Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia.
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ABSTRACT:
SUBMITTER: Al-Turki AA
PROVIDER: S-EPMC5541182 | biostudies-other | 2017 Jun
REPOSITORIES: biostudies-other
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Project description:ObjectiveTo evaluate the outcome of complicated osteoarticular brucellosis.MethodsA retrospective chart review was conducted at King Abdulaziz Medical City (KAMC), in Riyadh, Saudi Arabia. All patients aged more than 14 who have been diagnosed with complicated brucellosis with osteoarticular disease between July 2016 and December 2022 were included.ResultsA total of 82 (10.7%) patients met the criteria, with a male predominance of 66 (80.4%), and their mean age was 56.4 ± 19.3 years. A positive blood culture was found in 33 (40.2%). The most common clinical presentation was fever (57.3%). All patients received a doxycycline-based regimen except one. 62 (75.60%) patients were treated with three or more medication regimens, while 20 (24.40%) patients received two drug regimens. The mean duration of therapy was 94.2 days for two-drug therapy and 116.4 days for three-drug therapy. A total of 78 out of 82 (95.1%) cases were cured at the end of treatment. Unfavorable outcomes were documented in four cases (two relapses and two treatment failures). Neither using three drugs regimen nor longer duration of therapy was associated with better outcome.ConclusionsUnfavorable outcomes have been noticed to be minimal in our cohort of patients with osteoarticular brucellosis, treated mainly with a three-drug regimen and a longer duration of therapy.
| S-EPMC10971777 | biostudies-literature
Project description:IntroductionTuberculosis is among the deadliest infectious diseases. Lymphadenitis is an inflammation of the lymph nodes which is the most common extrapulmonary manifestation of tuberculosis. Saudi Arabia is rated as a country with a low incidence of tuberculosis. The study's objective is to describe the clinical characteristics and outcome of TB lymphadenitis (TBL) at a large tertiary care center in Riyadh, Saudi Arabia.MethodAll patients 18 years and older diagnosed with TB lymphadenitis between 2010 and 2021 at a single tertiary center in Riyadh, Saudi Arabia, were reviewed retrospectively for their clinical presentation, diagnostic yield, therapy, and outcome.Result107 patients were included in the final analysis. The distribution of males and females were nearly equal, at 50.5 % and 49.5 %, respectively. The average age was 45. During the ten-year period of our investigation, the number of confirmed TBL ranged from 19 (the highest in 2010) to as little as one patient in 2021. 72.8 percent of patients presented with TBL affecting the neck. The most commonly used diagnostic method was histopathological examination of the tissue sample, granulomatous inflammations were found in 89.2 % of cases of theses necrotizing granuloma. 10.7 % of our isolates had resistance. The average duration of anti-TB treatment was 6.8 months with a cure rate of 72.9 %.ConclusionThe majority of patients in this study had cervical lymphadenopathy, with histopathology being the mainstay of diagnosis. 90 % of TBL cultures were susceptible to first-line anti-TB therapy.
| S-EPMC10727992 | biostudies-literature
Project description:BackgroundInternationally, Cystic fibrosis-associated liver disease (CFLD) is considered the third leading cause of death, following lung disease and transplantation complications.AimsTo identify the prevalence of CFLD in cystic fibrosis (CF) patients.MethodologyA retrospective chart review for all patients with CF liver disease from a tertiary care center.ResultA total of 341 CF patients were included. The mean age at the diagnosis of liver disease is 13.5 (7.6) years.The first elevated ALT was reported in 190/341 patients (56%), elevated AST in 124 patients (36%), elevated alkaline phosphatase (ALP) in 166 patients (49.1%), elevated GGT in 57 patients (23%), and elevated bilirubin in 24 patients (7%). There was an improvement of the liver enzyme values during the follow-up period, P-value = (<0.05).Ultrasound liver assessments were performed in 258/341 patients (75.7%). One hundred and twelve patients (43%) had abnormal findings. In 14 patients (5.4%), assessment exhibited advanced liver disease (liver cirrhosis and periportal fibrosis). Out of 190 patients, who were given ursodeoxycholic acid for elevated liver enzymes, 180 (94.7%) exhibited improvement. One patient underwent liver transplant at the age of 12. Four patients were submitted for liver biopsy; periportal fibrosis was observed in 4 patients (1.6%), and liver cirrhosis by ultrasound (US) in 10 patients (4%).ConclusionPatients with CF should be screened early for liver enzymes, and should undergo the US study to detect liver disease at early stages and to prevent its progression.
