Saudi Tertiary Hospital Research Articles

Evaluating the Efficiency and Staff Satisfaction of the Point-of-Care IV Activated System Versus Traditional Piggyback in Administering IV Antibiotics at a Saudi Tertiary Hospital.

This study aims to compare resource utilization and staff satisfaction between the point-of-care (POC) activated system and the traditional intravenous piggyback (PB) system in hospital pharmacy settings. Employing a pre-post quasi-experimental design from November 2019 to April 2020, the study assessed resource requirements for both the POC activated system and the traditional PB system. Additionally, a staff satisfaction survey was conducted, focusing on staff experiences related to the pharmacy preparation process and the subsequent activation of the system by nurses. The POC activated system required significantly fewer full-time equivalents (FTEs) per month compared to the PB system (0.36 ± 0.05 vs. 1.56 ± 0.07; p < 0.0001). Using POC in automated dispensing cabinets (ADCs) reduced medication administration time and returns (6.41% vs. 1.75%; p < 0.0001). The staff satisfaction survey revealed greater satisfaction with the POC activated system. A subsequent analysis showed the POC activated system had a low expiration rate of 0.1% and a cost of 39 Saudi riyal, while the traditional system had higher expiration rates and cost of 46,260 SR. The POC activated system reduced FTEs, decreased returned medications, and enhanced staff satisfaction compared to the PB system.

Age, Sex, and Clinical Characteristics of Juvenile Open-Angle Glaucoma Patients in a Saudi Tertiary Hospital: A Retrospective Study of Surgical and Non-Surgical Outcomes.

Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes in JOAG patients. Methods: We carried out a retrospective study at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, from 2015 to 2022. We extracted data from the medical records. Visual acuity data were converted to the logarithm of the minimum angle resolution (LogMAR) for standardized analysis. The CARL ZEISS Humphrey 745i Field Analyzer/HFA II-i Visual Field Analyzer was used to perform visual field examinations under the 24-2 program SITA standard. Results: The study involved 45 JOAG patients (87 affected eyes) with a mean age of 26.91 years. Myopia was the prevailing trait (93%), and a family history of glaucoma was found in 51.1% of cases. Most of the patients presented with severe visual field defects in both eyes (right-57.1%, left-44.4%). Regarding visual acuity, we found that the majority of affected categories belonged to either mild or moderate in both eyes. Initial and final Intraocular pressure (IOP) measurements together showed a significant reduction (p < 0.001) and clearly demonstrated the need for IOP control. Surgical and non-surgical treatments significantly reduced IOP, with no gender or eye differences Conclusions: This research offers important data concerning JOAG demographics (age and gender), clinical picture, and treatment results. Though early-onset presents challenges, multidimensional therapeutic methods have great potential to get JOAG under control and maintain visual function. Additional research is needed to study the genetic causes of JOAG and assess the long-term treatment outcomes.

Gastrointestinal Stromal Tumors: A Retrospective Study at a Tertiary Care Center in Saudi Arabia in the Last Decade.

Gastrointestinal stromal tumors (GISTs) are a significant subset of mesenchymal tumors primarily found in the gastrointestinal tract, impacting diagnostic and therapeutic approaches. Understanding their epidemiology is crucial for improving patient care and advancing treatment strategies. Our study at a Saudi tertiary hospital analyzed 50 patients with GIST, focusing on demographics, tumor locations, and risk assessments. We examined predictors of tumor size, including mitosis frequency, and assessed the impact of anatomical location and risk on clinical outcomes using RStudio software (Posit, Boston, MA). Among 50 patients with GIST, 36 (72.0%) were male with a median age of 60.5 years, and most tumors (33, 66.0%) were in the stomach. Risk assessments categorized tumors as follows: 20 (40.0%) low risk, 12 (24.0%) high risk, 7 (14.0%) moderate risk, 7 (14.0%) very low risk, and 4 (8.0%) no risk. Most tumors were low-grade (41, 82.0%) and nonmetastatic (47, 94.0%), predominantly spindle cell type (37, 74.0%). Tumor size varied significantly across risk categories: high-risk tumors averaged 10.3 cm versus 0.5 cm for no risk and 3.5 cm for very low risk (P < 0.001). Mitosis frequency differed significantly by risk category and tumor grade (P < 0.001). Tumor grade varied notably with risk categories and morphologic types, especially high-grade tumors in high-risk groups (8, 66.7%) and epithelioid tumors (2, 100%). Multivariable analysis identified predictors of tumor size: anatomical location (extra-GI, intra-abdominal; beta = 7.08, P = 0.011) and risk assessment (low risk, beta = 6.91, P = 0.001; moderate risk, beta = 11.2, P < 0.001; high risk, beta = 8.93, P < 0.001). Liver metastasis did not differ significantly across gender, anatomical location, risk assessment, or tumor grade. In Saudi Arabia, GISTs predominantly affect males and are primarily located in the stomach. Our findings highlight significant variations in tumor size and grade based on risk assessments and anatomical location. Most GISTs were low-grade, nonmetastatic, and spindle cell type, emphasizing the need for enhanced research to improve diagnostics, tailor treatments, and optimize outcomes in the region.

