ABSTRACT
Background: Proper postoperative pain management, which can be advanced using a multimodal approach, results in pain relief with minimal side effects. Newer recovery protocols, along with minimally invasive surgeries add to the better management of post-operative complication. Many factors play a role in failure of proper postoperative pain management, which mainly include insufficient education, fear of complications associated with analgesic drugs, poor pain assessment and inadequate staffing
Methodology: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE from January 1987 to March 2017. The following search terms were used: post-operative pain mechanism, post-operative pain management, non-opioid pain management
Aim of the work: In this study we aimed to understand the mechanism and the management of post-operative pain, along with shining some light upon the recent advances
Conclusion: Various combinations and modalities of pain management exist, and their use depends largely on the case, the patients, and their perception of pain. Enhanced recovery protocols have significantly improved perioperative and postoperative pain management, making the decrease in opioids need a priority
ABSTRACT
Background: Hepatitis B is one of popular health problem and is considered as major global infectious hazard. It represents an occupational risk for all people who are working in healthcare, including doctors, nurses, laboratory staff, and training interns as well as the student who is trained in hospitals. This can be correlated with their contact with body fluids during clinical rotations and activities. However, protection from getting any infection logically is mandatory for healthcare worker
Aim: Our problem in this study was to assess how our new doctors in Saudi Arabia, specifically those in Riyadh Region and Eastern Region are safe and are protected from hepatitis B infection by evaluating their knowledge, attitude and practice towards Hepatitis B
Method: That was a cross-sectional study which was conducted to intern doctors in Riyadh and Eastern Regions. Random sampling technique was used to select 350 intern doctors. Study tool was a self-administrated questionnaire that is made online by using Google drive forms and sent as an internet link to all interns via WhatsApp mobile application. Data analysis was done using computer application SPSS 24. Comparison between results and many variables was done using Chi-Square test and statistical significance is considered when P-Value < 0.05
Result: In this study, 131 intern doctors participated out of 350 who received the questionnaires [response rate 94.6%]. Regarding the level of knowledge, attitude, and practice, around 86% of participants have good knowledge, 63% of them have a positive attitude and 85% have a good practice. Chi-Square test was applied to compare our results of KAP with gender and region. No difference between males and females was found in the level of knowledge and attitude [P-value > 0.05]. Males were better than females in practice [P < 0.05]. Intern doctors in Riyadh region were better than those in Eastern region in knowledge and attitude [P-value < 0.05], no difference was found between them in practice [P-value > 0.05]
Conclusion: It was obvious that our new doctors in Eastern and Riyadh regions have good knowledge, attitude and practice for Hepatitis B. People in Eastern region have less knowledge and attitude compared to those in Riyadh with a significant difference between them. Also, males interns have a better practice than females interns in general
ABSTRACT
Background: Hepatitis B is one of popular health problem and is considered as major global infectious hazard. It represents an occupational risk for all people who are working in healthcare, including doctors, nurses, laboratory staff, and training interns as well as the student who is trained in hospitals. This can be correlated with their contact with body fluids during clinical rotations and activities. However, protection from getting any infection logically is mandatory for healthcare worker
Aim: Our problem in this study was to assess how our new doctors in Saudi Arabia, specifically those in Riyadh Region and Eastern Region are safe and are protected from hepatitis B infection by evaluating their knowledge, attitude and practice towards Hepatitis B
Method: That was a cross-sectional study which was conducted to intern doctors in Riyadh and Eastern Regions. Random sampling technique was used to select 350 intern doctors. Study tool was a self-administrated questionnaire that is made online by using Google drive forms and sent as an internet link to all interns via WhatsApp mobile application. Data analysis was done using computer application SPSS 24. Comparison between results and many variables was done using Chi-Square test and statistical significance is considered when P-Value < 0.05
Result: In this study, 131 intern doctors participated out of 350 who received the questionnaires [response rate 94.6%]. Regarding the level of knowledge, attitude, and practice, around 86% of participants have good knowledge, 63% of them have a positive attitude and 85% have a good practice. Chi-Square test was applied to compare our results of KAP with gender and region. No difference between males and females was found in the level of knowledge and attitude [P-value > 0.05]. Males were better than females in practice [P < 0.05]. Intern doctors in Riyadh region were better than those in Eastern region in knowledge and attitude [P-value < 0.05], no difference was found between them in practice [P-value > 0.05]
Conclusion: It was obvious that our new doctors in Eastern and Riyadh regions have good knowledge, attitude and practice for Hepatitis B. People in Eastern region have less knowledge and attitude compared to those in Riyadh with a significant difference between them. Also, males interns have a better practice than females interns in general
ABSTRACT
