The Impact of Midodrine Tapering Versus Nontapering Regimens on the Clinical Outcomes of Critically Ill Patients: A Retrospective Cohort Study.

BACKGROUND: Midodrine has been used in the intensive care unit (ICU) setting to reduce the time to vasopressor discontinuation. The limited data supporting midodrine use have led to variability in the pattern of initiation and discontinuation of midodrine. OBJECTIVES: To compare the effectiveness and safety of 2 midodrine discontinuation regimens during weaning vasopressors in critically ill patients. METHODS: A retrospective cohort study was conducted at King Abdulaziz Medical City. Included patients were adults admitted to ICU who received midodrine after being unable to be weaned from intravenous vasopressors for more than 24 hours. Patients were categorized into two subgroups depending on the pattern of midodrine discontinuation (tapered dosing regimen vs. nontapered regimen). The primary endpoint was the incidence of inotropes and vasopressors re-initiation after midodrine discontinuation. RESULTS: The incidence of inotropes or vasopressors' re-initiation after discontinuation of midodrine was lower in the tapering group (15.4%) compared with the non-tapering group (40.7%) in the crude analysis as well as regression analysis (odd ratio [OR] = 0.15; 95% CI = 0.03, 0.73, P = 0.02). The time required for the antihypertensive medication(s) initiation after midodrine discontinuation was longer in patients who had dose tapering (beta coefficient (95% CI): 3.11 (0.95, 5.28), P = 0.005). Moreover, inotrope or vasopressor requirement was lower 24 hours post midodrine initiation. In contrast, the two groups had no statistically significant differences in 30-day mortality, in-hospital mortality, or ICU length of stay. CONCLUSION AND RELEVANCE: These real-life data showed that tapering midodrine dosage before discontinuation in critically ill patients during weaning from vasopressor aids in reducing the frequency of inotrope or vasopressor re-initiation. Application of such a strategy might be a reasonable approach among ICU patients unless contraindicated.

Outcomes of Trauma Patients Present to the Emergency Department with a Shock Index of ≥1.0.

Introduction: The study aimed primarily to evaluate the association between the initial shock index (SI) ≥1.0 with blood transfusion requirement in the emergency department (ED) after acute trauma. The study's secondary aim was to look at the outcomes regarding patients' disposition from ED, intensive care unit (ICU) and hospital length of stay, and deaths. Methods: It was a retrospective, cross-sectional study and utilized secondary data from the Saudi Trauma Registry (STAR) between September 2017 and August 2020. We extracted the data related to patient demographics, mechanism of injuries, the intent of injuries, mode of arrival at the hospital, characteristics on presentation to ED, length of stay, and deaths from the database and compared between two groups of SI <1.0 and SI ≥1.0. A P < 0.05 was statistically considered significant. Results: Of 6667 patients in STAR, 908 (13.6%) had SI ≥1.0. With SI ≥1.0, there was a significantly higher incidence of blood transfusion in ED compared to SI <1.0 (8.9% vs. 2.4%, P < 0.001). Furthermore, SI ≥ 1.0 was associated with significant ICU admission (26.4% vs. 12.3%, P < 0.001), emergency surgical intervention (8.5% vs. 2.8%, P < 0.001), longer ICU stay (5.0 ± 0.36 vs. 2.2 ± 0.11days, P < 0.001), longer hospital stays (14.8 ± 0.61 vs. 13.3 ± 0.24 days, P < 0.001), and higher deaths (8.4% vs. 2.8%, P < 0.001) compared to the patient with SI <1.0. Conclusions: In our cohort, a SI ≥ 1.0 on the presentation at the ED carried significantly worse outcomes. This simple calculation based on initial vital signs may be used as a screening tool and therefore incorporated into initial assessment protocols to manage trauma patients.

Assessment of the knowledge and practice toward male's participation during their wives' prenatal and postnatal care at King Saudi Medical City, Riyadh: KSA.