Evaluation of Weight-Based Co-trimoxazole Dosing in a Saudi Tertiary Hospital.

Infections caused by Stenotrophomonas maltophilia(S. maltophilia)and Pneumocystis jirovecii (Pneumocystis jirovecii pneumonia (PJP)) require weight-based dosing for co-trimoxazole. The aim of this study is to assess the appropriateness of co-trimoxazole dosing in adult inpatients for the treatment of these infections. This is a single-center, cross-sectional study that included adult inpatients treated with co-trimoxazole for a weight-based dose indication (S. maltophilia and PJP). The primary outcome was the appropriateness of co-trimoxazole dosing for these infections. Forty-three patients were included in the study. Of the 43 patients, 29 (67.4%) were using co-trimoxazole for PJP treatment, and 14 (32.6%) were using it for S. maltophilia treatment. The co-trimoxazole dose was appropriate in 22 (51.2%) patients, 21 (72.4%) in the PJP treatment group, and one (7.1%) in the S. maltophilia treatment group. Underdosing was observed in 21 (48.8%) patients, of whom eight (27.6%) were in the PJP treatment group and 13 (92.9%) were in the S. maltophilia treatment group. This study found a relatively high rate of underdosing of co-trimoxazole based on weight in hospitalized adults with PJP and S. maltophilia infections.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

"Incidence and risk factors associated with surgical site infection among patients that underwent stoma reversal at a Saudi tertiary hospital"

"Incidence and risk factors associated with surgical site infection among patients that underwent stoma reversal at a Saudi tertiary hospital"

Burnout Among Respiratory Therapists in a tertiary hospital in Saudi Arabia.

Background: Respiratory therapists (RTs) provide various types of patient care in different clinical settings. Burnout can have an undesirable effect on RTs and their patients. Managing the COVID-19 pandemic, specifically in hospitals, could induce stress in RTs and increase the likelihood of burnout. Therefore, this study aimed to measure the level of burnout among RTs during the COVID-19 pandemic.Method: A validated cross-sectional questionnaire was used to identify the prevalence and characteristics of burnout among RTs. The questionnaire was administered by the respiratory care department of a tertiary healthcare center in Riyadh, Saudi Arabia. The data analysis included descriptive, inferential, and correlational tests.Results: The survey was distributed among 100 RTs with a response rate of 66%. Most respondents reported high burnout levels in the three domains of burnout: 77% reported emotional exhaustion, 98% reported depersonalization, and 73% reported low personal achievement. Univariate analysis revealed that emotional exhaustion was significantly higher among RTs who were male, married, or working in critical care settings. Female RTs and those working in general care settings reported feelings of reduced personal achievement. Furthermore, the analysis revealed a moderate positive correlation between the years of experience and emotional exhaustion (r=0.6, p<0.001).Conclusions: A high prevalence of burnout was observed among RTs in one Saudi tertiary hospital. Burnout is associated with several factors, and interventions should target all domains of burnout. RT management and staff are responsible for addressing their needs and collaboratively working together to overcome burnout. Further investigations focusing on techniques and strategies to alleviate burnout are required.