Acquired angioedema [AAE] is defined by acquired deficiency of C1 esterase inhibitor. It is a rare disorder characterized by recurrent angioedema without urticiaria, which may be associated with lymphoproliferative disorders [LPD]. We are reporting a case of 71 years old female, known case of Chronic Lymphocytic Leukaemia [CLL] who presented to the emergency room [ER] with generalized body swelling during her disease course. Investigations were ordered to confirm that the symptoms were due to acquired angioedema, and the patient was managed for this diagnosis. Knowing the association between acquired angioedema and lymphoproliferative disorder is crucial, because AAE can be treated medically and responds within hours but delayed diagnosis can lead to unnecessary invasive procedures or asphyxiation and death due to laryngeal oedema. Finally, treating the underlying cause as CLL in our case could prevent further recurrence of angioedema
ABSTRACT
Acquired angioedema [AAE] is defined by acquired deficiency of C1 esterase inhibitor. It is a rare disorder characterized by recurrent angioedema without urticiaria, which may be associated with lymphoproliferative disorders [LPD]. We are reporting a case of 71 years old female, known case of Chronic Lymphocytic Leukaemia [CLL] who presented to the emergency room [ER] with generalized body swelling during her disease course. Investigations were ordered to confirm that the symptoms were due to acquired angioedema, and the patient was managed for this diagnosis. Knowing the association between acquired angioedema and lymphoproliferative disorder is crucial, because AAE can be treated medically and responds within hours but delayed diagnosis can lead to unnecessary invasive procedures or asphyxiation and death due to laryngeal oedema. Finally, treating the underlying cause as CLL in our case could prevent further recurrence of angioedema
ABSTRACT
Background: The study aimed at investigating the knowledge in pediatric residents and fellows in two Saudi hospitals, putting shedding lights on the information available for patients and their relatives concerning the risk assessment of radiation used in radiological investigations for children
Methods: This study was a cross sectional study based on a questionnaire of multiple-choice questions. The questionnaire was distributed to 40 pediatric residents and fellows from two hospitals in Tabuk city in Saudi Arabia, military hospital [NWAFH] and KKH. Statistical analysis of the data was done using SPSS, version 17.0 [SPSS, Chicago, IL, USA]. The percentage of participants who gave correct answers was calculated for each question. Individual questions were analyzed using Chi-squared test of independence. All statistical significance values were P < 0.05
Results: Only35 from the 40 questionnaires were completed then analyzed [87.5%]. Only 10 surveyed [34.5%] was considered competent torisk radiation knowledge for commonly performed radiological examination. Regarding to the Percentage of correct answers, at least 50% [adequate knowledge was considered with seven minimum score of correct answers out of thirteen]
Conclusion: The knowledge of radiation doses and risks from common radiological tests was sub-optimal among the fellows and residents in pediatric department. Awareness of radiation hazards for fellows and residents during radiation exposure risk examinations should be considered an essential part of medical education
ABSTRACT
The main objective of the article is to provide the necessary awareness on decision making in order to support better patient care. The awareness is through advisory technique with more emphasis on practical application. The article has analysis of the opinions from experts on synthesis. More so, there is provision of better ways to clinical data feasibility, open forum consultations and surveys from experts on anesthesia. The main emphasize of the article is decision making in improvement of the patient care. Although advisories are important, the aim should always be decision making and the article focuses on practice in order to improve medical knowledge. The article gives an outline on additional measures to be taken to improve the medical practice according to Anesthesiology. The article emphasizes the advisory from the anesthesiologists and all the supporting physicians. In addition, there is also provision of advisory to individuals who administer general anesthesia. Review of the article on Metal-Analysis study has identified many characteristics of patients who have been associated with the risk of little awareness. The review has explained the procedures to be followed when dealing with situations of higher risks on intraoperative awareness. The anesthetic techniques on intraoperative awareness are also included in the preoperative awareness
ABSTRACT
Background and purpose: questions remain unclear about the association of smoking status and the development of acute pancreatitis [AP]. We performed a meta-analysis of observational studies to explore this association
Materials and Methods: a computerized literature search was performed in MEDLINE and EMBASE through October 15, 2016. We also searched the reference lists of pertinent articles. We used a rand om-effects model to calculate the summary relative risks [SRRs] and their corresponding 95% confidence intervals [CIs]
Results: a total of 8 observational studies [4 case control and 4 prospective cohort/nested case control studies] were identified. Compared with never smokers, the summary RR estimates were 1.49 [95% CI, 1.29-1.78] forever smokers, 1.69 [95% CI, 1.42-2.21] for current smokers, and 1.19 [95% CI, 1.11-1.52] for former smokers. Smoking is found to be a potential risk factor for alcohol use, idiopathic factors and drugs related AP, but not for gallstone related AP, in the ever and current smokers. A dose response effect of tobacco use on the risk was ascertained: current smokers had a 40% [95% CI, 30%-50%] increased risk of AP for every additional 10 cigarettes per day
Conclusion: the current analysis suggests that smokers have an elevated risk of AP development. Further studies, however, are warranted before definitive conclusions can be drawn
ABSTRACT
Background: Asthma, being a chronic inflammatory disease requires not only medical treatment but also complimentary healthcare, self-management strategies and interventions for the appropriate management and possible prevention of attack as well as reduction of school absences and days of restricted activity and decrease emergency room utilization
