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

Anaplastic transformation of differentiated thyroid carcinoma

Anaplastic thyroid cancer [ATC] is one of the most aggressive malignancies that arise from transformation of preexisting differentiated thyroid cancer [DTC]. However, the carcinogenic mechanism of anaplastic transformation remains unclear. We describe a case for huge goiter diagnosed as papillary thyroid carcinoma, which underwent thyroidectomy. The final histology showed anaplastic transformation. The clinical and possible etiological aspects are discussed

Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate?

To determine the incidence of negative appendectomies and to identify factors that may reduce the risk of having the normal appendices removed surgically. Cross-sectional study. College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia. The surgical and histological data of 852 patients who underwent appendicectomy were reviewed. All incidental or interval appendicectomies were excluded. Only patients who were admitted and whose appendices were removed and subjected to histology were included [585 patients]. The data on patients who had a normal appendix on histology further analyzed to include demographics, specific investigations, operative findings of the appendix and additional operative findings that need other surgical procedures. A normal appendix was removed in 54 [9.2%] of the patients. Only 5.5% of those patients had a computed tomography [CT] scan preoperatively and 3.7% had diagnostic laparoscopy. In 21 patients, additional operative and histological findings were obtained that might have caused the right lower abdominal pain. In spite of the advances in the diagnostic and imaging techniques, the rates of negative findings on appendicectomy have not decreased much. Clinical judgment is still the most important factor in the management of patients with suspected acute appendicitis. The routine use of CT scan or diagnostic laparoscopy for all patients who are suspected to have appendicitis is neither cost-effective nor safe

Feasibility and acceptability of objective structured clinical examination [OSCE] for a large number of candidates: experience at a university hospital

Objective: to assess the feasibility and acceptability of using objective structured clinical examination [OSCE] for a large number of medical students

Methods: all medical students [291] who had completed the basic surgical course were examined by objective structured clinical examination [OSCE] at the College of Medicine, Riyadh, for the first time. A 5-scale questionnaire was filled by the examiners at the end of the examination each day. Another questionnaire was filled by the students as a feedback

Results: all students agreed that the organizational aspect of the examinations was smooth and the time for each station was adequate. 86% of the students agreed that the stations were within the content of the course, 82% agreed that the examination was fair and objective and 93% wanted this method to be followed in the assessment of third year medical students, instead of the traditional examination [written and single long case]. Similar responses were received from the examiners who were involved in the exams

Conclusion: OSCE is a practical and acceptable method for assessing medical students' basic surgical skills, even for a large number of candidates, if facilities are available in the examination center. Replacing written exams with OSCE depends on the design of stations to test knowledge adequately in scope and depth probably at problem solving level