Alsultan A.,King Saud University |
Alabdulaali M.K.,King Fahad Hospital |
Griffin P.J.,Boston University |
Alsuliman A.M.,King Fahad Hospital |
And 6 more authors.
British Journal of Haematology | Year: 2014
Sickle cell disease (SCD) in Saudi patients from the Eastern Province is associated with the Arab-Indian (AI) HBB (β-globin gene) haplotype. The phenotype of AI SCD in children was described as benign and was attributed to their high fetal haemoglobin (HbF). We conducted a hospital-based study to assess the pattern of SCD complications in adults. A total of 104 patients with average age of 27 years were enrolled. Ninety-six per cent of these patients reported history of painful crisis; 47% had at least one episode of acute chest syndrome, however, only 15% had two or more episodes; symptomatic osteonecrosis was reported in 18%; priapism in 17%; overt stroke in 6%; none had leg ulcers. The majority of patients had persistent splenomegaly and 66% had gallstones. Half of the patients co-inherited α-thalassaemia and about one-third had glucose-6-phosphate dehydrogenase deficiency. Higher HbF correlated with higher rate of splenic sequestration but not with other phenotypes. The phenotype of adult patients with AI SCD is not benign despite their relatively high HbF level. This is probably due to the continued decline in HbF level in adults and the heterocellular and variable distribution of HbF amongst F-cells. © 2013 John Wiley & Sons Ltd.
Hassan A.,Taibah University |
Al-Quliti K.W.,Taibah University |
Al-Quliti K.W.,King Fahad Hospital
Neurosciences | Year: 2014
Epilepsy is a common and serious chronic neurological disorder, affecting around 65 million people worldwide. Despite the advances in pharmacologic treatments for epilepsy, approximately 30% of the patients remain medically refractory and continue to have seizures on medications, in such cases, other treatment approaches are necessary. Resection surgery can be an alternative in many patients to achieve good seizure control; however, not all patients are suitable candidates for surgery. Electrical stimulation of the brain is a rapidly evolving therapy for patients with uncontrolled seizures despite the best medical and surgical treatment. Vagus nerve stimulation, deep brain stimulation of the anterior nucleus of thalamus, and responsive neurostimulation have class I evidence supporting their use in patients with intractable epilepsy. In this review, we discuss the evidence of these therapeutic modalities, their mechanism of action, efficacy, outcome, and their application in clinical use.
Siddiqui F.A.,King Fahad Hospital |
Chopra R.,King Fahad Hospital |
Al-Marzooq Y.,King Fahad Hospital
Acta Cytologica | Year: 2014
Background: Tailgut cyst is a rare tumor believed to originate from small portions of the embryonic tailgut, which normally disappear in early fetal development. It is often misdiagnosed due to the general unfamiliarity with this entity and also because of its clinical presentation similar to other more common diseases such as perianal fistulas and abscesses. Case: The authors take this opportunity to report a case of tailgut cyst in a 21-year-old Saudi female. The patient had presented with painful low back swelling, which had been gradually increasing in size. The case was diagnosed by fine needle aspiration cytology (FNAC) as tailgut cyst and later confirmed by histopathology. Conclusion: Tailgut cysts are congenital cystic hamartomatous lesions, which are rare in occurrence. They are generally benign, but malignancy has also been reported, which is even rarer in occurrence. FNAC is an effective diagnostic tool, which if applied appropriately can be used for the early detection of rarer lesions such as tailgut cyst. © 2014 S. Karger AG, Basel.
