Tertiary Care Center In Riyadh Research Articles

Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway.OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB).DESIGN: Retrospective, cross-sectional.SETTING: Tertiary care center in Riyadh.PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded.MAIN OUTCOME MEASURES: Findings of FFL.SAMPLE SIZE: 217 pediatric patients.RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P<.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P<.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB.CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor.LIMITATIONS: Retrospective design and single-centered.CONFLICTS OF INTEREST: None.

Colorectal Cancer Surveillance after Resection

Background: Multiple guidelines have recommended performing surveillance colonoscopies after resection of colorectal cancer. However, there has been debate about the optimal frequency of endoscopic surveillance and its yield. Objective: The objective of this study was to explore the adherence and the yield of surveillance colonoscopy in our population. Design: This was a retrospective cohort study. Setting: This study was carried out in two tertiary care centers in Riyadh of all patients who were found to have colon cancer on colonoscopy. Patients and Methods: All patients who were found to have colon cancer on colonoscopy at one center from January 2016 to July 2019 and the second center from April 2012 to April 2019 were included in the study. The main outcome measures were as follows: rate of adherence to surveillance colonoscopies as well as the rate of synchronous and metachronous tumors identified. The sample size was not calculated. Results: A total of 280 patients were identified with a mean age of 64.5 years (standard deviation: 13.1), 61.4% were male, and the majority (72%) of the original cancers were left sided (rectum – 25.45%, rectosigmoid – 13.45%, sigmoid – 25.82%, and descending colon – 7.27%). Surveillance was performed in 55.7%, 17.9% did not attend their scheduled procedures, 2.1% refused, while there was no clear reason in 8.9%. Surveillance was not applicable to 15.3% of the study population. Over the course of three rounds of surveillance, the timing of the procedures was in line with recommendations in 66.8% in the first round while it was 20% in the second and third rounds. The procedures were normal in 69%, 71.9%, and 90% of the first, second, and third rounds, respectively. Metachronous adenocarcinoma was seen in 2.6% and synchronous adenocarcinoma in 0.6% during the first round. Adenocarcinoma was found in 5 out of 75 patients in the second round and 1 out of 10 in the third round. Conclusion: The attrition rate and deviation from timing suggested by guidelines are high. Furthermore, the yield of surveillance colonoscopies for important findings is clinically relevant. The limitations of this study were as follows: retrospective, probability of unmeasured confounders, as well possibility of attrition bias.

Pilonidal sinus disease recurrence at a tertiary care center in Riyadh.

BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease of the sacrococcygeal area. Pilonidal sinus recurrence is a matter of concern to both patients and healthcare providers.OBJECTIVES: Estimate the rate of PSD recurrence in our center and identify any risk factors contributing to disease recurrence.DESIGN: Retrospective.SETTING: Tertiary care center in Riyadh.PATIENTS AND METHODS: All patients who underwent surgery for primary or recurrent pilonidal sinus between 1 January 2016 to 30 June 2019 were included to allow for at least 1-year of follow-up at the time of data collection.MAIN OUTCOME MEASURE: Recurrence rate of PSD and risk factors for recurrence.SAMPLE SIZE AND CHARACTERISTICS: 369 patients: 329 males (89.2%) and 40 (10.8%) females. Median (interquartile range) age was 21 (18-26) years.RESULTS: Of the 369 included patients, recurrence was identified in 84 (22.8%) cases [95% confidence interval (CI) 18.6-27.4], and the mean timing of recurrence was 1.8 (1.6) years after the primary surgery. In a multivariate logistic regression analysis, increased age and post-operative seroma fluid discharge were independent risk factors for recurrence. In contrast, preoperative antibiotic prophylaxis and postoperative hair removal were effective in reducing recurrence. Type of surgery closure had no effect on recurrence, yet primary closure was associated with early onset of recurrence compared to secondary closure (P=.02).CONCLUSION: Our findings on the factors associated with recurrence of PSD are consistent with many reports in the literature. Reported prevalence estimates vary widely.LIMITATION: Single center, small sample size, retrospective.CONFLICT OF INTEREST: None.

