Cancellation of operations in Saudi Arabian hospitals: Frequency, reasons and suggestions for improvements.

OBJECTIVE: To identify the frequency and reasons of operations cancellation in 25 Makkah region hospitals in Saudi Arabia. METHODS: Retrospective evaluation of the rate of surgery cancellation in 25 hospitals of Makkah region was performed in this study. The data of scheduled surgeries from 15 different surgical specialties was collected from January to December 2013. Frequency and reasons of cancellation of elective surgical cases in different specialty were studied with a view to recommend suggestions for improvement. Data was analyzed on SPSS -16. RESULTS: There are 120 operating rooms (OR) in 25 Makkah region hospitals and during the year 2013, a total of 16,211 surgery cases were listed, and 1,238 (7.6%) cases were canceled. Contribution to total cancellation was highest in orthopedic 33.8% followed by general surgery 27.5%, obstetrics 7.7% and ENT 5.2%. According to category, 42.81% rate of cancellation was patient related, 20.03% facility related, 9.45% due to improper work-up, 1.45% associated with anesthesia, 7.19% related to surgeons, and 18.90% other/and not recorded reasons. CONCLUSIONS: Present study found 7.6% cancelation rate in Makkah region hospitals and three most common causes for cancellations were patients related, facility related and improper work-up.

Reasons for delay in inpatient admission at an emergency department.

OBJECTIVE: This study highlighted the reasons which contributed to longer stay of patients in Emergency Department (ED) who were advised admission. METHODOLOGY: This study was conducted from August 4 to 11, 2004G as a retrospective review of the ED cards of patients admitted to inpatients wards of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The demographic data, doctors & nurses notes with their timings were reviewed. The maximum consumed time by a reason was considered as the main reason of delay for that subject. The delayed patients were divided into Group A and B, delayed before and after admission was advised, respectively. Prolonged length of stay (Delay) in ED was defined as stay longer than 2 hours after patient's arrival in ED until they were received to wards. RESULTS: Out of total 4876 visits during study period, 355 (7.3%) patients were admitted, and 238 (67%) were delayed. Age group 13-30 years was common in delayed 78 (32.8%) and not delayed 56 (47.9%) subjects. The mean length of stay of delayed subjects was 256 minutes. Group A 146 (61.4%) had more subjects than group B 92 (38.6%) (p < 0.001). Fifty eight (39.7%) patients stayed between 2-3hours in Group A vs. B 23 (25%) (OR 2, 95% CI 1.1-3.5). Common reason of delay in Group A was multiple consultations with further investigations 70 (48%) (p < 0.001) while file making process was common 40 (43.5%) in group B (p < 0.001). CONCLUSIONS: Out of admitted patients 67% were delayed mainly due to late advised admission with major reason of delay were multiple consultations.

Prevalence of gastroesophageal reflux disease in patients with laryngeal and voice disorders.

OBJECTIVE: To determine the prevalence of gastroesophageal reflux disease (GERD) for the management of patients with laryngeal and voice disorders. METHODS: This study consisted of 30 patients from Ear, Nose and Throat (ENT) and Phoniatric outpatient clinics at Al-Noor Specialist Hospital in Holy Makkah, Saudi Arabia complaining of laryngeal symptoms mainly dysphonia, during one year period from May 2005 to May 2006. All patients were subjected to: voice evaluation, which include searching for etiological factors, auditory perceptual assessment (APA), laryngeal examination and upper gastrointestinal tract (GIT) endoscopy. RESULTS: The onset of complaint of voice changes was gradual (93%), the duration was more than 6 months (90%) and the course was intermittent in 43% of patients. Phonasthenia symptoms were common. The change of voice was mainly due to high vocal demand (63.3%), tense temperament (93.3%) and spicy foods (60%). The grade of dysphonia was slight in 50% of patients, the characters of voice were mainly strained and leaky (76.7%) and the pitch was mainly decreasing (56.7%). Hyperfunctional dysphonia was present in 26.7% of patients, phonasthenia in 16.7%, vocal fold (VF) polyp in 13.3% and contact granuloma in 6.7%. Presence of GERD with hiatus hernia in 63.3% of patients, GERD with acute gastritis and duodenitis in 10% and incompetent lower esophagus in 6.67%. CONCLUSION: Laryngeal and voice disorders was mostly due to GERD in 80% of patients, which was mainly GERD with hiatus hernia.