A comparison of cesarean section indications and characteristics in 2009 and 2020 in a Saudi tertiary hospital

Background: Cesarean section (CS) has been increasing in recent years with a wide range of etiologies. This study aimed to assess the indications, outcomes, and complications of CS in a hospital in Riyadh, Saudi Arabia. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. The study included two cohorts including G1 (2009) and G2 (2020). Variables including CS indication, neonatal and maternal complications, CS type, age of the mother, body mass index, parity, gestational age, and neonatal data were assessed. Results: A total of 399 women were recruited and divided into two groups, G1 (n = 199) and G2 (n = 200) with a mean age of 32 ± 6 years. G1 and G2 had significant differences in mean age with 30 ± 6 and 34 ± 5 years, respectively (p &amp;le; 0.001), which indicated delayed fertility between the groups by 4 years. Moreover, the breech presentation was less likely to occur in G2. Maternal causes, such as repeated c-sections and maternal medical conditions were more likely to happen in G2. Furthermore, postpartum hemorrhage showed an increase of 12% in G2. G2 patients were more likely to be admitted to the neonatal intensive care unit and to the special care baby (p &amp;le; 0.001), compared to regular nursery admission. Conclusion: Multiple factors contributed to the increase in the CS rate in a Saudi tertiary hospital. The factors were suggested to be previous CS, abnormal fetal heart rate, malpresentation, and maternal or fetal medical condition.

Infants routine video electroencephalogram findings in a Saudi tertiary hospital.

Objectives:To report the existence and describe the non-epileptic abnormalities, interictal epileptiform discharges, and seizures in routine electroencephalograms (EEGs) of infants in a tertiary hospital out-patient neurophysiology clinics.Methods:This is a non-interventional, retrospective descriptive study that involved the review of 172 infants’ EEGs conducted from July 2018 to June 2019 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.Results:Total of 172 EEGs were reviewed; 152 routine EEGs for infants and 20 neonatal EEGs. Seventy-six (50%) EEGs were reported to be normal. Among the remaining EEGs, 54 were characterized by generalized slow background abnormalities (31.3 %), seven (4%) by background asymmetry, one (0.5%) by generalized low amplitude, and one (0.5 %) by an alternate trace that was dysmature for age. Interictal epileptiform discharges (IED) were present in 75 (43.6%) EEGs and they were focal in 72 (41.8%) EEGs, and generalized spike wave discharges were seen in only 3 (1.7%) EEGs with focal interictal epileptiform discharges. A diagnosis of hypsarrythmia was made from 15 (8.7%) EEGs. There were seizures in 11 (6.4%) EEGs, of which three were in neonates (15% of neonatal EEGs), and 8 in infants (4.6 % of infant EEGs).Conclusions:Fifty % of routine infants‘ EEGs had abnormalities and hypsarrythmia was the most common abnormal background associated with seizures. Ictal discharges in form of generalized electrodecremental pattern associated clinically with epileptic spasm was the most common type of seizures

Antibiotic sensitivity of Mycobacterium tuberculosis isolates; a retrospective study from a Saudi tertiary hospital.

ObjectivesThis study aims to examine the antibiotic sensitivity of Mycobacterium tuberculosis isolates and its drug resistance. We also evaluated the relationship between demographic characteristics and tuberculosis (TB) drug susceptibilities.MethodsA retrospective study was conducted to analyse the antibiotic sensitivity of M. tuberculosis isolates and its resistance to first-line anti-TB drugs. During the period 2008–2013, the medical records of 191 patients from the TB ward and the Out-Patient Department in an Eastern KSA tertiary hospital were reviewed.ResultsWe classified the specimens into two categories: extra-pulmonary and pulmonary TB. Among the extra-pulmonary TB specimens, 36.5% were from body fluids, 29.2% from tissue cultures and 5.2% from body abscesses. In case of pulmonary TB, sputum samples accounted for the highest proportion of the specimens (28.6%), followed by bronchial aspirates and pleural fluid (13.2% and 5.7%, respectively). Clinical isolates from women showed higher resistance to ethambutol compared to those from men. Isoniazid showed the highest resistance pattern among all antibiotics tested (17%). Meanwhile, tissue cultures had higher resistance to Isoniazid antibiotic compared to the other specimens.ConclusionResistance to first-line TB drugs is higher in extra-pulmonary TB isolates than pulmonary isolates. Nearly one-fourth of all M. tuberculosis clinical strains were resistant to the antibiotics tested in mono-resistant or multi-resistant manners. Women had greater resistance to TB drug ethambutol as compared to men. Meanwhile, extra-pulmonary TB specimens, specifically that from tissue cultures, showed greater resistance to Isoniazid than other clinical specimens.

