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Oreibi T, Alenezi F, Ahmed AM, Humaid FB, Sadat M, Tamim HM, Baseet FF, Naidu B, Arabi YM. Outcomes of patients admitted to the intensive care unit with community-acquired pneumonia in a tertiary care center in Riyadh, Saudi Arabia. Ann Thorac Med 2023; 18:206-210. [PMID: 38058784 PMCID: PMC10697301 DOI: 10.4103/atm.atm_49_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2003] [Revised: 05/01/2023] [Accepted: 08/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) morbidity and mortality. Despite extensive international epidemiological and clinical studies to improve those patients' outcomes, local statistics in Saudi Arabia are limited. The objective of this study is to describe the clinical characteristics and outcomes of patients admitted to the ICU with the diagnosis of CAP reflecting the experience of a tertiary center over an 18-year period. METHODS A retrospective cohort study included all consecutive adult ICU patients diagnosed with CAP between 1999 and 2017. Baseline demographics, patients' risk factors, and initial admission laboratory investigations were compared between survivors and nonsurvivors. A multivariate regression model was used to predict mortality. RESULTS During the study period, there were 3438 patients admitted to the ICU with CAP (median age 67 [Quartile 1, 3 (Q1, Q3) 51, 76] years) and 54.4% were males, of whom 1007 (29.2%) died. The survivors compared with nonsurvivors were younger (65 vs. 70 years), less likely to have chronic liver disease (2.4% vs. 10.5%), chronic renal failure (8.1% vs. 14.4%), and be immunocompromised (10.2% vs. 18.2%), and less frequently required mechanical ventilation or vasopressors (46.2% vs. 80.5% and 29.6% vs. 55.9%, respectively). Acute Physiology and Chronic Health Evaluation (APACHE) II score was significantly higher among nonsurvivors (median score 26 vs. 20) with a longer duration of mechanical ventilation and ICU stay. Using a multivariate regression model, age, APACHE II score, bilirubin level, vasopressors, and mechanical ventilation were significantly associated with increased mortality, while diabetes was associated with lower mortality. CONCLUSION Around one-third of patients admitted to the ICU with CAP died. Mortality was significantly associated with age, APACHE II score, vasopressor use, and mechanical ventilation. A comprehensive national registry is needed to enhance epidemiological data and to guide initiatives for improving CAP patients' outcomes.
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Affiliation(s)
- Talal Oreibi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farhan Alenezi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amjad M. Ahmed
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hani Mohammed Tamim
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- American University of Beirut-Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Faisal Fouad Baseet
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Brintha Naidu
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Jakariya M, Alam MS, Rahman MA, Ahmed S, Elahi MML, Khan AMS, Saad S, Tamim HM, Ishtiak T, Sayem SM, Ali MS, Akter D. Assessing climate-induced agricultural vulnerable coastal communities of Bangladesh using machine learning techniques. Sci Total Environ 2020; 742:140255. [PMID: 32721709 PMCID: PMC7297150 DOI: 10.1016/j.scitotenv.2020.140255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 05/24/2023]
Abstract
The agricultural arena in the coastal regions of South-East Asian countries is experiencing the mounting pressures of the adverse effects of climate change. Controlling and predicting climatic factors are difficult and require expensive solutions. The study focuses on identifying issues other than climatic factors using the Livelihood Vulnerability Index (LVI) to measure agricultural vulnerability. Factors such as monthly savings of the farmers, income opportunities, damage to cultivable lands, and water availability had significant impacts on increasing community vulnerability with regards to agricultural practice. The study also identified the need for assessing vulnerability after certain intervals, specifically owing to the dynamic nature of the coastal region where the factors were found to vary among the different study areas. The development of a climate-resilient livelihood vulnerability assessment tool to detect the most significant factors to assess agricultural vulnerability was done using machine learning (ML) techniques. The ML techniques identified nine significant factors out of 21 based on the minimum level of standard deviation (0.03). A practical application of the outcome of the study was the development of a mobile application. Custom REST APIs (application programming interface) were developed on the backend to seamlessly sync the app to a server, thus ensuring the acquisition of future data without much effort and resources. The paper provides a methodology for a unique vulnerability assessment technique using a mobile application, which can be used for the planning and management of resources by different stakeholders in a sustainable way.