Diseases pattern among patients attending Holy Mosque (Haram) Medical Centers during Hajj 1434 (2013).

OBJECTIVE: To evaluate the diseases pattern among pilgrims attending the 2 Holy Mosque (Haram) Health Care Centers during the Hajj season 2013 (Hijra 1434).  METHODS: In this cross-sectional study, data was collected from 2 medical centers located in the Holy Mosque in Makkah city, Saudi Arabia, from the first of Dhul-Hijjah to sixteenth Dhul-Hijjah 1434. The present study was completed in 16 days (6th October to 21st October 2013). RESULTS: Over 16 days, 1008 patients attended the medical centers during Hajj 1434, (2013), out of which 554 (55%) were males and 454 (45%) were females. Most of the patients were Egyptians (n=242, 24%), followed by Saudis (n=116, 11.5%), Pakistani (n=114, 11.3%), Turkish (n=50, 5%), and other nationalities (n=404). According to age distribution, mostly were in the 51-60 years age group (n=237, 23.5%), followed by other age groups. Out of 1008 patients, 842 (83.5%) patients were treated and subsequently discharged, while 166 patients (16.5%) were referred to the tertiary centers. According to the diseases pattern, most of the patients were suffering from respiratory problems (n=177, 17.6%) followed by skin diseases (n=158, 15.7%), gastrointestinal tract (GIT) diseases (n=133, 13.2%), and others. CONCLUSION: Most of the patients were suffering from respiratory problems followed by skin and GIT diseases, and less than 25% of patients were referred to tertiary care centers.

Audit of an urban paediatric emergency department visits.

BACKGROUND: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED). MATERIALS AND METHODS: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. RESULTS: In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1-6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift "2", i.e., 15:30 hours to 23:30 hours. Among the patients "diseases of respiratory system" were found more frequent 4170 (68.1%) and main diagnosis was "acute upper respiratory tract infection" 3300 (53.9%). Non-urgent cases were 2020 (33%) while 244 (4%) were admitted. CONCLUSION: Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.

Prevalence of Intestinal Parasites among Patients of Al-Noor Specialist Hospital, Makkah, Saudi Arabia.

OBJECTIVES: To determine the prevalence of intestinal parasites among patients of a tertiary care hospital. METHODS: A total of 12,054 samples received from the outpatient as well as inpatient departments from January 1, 2004 to December 31, 2009 in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Stool examinations were performed by direct method and concentrated Techniques for all patients. RESULTS: Overall, the prevalence of intestinal parasites was 6.2% (740 cases). Majority of patients were infected by Entamoeba histolytica (4.7%) followed by Giardia lamblia (1.3%), while Ankylostoma duodenal (0.02%) exhibited the minimum prevalence. Parasitic infections were more frequent in non-Saudis than Saudis patients (7.1% vs. 5.8%; p<0.05). There was no significant difference between males and females regarding parasitic infections, with a female:male ratio of 1:1.08. There was a higher prevalence in patients under five years of age (9.1%), followed by patients aged 5-14 years (7.5%). CONCLUSION: The notable finding from this study is the high prevalence of E. histolytica. Overall, parasitic infections were more prevalent in patients under five years of age and in non-Saudi nationals.

Predictors of asthma severity during the pilgrimage to Mecca (Hajj).