| S-EPMC9152554 | biostudies-literature
Project description:Results:A total of 216 patients with AA were included. The overall prevalence of AA was approximately 2.3%. The mean disease duration at the time of presentation was 2 months while the mean age of onset was 25.61 years. The most common type of AA in both adult and pediatric groups was the patchy type involving the scalp. Comorbid diseases were found in 32.41% of patients. Common associated conditions included hypothyroidism, diabetes mellitus, and atopic diseases. Conclusion:The overall prevalence of AA among a population of Saudi patients is 2.3%. AA prevalence is higher in pediatrics than adults. Common comorbid conditions include hypothyroidism, diabetes mellitus, and atopic diseases.
| S-EPMC7093899 | biostudies-literature
Project description:AimThis study aimed to (i) assess the level of patient satisfaction and its association with different sociodemographic and healthcare characteristics in an emergency care centre (ECC) in Saudi Arabia and (ii) to identify the predictors of patients' satisfaction.MethodsA prospective cohort study of 390 adult patients with Canadian triage category III and IV who visited ECC at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 1 July and end of September 2011 was conducted. All patients were followed up from the time of arrival at the front desk of ECC until being seen by a doctor, and were then interviewed. Patient satisfaction was measured using a previously validated interview-questionnaire, within two domains: clarity of medical information and relationship with staff. Patient perception of health status after as compared with before the visit, and overall life satisfaction were also measured. Data on patient characteristics and healthcare characteristics were collected. Multiple linear regression analysis was used, and significance was considered at p≤0.05.ResultsOne-third (32.8%) of patients showed high level of overall satisfaction and 26.7% were unsatisfied, with percentage mean score of 70.36% (17.40), reflecting moderate satisfaction. After adjusting for all potential confounders, lower satisfaction with the ED visit was significantly associated with male gender (p<0.001), long waiting time (p=0.032) and low perceived health status compared with status at admission (p<0.001). Overall life satisfaction was not a significant predictor of patient satisfaction.ConclusionsAn appreciation of waiting time as the only significant modifiable risk factor of patient satisfaction is essential to improve the healthcare services, especially at emergency settings.
| S-EPMC5256124 | biostudies-literature
Project description:BackgroundThe clinical teaching unit (CTU) is a commonly used model of patient care and teaching. Despite being a common model of care, very few studies have looked at its impact on the education of trainees. In addition, it is a relatively new structure for pediatric inpatient care in Saudi Arabia. The purpose of this study was to compare postgraduate trainees (residents) and staff perceptions of the old and the new (the CTU) inpatient team structures, and to evaluate the impact of the CTU on residents' education.MethodsAn online survey was sent to nurses, pediatric residents, and attending physicians who worked under both structures. Questions for residents were adopted from the National training survey of the General Medical Council, United Kingdom.ResultsA total of 147 pediatric healthcare workers completed the survey (97 nurses, 39 residents, and 11 attending physicians), most of whom worked in both the old and new inpatient team structures. More than 97% of residents reported being supervised by their attending on a daily basis in the CTU structure as compared with 15% in the old structure. A higher proportion of residents favored the old structure in terms of the opportunity it provided to develop their leadership skills. Eighty-seven percent of nurses believed the CTU had improved patient safety of pediatric inpatients. Overall, 82% of residents, 91% of nurses, and 100% of attending physicians favoured the CTU structure over the old inpatient model.ConclusionsOur study shows that pediatric residents and staff perceived the CTU structure as superior to the old inpatient team structure, especially in terms of patient safety. Although the CTU seemed to have a positive impact on residents' education, this must be further examined especially with respect to its impact on residents' leadership skills.