Background: Access to skilled health care services during pregnancy, childbirth, and postnatal period for obstetric care is one of the strongest determinants of maternal and newborn health outcomes. The main objective of the present study is to assess the knowledge and practice toward male's participation during their wives' prenatal and postnatal care at King Saud Medical City. Methods: We conducted a single center, a quantitative, cross-sectional study based on a personal-interviewed structured questionnaire in 2019 adopting a stratified random sampling technique. Married men above 18 years with at least one child were interviewed using a structured questionnaire. Results: The knowledge level was positive and moderately correlated with the practice on prenatal and postnatal care r = +0.641(P = 0.000) and was statistically significant. There was a significant difference between pregnancy intention and level of education (P = 0.000). The score of knowledge and practice increased with the increase in the number of children. Conclusion: Socioeconomic factor was the major determinant for men's knowledge and practice in maternal and newborn health services. In the future, studies with a large sample size are required to increase men's awareness regarding MNH issues, but should not be limited to this.

The Prevalence of Peritonitis among Pediatric Peritoneal Dialysis Patients at Large Saudi Center.

Peritonitis is a common and serious complication of peritoneal dialysis (PD) and it is a direct or major contributing cause of death in around 16% of PD patients. Severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure, PD technique failure, and conversion to long-term hemodialysis (HD). This is cross-sectional record-based study in which the records of all children aged <14 years with end-stage renal disease on PD either on coiled or straight PD catheter had been reviewed at pediatric nephrology department in a tertiary care hospital, Riyadh, over the period of three years from 2017 to 2019. All information was collected using a structured data collection form. Our study had 30 patients on automated PD with 10 females (33.3%) and 20 males (66.7%) during the study period. The age ranged from 11 months to 14 years with a median 5.5 years, all of them were new to dialysis. A total of 11 out of 30 patients had multiple episodes of PD-associated peritonitis and the prevalence of peritonitis among the 30 patients was 37%. Peritoneal fluid cultures were positive in 100% episodes. Gram-positive, Gram-negative, and fungal organisms were identified in 72.7%, 18.1%, and 9.0% episodes, respectively. The analysis showed the exit-site infection (ESI) to be a risk factor to develop peritonitis, where 21 patients out of 30 had at least one ESI, 52% end by peritonitis in coiled catheter group. No mortality among our cohort of patients was noted, even removal of or changing PD catheter and transfer to HD. Our data showed that the prevalence of peritonitis secondary to ESI with Gram-positive organisms was significantly high, especially in coiled catheter group.

Testing of Defects per Million Medication Orders as a SMART Indicator for Monitoring Medication Safety in Admission and Discharge Orders.

Introduction: The study investigated the use of defects per million medication orders (DPMMO) as a SMART (specific, measurable, achievable, realistic, and timely) indicator for monitoring medication safety in admission and discharge orders. The study aimed to develop and test a new indicator as an investigator of medication safety. Methods: The study was conducted in 2018 at King Saud Medical City in Riyadh City in Saudi Arabia. A retrospective cross-sectional design was used. The research sample had 292 patients. The selected medication orders included two types of medication orders (admission and discharge order). After sufficient data had been gathered from the hospitals, a statistical analysis was carried out. Results: Analysis of admission and discharge orders indicated that defects per million opportunities (DPMO) and DPMMO count were slightly low, while the sigma level for admission orders was slightly high. Thus, the admission order process was slightly better than the discharge order process. Conclusion: The DPMMO indicator could serve as a SMART indicator of medical safety. It can be used as a standardized indicator in any healthcare facility, which serves as a recommendation guide in monitoring and evaluating healthcare processes or systems that affect the safety and outcomes of patients.

Radiographic evaluation of bone density in dentulous and edentulous patients in Riyadh, KSA.