Methicillin-Resistant Staphylococcus Aureus Bacteremia: Epidemiology, Clinical Characteristics, Risk Factors, and Outcomes in a Tertiary Care Center in Riyadh, Saudi Arabia.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common in hospitals worldwide. In an era of pandemics, it is important to understand all types of infectious diseases in order to control its outcome and reduce mortality rates related to it. This study aims to identify the epidemiology of MRSA bloodstream infection, risk factors, and mortality in King Abdulaziz Medical City in Riyadh.MethodsThis is a retrospective chart review study from January 2013 to June 2017. All patients with positive blood culture for MRSA at King Abdulaziz Medical City (KAMC), which is a tertiary care center in Riyadh, Saudi Arabia, were included. Data were extracted from electronic and paper medical records for patients who had a positive blood culture for MRSA. Data collected included demographics, microbiological details, risk factors, and 30-day mortality.ResultsFrom 2013 through June 2017, 633 Staphylococcus aureus bacteremia were reported in KAMC, of which 184 (29.1%) were MRSA with a mean age of 60±19 years. Almost all of our isolates were susceptible to vancomycin, linezolid, and tigecycline. The most common infectious syndrome these patients presented with was an endovascular infection which accounts for 30.4% while 19.9% presented as a case of pneumonia. The mortality within 30 days of collection of the positive blood culture was 20.65%. Male gender (OR = 2.33; 95% CI = 1.34-4.05; P-value = 0.003) and patients with history of recent hospital (OR = 2.34; 95% CI = 1.27-4.34; P-value = 0.007) or ICU (OR = 1.66; 95% CI = 1.09-2.52; P-value = 0.018) admissions were more likely to acquire MRSA.ConclusionsThe incidence of MRSA bacteremia at King Abdulaziz Medical City is high and increasing in conjunction with incidence rate posing a significantly high rate of mortality. Recent history of hospital admission, ICU admission and males were found to be significantly associated with higher rates of MRSA infection. Some modifiable risk factors that could be used to facilitate the reduction of MRSA acquisition rates is to avoid unnecessary hospital and ICU admissions.

Assessment of normal reference values for thyroid uptake of technetium-99m pertechnetate in a Saudi population.

BACKGROUND: Thyrotoxicosis is a common medical problem. Thyroid nuclear imaging with either I123 or technetium-99m (Tc-99m) pertechnetate are used to determine the cause. Although I123 has been the standard technique, Tc-99m pertechnetate is now commonly used, acceptable and easier to perform. The commonly used normal value of Tc-99m pertechnetate is 1–4%, but lower normal values have been reported in different populations.OBJECTIVE: Determine normal reference range of Tc-99m pertechne-tate thyroid uptake for thyroid scintigraphy in Saudi Arabia.DESIGN: Retrospective, cross-sectional.SETTING: Nuclear medicine service at tertiary care center in Riyadh.PATIENTS AND METHODS: We used data from biochemically euthyroid patients who underwent a thyroid Tc-99m pertechnetate scan while having parathyroid scintigraphy for hyperparathyroidism between April 2009 to April 2019. Medical records and biochemical thyroid function tests were reviewed and Tc-99m pertechnetate thyroid uptake values were determined for each patient.MAIN OUTCOME MEASURES: Thyroid uptake of Tc-99m pertechne-tate in euthyroid patients.SAMPLE SIZE: 167RESULTS: The mean and median uptake of Tc-99m pertechnetate in euthyroid patients were 0.86% and 1.0%, respectively, and the inter-quartile range was 0.0–1.0%. The normal reference range in the study population was 0.2-2%. Thyroid uptake inversely correlated with age in females (r=−0.37, P<.001), males (r=−0.46, P=.001), and for all patients (r=?0.39, P<.0001).CONCLUSION: The range for normal thyroid Tc-99m pertechnetate was lower than the standard 1-4% range. Moreover, uptake decreased with age. Further studies are needed to establish the normal age-adjusted uptake for the thyroid Tc-99m pertechnetate scan.LIMITATIONS: Single center and retrospective.CONFLICT OF INTEREST: None.