| S-EPMC8826672 | biostudies-literature
Project description:BackgroundInterest in outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) has increased recently as part of value-based care and early recovery protocols. Outpatient pathways require significant paradigm shifts, are not used widely, and are mostly implemented at outpatient surgery centers or orthopedic specialty hospitals. In this article, we report on the outcomes of implementation of an outpatient arthroplasty protocol at a tertiary care academic medical center.MethodsWe performed a retrospective review on a series of 105 consecutive patients who underwent THA or TKA following our newly implemented outpatient arthroplasty protocol. We compared these patients to a group of inpatient arthroplasty patients from the same time period.ResultsEighty-three of 105 (79%) patients were successfully discharged home on the day of surgery. Successful same-day discharge was predicted by early ambulation (P = .01), TKA over THA (P = .04), and shorter duration of surgery (P = .01). General anesthesia correlated with better early ambulation distances (P = .03) and a lower incidence of urinary retention (P = .049). The outpatient readmission and complication rates were 0.95% and 1.9%, respectively, whereas the matched inpatient rates were 3.7% and 2.9%, respectively.ConclusionsOutpatient THA and TKA in a well-selected patient is feasible in an academic multidisciplinary tertiary care hospital, with complication rates approximating inpatient surgery. The findings reported here can be used to further optimize outpatient arthroplasty protocols.
| S-EPMC6470322 | biostudies-literature
Project description:Discrepancies exist between osteoarthritic joint changes and pain severity before and after total hip (THR) and knee (TKR) replacement. This study investigated whether the interaction between pre-operative widespread hyperalgesia and severity of radiographic osteoarthritis (OA) was associated with pain severity before and after joint replacement.Data were analysed from 232 patients receiving THR and 241 receiving TKR. Pain was assessed pre-operatively and at 12 months post-operatively using the WOMAC Pain Scale. Widespread hyperalgesia was assessed through forearm pressure pain thresholds (PPTs). Radiographic OA was evaluated using the Kellgren and Lawrence scheme. Statistical analysis was conducted using multilevel models, and adjusted for confounding variables.Pre-operative: In knee patients, there was weak evidence that the effect of PPTs on pain severity was greater in patients with more severe OA (Grade 3 OA: ß = 0.96 vs. Grade 4: ß = 4.03), indicating that in these patients higher PPTs (less widespread hyperalgesia) was associated with less severe pain. In hip patients, the effect of PPTs on pain did not differ with radiographic OA (Grade 3 OA: ß = 3.95 vs. Grade 4: ß = 3.67). Post-operative: There was weak evidence that knee patients with less severe OA who had greater widespread hyperalgesia benefitted less from surgery (Grade 3 OA: ß = 2.28; 95% CI -1.69 to 6.25). Conversely, there was weak evidence that hip patients with more severe OA who had greater widespread hyperalgesia benefitted more from surgery (Grade 4 OA: ß = -2.92; 95% CI -6.58 to 0.74).Widespread sensitization may be a determinant of how much patients benefit from joint replacement, but the effect varies by joint and severity of structural joint changes.Pre-operative widespread hyperalgesia and radiographic osteoarthritis (OA) severity may influence how much patients benefit from joint replacement. Patients undergoing knee replacement with less severe OA and greater widespread hyperalgesia benefitted less from surgery than patients with less hyperalgesia. Patients undergoing hip replacement with more severe OA and greater widespread hyperalgesia benefitted more than patients with less hyperalgesia.