BACKGROUND: The Cone Beam Computed Tomography (CBCT) is currently being used as the most common diagnostic method to evaluate the bone density of the maxilla and the mandible for planning dental implant. Aim: The aim of the study is to check the quantitative alveolar bone density in complete or partial edentulous and dentulous male and female patients among Riyadh sample population in Saudi Arabia. MATERIALS AND METHODS: The study involved a cross-sectional analysis of 231 consecutive CBCT images of 231 different patients (115 males and 116 females). The scans were of Saudi National patients who were partially or completely edentulous without any bone infections in the maxilla and the mandible. The findings are presented as descriptive statistics and inferential statistics: student -t-test for two group means, ANOVA for three groups, Post-hoc LSD test for multiple comparisons, Levene statistics for testing the homogeneity of variances and a statistical significance at 5% level. RESULTS: Comparison of mean alveolar bone density in maxillae of dentulous male smokers showed a statistically significant difference for bucco-cortical plate and cancellous bone among different regions. In dentulous male nonsmokers, no significant difference was observed for maxillary regions, while in mandibular areas, a statistically significant difference was seen for buccal cortex, palatal cortex, and cancellous bone among different regions. While studying the scans of female dentulous patients, a statistically significant difference was observed in alveolar bone density for all the areas. CONCLUSION: Evaluation of bone density is an important step in treatment planning and this study was aimed to provide insight into bone density patterns of population in Riyadh, Saudi Arabia. Further similar studies in different populations can help in planning for more efficient treatment outcomes.

Attitude and knowledge about foot care among diabetic patients in Riyadh, Saudi Arabia.

INTRODUCTION: Saudi Arabia ranks second as the highest country with the highest prevalence of diabetes mellitus (DM) in the Middle East and seventh in the world. Knowledge, attitude, and good practice for foot care are essential in the management and prevention of diabetic foot ulcers. OBJECTIVE: This study was conducted to determine the knowledge, attitude, and practice to diabetic foot care among patients attending a diabetic clinic in Riyadh, Saudi Arabia. MATERIALS AND METHODS: We conducted a descriptive cross-sectional study of all the patients with Type 1 and Type 2 diabetes aged ≥15 years seen at a diabetic clinic of King Saud Medical City in Riyadh, Saudi Arabia. A structured questionnaire on knowledge, attitude, and practices was used to collect the data. RESULTS: In total, 368 diabetic patients were surveyed, comprising 111 (30.2%) males and 257 (69.8%) females. About 282 (76.6%) patients had good knowledge of diabetic foot and foot ulcers. Only 41 (11.1) patients have attended a class on diabetic foot care, and 81 (22.0%) received education on diabetic foot care from a doctor and 38 (10.3%) from a nurse. Majority of them washed their feet daily (98.4%), 59.8% inspects shoes before wearing them, but less than half of the patients (47.6%) actually self-inspect their foot daily. Being married, having a secondary and university level of education, and being a government employee had significantly better knowledge of diabetic foot compared with their counterparts. There were no significant differences in the attitude toward diabetic foot and diabetic foot care across age groups. Patients with longer duration of diabetes (>5 years) significantly had better practice of diabetic foot care. CONCLUSION: This study revealed a high percentage of the surveyed population with good knowledge and good practice of diabetic foot care, however with a poor attitude toward foot care. There were very few patients who received formal education on diabetic foot and diabetic foot care. There is a need for awareness program for these patients not only to improve their knowledge and practices, but also to motivate patients to have a positive attitude toward diabetic foot care.

Delirium Incidence and Risk Factors in Adult Critically Ill Patients in Saudi Arabia.

BACKGROUND: Delirium in intensive care units (ICUs) is associated with long ICU stay, long hospital stay and increased costs of treatment. Unfortunately, delirium in ICU is significantly underestimated and overlooked by healthcare providers. AIMS: The aim of this tudy is to determine the incidence and associated risk factors of delirium among critically ill patients in Saudi Arabia. METHODS: This is a prospective study. Patients were assessed for delirium using the confusion assessment method for the ICU. Delirium was the independent variable in this study. RESULTS: Fifty-nine patients (17.3%) showed positive delirium at least once compared to 283 patients (82.7%) who did not show positive delirium. Certain factors for delirium found to be significantly correlated with delirium (P < 0.005); including receiving sedation, mode of sedation, receiving mechanical ventilation, resistance to mechanical ventilator, and baseline Glasgow Coma Scale. CONCLUSION: Delirium occurred in >17% of our ICU patients. More efforts should be directed to consider ICU delirium and to minimize its triggering factors.

Primary school female teachers' knowledge, attitude, and practice toward students with epilepsy in Riyadh, Saudi Arabia.

