Journal of King Abdulaziz University: Medical Sciences

Association Between Long Boarding Time in the Emergency Department and Mortality at King Abdul-Aziz Hospital

2023-09-11T16:50:36+00:00

Objective: To assess the association of boarding time in the ED and increased patient mortality at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia.

Methods: A retrospective study was conducted on 28,066 patients admitted through the ED and discharged from January to December 2019 at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia. Data on patients' demographics, age, nationality, arrival method, eligibility, triage level, outcome, and fate (death or alive) were collected from medical records.

Results: This study found a strong link between patient mortality and boarding time, with patients who died experiencing significantly longer boarding times than those who survived. The average boarding time for those who died was more than 12 hours, compared to only 2.2% of those who did not. Additionally, the death rate was higher among non-eligible and male patients, and patients with injuries or orthopedic diseases had notably higher percentages of more than 12 hours of boarding time. Both long boarding time and non-eligibility for management were risk factors for death among the patients studied.

Conclusion: This paper highlights the impact of protracted boarding times on patient outcomes and emphasizes the urgent need to take immediate steps to decrease ED boarding.

Anatomical Variations of Hepatic Arterial Anatomy on Abdominal Computed Tomography in over 300 Scans

2023-10-15T09:49:30+00:00

Abstract:

Aim:

Identifying anatomical variations in the hepatic artery is crucial before performing surgical or radiological interventions to avoid damaging abnormal, replaced, or uncommon arterial supplies. Our study measured the occurrence of hepatic arterial anatomical variations in a local population using computed tomography (CT).

Materials and Methods:

We analyzed all abdominal CT studies with intravenous contrast conducted at King Abdulaziz University Hospital over one fiscal year. The study included 351 studies. Michel’s and Hiatt’s classification systems were adopted to describe the variations.

Results:

In our study of 351 abdominal CT scans, we discovered that the accessory left hepatic artery (Type V) was the most prevalent abnormal variation based on Michel’s classification, occurring in 13.1% of cases. Hiatt’s classification identified the replaced or accessory left hepatic artery (Type II) as the most common abnormality, occurring in 19.1% of cases. Other variations were observed.

Conclusion:

Our study highlights the significance of hepatic artery variations in liver surgery and interventional radiology, such as the presence of accessory left hepatic artery and replaced hepatic arteries. Understanding these variations is crucial for optimizing patient care and improving outcomes in various clinical scenarios. Ongoing research is crucial for advancing this field.

Adenovirus Genotyping Based on Penton Gene Expression

2023-10-29T08:45:30+00:00

Adenoviruses contain double-stranded DNA, and human adenoviruses are no exception. An individual's immune status and the type of infection can determine the severity of adenovirus infections. There have been many successful vaccines developed using vectors derived from adenoviruses, including the COVID-19 vaccines manufactured by AstraZeneca and Johnson & Johnson, Ervebo, which uses an adenovirus vector to deliver a gene for the Ebola virus glycoprotein, Rabies vaccine, Imovax, which delivers the rabies virus glycoprotein gene using an adenovirus vector. As part of the icosahedral virus particle, the penton protein is encoded by the penton gene of the adenovirus. Additionally, the penton protein is required for initiation of virus entry into cells and virus attachment to host cells. Adenovirus HVR region limited typing was examined to determine the genotype of the virus. In order to construct phylogenetic trees for HAdV-D types 1 to 70, 9 isolates were typed, sequenced, and phylogenetic trees were constructed for the penton HVR loop regions that recorded a novelty strains that have not been reported previously. DNA extraction, PCR were conducted in this study with phylogenetic analysis.

Examining Dietetic Students' Feedback on Integrated Simulation-Based Education and Objective Structured Clinical Examination: A Mixed-Methods Approach

2024-01-08T06:26:34+00:00

Background: Objective Structured Clinical Examination (OSCE) and simulated-based learning (SBL) are feasible models to assess and improve students’ clinical skills.

Objectives: To evaluate the Saudi dietetic students' perceptions of the implemented structured clinical education approaches (OSCE) and (SBL) effectiveness. The primary focus is evaluating gained competencies and readiness for future clinical placements.

Methods: The study implemented a developed and validated electronic survey to evaluate the executed OSCE and SBL approaches in King Abdulaziz University's dietetic program in Jeddah, Saudi Arabia. Dietetic seniors (n=37) completed an online survey with open and closed-ended questions after completing the 2018-2019 academic year clinical education course.

Statistical analysis included descriptive data that are summarized using frequencies and percentages. Content Analysis was utilized for the students' reflections and feedback.

Results: 182% response rate, 37 students recruited, and 45 responses received (some did double survey). Results (95.6%, n=43) indicate that the implemented approaches effectively prepared students for the practical application of learned theories and concepts in managing inpatient cases. Students combined and contrasted information from different resources with confidence (86.5%, n=32) and made evidence-based decisions in patient nutrition management. Eighty-nine percent of students were familiar with the abbreviation OSCE, with 88.9% (n=40) stating that they found the OSCE stressful and 91% felt well-prepared for future clinical placement and supported continuing the approach in the next academic year.