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Affiliation(s)
- Md Jakariya
- Department of Environmental Science and Management, North South University, Bangladesh.
| | - Md Sajadul Alam
- Department of Environmental Science and Management, North South University, Bangladesh
| | - Md Abir Rahman
- Department of Environmental Science and Management, North South University, Bangladesh
| | - Silvia Ahmed
- Department of Electrical and Computer Engineering, North South University, Bangladesh
| | - M M Lutfe Elahi
- Department of Electrical and Computer Engineering, North South University, Bangladesh
| | | | - Saman Saad
- Department of Environmental Science and Management, North South University, Bangladesh
| | - H M Tamim
- Department of Electrical and Computer Engineering, North South University, Bangladesh
| | - Taoseef Ishtiak
- Department of Electrical and Computer Engineering, North South University, Bangladesh
| | - Sheikh Mohammad Sayem
- Department of Agricultural Statistics, Bangladesh Agricultural University, Bangladesh
| | - Mirza Shawkat Ali
- Department of Environment, Government of the People's Republic of Bangladesh
| | - Dilruba Akter
- Department of Environment, Government of the People's Republic of Bangladesh
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Arabi YM, Al-Dorzi HM, Mehta S, Tamim HM, Haddad SH, Jones G, McIntyre L, Solaiman O, Sakkijha MH, Sadat M, Afesh L, Kumar A, Bagshaw SM, Aldawood AS. Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial. Am J Clin Nutr 2018; 108:988-996. [PMID: 30475959 DOI: 10.1093/ajcn/nqy189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Background The optimal amount of protein intake in critically ill patients is uncertain. Objective In this post hoc analysis of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we tested the hypothesis that higher total protein intake was associated with lower 90-d mortality and improved protein biomarkers in critically ill patients. Design In this post hoc analysis of the PermiT trial, we included patients who received enteral feeding for ≥3 consecutive days. Using the median protein intake of the cohort as a cutoff, patients were categorized into 2 groups: a higher-protein group (>0.80 g · kg-1 · d-1) and a lower-protein group (≤0.80 g · kg-1 · d-1). We developed a propensity score for receiving higher protein. Primary outcome was 90-d mortality. We also compared serial values of prealbumin, transferrin, 24-h urinary nitrogen, and 24-h nitrogen balance on days 1, 7, and 14. Results Among the 729 patients included in this analysis, the average protein intake was 0.8 ± 0.3 g · kg-1 · d-1 [1.0 ± 0.2 g · kg-1 · d-1 in the higher-protein group (n = 365) and 0.6 ± 0.2 g · kg-1 · d-1 in the lower-protein group (n = 364); P < 0.0001]. There was no difference in 90-d mortality between the 2 groups [88/364 (24.2%) compared with 94/363 (25.9%), propensity score-adjusted OR: 0.80; 95% CI: 0.56, 1.16; P = 0.24]. Higher protein intake was associated with an increase in 24-h urea nitrogen excretion compared with lower protein intake, but without a significant change in prealbumin, transferrin, or 24-h nitrogen balance. Conclusions In the PermiT trial, a moderate difference in protein intake was not associated with lower mortality. Higher protein intake was associated with increased nitrogen excretion in the urine without a corresponding change in prealbumin, transferrin, or nitrogen balance. Protein intake needs to be tested in adequately powered randomized controlled trials targeting larger differences in protein intake in high-risk populations.
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Affiliation(s)
- Y M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - H M Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - S Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - H M Tamim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S H Haddad
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - G Jones
- Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | - L McIntyre
- Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | - O Solaiman
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - M H Sakkijha
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - M Sadat
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - L Afesh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - A Kumar
- Health Sciences Center, Manitoba, Canada
| | - S M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - A S Aldawood
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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4
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Arabi YM, Al Owais SM, Al-Attas K, Alamry A, AlZahrani K, Baig B, White D, Deeb AM, Al-Dozri HD, Haddad S, Tamim HM, Taher S. Learning from defects using a comprehensive management system for incident reports in critical care. Anaesth Intensive Care 2016; 44:210-20. [PMID: 27029653 DOI: 10.1177/0310057x1604400207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Incident reporting systems are often used without a structured review process, limiting their utility to learn from defects and compromising their impact on improving the healthcare system. The objective of this study is to describe the experience of implementing a Comprehensive Management System (CMS) for incident reports in the ICU. A physician-led multidisciplinary Incident Report Committee was created to review, analyse and manage the department incident reports. New protocols, policies and procedures, and other patient safety interventions were developed as a result. Information was disseminated to staff through multiple avenues. We compared the pre- and post-intervention periods for the impact on the number of incident reports, level of harm, time needed to close reports and reporting individuals. A total of 1719 incidents were studied. ICU-related incident reports increased from 20 to 36 incidents per 1000 patient days (P=0.01). After implementing the CMS, there was an increase in reporting 'no harm' from 14.2 to 28.1 incidents per 1000 patient days (P<0.001). There was a significant decrease in the time needed to close incident report after implementing the CMS (median of 70 days [Q1-Q3: 26-212] versus 13 days [Q1-Q3: 6-25, P<0.001]). A physician-led multidisciplinary CMS resulted in significant improvement in the output of the incident reporting system. This may be important to enhance the effectiveness of incident reporting systems in highlighting system defects, increasing learning opportunities and improving patient safety.
