Prevalence and Predictive Factors of Compassion Fatigue among Healthcare Workers in Saudi Arabia: Implications for Well-Being and Support.

Compassion fatigue (CF) poses significant challenges to healthcare workers' (HCWs) well-being. This study aimed to estimate the prevalence of CF and identify its predictive factors among HCWs in all regions of Saudi Arabia (SA). As such, all HCWs from different disciplines in different centers were allowed to participate, resulting in 678 participants. The study tool, distributed between October 2022 and January 2023, consisted of a questionnaire created by the authors based on the Professional Quality of Life Scale (ProQOL). The ProQOL measures the positive (compassion satisfaction [CS]) and negative (CF) effects of helping those who have suffered, noting that burnout (BO) and secondary traumatic stress (STS) are the two subscales that constitute CF. Our findings revealed that 63.9% of HCWs experienced average STS, while 57.2% reported average BO levels. HCWs in the southern and northern regions exhibited higher STS (p-value = 0.003 and 0.010, respectively). Physicians displayed higher BO levels (p-value = 0.024). Higher levels of CS were found among older HCWs (p-value = 0.001) and lower levels among those with more years of experience (p-value = 0.004). Support at work and job, life, and financial income satisfaction were significantly and positively correlated with CS and negatively correlated with BO and STS. These findings highlight the need for tailored awareness campaigns targeting HCWs, particularly physicians, to promote well-being, enhance coping skills, and foster problem-solving techniques. Keywords: burnout; compassion fatigue; compassion satisfaction; healthcare workers; professional quality of life; Saudi Arabia; secondary traumatic stress; medical trainees' well-being.

Chronic pain after colon cancer surgery: Translation and validation of a scoring system.

OBJECTIVE: The aim of this study was to translate and validate the chronic pain score (CP score) in a cohort of colon cancer patients. Chronic pain following colon cancer surgery is still poorly understood, in particular the lack of a validated tool for measuring chronic pain is a major issue as such an instrument is critical for evaluating the incidence and risk factors. The CP score was created using data from Danish rectal cancer patients. METHODS: Danish colorectal cancer survivors diagnosed between 2001 and 2014 completed the CP score and two quality of life (QoL) measures. Clinical data were obtained from a national database. Convergent validity was investigated by testing the association of the CP score with a single ad hoc QoL item and the EORTC QLQ-C30, and discriminative validity was tested as the score's ability to differentiate between gender and age groups. Sensitivity and specificity were evaluated by determining the ability of the score to identify patients with a major impact of pain on QoL. RESULTS: Responses from 7127 colon cancer were included. Convergent validity was confirmed, as the score was associated with both QoL measures (p < 0.001). Moreover, the score could differentiate between males/females and older/younger patients (p < 0.001, respectively), reflecting high discriminative validity. Finally, the score was able to identify patients with a major impact on QoL, with a sensitivity of 87% and specificity of 82%. CONCLUSION: The CP score is a valid tool for measuring chronic pain after colon cancer surgery and should be used to homogenize outcomes in future studies.

Isolated Perianal Endometrioma: A Case Report and Literature Review.

BACKGROUND Endometriosis, a common condition among women of reproductive age and infertile women, occurs when the endometrium extends outside the uterus. When this endometrial tissue grows and sheds, symptoms will develop. The presentation varies depending on the site involved; however, cyclical pain is among its most common symptoms, along with bleeding and cramping. It is frequently observed in the ovaries and fallopian tubes; in contrast, the anal canal is rarely involved. Here, we report a very unusual presentation of the disease. CASE REPORT A 33-year-old woman with a history of episiotomy presented to the Emergency Department reporting perianal swelling in the previous year. The swelling was associated with intermittent pain and difficulty passing stool. She reported no fever. On examination, there was a 3×4 cm palpable tender perianal mass extending to the anal sphincter at the 11 o'clock position. Bedside ultrasound revealed a mass. Magnetic resonance imaging showed a hemorrhagic 3×4 cm mass in the right perianal region pressing on and indenting the right aspect of the distal external sphincter. The mass was excised completely with local perianal incision over the mass at 11'o clock. Surgical pathology revealed an isolated endometrioma in the perianal area. CONCLUSIONS Isolated perianal endometrioma is a rare disease, with only 21 published cases. Its diagnosis is difficult to establish, and a wide range of tests is often needed. Laparoscopic or surgical intervention may be required in cases of rectal endometriosis for an accurate diagnosis. Careful history taking and examination along with a high index of suspicion are necessary to diagnose perianal endometrioma.

A long-term follow-up after open ileal J pouch volvulus repair in a FAP patient - A case report.