Conclusion: Dietetic seniors' positive feedback highlights the significance of incorporating well-structured SBL sessions and OSCE exams in dietetic education in the academic year 2018-2019.

Keywords: Competencies, Dietetics, OSCE, Simulated-based. King Abdulaziz University.

Pharmacotherapy of drug resistance epilepsy: A Meta-analysis

2023-11-04T11:07:57+00:00

Background: Epilepsy is a common neurological disorder. The primary objective of treatment with anti-elileptic drugs is to achieve seizure freedom.

Objective: This systematic review and meta-analysis aimed to summarize the evidence-based medicine to treat drug-resistant focal epilepsy.

Method: The literature search was done through electronic databases including PubMed, MEDLINE, Cochrane, Scopus, and Google Scholar for 1^st January 2019 to 30 December 2022. The characteristics of selected drug-resistant focal epilepsy patients including the type of study, intervention, and treatment outcome were reported to estimate the reduction in seizure frequency. Study quality assessment was done using MMAT 2018.

Results: A total of nine articles were included in this study for qualitative assessment. Five articles were included in the meta-analysis. A total of 6665 participants from all included studies were examined for the presence of drug-resistant focal epilepsy. The age of the study participants ranged from 1 month to 70 years. The included observational studies were on newer anti-elileptic drugs including lacosamide, levetiracetam, lamotrigine, and perampanel. The randomized control trials examined were on oral cannabidiol 25mg/kg/day or 50mg/kg/day dose versus placebo, 200 mg/d dose of cenobamate in patients with ≤ 3 anti-epileptic drugs, and oral cenobamate adjuvant dose of 100mg, 200mg and 400mg daily. The total 95% confidence interval for pooled seizure reduction frequency was 4.19 and I2 statistics 90.36 demonstrating marked heterogeneity between studies.

Conclusion: To conclude, the use of third-generation and newer anti-seizure drugs has the potential to treat drug-resistant focal epilepsy.

Medical Conditions that Could Affect Oral Health Care Among Children Living in Governmental Orphanage Centers: A Case-Control Study

2023-11-19T16:03:10+00:00

The study aimed to assess the medical health conditions that could affect oral health care among children living in governmental orphanage centers compared to non-orphan children living with their parents. This case-control study included 6- to-12-year children living in five-governmental orphanages (cases) that are matched in gender and age with children living with their parents (controls) in Jeddah, Saudi Arabia. At the scheduled appointment, a trained dentist interviewed the caregiver through a validated Arabic questionnaire consisting of the Socio-demographic information of the child and guardian and the medical history of the children. A total of 70 children in the case group and 155 in the control group were included with a mean age of 7.47±2.26. Significantly more children living in governmental orphanage centers were diagnosed with medical problems that might affect their dental health, including congenital heart disease (P=0.029) and mental/cognitive/psychologic and behavioral disorders (P=0.005). Children living in governmental orphanage centers are more likely than children who live with their parents to be affected by medical conditions that might impact their dental health care, which calls for special dental care precautions for this population.

Hyperkyphosis and Diffuse Platyspondyly in a 20-Year-Old Woman with Laron Syndrome: A Case Report

2024-08-29T12:44:29+00:00

Background: Laron syndrome (LS) is a rare genetic disorder caused by
mutations in the growth hormone receptor gene. It is characterized
by severe dwarfism resistant to growth hormones, metabolic
abnormalities, and an increased risk of developing type 2 diabetes.
Patients with LS often present with spinal abnormalities, including
hyperkyphosis. However, hyperkyphosis and diffuse platyspondyly are
unusual features in patients with LS; to our knowledge, no case has
been reported to date.
Case Report: This report presents the case of a 20-year-old
woman with LS who visited the orthopedic outpatient clinic with
hyperkyphosis. She received an LS diagnosis during childhood, and
her family members also had hyperkyphosis. The patient reported a
gradual worsening of her condition, accompanied by back pain and
difficulty in daily activities. Physical examination showed increased
thoracic curvature and reduced height. Radiographic investigations
included long spine radiographs, a computed tomography scan, and
magnetic resonance imaging. The radiographs revealed kyphosis
with flattened vertebral bodies, and the magnetic resonance imaging
demonstrated degenerative changes and spinal cord assessment.
Diffuse platyspondyly, kyphosis centered around the T11 level, and
degenerative changes were observed.
Conclusion: The case report highlights hyperkyphosis in a patient
with LS and emphasizes the importance of further investigation
for hereditary skeletal dysplasia. This case report contributes to the
understanding of the musculoskeletal manifestations of LS, specifically
hyperkyphosis and spinal abnormalities. Further research is warranted
to explore the underlying mechanisms and develop targeted treatment
strategies for individuals with LS and its associated spinal deformities.