Nasr M.M.,King Fahad Hospital
Journal of Gastrointestinal Surgery | Year: 2016
Background: The performance of laparoscopic cholecystectomy could be a technical challenge. Procedure success depends on multiple factors namely: hepatobiliary anatomical variations, pathologic changes in the gallbladder and surrounding tissues, pre-operative interventional attempts, the individual surgeon’s skill and finally patient co-morbidities. Anticipating the attendant challenges, can help to avoid several known complications associated with this procedure. Searching a more reliable anatomical topography to adopt during laparoscopic cholecystectomy is the basis for a safe surgical technique. Methods: Between January 2012 and August 2015, 525 cases were presented with acute cholecystitis. Patients were classified in to two groups regarding degree of dissection difficulty. The study concept is defined and applied by the author in all study cases. No single case was excluded from the study. Results: Results are processed in comparative way between both groups of the study. The increased risk results in Group B are related to technical difficulties. Conclusion: The study has offered a novel anatomical concept and safe surgical technique avoiding exploration of Calot’s triangle. The new concept has minimized dissection demands and risk of injury related to the traditional laparoscopic cholecystectomy. The study has proposed a potentially secure and empirical laparoscopic cholecystectomy technique that could be considered in every case. © 2016 The Society for Surgery of the Alimentary Tract
Muhammad M.I.A.,King Fahad Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2011
Objectives: The approach to the pericardial window in patients with pericardial effusion (PE) remains undefined as to whether a surgical (transthoracic or subxiphoid) or a thoracoscopic pericardial window is the optimal operative approach to PE. We hypothesized that the window into the pleural space created by the thoracoscopy might improve the outcome. Methods: We conducted a prospective study between September 2007 and October 2009. All patients with PE diagnosed by echocardiography who attended the Cardiothoracic Department in King Fahd Hospital are included in this study. They were 30 patients (18 males, 12 females aged 44±1.22 years). Patients were subdivided into two groups. Group A, 15 patients underwent the surgical (transthoracic or subxiphoid) procedure and Group B, 15 patients underwent the video-assisted thoracoscopy procedure. Preoperative, intraoperative and postoperative variables, morbidity, recurrence, and survival were compared in both groups. Results: Preoperative variables were well-matched for age, sex, preoperative tamponade, echocardiographical characteristics and co-morbidities between both groups. No recurrence of effusion was observed in the two groups. Operative time was statistically highly significant (P<0.001); it was longer in Group B. There was no intraoperative complication in both groups. There was no postoperative complication in both groups except one case of superficial wound infection in Group A. There was no significance difference between both groups as regard duration of chest tube drainage and length of hospital stay. There was no inhospital mortality in both groups. Conclusions: Pericardial window by video-assisted thoracoscopy is an effective technique for pericardial drainage and biopsy. Apart from its diagnostic value, it allows the physician to fashion a pleuropericardial window for effective drainage while avoiding the complications of classic surgical procedures. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Bashir T.,King Fahad Hospital
Pakistan Journal of Medical and Health Sciences | Year: 2015
Background: Acute Appendicitis is one of the most common presentation on surgical floor and Appendectomy is one of the most common emergency operation being done worldwide. Although emergency appendicectomy is consider as standard treatment for acute appendicitis but acute appendicitis can also be managed by non operative means in carefully selected/closely observed pts. Methods: Patients presented with clinically suggestive Appendicitis during my emergency on call duties in King Fahad Hospital Al baha (KFH), KSA from Aug. 2011 to Aug. 2012 were selected for the conservative treatment by means of NPO, I/V fluids. More over selected patients were also subjected to single shot of cefuroxime and flagyl. These were adult patients with age ranging from 12 to 80 years. The success rate, conversion rate, recurrence, morbidity and mortality was evaluated. The criteria of inclusion were suggestive clinical features of acute appendicitis, first time presentation, patients with age 12 or above and Alvarado's score 5 or above. Whereas criteria of exclusion were patients with clinical features of complicated appendicitis, recurrent disease, or diabetic. The patients were observed 6 hourly intervals for further consideration regarding conservative treatment and subsequently discharge home or converted for operation. The discharged patient with non operative management was followed up for one year in follow up clinic, ER and through medical record. Results: Out of 305 patients admitted with provisional diagnosis of acute appendicitis, 176(57.71%) patients were selected for conservative treatment, 102(58%) female and 74(42%) were male Conservative treatment was proven successful in 150(85.23%) patients, while failed in 26(14.77%) patients out of 176 selected for non operative management. So out of 305 patients admitted with provisional diagnosis of acute appendicitis, 150(49.18%) were successfully treated by non operative means. It means that almost half of the patients with acute appendicitis can be selected for non operative management with or without antibiotics. Conclusion: Non operative management in acute appendicitis is a successful alternative option in carefully selected cases through closed observation and regular monitoring. There is acceptable risk of recurrence and complication.
Albasri A.,Taibah University |
Sawaf Z.,Taibah University |
Hussainy A.S.,Taibah University |
Alhujaily A.,King Fahad Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2014
Objectives: This study aimed to characterize the histopathological pattern of thyroid lesions among Saudi patients and to highlight the age and gender variations of these lesions as base line data. Materials and Methods: We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Results: The 292 thyroidectomy specimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving a female: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Two hundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. The non-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%), nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave's disease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among the benign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was the commonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicular carcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%). Conclusions: Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was the most common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was the commonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis, most being diagnosed at an advanced stage.