BACKGROUND: Epilepsy is the most neurological condition prevalent in humanity and it is associated with stigma and discrimination. Knowledge and practice of primary care teachers toward students with epilepsy, especially at young age, is imperative for their development. OBJECTIVES: This study was designed to assess the level of knowledge, attitude, and practice of female primary school teachers toward students with epilepsy in Riyadh, Saudi Arabia. SUBJECTS AND METHODS: In this cross-sectional study, 582 female primary school teachers had volunteered. They were assessed on their knowledge, attitude, and practice toward students with epilepsy using a self-administrated questionnaire. The questionnaire was cross-culturally validated before the distribution. RESULTS: The results suggest above-average familiarity with epilepsy (79.2%). Younger teachers are less likely to associate epilepsy with retardation (P = 0.038). In general, the attitude was positive among the teachers, and 36.9% felt that the students should be treated normally and 63.1% with compassion toward them. Only 14.3% answered that epileptic students should be transferred to special need schools. Highly educated teachers were less likely to feel that epileptic students can cause problems (P = 0.038). The practice was poor with 31.8% expressed the ability to provide first aid to epileptic students. Only 27.5% accepted to give the students prescribed medications. CONCLUSION: The knowledge about epilepsy needs improvement among primary school teachers in Riyadh. Public level interventions through proper courses can provide a leverage. The higher level of knowledge can be pivotal in increasing the positive attitude and practice of teachers toward epileptic students.

Breastfeeding practice and knowledge among women attending primary health-care centers in Riyadh 2016.

INTRODUCTION: Breast milk is the best natural essential nutrition to newborns and infants. However, the practice of breastfeeding (BF) has declined in Saudi Arabia. OBJECTIVE: The objective of this study was to assess the knowledge and practice of BF with their determinants among mothers in Riyadh. MATERIALS AND METHODS: In this cross-sectional study, 252 mothers attending the well-baby clinics in Riyadh from March 2016 to May 2017 were selected randomly with their consent and studied by a standardized questionnaire. RESULTS: Of the 252 women, 69.4% were 25-35 years of age and 56.7% with a bachelor degree or higher education. Nearly 75% mothers had education on BF before our study. Mixed feeding was the most preferred method (51.6%) followed by artificial milk (29.4%). The most reported reason for discontinuing BF was breast milk insufficiency (37.3%) and of breastfeed continuation was their perceived benefit (36.6%). Excellent knowledge was observed among 12.7%, good knowledge in 57.1%, and unsatisfactory level in 30.2% mothers. The regression model shows that high school education improved the knowledge by 10.9 points (P = 0.024) and undergraduate by 18.7 points (P value = 0.001) when compared to women who were literate. Women with parity >5 improved knowledge score by 17.3 points (P < 0.001). CONCLUSION: We observed that majority (57.1%) of Saudi mothers had a moderate level of knowledge on BF benefits and 19% had practiced exclusive BF. There is a need for better educational programs to increase awareness on its benefits for the health situation in the country on the long term.

Domestic microwave versus conventional tissue processing: a quantitative and qualitative analysis.

BACKGROUND: Microwave irradiation has been tried as a replacement for the conventional tissue processing technique in histopathology laboratories for quite some time. Studies have shown that Domestic Microwave Tissue Processing (DMWTP) provides a faster delivery of the tissue sections with a morphology which is similar to that which is seen Conventional Tissue Processing (CTP). But many laboratories still confine the domestic microwave tissue processing method only to the handle selected specimens, for which urgent reports are needed. One of the probable reasons is that, understanding about the number of tissue sections which can be processed using a microwave oven at a time, with the appropriate quality, still remains unclear. AIM: The aim of this study was to quantitatively analyze the optimum number of samples that a domestic microwave could process at a time, as well as to qualitatively analyze the morphological outcome of those tissue sections with that of conventional processing. MATERIALS AND METHODS: This study was approved by the research and ethical committee of Sree Balaji Medical College and Hospital. A total of 135 paired tissue sections were included in the study. Ten tissue sections (which are mentioned hereafter as A10) were processed in a domestic microwave and their paired 10 tissues were processed by a conventional method. Subsequently, the number of tissues which was to be processed was increased to B15, C20, D25, E30 and F35, after ascertaining that the morphological qualities of the previously processed tissue sections were satisfactory. Sections of 4 µm thickness were taken and they were stained by the Haematoxylin and Eosin method. The slides of the tissues which were processed by the microwave method and the conventional method were randomly numbered, for a blind study, which were independently evaluated by two observers. The qualities of slides were assessed, based on 4 parameters: the cytoplasmic details, the nuclear details, the tissue architecture and the staining characteristics. The statistical analysis was done by using SPSS 15.0. RESULTS: The morphological outcomes (quality) of the DMWTPs were comparable to that of the CTPs, when the sample load (quantity) in the microwave oven was up to 25 samples. CONCLUSION: Domestic microwave processing can be effectively used in laboratories with a maximum sample size of 25 samples per load. This has the advantage of being rapid, with its morphological quality being identical to that of conventional processing.