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Affiliation(s)
- Y M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - S M Al Owais
- Quality Management Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - K Al-Attas
- Anesthesia Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - A Alamry
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - K AlZahrani
- Quality Management Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - B Baig
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - D White
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - A M Deeb
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - H D Al-Dozri
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - S Haddad
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - H M Tamim
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - S Taher
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Musallam KM, Porter JB, Sfeir PM, Tamim HM, Richards T, Lotta LA, Peyvandi F, Jamali FR. Raised haematocrit concentration and the risk of death and vascular complications after major surgery. Br J Surg 2013; 100:1030-6. [DOI: 10.1002/bjs.9176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Preoperative anaemia is associated with adverse postoperative outcomes. Data on raised preoperative haematocrit concentration are limited. This study aimed to evaluate the effect of raised haematocrit on 30-day postoperative mortality and vascular events in patients undergoing major surgery.
Methods
This was a cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Thirty-day mortality and vascular events, demographics and perioperative risk factors were obtained for adults undergoing major surgery. The adjusted effect of raised (over 0·50) compared with normal (0·41–0·50, American Medical Association reference range) preoperative haematocrit concentration on postoperative outcomes was assessed. Separate sex-specific analyses were also conducted, using haematocrit concentration thresholds commonly used in the diagnosis and management of apparent or absolute erythrocytosis.
Results
Some 3961 (2·0 per cent) of 197 469 patients had a raised haematocrit concentration before surgery. After adjustment, the 30-day postoperative mortality rate was higher in patients with raised haematocrit than in those without (odds ratio (OR) 2·23, 95 per cent confidence interval 1·77 to 2·80). Thirty-day rates of deep vein thrombosis (OR 1·95, 1·44 to 2·64) and pulmonary embolism (OR 1·79, 1·17 to 2·73), but not myocardial infarction or stroke, were also higher in patients with a raised haematocrit concentration. The effect on mortality was noted beyond the haematocrit thresholds of 0·48 in women and 0·52 in men; the effect estimates were considerably higher for values exceeding 0·54. Values between 0·41 and 0·45 were not associated with increased mortality risk. Similar observations were noted for venous thrombosis, although with apparent sex differences.
Conclusion
A raised haematocrit concentration was associated with an increased risk of 30-day mortality and venous thrombosis following major surgery.
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Affiliation(s)
- K M Musallam
- Department of Internal Medicine, UK
- Angleo Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties, Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | - J B Porter
- Department of Haematology, University College London, UK
| | - P M Sfeir
- Department of Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | | | - T Richards
- Division of Surgery and Interventional Science, University College Hospital, London, UK
| | - L A Lotta
- Angleo Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties, Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | - F Peyvandi
- Angleo Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Medicine and Medical Specialties, Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | - F R Jamali
- Department of Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
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Balkhy HH, Bawazeer MS, Kattan RF, Tamim HM, Al Johani SM, Aldughashem FA, Al Alem HA, Adlan A, Herwaldt LA. Epidemiology of Acinetobacter spp.-associated healthcare infections and colonization among children at a tertiary-care hospital in Saudi Arabia: a 6-year retrospective cohort study. Eur J Clin Microbiol Infect Dis 2012; 31:2645-51. [PMID: 22476386 DOI: 10.1007/s10096-012-1608-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/07/2012] [Indexed: 12/01/2022]
Abstract
A retrospective cohort study was conducted among hospitalized children less than 12 years of age who had Acinetobacter spp. isolated from ≥1 cultures between October 2001 and December 2007 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Children with multidrug-resistant (MDR) Acinetobacter spp. healthcare-associated infections (HAIs) were compared to children with antimicrobial-susceptible Acinetobacter spp. HAIs and to children colonized with Acinetobacter. Children with MDR Acinetobacter spp. HAIs were older (p = 0.01), more likely to be admitted to an intensive care unit (ICU) (p = 0.06), and had a higher mortality rate (p = 0.02) than colonized children. Children with MDR Acinetobacter spp. HAIs were older than children with antimicrobial-susceptible Acinetobacter spp. HAIs (p = 0.0004), but their mortality rates were similar. Among children with MDR Acinetobacter spp. HAIs, burn injuries were the most common underlying illness. HAIs caused by MDR or susceptible Acinetobacter spp. occurred after prolonged hospitalization, suggesting nosocomial acquisition. Patients infected with MDR Acinetobacter spp. frequently received inappropriate empiric therapy (73.9 %). Further studies are needed in order to identify effective strategies to prevent nosocomial transmission and effective ways of improving patient outcomes.