| S-EPMC5245112 | biostudies-other
Project description:BackgroundPharmacovigilance (PV) demarcates all actions involving the detection and prevention of adverse drug reactions (ADR) for marketed drugs. However, ADRs are considerably underreported worldwide and continue to be a major concern to health care systems. This study aims to assess the knowledge, attitude, and perception of hospital pharmacists regarding medication safety concerning PV and ADRs across multiple tertiary care centers around Saudi Arabia.MethodsThis cross-sectional study was conducted between July 2019 and January 2020. Pharmacists working in the tertiary care centers of Riyadh City, Saudi Arabia were asked to participate in the study. A self-administered questionnaire was used to conduct this study, it consisted of: 63 questions out of which 19 questions were knowledge-based, 15 were attitude-based, and 29 were practice-based questions.ResultsA total of 350 pharmacists were distributed and 289 agreed to participate, giving a response rate of 82.6%. Most pharmacists were aware of the concept of VP and its functions (96.5%) and (87.2%), respectively. Moreover, 90% said that ADR can be preventable and non-preventable. However, the findings revealed inadequate knowledge about the overall PV field, where the majority of the pharmacists failed to correctly answer questions related to independent ADRs treatment, Augmented drug reaction, the international location of ADR, and the World Health Organization "online database" for reporting ADRs. Moreover, incomplete and/or wrong answers were recorded for questions that included single or multiple correct answers. Regarding the participants" attitude, 96.9% were interested in ADR reporting, agreeing that ADR is important to enable safe drug usage. Although a general positive attitude was recorded, pharmacists have stated that the three main barriers that hinder reporting ADRs are: unavailability of information about ADRs, lack of awareness about the need to report ADRs, and lack of time. Concerning practice, 69.2% said they received training in ADRs reporting, and 70% have reported ADRs more than once a week.ConclusionSurveyed pharmacists from Riyadh hospitals showed narrow knowledge of the PV field. However, a positive attitude and satisfactory practice was observed among pharmacists. These findings warrant the need for educational programs and an encouraging environment for ADR reporting to increase ADR reporting rates and support PV activities in Saudi Arabia.
| S-EPMC8274029 | biostudies-literature
Project description:IntroductionBacterial infections in CF patients are common and start early in life. The prognosis of the disease is substantially dependent on chronic respiratory infection and inflammation. Pseudomonas aeruginosa (PA) infection or chronic colonization have been established to cause a chronic decline in pulmonary function (PFT), and/or increase CF mortality.ObjectivesTo obtain the prevalence of all bacterial pathogens in our CF patients and assess their evolution over time.MethodA retrospective review of 327 patients with confirmed CF of all age groups, who had respiratory culture samples at the first visit and on a regular follow-up between January 1, 1990 and December 2018, was conducted.ResultsA total of 327 patients had a respiratory culture obtained at presentation. Two hundred and sixteen (66%) of 327 patients are alive, while 111 (34%) have died. Respiratory cultures were taken from nasopharyngeal aspiration (NPA) in 199 patients (61%), tracheal aspirate in 9 (3%), bronchoalveolar lavage (BAL)in one (0.29%), and in 124 patients (38%), sputum was induced. The eastern province contributed to the highest number of patients (122, 37.7%). There is a persistent increase in the prevalence of the common bacteria over the follow-up period of 7 years, namely Hemophilus influenzae (H. influenzae), Staphylococcus aureus (S. aureus), and all Pseudomonas (P. aeruginosa) culture types.Comparing cultures from the first and last follow-up visits, there was an increase in the prevalence of all (P. aeruginosa) cultures from 120 (34%) to 137 (53%), and a decrease in the prevalence of (S. aureus) and (H. influenzae) during the same follow-up period.ConclusionThere is a progressive increase in the number of patients with the most pathogenic types of bacteria because of the advanced age at presentation. As more adult patients are enrolled, there is a need for improved awareness regarding the early eradication of pathogenic bacteria to prevent progressive pulmonary damage.
| S-EPMC9152558 | biostudies-literature