The red cell distribution width as a sensitive biomarker for assessing the pulmonary function in automobile welders- a cross sectional study.

CONTEXT: Welding fumes are considered as a risk factor for pulmonary diseases and a periodic spirometry is essential to evaluate the lung function of the welders. The Red Cell Distribution Width (RDW) is a red cell measurement which is provided by automated haematology analyzers. It reflects the range of the red cell sizes which are measured within a sample. Few studies have shown a relationship between the RDW values and the changes in the spirometry. AIMS: This study was aimed at correlating the RDW% and the spirometry FEV1/FVC ratio (%) among automobile welders (cases). Further, we have analyzed the effect of smoking on the FEV1/FVC ratio% and the RDW% in the cases. SETTINGS AND DESIGN: A cross sectional study was done on 50 welders and 50 non-welding office workers (controls) who were working in an automobile industry on the outskirts of Chennai, india. All the cases were arc welders and the controls were from the same production unit, who had never worked as welders. This study was conducted during the period from March 2012 to May 2012. METHODS AND MATERIAL: The demographic data, smoking habits, work history and the respiratory symptoms were gathered by using a standard self -administered questionnaire. A complete haemogram study was done and pulmonary function tests were performed for both the cases and the controls. All the cases and the controls were examined in the hospital outpatients room and subsequently, their blood samples were collected. The pulmonary function tests were conducted in the spirometry room in the hospital. The statistical analysis was done using the SPSS, version 15.0. RESULTS: A statistically significant inverse correlation was found between the RDW% and the FEV1/FVC ratio% in the cases. CONCLUSIONS: RDW can be used as a biomarker to identify the pulmonary compromise in automobile welders.

The reference intervals for the haematological parameters in healthy adult population of chennai, southern India.

BACKGROUND: The haematological parameters are influenced by various factors like age, ethnicity, diet, genetic and gender differences and hence it is important to define the specific reference values with regards to the age, gender and the region. The indices like the Red Cell Distribution Width (RDW), the Mean Platelet Volume (MPV) and the Platelet Distribution Width (PDW) are newer haematological parameters which are calculated by automated haematology analyzers. There is an increasing evidence that these are clinically valuable bio markers. But not many studies have estimated the reference intervals for these parameters in our population. AIM AND OBJECTIVE: Our primary objective was to identify the gender specific reference intervals for RDW, MPV, PDW and other haematological parameters for the healthy adult population of our region. We also aimed at comparing the study reference intervals with the existing reference ranges. MATERIALS AND METHODS: A retrospective review of 2443 medical case sheets of the individuals who attended the preventive health check up program in a tertiary care hospital in the year 2011, was done. With 500 subjects who satisfied our study criteria, the haematological reference intervals were established. RESULTS: Gender specific reference intervals were established for the newer indices as well as for the other haematological parameters. We derived the reference intervals for the newer parameters in our population as: RDW: 12.23%-15.36% in males and 12.3%-15.85% in females. MPV: 7.9 fL-13.7 fL in males and 8 fL -13.28 fL in females PDW: 9 fL -16.56 fL in males and 8 fL -13.28 fL in females. CONCLUSION: Our values differed from the existing haematological reference values, thus showing the importance of developing region-specific reference intervals. Our data also showed the importance of establishing gender specific reference intervals.