Estimating the neonatal length of stay for preterm babies in a saudi tertiary hospital

Introduction: The most frequent cause of morbidity and mortality in neonatal care units worldwide is prematurity. It represents the second leading cause of neonatal death after congenital anomalies and a significant determinant of newborn and infant morbidity. Objective: The objective is to have a local estimate of the length of stay (LOS) and risk of death for babies admitted to neonatal intensive care units, which facilitate planning and family counseling. Materials and Methods: This study is a retrospective review for all babies born at 23–36 weeks of gestational age (GA) and admitted to the neonatal unit from January 2010 to April 2019. We calculated the actual median LOS for babies and compared them with days to due date based on the GA and birth weight (BW). Results: There were 2913 babies born at 23–36 weeks GA admitted to the neonatal unit. In addition, the majority of babies (2845) did not require surgical intervention; only 61 babies did require surgical intervention. There was a negative correlation between the LOS median (interquartile range) and each of the GA or BW of the babies (LOS decreased as the week of GA and BW increased), while GA had a positive association with the BW. The total number of babies discharge from neonatal care was 2605 (89.7%). Conclusion: BW and GA are inherent factors that allow for a simple and objective prediction of the LOS in the neonatal unit, which can estimate on the 1st day of life.

Prevalence and Clinical Significance of Hyponatremia in Pediatric Intensive Care.

A retrospective chart review was conducted to estimate the prevalence and severity level of hyponatremia on admission at the pediatric intensive care unit (PICU) in a Saudi tertiary hospital. Hyponatremia was highly prevalent (67.2%) and severe hyponatremia was frequent among patients with Pediatric Risk of Mortality score > 10%. Severe hyponatremia was also associated with increased length of stay ( p = 0.04) and a trend of increased mortality ( p = 0.054). However, disease severity was not an independent risk factor of mortality in PICU, but might confound other risk factors that render the children requiring prolonged hospital stay, mechanical ventilation, and increased health costs.

Assessment of inflammatory cytokines and soluble adhesion molecules in patients with systemic inflammatory response syndrome in an intensive care unit of a Saudi tertiary hospital

Cytokines are endogenous inflammatory mediators, which play a central role in the pathophysiology of sepsis and in the expression of the adhesion molecules. The aims of this study are to analyze the levels of cytokines and the soluble adhesion in serum of infected (N = 68) and non-infected (N = 41) patients with systemic inflammatory responsemolecules (SIRS). 109 patients in the intensive care unit (ICU) of a tertiary hospital were included. IL-6, TNF-α, IL-10, IL-13, sICAM-1 and VCAM-1 were measured using enzyme-linked immunosorbent assay (ELISA). Patients with infectious SIRS, the levels of IL-6 varied between 27.65 to 39.6 pg/L (mean = 33.4 pg/L); the levels of sVCAM-1 varied between 543 and 1079 ng/ml (mean = 782 ng/ml) and the levels of sICAM-1 varied between 320 and 664 ng/ml (mean = 458 ng/ml). In patients with non-infectious SIRS the levels of IL-6 varied between 18.2 to 20.3 pg/L (mean 19.2 pg/L); the levels of sVCAM-1 varied between 251 and 635 ng/ml (mean = 286 ng/ml) and the levels of sICAM-1 varied between 98 and 351 ng/ml (mean = 168 ng/ml). The levels of IL-6, sVCAM-1 and s ICAM-1 were significantly higher in septic patients than in non-septic patients (p = 0.002; p = 0.003 and p = 0.0002, respectively). There was no statistically significant difference in the levels of TNF-α, IL-10 and IL-13 between infectious and non-infectious SIRS patients. Measurement of pro-and anti- inflammatory cytokines and soluble adhesion molecules may be useful in the follow up of ICU patients and in providing a point of care tests that will help in decision making and in management of ICU patients. Key words: Cytokines, adhesion molecules, enzyme-linked immunosorbent assay(ELISA), intensive care unit (ICU) patients.

R2189 Antibiotic usage and resistance patterns in a Saudi tertiary hospital

R2189 Antibiotic usage and resistance patterns in a Saudi tertiary hospital