INTRODUCTION: Most patients with familial adenomatous polyposis (FAP) undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouch volvulus is one of the very rare complication of open IPAA surgery that can mimic small bowel obstruction secondary to adhesion. High index of suspicion and proper investigation is required. PRESENTATION OF CASE: The patient is a 44-year-old female with FAP who is currently on the mend after a 2-stage total proctocolectomy with ileal pouch-anal anastomosis. Presented eight years after indexed surgery with pouch volvulus, successfully treated with bowel resection without pouchopexy. DISCUSSION: The surgery of choice for most patients with FAP is IPAA. Pouch volvulus is a rare complication of laparoscopic IPAA surgery and extremely rare after open surgery which can be treated surgically in various ways. But it can be catastrophic if not treated in timely manner. This case report presents a FAP patient with pouch volvulus after open IPAA treated with bowel resection and obliteration of space between the pouch mesentery and the sacral space without standard pouchopexy. CONCLUSION: Volvulus is a rare side effect of an IPAA. Managing the initial procedure successfully is critical in order to avoid recurrence and consequences. The goal of this study is to identify symptoms and a successful management strategy for pouch volvulus.

Long-term outcomes after complete mesocolic excision for colon cancer at a tertiary care center in Saudi Arabia.

BACKGROUND: Data on long-term survival and recurrence of cancer after complete mesocolic excision (CME) for colon cancer has not been reported from our center and related to international data. OBJECTIVE: Describe overall and disease-free survival, survival by surgery site and stage, and recurrence rates after curative surgery. DESIGN: Retrospective chart review. SETTINGS: Academic tertiary care center. PATIENTS AND METHODS: The study included all patients who underwent either laparoscopic or open surgery for colon cancer with curative intent between 2001 and 2011. The colorectal database was reviewed for the following: demographic data, comorbidities, radiologic investigations, clinical stage, type of operation, complications, pathologic assessment, adjuvant treatment, recurrence and survival. Survival and recurrence rates were calculated, and survival curves were generated. MAIN OUTCOME MEASURES: 5-year overall survival, secondary endpoints were 5-year disease-free survival, survival by surgery site and stage, and recurrence rates. SAMPLE SIZE: 220. RESULTS: The mean (SD) age at diagnosis was 57 (13) years (CI 95%: 55-59 years). There were 112 males. Mean (SD) body mass index was 27.6 (5.7) kg/m2 (CI 95%: 27-28). Pathological assessment revealed R0 (microscopically margin-negative) resection in 207 (94%). The overall 5-year survival and disease-free survival was 77.9% and 70%, respectively. The 5-year disease-free survival was 69% for the sigmoid/left colon and 69% for the right colon (difference statistically nonsignificant). Stages at the time of resection were stage 0 for 2 (0.01%) patients, stage I for 18 (8%), stage II for 92 (42%), stage III for 100 (46%), and stage IV for 6 (3%). The 5-year overall survival by stages I, II, III and IV was 94%, 80%, 75% and 50%, respectively (difference statistically non-significant). The overall 5-year recurrence rate was 23.4%. CONCLUSION: The outcomes of surgical treatment for colon cancer at our institution are equivalent to international sites. No difference was noted between left and right colon in terms of survival after CME. LIMITATIONS: Single center, retrospective, small sample size. CONFLICT OF INTEREST: None.

Pancreatic tuberculosis in immunocompetent patients. At the University Hospital in Kingdom of Saudi Arabia.

OBJECTIVES: To raise awareness of practitioners on benign treatable conditions such as pancreatic tuberculosis (TB). Methods: A retrospective study at King Khaled University Hospital, Riyadh, Saudi Arabia of all patient charts presented with pancreatic mass for a period of 10 years (2007-2017) with a study duration of 4 years between 2013 and 2017. Patients with confirmed diagnosis of pancreatic cancer were excluded. A written ethical approval was obtained accordingly. Results: All adult patient charts were retrospectively reviewed with a pancreatic mass for a period of 10 years (2007-2017). Nine patients were identified with proven diagnosis of TB. The data were obtained based on demographic features, sign and symptoms, duration of illness, imaging, ultrasound, contrast enhanced computed tomography scan, cytology or histopathology, polymerase chain reaction, culture and follow up with anti-tuberculous therapy and samples for cytology or histology. The histological findings of granuloma with caseation or positive culture were used confirming the diagnosis of TB. All patients were immunocompetent and screened for human immunodeficiency viruses before starting anti-TB treatment. Results were negative. All patients who underwent fine needle aspiration (FNA) and endoscopic ultrasound (EUS) for suspicious pancreatic mass were provided trial of antibiotics as cases of pancreatic tuberculosis showed dramatic improvement during follow up and cured from the disease. Conclusion: The EUS and FNA are good tools to confirm malignancy and rule out benign treatable conditions like TB for any patient with a pancreatic mass suspicious for carcinoma.