Exposure and perception of general surgery residents' toward robotic-assisted surgeries in Riyadh, Saudi Arabia

Introduction: Robotic surgery is one of the rapidly expanding technologies in the field of medicine. It has been implemented since 2000; and its use has expanded over the past years. Da Vinci system was first introduced to the Middle East in 2003 by Saudi Arabia; then over the following 15 years it was utilized by other gulf countries. With the expanding knowledge of this technology and the effectiveness of its utilization; formal training programs were introduced by many hospitals. However; there are no established credentialing standards or well-structured curriculum to provide this training in the gulf region. Method: This we aim to understand the perception of general surgery residents toward robotic surgery training in tertiary care centers in Riyadh; Saudi Arabia. An anonymous web based survey was conducted on general surgery residents enrolled in Saudi Commission for health specialties approved residency training hospitals in Riyadh. Results: 50% of GS residents were involved in robotic assisted surgery which was significantly associated with the presence of robotic machines in their training centers (P0.025). Sixty Percent of residents who were involved in RAS did not receive a formal training prior to their participation, barely even a brief introduction. Conclusion: exposure and education about RAS at early training years showed that residents have better technical performance during their fellowship training. However, it should not the main focus of the training.

Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia.

Objectives:To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA.Methods:Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018.Results:Thrombolysis was performed in 148 patients (mean age: 58.2±14.5 years), 94 (63.5%) of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke Scale score upon admission was 13. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were the most common risk factors for stroke. The most common mechanism of stroke was cardioembolism (43.2%), which was associated with a more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 patients (66.2%); the rest received intravenous tissue plasminogen activator plus endovascular therapy or endovascular therapy alone. The median door-to-needle (DTN) time was 70.5 min, with a significant improvement from 2012 (111.6 minutes) to 2018 (69.9 minutes) (p<0.001). Among the patients, 53 (35.8%) showed a good outcome (with a modified Rankin score of 0–2) whereas 14 (9.5%) died. Symptomatic intracranial hemorrhage (sICH) was seen in 8.1%. All vascular risk factors were more common in patients aged >60 years, except smoking, which was more common in the younger age group (p=0.007).Conclusion:In our cohort, the utilization of thrombolysis and the DTN time improved over time. One-thirds of the patients received endovascular treatment. Moreover, the frequency of the vascular risk factors was high. Compared with the published findings, our results showed that cardioembolic strokes were the most frequent and had severe presentation and were likely the cause of the slight increase in mortality and sICH.

Reducing the Length of Stay by Enhancing the Patient Discharge Process: Using Quality Improvement Tools to Optimize Hospital Efficiency.

Delays in the discharging process can affect hospital efficiency. Improving patient flow in acute care hospitals is an essential issue that hospital management and research aim to achieve. Admission volume and LOS for hospitalized patients in the medical specialties department was examined at a tertiary care center in Riyadh, Saudi Arabia, to explore practical approaches to reduce the LOS. We aimed to identify and manage reasons for the delay in discharging patients from the medical specialties department at a tertiary care center in Saudi Arabia. Admission and discharge data for hospitalized patients were collected from 2016-2018. In 2017, a FOCUS (find, organize, clarify, understand, select)-PDSA (plan, do, study, act) quality improvement method was used to improve the discharge processes, with specific measurable targets per year. The number of readmissions and mortality rates decreased significantly after the intervention was implemented, suggesting an improvement in the quality of treatment and the process of admission and discharge. Despite gradual increases in admissions from 2016 to 2018, the mean LOS decreased significantly between 2016 and 2018, from 9.16 to 7.47 days (p < 0.001). The number of readmissions and mortality rates decreased after the intervention was implemented in 2017, suggesting an improvement in the process of admission and discharge. The LOS can be reduced by implementing a quality improvement intervention, driven by a multidisciplinary committee involving healthcare personnel, to facilitate the optimal discharge mechanism through available hospital resources and services.

SARS-CoV-2 infection in children, clinical characteristics, diagnostic findings and therapeutic interventions at a tertiary care center in Riyadh, Saudi Arabia

BackgroundCoronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 was first identified in Wuhan, China. All ages are susceptible to SARS-CoV-2 infection. Few studies had reported milder course in children however, severe course of illness has been reported. We aimed to describe the clinical features of COVID-19 in pediatric patients including diagnostic findings and therapeutic interventions in sever disease manifestation. MethodsWe retrospectively reviewed 742 patients with SARS-CoV-2 proven infection at King Abdullah Specialist Children’s Hospital, from April 2020 and July 2020. Inpatients, outpatient, including those with sever manifestation treated at the Intensive Care Unit (ICU) were included. We collected data including demographic data, comorbidities, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of patients with COVID-19. ResultsAmong of 742 patients, 71 (9.6%) were hospitalized. The median age of patients was 75 months old and 53.6 were male. A total of 461 (62.1%) had close contact with confirmed cases, 45 (6.1%) had no contact history, and 236 (31.8%) with unknown exposure risk. The most common symptoms at the onset of illness were fever (32.5%), respiratory symptoms (21%) and gastrointestinal symptoms (10.3%). Among the entire cohort, 7 patients were admitted to PICU with COVID-19 related symptoms, five patients diagnosed with MIS-C, one patient with Kawasaki, and one patient with pneumonia. All patients received supportive therapy, no antiviral treatment had been used however, in MIS-C patients IVIG had been given to all patients, five patients received Anakinra; and one patient received tocilizumab. ConclusionsIn this study, children infected with SARS-CoV-2 are less likely to develop symptomatic or serious diseases. Among symptomatic children, the most common clinical features were fever and respiratory symptoms followed by gastrointestinal manifestations. The majority of infected children have reported contact with an infected individual. MIS-C associated with COVID-19 is a severe presentation of SARS-CoV-2 infection and of a major concern as an overlapping features with other diseases could happen, making the diagnosis challenging.

Effect of hormonal manipulation using clomiphene citrate prior to microdissection testicular sperm retrieval

Introduction:Microdissection Testicular Sperm Extraction (micro-TESE) is a surgical method used for retrieving sperm from men with non-obstructive azoospermia. Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM) that stimulates luteinizing hormone (LH) and follicle-stimulating hormone (FSH) production. It is believed that treating patients with CC prior to micro-TESE increases the chance of sperm retrieval.Methods:This retrospective study was conducted in a tertiary care center in Riyadh, Saudi Arabia and included all patients who underwent Micro-TESE from August 2015 to November 2018. Data related to the pre-surgery hormonal levels, testicular volume, and associated genetic abnormalities were collected. chi-square and t-test were used to compare variables. A p-value of less than 0.05 was considered significant.Results:A total of 122 patients were included in this study, with 30.0% (n=37) treated with CC. The overall sperm retrieval rate was 44.3%. Micro-TESE results were not statistically affected by age, testosterone levels, Klinefelter syndrome, or taking CC. However, higher testicular volumes and lower LH and FSH levels had more positive micro-TESE results.Conclusion:In conclusion, Micro-TESE results were not affected by CC, age or testicular volume.

Prevalence of Varicose Veins Among Nurses at Different Departments in a Single Tertiary Care Center in Riyadh.

BackgroundVaricose veins (VV) is a chronic venous disease that affects the lower extremities. It is the dilation of subcutaneous veins, three to four millimeters in diameter. VV can be attributed to several risk factors such as age, obesity, multiple parities, heavy lifting, and long-standing hours. Direct and indirect complications can occur due to VV. Several studies were conducted to estimate the prevalence of VV.MethodsA self-administered questionnaire was used to estimate the prevalence of VV among nurses from different departments in the National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. The questionnaire included questions on weight, height, work history, lifestyle, and multiple diseases. The chi-square test and Fisher’s exact test were used for testing the association between the various predictors and the diagnosis of VV.ResultsA total of 366 nurses participated in the study. There were 40 (39 females and one male) cases of VV accounting for 11.0%. Variables that have a statistically significant association with VV were social status and lifting heavy objects (p=0.02), a family history of VV (p-value=<0.001), and the number of childbirths (p=0.04). The observation of each department was not statistically significant with VV (p=0.35).ConclusionAmong nurses, positive family history, age, marital status, long-standing hours, and heavy object lifting were significant risk factors for the development of VV. However, the prevalence of VV in the four departments was low.

COVID-19 and Palliative Care Services: Comparative Patterns of Inpatient, Outpatient, and Consultation Services in a Tertiary Care Center in Riyadh.

