CYTOMEGALOVIRUS (CMV) DISEASE IN RENAL ALLOGRAFT RECIPIENTS IN THE NEW IMMUNOSUPPRESSION ERA

Despite aggressive prophylaxis with antivirals, CMV infection remains a major complication of immunosuppression in renal transplantation with remarkable health and economic impacts. The incidence of new and recurrent CMV disease in adult renal transplant recipients at a single tertiary care hospital were studied, and multivariable analyses conducted to identify major predictors for CMV disease in the current immunosuppression era. Patients transplanted between January 1, 1999 and December 31, 2002 were included and followed prospectively until December 31, 2006. The primary end point was development of CMV disease and the incidence was 14.6% (95% Cl, 11.7-18%). None had recurrent CMV disease. Using multivariable analysis, factors associated with increased risk of developing CMV disease were CMV sero-status and positive B- cell cross match at time of transplantation. Patients with a positive B-cell crossmatch had a 3 times greater associated risk for developing CMV disease than those with a negative cross-match (OR = 3.23, 95% Confidence Interval, 1.16 - 9.0, p = 0.025). This association has not been previously reported and should be considered when identifying risks and complications with patients

Training, Education, and Research in COVID-19 Times: Innovative Methodological Approaches, Best Practices, and Case Studies

The recent pandemic of COVID-19 challenges the delivery of training and education worldwide [...

Outcome of recipients of human leukocyte antigen incompatible kidney transplants who underwent desensitization at King Fahad Specialist Hospital, Dammam, Saudi Arabia

In patients whom are highly sensitized immunologically, the benefit of kidney transplantation can be extended to this population through the utilization of organs from human leukocyte antigen incompatible (HLAi) donors. This retrospective observational study was designed to identify the incidence and predictors of acute antibody-mediated rejection/acute cellular rejection (AMR/ACR) in our kidney recipients from living kidney donors (sensitized and those with low immunologic risk). This single-center study has been conducted at King Fahad Specialist Hospital, Dammam (KFSH-D), Saudi Arabia; during the period of September 2008- August 2013. All eligible recipients of living donor kidneys during the study period were included (n = 213) in the study. Over 60% of patients in the study were females. Thirty of the 213 kidneys were from HLAi donors. During the follow-up period (median follow-up time = 16 months; 3–27 months), the incidence rate of ACR among HLA compatible (HLAc) and HLAi groups was 22.2% and 16.7%, respectively (P >0.05). The incidence rate of AMR was 2.6% in HLAc group and 16.7%in the HLAi group (P<0.05). The significantly higher incidence of AMR in HLAi group can be explained by the presence of the donor-specific antibodies in weak titers. These results are consistent with studies from similar populations in published literature. However, the relatively small number and short duration of the study are considered, and longer follow-up of this population will be needed for conclusions on the sustainability of our findings

Peritoneal dialysis for chronic kidney disease patients: A single-center experience in Saudi Arabia

To evaluate the peritoneal dialysis (PD) program in our hospital, we retrospectively studied all patients dialyzed with this modality over the last 5 years. A total of 56 patients having end-stage renal disease (ESRD), with mean age ± SD of 49 ± 20 years (range 16-92 years), were dialyzed with PD: 38 (68%) patients with continuous ambulatory PD and 18 (32%) patients with automated PD. Twenty-six (46%) patients were females. The mean follow-up time of these patients was 17 ± 14 months. The underlying etiologies for ESRD in these patients were diabetes mellitus (48%), glomerulonephritis (9%), and hypertension (7%). Twenty-seven patients (48%) were put on PD from the start, while 29 (52%) patients were switched from hemodialysis (HD) to PD. Nineteen (34%) patients developed a total of 29 episodes of peritonitis. The incidence of peritonitis was 0.4 episode per patient-year. Exit-site infections occurred in 17 (30%) patients. No tunnel infection was observed during the study period. Non-infectious catheter-related complications occurred in 12.5% of the patients; six (11%) patients had hernia (umbilical or inguinal). At the end of the study, 23 (41%) patients continued on PD, 17 (30%) received a renal transplant, 7 (13%) suffered technique failure and subsequently switched to HD, and 9 (16%) patients died. To conclude, our study demonstrates that the rate of PD related complications is found to be quite low in our program, with an acceptable technique failure rate and mortality. Therefore, PD is a safe and an effective treatment modality in the integrated care approach to patients with ESRD

