Surgical Site Infection in a Teaching Hospital: a Prospective Study

Objectives: To investigate the risk factors for surgical site infection together with the identification of the etiological pathogens and their antimicrobial susceptibility at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Methods: A prospective case series study conducted at King Khalid University Hospital to all patients admitted to the surgical wards during the period between January 1st and September 30th 2007. The demographic data, diagnostic criteria, associated risk factors and laboratory data including gram stain, culture results and antimicrobial susceptibility of swabs from the surgical sites were collected. Results: Out of the one hundred and thirty one patients recruited in the study, nine patients showed evidence of sepsis yielding an infection rate of 6.8%. Emergency operations and associated diabetes showed significantly higher rates of infection compared to their counterparts. The most commonly isolated bacteria were: E. coli, Pseudomonas aurigenosa and Staphylococcus aureus.Conclusion: The rate of surgical site infection was 6.8% which was comparable to that reported literature. E. coli was the most commonly isolated bacteria. Neither MRSA nor Acinetobacter species were common isolates. The rate of infection in diabetics and those who underwent emergency operations was significantly higher than others. Other comorbidities did not directly affect the rate of surgical site infection in our series

Pattern of liver function tests in morbidly obese Saudi patients undergoing bariatric surgery

Morbidly obese patients have a high prevalence of fatty liver disease and its serious complications, and high prevalence of abnormal liver function tests [LFT]. The LFT can give a clue to the liver damage and correlate with activity. We aim to study the pattern of LFT in morbidly obese Saudi patients undergoing bariatric surgery in Eastern region. Medical records of patients undergoing bariatric surgery were reviewed. Demographic data, comorbid conditions, and medications taken were recorded. Intraoperative liver appearance was noted. Patients with alcohol intake or without LFT were excluded. Out of 113 patients, 15 patients were excluded, and of the remaining 98 patients analyzed, 58.2% were females. Mean age was 33.1 +/- 8.87 years. Mean body mass index [BMI] was 53.7 +/- 1.27 kg/m[2]. Abnormal LFT [alanine aminotransaminase [ALT] aspartate aminotransaminase [AST] alkaline phosphatase [ALK], and Gamma glutamyl transpeptidase [GTT] were observed in 17.3%, with 1.5 to 2 times the upper limit of normal. ALT was most elevated in 12.2%. Abdominal ultrasonography was done in 67 [68.4%] patients, of whom 51 [76%] had fatty liver. Comorbid conditions including diabetes mellitus, hypertension, hyperlipidemia, bronchial asthma, and obstructive sleep apnea were observed in 51 [51.50%] patients, eight of them [16.3%] had abnormal LFT. No intraoperative changes of cirrhosis were observed. The prevalence of abnormal LFT is low in morbidly obese patients from the eastern region of Saudi Arabia. A prospective study with a larger sample and liver biopsy, is needed to clarify the findings

Risk factors of post-asphyxial hypoxic-ischemic encephalopathy [PAHIE] Abha City -Southwestern Saudi Arabia: a case-control study

A case-control study of neonatal encephalopathy was conducted in Abha General Hospital to determine some possible risk factors of encephalopathy. A total of 57 full term infants with evidence of neonatal encephalopathy at 6-24 hours after birth were recruited over a I period of 3 years, and compared with the same number of a control group of normal newborns.' The cumulative incidence of neonatal encephalopathy was 4.9 per 1000 live births [95% Cl : 3.1 to 6.3]. Moderate or severe encephalopathy occurred in about 63% of all infants, with seizures in 67%. All of the 57 [100%] infants with encephalopathy required one or more of the resuscitation measures compared with 8 [14%] of the control. Significant antepartum risk factors of encephalopathy include: primiparity [OR=3.13], nonaccessibility to antenatal care [OR=1.89], and pregnancy-induced hypertension [OR=2.13]. Significant possible labour and delivery risk factors include: noncephalic presentation [OR=2.76], meconium stained amniotic fluid [OR=4.18]], fetal bradycardia [OR=5.23], abnormal fetal heart rate [0R=2.34], antepartum haemorrhage [OR=4.32], instrumental delivery [OR=2.1], and prolonged 2nd stage of labour [0R=6.67]. In conclusion, both antepartum and intrapartum factors are important in the causation of neonatal encephalopathy in Abha City. Improvement of both antenatal care and care during delivery is a necessity

pattern of peripheral lymphadenopathy in childhood in the Assir region of Saudi Arabia

Objective: The purpose of this study was to identify the anatomic distribution and histological types of the peripheral lymphadenopathy in the paediatric age group in the Assir region of Saudi Arabia

Method: 148 children, 12 years of age and below who presented with peripheral lymphadenopathy to the Assir Central hospital and had biopsies done over a 17-year period [1986-2002] formed the basis of this retrospective study

Results: The commonest anatomical location of peripheral lymphadenopathy was the cervical region [80.4%] The commonest histological diagnosis was non-specific reactive lymphoid hyperplasia 81 [54.7%] followed by granulomatous lymphadenitis 35 [23.6%], malignant lymphoma 24 [16.2%], metastasis 3 [2.0%] and miscellaneous lymphadenopathies 5[3.4%]

Conclusion: The majority of peripheral lymphadenopathy in childhood in the Assir region is due to reactive hyperplasia, a benign condition whilst other causes such as infections and malignancy occur to a lesser extent. Cervical lymphadenopathy was the commonest observed in consonance with the pattern world wide

Pattern of childhood poisoning in Abha city - southwestern Saudi Arabia

Objective: to describe the pattern of childhood poisoning in the Emergency Room [ER] of the Pediatrics Department in Aseer Central Hospital [ACH], in order to suggest possible causes and preventive measures