IntroductionThe coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the 21st century. The World Health Organization declared the COVID-19 outbreak as a pandemic on March 11, 2020. Lockdowns were imposed in multiple countries affecting patient flow in hospitals.MethodsThis is a retrospective study conducted at King Fahad Medical City (KFMC), a tertiary care hospital in Riyadh, Saudi Arabia, which examined the differences in palliative care services during the initial four months of the COVID-19 pandemic compared to the respective four months in 2019 (March, April, May, June).ResultsA total of 319 patients were seen at the palliative care department from March to June 2020 during the COVID-19 pandemic (119 inpatient, 200 outpatient), compared to 346 patients seen during the corresponding months in 2019 (97 inpatient, 249 outpatient). Our main findings included more patients being discharged home, lesser transfers, shorter hospital length of stay, lesser imminent death protocols, and a higher palliative performance score (PPS) during the COVID-19 pandemic. Although there were more cancelations by the hospital for the outpatient department, a virtual clinic was started, and 84 patients were effectively seen. Around 87% of patients were fully satisfied (5/5) with the services provided by the virtual clinic. There were no positive COVID-19 cases in our healthcare workers in the palliative care department due to the high standard precautions applied at KFMC. Family meetings as well as administrative and academic meetings have been efficiently held virtually and may possibly become the standard of practice.ConclusionPalliative care services were successfully maintained during the COVID-19 pandemic at KFMC.

The clinical outcome of HIV infection at a tertiary care center in Riyadh, Saudi Arabia.

Objectives:To investigate clinical characteristics and the outcome of people living with HIV (PLWHIV) at tertiary care center in Riyadh, Saudi Arabia.Methods:The present retrospective, observational study was carried between 2000-2019 at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. The demographic and clinical characteristics of 137 PLWHIV patients were collected by reviewing the medical data record.Results:Of the total 137 PLWHIV, 78.8% were male and 21.2% were female. At care entry, the most opportunistic infections found were the cytomegalovirus infections. cytomegalovirus (CMV) infections in 13.8% of patients, tuberculosis (8%), AIDS associated malignancy (10.9%), hepatitis B (5.8%), NTM (3.6%), hepatitis C (2.2%). In the present study, more than half of the patients received integrase based combination therapy. The highest number (n=20) of patients were diagnosed in 2018.Conclusions:Our findings describe the clinical characteristics and outcomes of PLWHIV at a major tertiary referral hospital in Saudi Arabia. The non AIDS related disease is the major cause of death in HIV infected patients. Early diagnosis and initiation of antiretroviral therapy resulted in a significant decrease in morbidity and mortality.

Antenatal care of mothers and morbidity and mortality disparities among preterm Saudi and non-Saudi infants less than or equal to 32 weeks' gestation.

ABSTRACTBACKGROUND: Premature non-Saudi infants comprise a significant proportion of neonatal intensive care unit admissions in Saudi Arabia. Any differences in antenatal care of mothers and neonatal outcomes compared with premature Saudi infants are unreported.OBJECTIVE: Assess antenatal care of mothers and neonatal outcomes among premature Saudi and non-Saudi infants, and investigate possible reasons for disparities.DESIGN: Retrospective cohort study.SETTING: Tertiary care center in Riyadh.PATIENTS AND METHODS: All neonates of gestational age ≤32 weeks and birthweight <1500 g admitted from 2015 to 2019 were included.MAIN OUTCOME MEASURES: Antenatal care of mothers and rates of neonatal mortality and morbidity in premature Saudi and non-Saudi infants.SAMPLE SIZE: 755 premature infants, 437 (57.9%) Saudi, 318 (42.1%) non-Saudi.RESULTS: Saudi mothers received more antenatal steroids and were more likely to have gestational diabetes mellitus (P=.01 and .03, respectively). Non-Saudi mothers were more likely to have pregnancy-induced hypertension (P=.01). Non-Saudi infants had significantly higher rates of intraventricular hemorrhage, patent ductus arteriosus, pulmonary hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis compared with Saudi infants (P=.03, <.001, .04, .002, and <.001, respectively). There were no significant differences in mortality rate, early-onset sepsis, and late-onset sepsis between Saudi and non-Saudi infants (P=.81, .81, and .12, respectively).CONCLUSIONS: Disparities exist in the antenatal care of Saudi and non-Saudi women and in the neonatal morbidities of their premature infants. There was no difference in the neonatal mortality rate. More quality improvement initiatives are required to reduce differences in antenatal and neonatal outcomes.LIMITATIONS: Retrospective, socioeconomic disparities not identified.CONFLICT OF INTEREST: None.

Knowledge regarding Zika Virus Infection among Healthcare Providers in an Academic Tertiary Care Center in Riyadh, Saudi Arabia: A Cross-Sectional Survey Study.

