Visits to emergency departments for gynecologic disorders in KSA

Background: Abnormal uterine bleeding [AUB] influences 20-30% of women sooner or later in their regenerative years and regularly cause women to look for urgent or emergent care

Purpose: To describe the population of women seeking urgent medical attention for abnormal uterine bleeding [AUB], in terms of symptoms, medical history, and clinical examination findings; and to determine characteristics associated with anaemia in this population

Materials and Methods: We implemented a retrospective cohort study of patients comprehended in King Abdulaziz Hospital Emergency Room for abnormal uterine bleeding from November 2016 to May 2017 [n=126]. Data collected included demographic factors, laboratory and radiologic findings, clinical history, and physical examination findings. We calculated pervasiveness ratios for moderate to severe anaemia [defined as haemoglobin less than 10 g/dL] and sensitivity and specificity of clinical characteristics for recognizing women with anaemia

Results: The median age of patients was 33 years [range 14-68 years]. Nearly half [47.6%] had a concurrent medical condition which could affect their treatment options and 15 had moderate to severe anaemia. The only factors related with moderate to severe anaemia were having both tachycardia and hypotension; duration of bleeding more than 7 days: and haemoglobin of less than 10 g/dL in the previous year

Conclusions: A substantial proportion of patients looking for urgent medical care for abnormal uterine bleeding had potential contraindications for the mainstays of treatment. Clinical symptoms and bleeding history were poorly predictive for moderate to severe anaemia in this population of women

Awareness about anesthesia amid general populace

Background: The public consciousness towards anesthesiologist and anesthesia is limited even in urban population. Our cross-sectional analysis highlights this lack of public awareness and discusses possible remedies to overcome these limitations

Materials and Methods: Surgical outpatient department was screened for 6 months period in King Abdulaziz Hospital. A questionnaire divided into three parts [awareness about anesthesiologist, consent, present surgical experience] was filled out for each patient. The patients on the basis of their answers were classified as aware or unaware, furthermore, source of patient data was analyzed

Results: Even with an exceptionally low threshold, only 44.86% of population could be categorized as aware, and commonest source of their information was not anesthesiologist but surgeon [56%]. 89.7% patients were not aware of contents of pre-operative consent they had signed and further, only 21.4% were aware of anesthesia-related issues. Pain was reported as the most mutual pre-operative fear and post-operative patient concern. 40.2% patients due to lack of pre-operative counseling were not able to recognize the type of anesthesia and thought they had received both general anesthesia and spinal anesthesia. Finally, after explaining the role of anesthesia for surgery, 98.1% patients presented desire to meet the anesthesiologist before if they were to be operated in future

Conclusion: The awareness about anesthesia is particularly low likely due to low knowledge rates and lack of pre-operative counseling by anesthesiologist. Both patient and anesthesiologist should understand the significance of consent, as it is not only a legal binding but can eliminate pre-operative factitious fears of patients and can improve patient satisfaction towards surgery

Purple glove syndrome is not always purple at the initial presentation: a case report and literature review

Background: Purple glove syndrome [PGS] is a rare complication of intravenous phenytoin use that typically presents with pain, edema, and discoloration at the injection site that spreads to the distal limb

Case Presentation: A 25-year-old female patient presented to Kind Fahad University hospital's emergency department [ER] following a seizure episode, on admission to the hospital she was found to have profound tonic-clonic seizures, flexed limbs, uprolling eyes and frothy secretion from her mouth. The patient received IV fluid 0.9 NS and diazepam 5 mg IV injection followed by Phenytoin 1g was IV administrated on 100cc NS over 3 hours with a dose of 50 mg IV/min, and was admitted to the medicine service. Soon, the patient felt pain, swelling, Erythema and abnormal movement from the site of the IV cannula over the left forearm while Phenytoin was being injected, however no purple discoloration was detected and the patient was diagnosed with purple Glove syndrome [PGS]. Accordingly, Phenytoin was held and replaced by carbamazepine for Seizure control, Brain MRI and EEG were ordered simultaneously. Patient symptoms were alleviated 2 days later and was ready for discharge. Follow-up visits were scheduled until the patient was fully recovered and aware of the implications of Phenytoin on her case

Conclusion: Since PGS is a rare complication of IV phenytoin therapy, it's not common to link the clinical symptoms of PGS to Phenytoin adverse reactions at the first prognosis especially when discoloration - which is a profound symptom of PGS -is missing. The risk of PGS for this patient may have been abated at the very early stage by decreasing the phenytoin infusion rate from 50 mg/min to less than 25 mg/min

Retrocecal appendectomy: a challenge

A case of 25 years old Saudi male underwent appendectomy two years ago at Mecca. He was admitted with complaint of sever painful swelling in right iliac fossa which aggravated with change of posture and was associated with anorexia .The diagnosis was made on clinical assessment and was supported by blood investigations, ultrasound of abdomen and CT scan showed a retrocecal abscess 6 cm x 7 cm layer underneath scar. The patient underwent emergency laparotomy, which revealed retrocecal abscess with old perforated appendix with a fecolith. Drainage of abscess and appendectomy was performed and emphasized the importance of early treatment of appendicitis

Postgraduate specialties interest, career choices and qualifications earned by male dentists graduated from King Saud university

To study the career development of male graduates of King Saud University [KSU], College of Dentistry in terms of pursuit of postgraduate dental education, higher degrees or Board Certification, choice of universities and countries of study, and place of work after qualification. A questionnaire survey was carried out through face to face or telephone interview among 666 KSU graduates of 1982-2004. 80% [532 graduates] response rate. [77%] finished postgraduate dental education. 17% specialized in Prosthodontics, 16% in Saudi Board Advanced Restorative Dentistry, 14% in Advanced General Dentistry, 10.5% in Orthodontics, 10% in Oral and Maxillofacial Surgery, 8.3% in Pediatric Dentistry, 7.7% in Endodontics, 6% in Periodontics, 5.5% in Operative Dentistry, 5% in other Specialties. 61% had a Master's degree and 16% had a Doctorate degree. 23% had Board Certificates and 8% had a Fellowship Certificate. [78%] are working in the government. 15% at the university and 6% in private, and 19% in administrative positions. Most of the dental graduates were motivated and eager to continue their postgraduate education to get either clinical specialty or academic degrees from nationally and internationally well recognized and known Universities and programs