Residents’ Training in COVID-19 Pandemic Times: An Integrated Survey of Educational Process, Institutional Support, Anxiety and Depression by the Saudi Commission for Health Specialties (SCFHS)

In late December of 2019, the outbreak of coronavirus disease (COVID-19) was first reported in the city of Wuhan, the capital of Hubei province in China, and was declared a pandemic by the World Health Organization in March 2020. Globally, as of 8 July 2020, there have been 11,669,259 confirmed cases of COVID-19, including 539,906 deaths. In Saudi Arabia, the confirmed cases have already reached 223,327, with 161,096 patients confirmed to have recovered, and 2100 deaths. This study aims to determine the effect of the COVID-19 pandemic on the training programs of the Saudi Commission for Health Specialties (SCFHS) and assess trainees&rsquo; mental health status (i.e., anxiety and depression). Trainee evaluations on training programs were also sought in order to obtain insights for strategic planning necessary for curricular modifications or improvements to address the clinical learning needs of trainees during this pandemic. The main contribution of our work is an investigation of the incidence of depression and anxiety regarding COVID-19 within the community of residents and fellows. Furthermore, we elaborate on key responsive actions towards the enhancement of the mental health of trainees. Last but not least, we propose the Saudi Commission for Health Specialties (SCFHS) Model for Residents&rsquo; Mental Health Enhancement during the COVID-19 Pandemic, which consists of five integrative value layers for medical education and training, namely: the knowledge creation process and innovation; technological capabilities for personalized medicine and patient-centric healthcare with a social impact; innovative applications of technology-enhanced learning and web-based active learning approaches for medical training and education; residents&rsquo; wellbeing and the impact of COVID-19 in strategic layers. In our future work, we intend to enhance the proposed framework with studies on trainee satisfaction and the efficiency of different technology-enhanced learning platforms for medical education

New-onset diabetes after transplantation among renal transplant recipients at a new transplant center; King Fahad Specialist Hospital-Dammam, Saudi Arabia

New-onset diabetes after transplant (NODAT) has been reported to occur in 4%-25% of renal transplant recipients. Its development has also been shown to be associated with an adverse impact on patient survival and an increased risk of graft rejection and graft loss, as well as an increased incidence of infectious complications. The study aims to describe the incidence of NODAT and its important risk factors in a single center. We conducted a retrospective analysis of data from all kidney transplant recipients in our center, transplanted between September 2008 and May 2013. Out of 311 patients, 77 had diabetes mellitus (DM) before transplantation and were excluded, leaving 234 patients as the study population. NODAT was diagnosed based on the WHO definition for DM: any two readings of fasting blood sugar >7 mmol/L or random blood sugar >11 or the use of hypoglycemic medications after 1st posttransplant month. The mean age of the study patients was 36 years ± 14 years; 55.5% were male, 69% had living-related transplant, 31% had deceased donor transplant, 98% were on tacrolimus-based immunosuppression regimen, 2% on cyclosporine and all patients were on the steroid-based regimen. The 1 and 5-year cumulative incidence of NODAT was 14.1% and 27.5%, respectively. The median duration to onset of NODAT was 2.5 months. The body mass index of >30 kg/m2 and age >60 years at the time of transplant were significantly associated with the occurrence of NODAT. Our finding of incidence was not different from what has been reported in the literature. Larger prospective and multicenter studies are needed

Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) - A pilot study

There are no available data about the prevalence of chronic kidney disease (CKD) and its risk factors in the general population of the kingdom of Saudi Arabia. To estimate the prevalence of CKD and its associated risk factors in the Saudi population, we conducted a pilot community-based screening program in commercial centers in Riyadh, Saudi Arabia. Candidates were interviewed and blood and urine samples were collected. Participants were categorized to their CKD stage according to their estimated Modification of Diet in Renal Disease (MDRD3)-based, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the presence of albuminuria. The sample comprised 491 (49.9&#x0025; were males) adult Saudi nationals. The mean age was 37.4 &#177; 11.3 years. The over-all prevalence of CKD was 5.7&#x0025; and 5.3&#x0025; using the MDRD-3 and CKD-EPI glomerular filtration equations, respectively. Gender, age, smoking status, body mass index, hypertension and diabetes mel-litus were not significant predictors of CKD in our cohort. However, CKD was significantly higher in the older age groups, higher serum glucose, waist/hip ratio and blood pressure. Only 7.1&#x0025; of the CKD patients were aware of their CKD status, while 32.1&#x0025; were told that they had protein or blood in their urine and 10.7&#x0025; had known kidney stones in the past. We conclude that prevalence of CKD in the young Saudi population is around 5.7&#x0025;. Our pilot study demonstrated the feasibility of screening for CKD. Screening of high-risk individuals is likely to be the most cost-effective strategy to detect CKD patients

A Progressive Model for Quality Benchmarks of Trainees’ Satisfaction in Medical Education: Towards Strategic Enhancement of Residency Training Programs at Saudi Commission for Health Specialties (SCFHS)

The latest developments in Sustainable Health focus on the provision of high quality medical training to health specialists, with a special focus on human factors. The need to promote effective Training Programs also reflects the job satisfaction needs of trainees. The objective of this study is to evaluate the trainees’ satisfaction with the quality of Training Programs and assess the degree of achievement based on the defined parameters to provide baseline data based on which strategies for improvement can be formulated. Our study was conducted in Saudi Arabia and our targeted population was residents in medical programs supervised by the Saudi Commission for the Health Specialties (SCFHS). The trainees’ response rate to the online survey was 27% (3696/13,688) and the key aspects of job satisfaction investigated include: Satisfaction with Academic Activities in the Center; Satisfaction with the Residents and Colleagues in the Center; Satisfaction with the Administrative Components in the Center; Satisfaction with the Training Programs; Satisfaction with the Specialty; Satisfaction with the Training Center; Satisfaction with the SCFHS. The main contribution of our work is a benchmark model for job satisfaction that can be used as a managerial tool for the enhancement of medical education with reference to the satisfaction of trainees. We analyze the key aspects and components of training satisfaction and we introduce our progressive model for Trainees’ Satisfaction in Medical Training. In future work, we intend to enhance the proposed framework with a set of key performance indicators as well as with a focused cause and effect focused survey on factors related to the key benchmark of this study

A Progressive Model for Quality Benchmarks of Trainees’ Satisfaction in Medical Education: Towards Strategic Enhancement of Residency Training Programs at Saudi Commission for Health Specialties (SCFHS)

The latest developments in Sustainable Health focus on the provision of high quality medical training to health specialists, with a special focus on human factors. The need to promote effective Training Programs also reflects the job satisfaction needs of trainees. The objective of this study is to evaluate the trainees&rsquo; satisfaction with the quality of Training Programs and assess the degree of achievement based on the defined parameters to provide baseline data based on which strategies for improvement can be formulated. Our study was conducted in Saudi Arabia and our targeted population was residents in medical programs supervised by the Saudi Commission for the Health Specialties (SCFHS). The trainees&rsquo; response rate to the online survey was 27% (3696/13,688) and the key aspects of job satisfaction investigated include: Satisfaction with Academic Activities in the Center; Satisfaction with the Residents and Colleagues in the Center; Satisfaction with the Administrative Components in the Center; Satisfaction with the Training Programs; Satisfaction with the Specialty; Satisfaction with the Training Center; Satisfaction with the SCFHS. The main contribution of our work is a benchmark model for job satisfaction that can be used as a managerial tool for the enhancement of medical education with reference to the satisfaction of trainees. We analyze the key aspects and components of training satisfaction and we introduce our progressive model for Trainees&rsquo; Satisfaction in Medical Training. In future work, we intend to enhance the proposed framework with a set of key performance indicators as well as with a focused cause and effect focused survey on factors related to the key benchmark of this study