Methods: Randomized clinical trial [RCT] data reviewed for outcomes and processes associated with asthma educational and behavioral interventions provided by different types of health professionals. The study group has synthesized studies that identified barriers and interventions to improve asthma symptoms and management in children through searching in MEDLINE, Cochrane EMBASE, TOXLine and CINAHL considering papers starting from 1999
Results: Physician-led interventions were most successful for outcomes related to the use of health care. Multidisciplinary teams were best in achieving symptom reduction and quality of life. Lay persons were best in achieving self-management/self-efficacy outcomes. Components most frequently employed in successful programs are skills to improve patient-clinician communication and education to enhance patient self-management. Fifty percent of interventions achieved reduction in the use of health care and one-third in symptom control. A combination approach including self-management and patient-clinician communication involving multidisciplinary team members may have the greatest effect on most outcomes
Conclusion: Strong evidences suggest that the development of self-management and clinician-patient communication skills are essentially required and considered as critical factors for Asthma patients particularly children symptoms alleviation and outcomes improvement in the long term. This can be achieved by appropriate self-care, awareness programs through effective educational and behavioral intervention which are crucial components associated with success across outcomes and providers
Subject(s)
Humans , Child , Behavior , Health Education , Patient Outcome Assessment , Child , Randomized Controlled Trials as TopicABSTRACT
Acute chest syndrome [ACS]is a known complication of sickle cell disease [SCD]. It carries high morbidity and mortality. To study the pattern of ACS among children with SCD in our region in a descriptive manner, and to compare our local experience with international experiences. We conducted a retrospective study of 28 children with ACS, to evaluate the frequency, clinical, laboratory, and radiological features of this complication among children with sickle cell disease in the Southern Province of Saudi Arabia. Our results revealed that the frequency of ACS episodes are age dependent, which occurred more frequently in young children, more than 4 years of age [n = 16] 57%. Fever and cough were the most frequent symptoms; [n = 26] 93% and [n = 24] 86% respectively. Most of the cases experienced respiratory distress such as tachypnea [n = 24] 86%, chest retraction [n = 18] 64%, and decreased breath sounds [n = 16] 57%. Small number of patients [n = 3] 11% had complete normal chest examination. In our study, painful crisis was the most commonly associated complication along with ACS [n = 22] 79%. All of the chest X-rays were positive at different anatomical sites; bilateral involvement was observed frequently [n = 33] 36%. This retrospective study demonstrates the clinical presentation of ACS in children with SCD in this part of Saudi Arabia. It is of great value as baseline study. Nevertheless, further studies of such condition are required to clearly understand this important complication of SCD
ABSTRACT
Three cases of boys were reported with severe hemophilia A [11 years, 5 years and 1 year old]. They all underwent central venous line [CVL] insertion for primary prophylaxis in the first and the third cases and for the induction of immune tolerance in the second case. In all cases, the CVL was a subcutaneous port-a-catheter and the CVL associated thrombosis was suspected because of malfunction of the port-a-catheter. In one of the boys, the port-a-catheter had been in place for 6 months and in the other 2 for over 3 years. In all three boys, there was no evidence of an underlying genetic predisposition to thrombosis, e.g., activated protein C [APC] resistance. All of them underwent bilateral arm venogram which confirmed the presence of CVL-related thrombosis. Thrombi were located in the left subclavian and brachiocephalic veins in the first and second cases, and in the left brachiocephalic vein in the third case. These findings were unexpected as historically hemophiliacs are thought to be protected from thrombosis by virtue of anticoagulation nature of their disease. Based on this observation, it is strongly recommend that physicians caring for hemophiliacs to critically should evaluate the risks and benefits related to CVL insertion
ABSTRACT
Objective: to determine the incidence, characteristics and the different factors associated with diarrhea events reported at the Primary Health Care [PHC] level in children under five years of age
Material and methods: all reported cases of diarrhea in children under 5 in the primary health care [PHC] center of Wasat Abha, Abha city during the year 2002. The medical records of patients were reviewed for name, sex, date, duration of diarrhea and character of stool, type of feeding, degree of dehydration, the treatment received and the outcome
Results: the overall incidence /child/year 2002 was 1.2 episodes. The total number of diarrhea episodes in that age group was 573 cases giving an incidence rate of 9.9% for the year 2002. . Two thirds of the episodes of diarrhea [64.6%] occurred in females, and 60.9% of the episodes affected 7-12-month olds. The majority of diarrhea episodes [89.4%] lasted less than 7 days and only 3.7% of cases were moderately dehydrated. Ninety four percent of the cases improved and only 1.7 % were admitted to the hospital
Conclusion: the incidence of diarrhea episodes in the under fives in the year 2002 was lower than the national rate reported in 1993. Female children had about twice the incidence of diarrhea in male children and the highest incidence was observed in the 7-12-month olds. The majority of cases were acute. It is recommended that studies on the incidence of diarrhea in all PHC centers be done in order to monitor the progress of diarrhea in children and implement suitable preventive measures