Methods: this is a retrospective study of cases of childhood poisoning or ingestions attending the pediatric emergency room of Aseer Central Hospital or those admitted to the Pediatric Department of same hospital in Abha, Kingdom of Saudi Arabia, during the period of January 2000 to December 2003. Children aged 12 years and below were included. Review of records was done to collect data on clinical information such as age, sex, type of poison, clinical condition on admission as well as the time, place and date of exposure to the offending agent

Results: in this study, 114 poisoned children aged 12 years and below were studied. It was found that children from 2-4 years were more liable to poisoning [81%, p<0.001]. Males were [68%] while females were [32%], with a sex ratio of 2.2:1. Medical drugs offended the most [72%, p<0.001]. As regards clinical condition on admission, drowsiness, nausea and vomiting as well as abdominal pain represented [82%] of the cases. Daytime was when 80% of poisoned cases were admitted [p<0.001]. The peak months were from June to August [71%, p<0.01]. As regard the place of exposure to offending agent, living rooms and bedrooms accounted for 58% of the cases [p<001]

Conclusion: the peak age for poisonings in children is before the age of four with significantly high diurnal frequency, significant seasonal variation in favor of summer. Medical drugs were the most common agents of poisoning, and living rooms and bedrooms the places where most poisoning occurred. Good and continuous supervision by parents is essential, especially from the age 1-5 years. There should also be legislation for the use of child resistant containers for home medicines nand household agents

Predictors of short term readmission of asthmetic children

Bronchial asthma admission rate has increased dramatically all over the world. Part of this increase in hospital admissions is due to patients readmission. Determining what risk factors are associated with short term hospital readmission of pediatric patients with asthma within two months of the last hospital admission.A retrospective case-control study using registration books of both admissions and discharges to identify patients groups. All hospital records were reviewed for patients admitted from August 1998 through December 2002 at Assir Central Hospital, southwestern of Saudi Arabia. Patients who were admitted at this period of study and they were readmitted to the hospital within two months constituted the study group [n=28] and those patients who were admitted within the same period but not readmitted within two months constituted the control group [n=45]. Demographic variables, route of admission, patient previous medical history, clinical assessment, hospital treatment as well as discharge treatment were extracted from medical records twenty eight patients were readmitted within two months of the discharge from hospital [17 boys and 11 girls] seventy percent of these were below four years of age. Significant predictors of readmission were; prior history of asthma admission [adjusted OR 1.81[1.20-2.73], NICU graduate [adjusted OR 4.44 [1.67-6.34], chronic lung disease [adjusted OR 3.06, 95% Cl 2.01-4.95], tracheosphageal fistula [Adjusted OR 3.19, 95% Cl 1.08-8.74], recurrent aspiration [adjusted OR 3.14, 95% Cl 1.90-4.27], duration of asthma symptoms more than four days [adjusted OR 0.23, Cl 0.21-0.42], moderate to severe clinical assessment [adjusted OR 1.67 95% Cl 1.15-3.04], intensive care admission [adjusted OR 2.96, 95% Cl 1.09-8.63], intravenous steroids [adjusted OR 2.21,95% Cl 1.36-4.67], and chest x-ray findings [adjusted OR 0.39, 95% Cl:0.20-0.64]. Previous NICU admission, bronchopulmonary dyspalsia, and history of previous asthma admissions, tracheosophageal fistula, recurrent aspirations, intensive care admission, intubation and intravenous steroids were significant predictors of asthma short readmission

Comparative study for the pattern of prescription writing in asthmatic children in Assir region, Kingdom of Saudi Arabia

A statistical and comparative study was done on the prescription prescribed for asthmatic children aged from 6 months up to 12 years, either by physicians of primary health care centers [PHCCs] or physicians of the Pediatric Department in Assir Central Hospital. Data regarding the prescriptions and all medical consultants were randomly collected without the physician's knowledge. The study showed that the significant differences in the prescription writing between the physicians of the Pediatric Department of Assir Central Hospital and those working in PHCCs were both in some missing items and prescribed drugs. The missing items were significant as regards the name in the prescription of PHCCs which was 26.47%, while that in the prescription of the Pediatric Department of Assir Central Hospital was 11.61%. The difference in the missing duration of medication was 34.31% in the prescriptions of PHCCs and 17.86% in the prescription of the Pediatric Department of Assir Central Hospital. As regards the prescribed drugs, the prescription of the Pediatric Department of Assir Central Hospital contained more certain drugs than in the prescriptions of PHCCs such as antibiotics and corticosteroids. While, the prescription of PHCCs contained more drugs than that of the Assir Central Hospital such as analgesic antipyretic drugs and antihistamines

under-use of steroids for children with asthma in southwestern Saudi Arabia

The aim of this study was to investigate how far corticosteroids and other medications are used for children with asthma visiting the emergency room [ER] for management. The study sample comprised 128 children, who visited the emergency rooms of Assir Central Hospital and Abha Private Hospital and received treatment for their asthma from August 1997 to 31 June 2002. Information about asthmatic patients were collected from records, regarding the previous medicines received prior the emergency visit and the treatment received at emergency room. Only children with age between 1-12 years who were discharged from the emergency rooms were included in this study. The results of the study showed that less than one tenth of the patients were given intravenous steroids, four patients were given oral steroids, while none of them were given intramuscular steroids at the emergency room. Also, more than half of the patients received anti-cough medicine and two thirds were given antibiotics. Therefore, the under-use of steroids and over-use of other medicines for patients with acute asthma were clarified in this study. Specific education programs focusing on the increase of prescription rate and adherence to steroids will improve the overall degree of asthma control