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Affiliation(s)
- H H Balkhy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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Haddad S, Aldawood AS, Alferayan A, Russell NA, Tamim HM, Arabi YM. Relationship between intracranial pressure monitoring and outcomes in severe traumatic brain injury patients. Anaesth Intensive Care 2012; 39:1043-50. [PMID: 22165356 DOI: 10.1177/0310057x1103900610] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Intracranial pressure (ICP) monitoring is recommended in patients with a severe traumatic brain injury (TBI) and an abnormal computed tomography (CT) scan. However, there is contradicting evidence about whether ICP monitoring improves outcome. The purpose of this study was to examine the relationship between ICP monitoring and outcomes in patients with severe TBI. From February 2001 to December 2008, a total of 477 consecutive adult (> or =18 years) patients with severe TBI were included retrospectively in the study. Patients who underwent ICP monitoring (n=52) were compared with those who did not (n=425). The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, mechanical ventilation duration, the need for tracheostomy, and ICU and hospital length of stay (LOS). After adjustment for multiple potential confounding factors, ICP monitoring was not associated with significant difference in hospital or ICU mortality (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 0.79 to 3.70, P = 0.17; OR = 1.01, 95% CI = 0.41 to 2.45, P = 0.99, respectively). ICP monitoring was associated with a significant increase in mechanical ventilation duration (coefficient = 5.66, 95% CI = 3.45 to 7.88, P < 0.0001), need for tracheostomy (OR = 2.02, 95% CI = 1.02 to 4.03, P = 0.04), and ICU LOS (coefficient = 5.62, 95% CI = 3.27 to 7.98, P < 0.0001), with no significant difference in hospital LOS (coefficient = 8.32, 95% CI = -82.6 to 99.25, P = 0.86). Stratified by the Glasgow Coma Scale score, ICP monitoring was associated with a significant increase in hospital mortality in the group of patients with Glasgow Coma Scale 7 to 8 (adjusted OR = 12.89, 95% CI = 3.14 to 52.95, P = 0.0004). In patients with severe TBI, ICP monitoring was not associated with reduced hospital mortality, however with a significant increase in mechanical ventilation duration, need for tracheostomy, and ICU LOS.
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Affiliation(s)
- S Haddad
- Intensive Care Department, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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8
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Abstract
The College of Medicine at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) was established in January 2004. The four-year curriculum was based on the Problem Based Learning (PBL) format and involved the web-based graduate medical program adopted from the University of Sydney, Australia. At KSAU-HS, one additional semester was added to the beginning of this curriculum to prepare the students in English language skills, PBL, Information Technology and Evidence Based Medicine (EBM). EBM is part of the Personal and Professional Development (PPD) theme of the medical curriculum and is integrated into each stage of the medical curriculum. These modifications of the University of Sydney curriculum are presented here as a model of EBM integration into a college of medicine curriculum.
