Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia.

BACKGROUND: Pediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia.  Patients' demographics and risk factors associated with sepsis-related mortality were also investigated. METHODS: A retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). RESULTS: Of the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30-9.93) and 9.27 (95% confidence interval: 1.28-67.29), respectively. CONCLUSIONS: The incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance.

Management of pilonidal sinus.

OBJECTIVE: Pilonidal sinus is a disabling nuisance in young adults, yet its management remains controversial. METHODS: Patients admitted to Prince Abdulrahman Sudery Hospital, Al Jouf, Kingdom of Saudi Arabia, over a period of 10-years from January 1990 to December 1999 were evaluated in this retrospective study. We compared 2 most commonly performed surgical operations in 272 patients consisting of group A, 176 patients, managed by excision and primary closure and group B, 96 patients, managed by excision and healing by the second intention. RESULTS: More than 90% of group A achieved primary healing within 10 days. Although 100% of group B achieved eventual healing, it took a significantly longer period, mean 48 days (p<0.0001). Failure of primary healing occurred in 16 (9.1%) group A patients but 6 (3.4%) of these were amenable to secondary closure and still achieved healing in a shorter period of time than group B (p<0.05). There was no significant difference in the recurrence in the 2 groups. CONCLUSION: We conclude that although hospital stay and consumption of inpatient hospital resources was greater for group A, excision and primary closure is a superior option for most patients and especially for patients who are largely young and active.