Background Zika virus (ZIKV) has become a major concern across the world. It is highly necessary for healthcare providers (HCPs) to have sufficient knowledge about such a disease. The purpose of this study is to assess the knowledge regarding ZIKV among HCPs in Riyadh, Saudi Arabia. Materials and Methods. A cross-sectional survey study was conducted at a tertiary care center in Riyadh, KSA, during a two-month period from September 19, 2016 to November 19, 2016. Descriptive statistics were performed on data collected. For continuous variables, data were expressed as means ± standard deviations (SDs), medians, and ranges. Proportions were used to describe categorical variables. Knowledge scores were evaluated and compared by demographic characteristics including age, designation, years of practice, and gender, using the t-test/Mann–Whitney U test or the Kruskal–Wallis test, as appropriate. Results A total of 336 HCPs from different specialties (physicians, dentists, nurses, pharmacists, and nutritionists) completed the questionnaire. Significant differences in knowledge about ZIKV were observed by participant's age. Significantly higher knowledge levels were observed among older participants (45 years or more; p=0.011). A substantial difference in the knowledge level was observed by department, with pairwise comparisons showing significant differences in knowledge scores between all departments except for Pharmacy vs. Nutrition and Nursing vs. Internal Medicine. Knowledge scores were not significantly different by years of practice. Conclusion Our study showed inadequate knowledge of HCPs from different specialties about ZIKV infection which needs to be improved in terms of infection prevention and control. Awareness about ZIKV infection should be ensured and maintained among HCPs to face any possible emergence in the region.

Safety and Efficacy of Ahmed Valve on Intractable Glaucoma in Saudi Population.

PURPOSE:The study aims to assess the efficacy and safety of Ahmed glaucoma valve implant in eyes with intractable glaucoma and to evaluate the risk factors for failure.METHODS:A retrospective evaluation of 83 patients (117 eyes) with intractable glaucoma who underwent silicone Ahmed glaucoma valve implant was done in a tertiary care center in Riyadh, Saudi Arabia, between January 2014 and December 2016. Complete success was defined as intraocular pressure (IOP) ≤21 mmHg without medication after a minimum follow-up of 6 months.RESULTS:Eighty-three patients (117 eyes) with intractable glaucoma were evaluated. After a mean follow-up duration of 20.8 ± 3.1 (12–24) months, the overall success rate was achieved in 104 eyes (88.9%). Thirty-six eyes (30.8%) had a complete success rate, whereas 68 eyes (58.1%) had a qualified success rate. Thirteen eyes (11.1%) failed to achieve controlled IOP. The postoperative probability to fail was found to be increasing with time from 0.9% (0.9) in the 1st month to 11.1% (9.9) after 1 year. Complications included a hypertensive phase in 25 eyes (21.4%), encapsulation in 10 eyes (8.5%), hyphema in 7 eyes (6%), hypotony in 2 eyes (1.7%), and blood clots in the implanted tube in 2 eyes (1.7%). The presence of hyphema, scleral patch, and coronary heart diseases was found to increase the risk of failure after Ahmed valve implantation (P = 0.006, 0.040, and 0.014, respectively).CONCLUSIONS:Ahmed glaucoma valve implant was safe and effective in treating cases of intractable glaucoma.

Cherry angioma: A case-control study.

BACKGROUND:Cherry angiomas (CAs) are very common asymptomatic vascular skin lesions. There are only a few studies on CAs in the literature and those assessing risk factors of CAs are scarce. The aim of our study was to determine risk factors for the development of CAs.MATERIALS AND METHODS:A case–control study was conducted at a tertiary care center in Riyadh, Saudi Arabia. Patients underwent a full-body examination for CAs. Demographics and other data including medical history and medications were extracted from electronic medical records.RESULTS:A total of three hundred patients were enrolled: one hundred cases with at least five CAs and two hundred controls without CAs. Bivariate analysis identified benign prostatic hyperplasia (odds ratio [OR]: = 2.591), malignancy (OR = 2.567), tamsulosin (OR = 3.171), and clopidogrel (OR = 0.321) as statistically significant associations. After multivariate logistic regression analysis, only tamsulosin (OR = 3.475, P = 0.009) and clopidogrel (OR = 0.281, P = 0.028) were found to be independent risk factors for CAs. Malignancies tended to be more associated with CAs, but this did not reach statistical significance (P = 0.07).CONCLUSION:Tamsulosin is a possible risk factor for the development of CAs. Clopidogrel seems to have a protective role preventing the development of CAs.