Alhazzani W.,McMaster University |
Alshahrani M.,King Fahad Hospital |
Jaeschke R.,McMaster University |
Forel J.M.,Aix - Marseille University |
And 3 more authors.
Critical Care | Year: 2013
Introduction: Randomized trials investigating neuromuscular blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness.Methods: We conducted a systematic review and meta-analysis. We searched the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and clinical trial registries for randomized trials investigating survival effects of neuromuscular blocking agents in adults with ARDS. Two independent reviewers abstracted data and assessed methodologic quality. Primary study investigators provided additional unpublished data.Results: Three trials (431 patients; 20 centers; all from the same research group in France) met inclusion criteria for this review. All trials assessed 48-hour infusions of cisatracurium besylate. Short-term infusion of cisatracurium besylate was associated with lower hospital mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I2= 0). This finding was robust on sensitivity analyses. Neuromuscular blockade was also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to 0.90; P = 0.02; I2= 0), but had no effect on the duration of mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to 5.99; P = 0.93; I2= 49%), or the risk of ICU-acquired weakness (RR, 1.08; 95% CI, 0.83 to 1.41; P = 0.57; I2= 0). Primary studies lacked protracted measurements of weakness.Conclusions: Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS. © 2013 Alhazzani et al.; licensee BioMed Central Ltd.
Hussainy A.S.,King Fahad Hospital |
Sundkji I.,King Fahad Hospital |
Alhujaily A.,Taibah University
Saudi Medical Journal | Year: 2014
Objectives: To observe the frequency of breast cancer among Saudi patients and to highlight the age variations and features of advanced cancer.Methods: A retrospective study of breast cancer biopsies from all Saudi patients performed between January 2006 and December 2013 in King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. All the available demographic and tumor related data was analyzed.Results: Of 1005 breast tissues reviewed, 982 specimens were from female, and 23 from male patients. In females, 398 specimens (40.5%) were diagnosed as malignant. Invasive ductal carcinoma (IDC) (85.2%) was most common, followed by ductal carcinoma in situ (8%), and invasive lobular carcinoma (2.7%). The mean age of Saudi females with IDC was 46.9 years. Approximately 48.7% IDC were Grade III tumors. A tumor size >2.5 cm was found in 61.1% patients, whereas axillary nodal metastasis was present in 57.1% and lymphovascular invasion in 64.1% who underwent axillary nodal dissection. In males, 4 specimens (17.4%) were malignant (all IDC).Conclusion: Our finding are consistent with previous reports of breast cancer being diagnosed in younger age group, in advanced stages, and with features of aggressive behavior; which signals the urgency for implementation of breast screening programs. © 2014, Saudi Arabian Armed Forces Hospital. All rights reserved.
Albasri A.,Taibah University |
Yosef H.,Taibah University |
Hussainy A.,Taibah University |
Bukhari S.,Taibah University |
Alhujaily A.,King Fahad Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2014
Aim: To evaluate the predominant colorectal polyps in the Almadinah region of Saudi Arabia. Materials and Methods: In this iretrospective study, we analyzed pathology reports of colonoscopies performed in King Fahad Hospital, Madinah, Saudi Arabia during the period 2006 to 2013. Data based on patient age, gender, size, site and type of polyps and the degree of dysplasia were analyzed by software SPSS 17 and compared with other published studies from different geographic regions of the world. Results: During these years, 224 patients had colonic polyps, of whom 149 (66.5%) were men and 75 (33.5%) were women. The most common types of polyps were adenomatous (166), followed by hyperplastic polyps (24), juvenile (18), inflammatory (13), lipomatous (2) and one patient with Peutz-Jegher polyps. Tubulovillous adenoma was the commonest adenomatous polyp (102), followed by tubular (41) and villous (23) types. The sigmoid colon was the most commonly involved region (36.6%). Dysplasia was significantly associated with female patients who had large size tubulovillous polyps located in the left colon. Conclusions: The type and distribution of colorectal polyps in Saudi Arabia is very similar to Western countries. Patient gender, and size, histological type and location of polyps are closely related to dysplastic change in colonic polyps.