23. Epidemiological aspects and clinical outcomes of mitral valve prolapse in Saudi adults over a 10 year period

Mitral valve prolapse (MVP) is a well recognized clinical entity that is associated with significant morbidity. Epidemiology, echocardiographic (echo) characteristics and clinical outcome of MVP in Saudi Arabia have not been studied. To determine the prevalence, echo features and clinical outcome of MVP among the adult Saudi patients who underwent echo evaluation over a 10-year period.Retrospective review of consecutive cases of MVP or any of its components as diagnose by echocardiogram. Study was conducted in King Abdulaziz Cardiac Center, Riyadh and included 121,419 adult echo studies done between January 2003 and December 2012. Study population consisted of 77,176 patients after removing duplicate studies. Echo parameters for all Saudi nationals ⩾14y of age were collected from the Xcelera database. Mitral valve disease due to non-myxomatous prolapse were excluded. Among the study population (n=77,176) 600 patients were labled as having MVP or any of its echo features (0.7%). Mean age was 64 years and 62% were males. Majority of patients (54.4%) had mild MVP, while moderate and severe prolapse were present in 21.1% and 24.5% respectively. Severe mitral regurgitation was present in 16.5% and chordal rupture was noted in 9%. Left ventricular size was moderately dilated in 7.6% and severely dilated in 1.3%.Prevalence of MVP in Saudi nationals at a referral cardiac center is less than the reported international figure of 1-3%. In contrary to published literature MVP in Saudi population seems to be more common in males and seems to be diagnosed at a later age

Perception and satisfaction of stakeholders regarding the patient care area pharmacist initiative in a military hospital in Saudi Arabia

Purpose: To explore the perceptions and satisfaction of stakeholders (physicians, nurses, and pharmacists) regarding services provided by the patient care area pharmacist (PCAP) initiative. Methods: This was a cross-sectional study conducted at Prince Sultan Military Medical City (PSMMC). The questionnaire was hand-delivered to a random sample of stakeholder groups (including physicians, nurses, and pharmacists) in three different areas of the hospital: the neonatal intensive care unit (NICU), high dependency unit (HDU), and pediatric nephrology. The questionnaire consisted of three sections. The first section collected demographic information of the participants, and the other sections collected anonymous opinions regarding services provided by the PCAP. Results: Ninety-nine participants, comprising physicians (n = 27; 27.27 %), nurses (n = 55; 55.55%), inpatient pharmacists (n = 13; 13.13%), and PCAPs (n = 4; 4.04%), participated in the survey. A majority of the respondents (92.3 %) were satisfied with the PCAP services, and all respondents recommended expansion of the PCAP service to cover all wards. Conclusion: The findings show that all participants have a positive perception of the PCAP service; PCAPs were seen by the participants as drug experts, and their recommendations were perceived as clinically relevant. All stakeholders sought to continue working with the PCAP. Keywords: Patient care, PCAP, Attitude, Satisfaction, Pharmac

Public knowledge of dehydration and fluid intake practices: variation by participants’ characteristics

Abstract Background Dehydration results from a decrease in total body water content either due to less intake or more fluid loss. Common symptoms of dehydration are dry mouth/tongue, thirst, headache, and lethargy. The aim of this study was to assess knowledge of dehydration definition, symptoms, causes, prevention, water intake recommendations and water intake practices among people living in Riyadh, Saudi Arabia. Methods A cross-sectional study using self-reported questionnaire was employed. Participants were invited during their visit to shopping malls. The shopping malls were selected based on geographical location covering east, west, north and southern part of the city. Self-filled questionnaires were distributed to 393 participants, using systematic sampling technique. Variables recorded included demographics, past medical history, knowledge of dehydration definition, symptoms, causes, prevention and daily water intake practices. Descriptive statistics were summarised as mean, standard deviation and proportions. Negative binomial model was used to identify the predictors of water intake. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results Out of 393 participants, 273(70%) were Saudi, 209(53%) were female, average age was 32.32 ± 8.78 years. Majority 366(93%) had good knowledge of dehydration definition, 332(84%) for dehydration prevention, and 293(74%) of water intake recommendation. Top three recognized dehydration symptoms were: dry lips (87%), thirst (84%), dry tongue (76%) and recognized dehydration causes were: diarrhoea (81%), sweating (68%) and vomiting (62%). The less recognized symptoms were fatigue 176(44.78%), lack of focus 171(43.5%), headache/dizziness 160(40.71%), light headedness 117(29.7%), muscle weakness 98(24.94%), rapid breathing 90(22.9%), and muscle cramps 64(16.28%).The participants had reported an average of 5.39 ± 3.32 water glasses intake per day. The total volume of water intake was significantly different between males n = 184 (3.935 ± 2.10 l) and females n = 209 (3.461 ± 2.59 l) (p = 0.046). The participants’ weight status, intake of juice or tea were the significant predictors of more water intake. Conclusion The participants displayed good knowledge of dehydration definition, prevention, and water intake recommendation. The participants also displayed good knowledge of the common symptoms, however knowledge was lacking for uncommon symptoms. Moreover, participants had reported adequate water intake, meeting the daily water intake recommendation of ≥3.7 l for men and ≥ 2.7 l for women