Sensitivity and specificity of a Middle East respiratory syndrome screening tool used in the emergency department

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) infection becomes a global health issue because of its ability to spread rapidly, especially in healthcare settings. Improper triage of MERS-CoV-infected patients in the emergency department (ED) increases the risk of infection in healthcare providers and other patients. Having a good triage screening tool would improve early detection and isolation of suspected infected patients, thus preventing future outbreaks. Materials and Methods: This is a retrospective cohort study performed in a large urban, academic ED in a tertiary care center in Riyadh, Saudi Arabia. The aim of the study was to assess the accuracy of the triage screening tool used in the ED. A convenience sample of 734 patients visiting the ED during the 2015 MERS-CoV outbreak was included. Patients deemed positive were isolated and underwent MERS-CoV polymerase chain reaction (PCR) testing. Patients deemed negative were followed up via phone after two weeks of their ED visit. They were checked for the development of symptoms and whether the patients sought medical advice in another hospital or underwent MERS-CoV PCR testing. Results: The sensitivity of the screening tool for detecting PCR-positive MERS-CoV infection was 100% (95% confidence interval [CI]: 15.8–100), and the specificity was 78.2% (95% CI: 75.1–81.2). Conclusions: The ED triage screening tool used during the 2015 MERS-CoV outbreak is highly sensitive. It is effective for early detection of infection in the ED, thus allowing timely isolation of suspected patients.

Characteristics and outcomes of osteoporotic hip fractures: treatment gaps in a tertiary care center in Riyadh, Saudi Arabia.

Hip fracture is the most clinically devastating and economically important complication of osteoporosis. Pain, suffering, loss of mobility and independence are some of the devastating consequences of hip fractures. The present study aimed to determine the main characteristics and outcomes of patients with osteoporotic hip fracture and treatment gaps at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. This is a single-center, retrospective cohort study analyzing charts of patients > 45years who were admitted for hip fracture secondary to low-grade trauma from 2008 to 2012. A total of 264 patients (50.4% males and 49.6% females) were included. The most common fracture types were trochanter (49%) and femoral neck (46%). History of falls was documented in 115 (43.6%) patients. Bone mineral density (BMD) was assessed in only 41 (15.5%) patients. Majority underwent surgery (92%). Surgical complications occurred in 15 (5.7%) patients and medical complications in 21 (7.9%) patients. Vitamin D and calcium were the most common medications, but given only to 45 (17%) patients. Bone mineral density (BMD) assessment was significantly more frequent post-surgery than pre-surgery (p = 0.03). Very few patients received osteoporosis-specific therapy. F ollow-up revealed that 62 (23.5%) patients died 1year after surgery. These present findings warrant urgent reassessment of clinical care and treatments provided to patients with osteoporotic hip fractures to prevent recurrent fractures. The introduction of Fracture Liaison Service (FLS) in institutions caring for patients with hip fractures as internationally recommended will definitely change the current status of care.

Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia - Single center experience

Thrombolysis in acute ischemic stroke although being standard of care is still significantly underutilized. There is no published data from Saudi Arabia about the use and outcomes of thrombolysis in stroke. To present single center experience of stroke thrombolysis from a tertiary care center in Riyadh, KSA. An IRB approved cross-sectional, observational study of patients receiving thrombolysis between January 2012 and December 2018. A total of 148 patients received thrombolysis, 94 (63%) were men; mean age 58.2 + 14.5years. Mean time from stroke onset to hospital arrival was 89 + 48 minutes; 25% arrived within one hour. Mean NIHSS score on admission was 13.4. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were commonest risk factors. Cardioembolism was the commonest mechanism of stroke (43.2%) and was associated with more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 (66.2%); the rest had IV tPA and endovascular therapy or endovascular therapy alone. Mean door-to-needle time was 79.7 minutes, showing significant improvement between 2012 (111.6 minutes) and 2018 (69.9 minutes); p-value <0.001. Good outcome (mRS of 0-2) was seen in 35.8%, whereas 14 (9.5%) patients died. Symptomatic ICH was seen in 11.5%. All vascular risk factors were more common in age > 60 years except smoking which was more common in younger (p = 0.007). In our cohort, high frequency of vascular risk factors was seen. One-third of patients received endovascular treatment. The mean door-to-needle time improved significantly over years. Cardioembolic strokes were the most frequent and more severe.