoperative complication (0/8). However, most probably due to small sample size, this difference was not statistically significant. PTH level was significantly associated with post thyroidectomy hypocalcaemia (43.7±39.3 versus 13.40±24.9 ng/L), P=0.014. Only negligible differences in the length of hospital stay were observed with and without post-thyroidectomy hypocalcaemia. Using post-thyroidectomy PTH levels to predict hypocalcaemia has been confirmed in the current study. So, the use of PTH levels allows for early risk stratification of our patients and we feel this has resulted in better patient satisfaction.

Investigating the Knowledge, Attitudes, Practices and Perceived Barriers of Breast Feeding among Saudi Women in the National Guard Hospital Jeddah

Investigating the Knowledge, Attitudes, Practices and Perceived Barriers of Breast Feeding among Saudi Women in the National Guard Hospital Jeddah

Assessment of Post-traumatic Stress Disorders (PTSD) among Saudi Mothers Having a Child Newly Diagnosed with Cancer

Background: Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder strike people who have experienced or witnessed a traumatic event. Parents' of children with cancer are at risk of PTSD. The aim of the study is to assess the posttraumatic stress disorder symptoms among Saudi mothers who have a child newly diagnosed with cancer. Methodology: A descriptive exploratory design was used with a convenient sample of 110 Saudi mothers. Mothers were recruited from pediatric oncology (Ward 11) at King Khalid National Guard Hospital (KKNGH), Jeddah. Mothers completed a questionnaire of self-report PTSD Checklist (PCL-C) The PTSD severity was determined by totaling the 20 PDS-5 as the higher the score the more the severity of PTSD. Results: the results revealed that the mean age of children and mothers was (4.43±SD3.6) and (37.6±SD9.3) respectively. More than half(57.2%) of mothers experienced with shock at the time of diagnosis. More than one-third (32.7%) meet the criteria of PTSD and severity of symptoms ranged from mild to very severe as (44.5%) have mild symptoms (14.5%), moderate (17.3%) severe compared by (6.4) experienced very severe symptoms of PTSD. Furthermore, there was a significant correlation between the severity of PTSD with the number of children, the age of parents, gender, literacy and economic state (P = 0.001). Conclusion and recommendation: the study concluded the presence of PTSD symptoms among participants of the current study. Additionally, factors such as age, sex, the number of children, educational state and economic state of the family can influence the severity of PTSD. Therefore, health professionals might screen the parents of children with chronic illnesses to ascertain whether they could benefit from stress management. By the same token, clinicians should recognize that most parents tend to cope well through reinforcing their adaptive coping skills.

Malignancy Risk for Fine-Needle Aspiration of Thyroid Nodules according to the Bethesda System for Reporting Thyroid Cytopathology, at King Abdul-Aziz, National Guard Hospital

Malignancy Risk for Fine-Needle Aspiration of Thyroid Nodules according to the Bethesda System for Reporting Thyroid Cytopathology, at King Abdul-Aziz, National Guard Hospital

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia.

Objectives:To examine the incidence and predictors of blood transfusion following total knee replacement (TKR).Methods:A retrospective study on 462 patients of primary TKR at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Descriptive statistics were compared by blood transfusion status and significant variables were further included in the multivariable model.Results:Overall transfusion rate following TKR was 35.3%. Regression analyses identified bilateral surgery, low preoperative hemoglobin (Hb) level, and high amount of blood loss as predictors of blood transfusion.Conclusion:Correction of Hb level prior to surgery, careful hemostasis, and avoiding bilateral surgery may reduce the rate of blood transfusion following TKR.

Physicians' attire. Parents preferences in a tertiary hospital.

Objectives:To assess Saudi mother’s preferences regarding Saudi children’s physicians’ attire, and its influence on the parents’ level of trust and confidence.Methods:A cross-sectional survey was conducted from January to April 2014. Our sample comprised mothers of pediatric patients in both inpatient and outpatient settings at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Mothers answered multiple questions, including their preferences regarding male and female pediatric physicians’ attire, their preferences regarding their children’s physician’s gender, and the impact of physician’s appearance on mothers’ confidence.Results:There were 259 female participants. Of all caregivers, 51.4% were 32-years-old or younger. Of those, 170 (65.6%) were educated (had completed high school or higher). Forty-four percent preferred that male physicians wear scrubs, while 5.4% preferred formal attire (tie, shirt, and trousers) and 27.8% preferred Saudi national attire (Thobe and shemagh). Most caregivers (57.9%) preferred that female physicians wear long skirts. Most caregivers (87.6%) preferred physicians to wear a white coat. Most (89.2%) believed that a physician’s appearance is very important.Conclusion:Gender of the treating physician is insignificant to mothers. However, the level of trust in a physician is related to his/her external appearance. Most mothers prefer their children’s physicians to wear scrubs.

Factors affecting the future medical specialty and training location selection

Introduction: Medical specialty selection for senior students and interns in Saudi Arabia is the most important issue during their modules and hospital training. Many factors affect this process, so the primary aim of this study is to assess participants' preferred specialty, location, and other factors influencing their choices. Materials and Methods: This cross-sectional study involved interns and 6th-year students from the medical schools in Saudi Arabia, conducted from October to November 2015. A self-reported questionnaire assessed baseline characteristics, specialties of interest, location, and psychological aspects of their preferences. Results: A response rate of 25.1% (540 participants) out of 2150 surveyed students and interns. About 70.2% were interns, 52.2% were male, with a mean grade point average of 3.75/5.0, and predominantly from Taif University. Nearly 58.3% were interested in local training programs. The National Guard Hospital was the most desired hospital while Riyadh was the preferred city for training. The preferred medical specialties were internal medicine and pediatrics, yet 5.9% were undecided about their future specialty. The most important factor in choosing a specialty is a student's personal interest while a training program's quality is also a compelling reason for a certain training site. Furthermore, 81.8% of those who chose international training programs preferred North America, those were more likely to have the required qualifications (P = 0.039) and more likely to be interested in academic positions (P = 0.007). Conclusion: Almost 70.2% of the participants are interns, 58.3% are interested in the local training programs, and the most desired specialty is internal medicine. The National Guard Hospital was considered as the best training location. Those selecting international residency programs were more likely to be interested in academic careers.