Prevalence and Clinical Characteristics of Alopecia Areata at a Tertiary Care Center in Saudi Arabia

Introduction. Alopecia areata (AA) is a common autoimmune disorder of hair follicles characterized by patches on nonscarring hair loss. Reports of prevalence and clinical characteristic of AA in Saudi Arabia are limited. The aim of our study is to describe the prevalence and clinical characteristics of Saudi patients with AA. Materials and Methods. A retrospective cross-sectional study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with AA between January 2016 and December 2017 were included. Data included patient demographics, type of AA, disease duration, family history of AA, and comorbid autoimmune diseases. Results. A total of 216 patients with AA were included. The overall prevalence of AA was approximately 2.3%. The mean disease duration at the time of presentation was 2 months while the mean age of onset was 25.61 years. The most common type of AA in both adult and pediatric groups was the patchy type involving the scalp. Comorbid diseases were found in 32.41% of patients. Common associated conditions included hypothyroidism, diabetes mellitus, and atopic diseases. Conclusion. The overall prevalence of AA among a population of Saudi patients is 2.3%. AA prevalence is higher in pediatrics than adults. Common comorbid conditions include hypothyroidism, diabetes mellitus, and atopic diseases

Successful Hand Replantation in a Case of Total Avulsion without Vein Graft

Summary:. Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation—a completely amputated hand—by vascular anastomosis technique was successfully performed.1 Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.2 in 1968. The overall success rate of limb replantation surgery is around 83.2%.3 The mechanism of injury plays a role in the outcome; guillotine amputations—for example—carry a better prognosis than crush amputations.4 We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his hand successfully with good functional outcome

Successful Hand Replantation in a Case of Total Avulsion without Vein Graft

Summary:. Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation—a completely amputated hand—by vascular anastomosis technique was successfully performed.1 Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.2 in 1968. The overall success rate of limb replantation surgery is around 83.2%.3 The mechanism of injury plays a role in the outcome; guillotine amputations—for example—carry a better prognosis than crush amputations.4 We present a case report of a 36-year-old male patient who presented with a total avulsion of the right hand with multiple fracture levels at the level of trans-carpal, distal radius extra-articulation fracture, and total avulsion of the hand. The patient was managed by a multidisciplinary team who were able to reattach his hand successfully with good functional outcome

Examining Anxiety, Sleep Quality, and Physical Activity as Predictors of Depression among University Students from Saudi Arabia during the Second Wave of the COVID-19 Pandemic

Conducted during the second wave of the pandemic, this cross-sectional study examined the link between sleep quality, physical activity, exposure, and the impact of COVID-19 as predictors of mental health in Saudi undergraduate students. A convenience sample of 207 participants were recruited, 89% of whom were females and 94% were single. The measures included questionnaires on the level of exposure and the perceived impact of COVID-19, a physical activity measure, GAD-7, PHQ-9, and PSQI. The results indicated that approximately 43% of participants exhibited moderate anxiety, and 50% were at risk of depression. Overall, 63.93% of students exposed to strict quarantine for at least 14 days (n = 39) exhibited a high risk of developing depression (χ2(1) = 6.49, p < 0.05, ϕ = 0.18). A higher risk of depression was also found in students whose loved ones lost their jobs (χ2(1) = 4.24, p < 0.05, ϕ = 0.14). Moreover, there was also a strong association between depression and anxiety (β = 0.33, p < 0.01), sleep quality (β = 0.32, p < 0.01), and the perceived negative impact of COVID-19 on socio-economic status (β = 0.26, p < 0.05), explaining 66.67% of depression variance. Our study highlights the socio-economic impact of this pandemic and the overwhelming prevalence of depression

Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following "Healed" Infective Endocarditis.

This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment. Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended. This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs). Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p  TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission