Pattern of Congenital Dislocation of the Hip in Arar City, Northern Saudi Arabia

Background: Developmental dysplasia of the hip (DDH) is one of the most widely discussed abnormalities in neonates. The etiology of DDH is unknown. There are many insights, however, from epidemiologic/demographic information. Aim of the study: To determine the incidence, risk factors and treatment modalities of congenital dislocation of the hip (CDH) in Arar city, Northern Saudi Arabia. Methods: This is prospective study involve 955(19100hips) infants referred to Arar central hospital. During the period from 1 January 2014, to 31 December 2016, each infant was evaluated by history taking, clinical and sonographic examination for hip abnormality. Results: The incidence of (CDH) was 3.1% (73.3% were females), 70.0% of the affected had positive family history and in 46.7% there was consanguinity between parents. In 80.0% there was regular follow up during pregnancy. 16.7% had history of oligohydramnios. Breech presentation was found in 26.7% and 15.0% delivered by caesarian section. First born children constituted 25.0%. The left hip joint was more affected( 41.6%) , the right hip joint affected in  28.3% and bilateral CDH were involved in 13.3%. In the studied cases, 40.0% of the infants were treated surgically, 30% conservatively, 16% by both and 14% were referred to higher centers. Conclusion and recommendations: CDH in Arar, Central hospital and by inference in Northern region of Saudi Arabia was found to be 3.1%. Awareness programs, routine neonatal hip joint examination at birth and up to one year of age as well as ultrasound examination of pelvis in high-risk babies are strongly recommended

Melasma and Associated Factors in Arar City, Kingdom of Saudi Arabia (KSA)

Melasma is a common dermatological disorder characterized by irregular brownish patches with unclear etiology and a variety of factors may be associated with its occurrence. Melasma patients suffer significant emotional and psychological problems making assessment of their quality of life is increasingly necessary. Aim of the study: This study was conducted to identify the frequency and factors associated with occurrence of Melasma in in Arar, KSA and its effect on some determinant of quality of life in the affected patients. Subjects and methods: A population based cross sectional study was conducted from January 2016 to January 2017. It included 470 individuals attended five randomly selected primary healthcare centers in Arar city in the Northern Province of Kingdom of Saudi Arabia and were selected by systemic random sampling. Data were collected by means of personal interview with the sampled population using a predesigned questionnaire. Results: Findings revealed that18.7 % of the studied population suffered from Melasma. Age and positive family history were significantly associated with the development of Melasma among the studied patients while gender, skin color, sun exposure and cosmetic use had no significant effect. Most of the studied determinants of quality of life were not affected by suffering from Melasma while lack of self-confidence was significantly associated with the presence of Melasma. Conclusion: less than on fifth (18.7%) of the studied patients suffered from Melasma. Age and positive family history are the most common associations. Melasma had a significant impact on self-confidence of the affected patients.Keywords: Melasma, risk factor, quality of life

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research