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Affiliation(s)
- H M Tamim
- College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - M Ferwana
- College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Family medicine, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - E Al Banyan
- College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - I Al Alwan
- College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - AH Hajeer
- College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pathology & Laboratory Medicine, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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Al-Atawi MS, Al-Alwan IA, Al-Mutair AN, Tamim HM, Al-Jurayyan NA. Epidemiology of nutritional rickets in children. Saudi J Kidney Dis Transpl 2009; 20:260-265. [PMID: 19237815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
In most developing countries, nutritional rickets is a major health problem. The aim of this study was to explore the magnitude of nutritional rickets among Saudi infants, and the various clinical presentations, as well as to address the possible operating risk factors behind the disease. We carried out a retrospective study at King Abdulaziz Medical City-King Fahad National Guard Hospital in Riyadh, Saudi Arabia. The records of Saudi infants under the age of 14 months over a 10-year period (between January 1990 and January 2000) were reviewed. Infor-mation collected included age, sex, clinical presentations, biochemical, radiological findings, infant nutrition, presence of other nutritional deficiencies and exposure to sunlight. There were 283 infants diagnosed with nutritional rickets due to Vitamin D deficiency (67% males) who were between 6 and 14 months of age. Among the total, 70% were exclusively breast-fed, and 23% were breast-fed until the age of 1 year. The most frequent clinical presentation was hypo-calcemic convulsions (34%) followed by chest infections (33%) and gastroenteritis (25%). In conclusion, nutritional rickets is still prevalent in Saudi Arabia with the primary etiology being vitamin D deficiency. Therefore we recommend that every infant, who is exclusively on breast-feeding, has routine supplement of vitamin D in the range of 200 IU/day (alone or as apart of multivitamin), started soon after birth until the time of weaning.
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Affiliation(s)
- M S Al-Atawi
- Department of Pediatric, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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10
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Tamim HM, Mahmud S, Hanley JA, Boivin JF, Stang MR, Collet JP. Antidepressants and risk of prostate cancer: a nested case – control study. Prostate Cancer Prostatic Dis 2007; 11:53-60. [PMID: 17684479 DOI: 10.1038/sj.pcan.4501003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although the association between antidepressant drug use and risk of cancer has received considerable attention in the past years, no work has been done specifically on prostate cancer. We carried out a population-based case-control study to assess the risk of prostate cancer in association with exposure to tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). 7767 prostate cancer cases diagnosed between 1981 and 2000 were accrued through the Saskatchewan Cancer Agency. Saskatchewan Health identified a total of 31,068 male controls who were matched on age and calendar time. Data on exposure to TCAs and SSRIs were compiled from the Saskatchewan outpatient prescription drug database, and covered a period upto 24 years. A positive significant association was found between TCA use and risk of prostate cancer, when exposure took place 2-5 years before diagnosis, with rate ratios of 1.31, 1.58, and 2.42 at the low, medium and high average daily dose levels, respectively. Exposure to SSRIs was not found to be significantly associated with the risk of prostate cancer. TCA use 2-5 years in the past was associated with a small dose-dependent increase in the risk of prostate cancer. Nevertheless, detection bias could have contributed to the observed association.
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Affiliation(s)
- H M Tamim
- Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Montréal, Québec, Canada.
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Healey JF, Barrow RT, Tamim HM, Lubin IM, Shima M, Scandella D, Lollar P. Residues Glu2181-Val2243 contain a major determinant of the inhibitory epitope in the C2 domain of human factor VIII. Blood 1998; 92:3701-9. [PMID: 9808564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The human blood coagulation factor VIII C2 domain (Ser2173-Tyr2332) contains an epitope recognized by most polyclonal inhibitory anti-factor VIII alloantibodies and autoantibodies. We took advantage of the differential reactivity of inhibitory antibodies with human and porcine factor VIII and mapped a major determinant of the C2 epitope by using a series of active recombinant hybrid human/porcine factor VIII molecules. A series of five C2-specific human antibodies and a murine anti-factor VIII monoclonal antibody, NMC-VIII/5, inhibited a hybrid containing a substitution of porcine sequence for Glu2181-Val2243 significantly less than human factor VIII. In contrast, four of the five patient antibodies and NMC-VIII/5 inhibited a hybrid containing a substitution of porcine sequence for Thr2253-Tyr2332 equally well as human factor VIII. Thus, a major factor VIII inhibitor epitope determinant is bounded by Glu2181-Val2243 at the NH2-terminal end of the C2 domain. Because C2 inhibitors block the binding of factor VIII to phospholipid and von Willebrand factor, for which binding sites have been localized to Thr2303-Tyr2332, these results imply that the segment bounded by Glu2181-Val2243 also is involved in these macromolecular interactions.
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Affiliation(s)
- J F Healey
- Emory University, Atlanta, GA; Holland Laboratory, American Red Cross, Rockville, MD, USA
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