Causes and management of urogenital fistulas. A retrospective cohort study from a tertiary referral center in Saudi Arabia.

OBJECTIVES: To reviewe the etiology and management of urogenital fistulas at a tertiary care referral center. METHODS: We retrospectively identified all patients with urogenital fistula referred to the King Fahad Medical City, Riyadh, Saudi Arabia, between January 2005 and July 2016 from electronic records. We collected data on age, parity, etiology and type of fistula, radiologic findings, management, and outcome. Results: Of the 32 patients with urogenital fistula identified, 17 (53.1%) had vesicovaginal fistula. The mean parity was 5.9 (0-15). Obstetric surgery was the most common etiology, accounting for 22 fistulas (68.8%). Twenty of these (90.9%) were complications of cesarean delivery, of which 16 (80%) were repeat cesarean delivery. Forty surgical repair procedures were performed: 20 (50%) via an abdominal approach, 11 (27.5%) via a vaginal approach, 7 (17.5) via a robotic approach, and 2 (5%) using cystoscopic fulguration. The primary surgical repair was successful in 23 patients (74%), the second repair in 5 (16.1%), and the third repair in one (3.1%). One fistula was cured after bladder catheterization, and 2 patients are awaiting their third repair. Conclusion: Unlike the etiology of urogenital fistulas in other countries, most fistulas referred to our unit followed repeat cesarean delivery: none were caused by obstructed labor, and only a few occurred after hysterectomy. Most patients were cured after the primary surgical repair.

Knowledge, attitudes, practices and perceptions of clinicians towards conducting clinical trials in an Academic Tertiary Care Center.

OBJECTIVES: To investigate the knowledge, attitudes practices and perceptions of clinicians concerning the conducting of clinical trials (CTs).  Methods: A cross-sectional study was conducted on clinicians at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire which divided into 5 sections: Section 1 covered respondents' demographics. The other 4 sections explored respondents' knowledge, attitudes, perceptions and practice towards conducting CTs.  Results: A total of 316 clinicians completed the questionnaire. The majority were assistant consultants and consultants 125 (39.5%) and 108 (34.2%), respectively. One hundred sixty-nine (56%) respondents were not aware of the Declaration of Helsinki at all. Two hundred seventy-five (88.4%) respondents expressed interest in conducting CTs and 61.7% and participants showed their willingness to facilitate and assist in CTs conducted by other clinicians. Moreover, 112 (35.9%) respondents participated in CTs previously. Regarding the disadvantages in conducting CTs, participants indicated that the paperwork was complicated and they believed that they might lose patients from their clinical practice once they are recruited in CTs. Lack of research protected time for clinicians 295 (97.7%), and a shortage of clinical research coordinators 293 (97%) were the main problems reported by respondents.  Conclusions: Although the majority of participants had an unsatisfactory level of knowledge and misperceptions about CTs, they showed an interest in and positive attitudes about conducting CTs.

Characterizing sleeping habits and disturbances among Saudi adults.

OBJECTIVES: To characterize sleeping habits, assess sleep disturbance prevalence, and identify associated factors among Saudi adults.  Methods: A total of 1720 adults were approached for this observational cross-sectional study between October 2014 and March 2015. The study took place in Riyadh, the capital of Saudi Arabia. We used a questionnaire to describe sleeping characteristics in relation to existing chronic diseases, smoking status, obesity, daily performance and sociodemographic variables. Results: The response rate was 79.6% (1369 participants), 61.6% have or may have sleeping disturbances of which 18.6% claimed either slowed or stopped breathing during sleep. Women reported a higher prevalence of sleep disturbances (65.2%). Feeling tired was significantly associated with sleep disturbance (49% versus 19.7%) (p greater than 0.001). Approximately 78.4% of those with sleep disturbance significantly believed that their ability to perform daily tasks is affected (p=0.005). Moreover, smoking and obesity were significantly associated with sleep disturbances (p less than 0.01). Participants with asthma, hypertension, chronic heart disease, and diabetes mellitus reported significantly more sleeping disturbance (p=0.016 to p=0.001). Conclusions: Sleep disturbances are associated with obesity, smoking, chronic health conditions, and lower performance among  Saudi adults.