INTRODUCTION: The annual pilgrimage to Mecca (Hajj) is one of the largest gatherings in the world and thus its participants are exposed to various communicable and noncommunicable diseases. This provides an opportunity to study travel epidemiology. OBJECTIVES: The aim of the study was to estimate the predictors of asthma severity during the Hajj. PATIENTS AND METHODS: The study cohort was recruited from patients who presented to the emergency department (ED) of the King Abdul Aziz Hospital, Mecca, Saudi Arabia, between December 3 and 18, 2008 (5-20 Dhul-Hijjah 1429 H). We included newly diagnosed and previously documented cases presenting with asthma symptoms. Sociodemographic and clinical data were collected and the risk factors were assessed. The severity of asthma exacerbation was measured according to the National Heart, Lung, and Blood Institute guidelines. Data were analyzed using the SPSS software. RESULTS: The study involved 58 subjects, including 38 women (65.5%). There were 27 subjects (46.6%) with mild asthma attack, 18 (31%) with moderate asthma attack, and no cases with life-threatening asthma. Insignificantly increased risk of severe asthma attack was observed in the following groups: women, people aged 46-60 years, pilgrims (hajis) who did not belong to a hajj group, non-hajis, illiterates, and nonsmokers - the odds ratio (OR) (95% confidence interval [CI]) was 3.7 (0.7-18.5), 1.7 (0.5-6.3), 2.4 (0.7-8.5), 5.1 (0.6-44.1), 2.3 (0.7-9.1), and 2.0 (0.4-10.4), respectively. Forty-six subjects (79.3%) had a history of allergy to components of smoke, detergents, dust, animal dander, and perfumes, while only 5 patients (8.6%) had drug allergy. High risk of severe asthma was observed in subjects with a history of drug allergy, as well as in obese subjects and those who often presented to the ED - OR (95% CI) was 6.5 (0.9-43.9), 18.0 (4.0-80.7), and 3.1 (0.8-11.5), respectively. CONCLUSIONS: Higher risk of severe asthma attack was observed in women, people aged 46-60 years, hajis who did not belong to a hajj group, non-hajis, illiterates, nonsmokers, obese patients, and those who often presented to the ED within the previous 12 months due to asthma exacerbation.

Pattern of psychiatry morbidity during Hajj period at Al-Noor Specialist Hospital.

OBJECTIVE: To study the pattern and extent of psychiatric morbidity in the Hajj period (pilgrimage to Mecca by a Muslim). METHOD: Study was conducted by psychiatry department and Health Research Centre, Al-Noor Specialist Hospital. We recorded demographic and clinical characteristics of all patients presenting during first two weeks of Zulhajjah, 1425H (11th to 24th of January 2005). Detailed clinical interviews were conducted by qualified psychiatrists and findings were recorded in semi-structured form. Diagnoses were made following the guidelines in clinical version of chapter V (Mental and Behavioral Disorders) of International Classification of Diseases (ICD-10). In difficult cases diagnosis was assigned by consensus between three psychiatrists. RESULTS: During study period 92 patients presented. Males were dominant (54%). Mean age was 43 +/- 17. Highest proportion (52%) belonged to young adults followed by middle-aged (20%). Majority (48%) belonged to Saudi Arabia. Self-referrals were 66% and 52% presented as first episodes. Behavior, mood, and sleep were affected more commonly (65%, 63%, and 59% respectively). Physical symptoms were reported by 28% of patients. Highest number (34%) belonged to "Neurotic, stress-related and somatoform disorders" followed by "Mood disorders" (22%). Medical disorder was reported by 33% of patients. Medications were advised to 79% and psychiatric admission to 6.5% of patients. CONCLUSIONS: In our study, important findings are outlined and discussed. Replication of study with increased sample size and planning of psychiatric services according to established need of population served particularly during hajj period is needed.

Evaluation of the available anti-HCV antibody detection tests and RT-PCR assay in the diagnosis of hepatitis C virus infection.

The aim of the present work is to evaluate the commercially available antibody tests in the diagnosis of hepatitis C virus (HCV) infection by comparing their results with the RT-PCR test. The study included 316 serum samples from three groups: blood donors, patients on maintenance hemodialysis (HD) and patients infected with the human immunodeficiency virus (HIV). Samples were subjected to HCV-antibody detection by ELISA and RIBA tests and HCV-RNA detection by RT-PCR assay. The percentage of infectivity for blood donors was 18.9% by ELISA, 20.8% by RIBA and 23.6% by RT-PCR test. For patients on HD and those positive for HIV, the test positivity was respectively 59.3% and 5.3% by ELISA, 64% and 10.5% by RIBA and, 66.3% and 21% by PCR test. The percentage of false negativity of HCV-Ab by ELISA and RIBA when compared with RT-PCR test was 3.5 and 8.1% for samples blood donors, 17.1 and 25.7% for HD patients and 5.6 and 16.7% for HIV-infected samples, respectively. The false positivity of HCV-Ab by ELISA and RIBA, when compared with RT-PCR, was 5%, 3.9% and zero for blood donors, HD patients and HIV-HCV co-infected cases, respectively. While comparing ELISA with RT-PCR, the false positivity was 10%, 5.9% and zero respectively for blood donors, HD patients and HIV-HCV co-infected cases. Thus, it is very important to screen blood donors, HD patients and HIV-infected patients by using the RT-PCR for HCV-RNA to avoid false negative results.