Knowledge, Attitude, Awareness, and Future Expectations of Robotic Surgery in Patients Attending Surgical Specialties Clinics.

Introduction The use of robotic-assisted surgeries (RAS) has been growing in surgical specialties. It allows surgeons to perform higher-quality operations with fewer complications, mortality, and morbidity. However, there are a lot of misconceptions about RAS among patients. Therefore, our study aimed to assess the knowledge, attitude, awareness, and future expectations of RAS in patients attending surgical clinics. Methods  A cross-sectional study was conducted in King Abdulaziz Medical City (KAMC) surgical clinics in Riyadh, Saudi Arabia. All participants <18 years of age were excluded. The questionnaire was distributed to 304 patients attending surgical clinics with a confidence level of 95% and a margin of error of 5%. Cluster sampling was used since the respondents were from multiple surgical specialties. Finally, multivariate analysis was performed to assess participants' preference for robotic surgery. Results Most participants (58.6%, n=178) were between 21 and 40 years old, and males were 52% of the participants. Many respondents thought a robot did not do the surgery. 70.7% of respondents had not heard of robotic surgery, with the media being the most common source of information. Internal damage was the prevalent concern (51.0%, n= 155) in malfunctions of robotic surgery. A significant relationship was found between participants from 21 to 40 years of age and a stronger preference for robotic surgery (p=.027). Respondents who preferred robotic surgery were discovered to have a significant relationship with participants who thought robotic surgery was safer and had better results (p<.001). 13.9% of participants who did not prefer robotic surgery also took cost into account significantly (χ2=28.93, p<.001, Cramer's V=.22). 67.2% (n=43) of respondents who preferred robotic surgery believed it might eventually replace present practices. Conclusion Our study concluded that the majority did not favor or were unsure whether to undergo robotic surgeries or not. However, most participants had some misconceptions and a lack of awareness about robotic surgeries. Raising awareness among patients can improve the mutual decision-making between them and their treating physician.

Further delineation of Wiedemann-Rautenstrauch syndrome linked with POLR3A.

Wiedemann-Rautenstrauch Syndrome (WRS; MIM 264090) is an extremely rare and highly heterogeneous syndrome that is inherited in a recessive fashion. The patients have hallmark features such as prenatal and postnatal growth retardation, short stature, a progeroid appearance, hypotonia, facial dysmorphology, hypomyelination leukodystrophy, and mental impairment. Biallelic disease-causing variants in the RNA polymerase III subunit A (POLR3A) have been associated with WRS. Here, we report the first identified cases of WRS syndrome with novel phenotypes in three consanguineous families (two Omani and one Saudi) characterized by biallelic variants in POLR3A. Using whole-exome sequencing, we identified one novel homozygous missense variant (NM_007055: c.2456C>T; p. Pro819Leu) in two Omani families and one novel homozygous variant (c.1895G>T; p Cys632Phe) in Saudi family that segregates with the disease in the POLR3A gene. In silico homology modeling of wild-type and mutated proteins revealed a substantial change in the structure and stability of both proteins, demonstrating a possible effect on function. By identifying the homozygous variants in the exon 14 and 18 of the POLR3A gene, our findings will contribute to a better understanding of the phenotype-genotype relationship and molecular etiology of WRS syndrome.

Severe Traumatic Brain Injury Presenting with Wide Complex Tachycardia: a Case Report.

Background: Ventricular tachycardia (VT) is an abnormal heart rhythm that can lead to pump failure and hypoperfusion. Its causes, presentation, and treatment are well established in the literature. However, the VT treatment algorithm is based on non-traumatic patients. Due to different pathophysiology and presentation, treating VT in trauma patients should be different. Objective: The main purpose is to emphasize the approach to treating VT in severe head trauma patients. Case presentation: This case is a unique presentation of severe head trauma with a paucity of treatment approaches in the literature. In this article, we present a case of a middle-aged male patient presented to a level one trauma center with a history of falls from 2 stories height with a Glasgow Coma Scale (GCS) of 3/15. ATLS approach was followed in treating this patient, his rhythm strip showed a wide complex regular rhythm, likely representing a VT with a pulse. The patient was treated as unstable because of a decreased level of consciousness. A 100 J synchronized cardioversion was given without restoration of normal sinus rhythm, followed by Mannitol 1g/kg, treating the possibility of high intracranial pressure (ICP), after which his rhythm was restored to sinus. Conclusion: The restoration of sinus rhythm after treating the possibility of high ICP suggests that the cause of VT in this severe TBI patient was the high ICP.

Does a Low Score in the Respiratory Visual Triage Tool Predict a Negative COVID-19 Test in an Admitted Patient?

Background: Fast and accurate COVID-19 identification is important to population and epidemic monitoring in hospitals. Visual triage or respiratory triage should be efficient and utilized as visual clues to alert HCWs on the case definitions. Objective: This study aims to evaluate the diagnostic value of the respiratory triage for COVID-19 infections and to evaluate the efficacy of the MOH triage tool in identifying low risk patients. Methods: A single-center retrospective chart review that was conducted at King Fahd Hospital of the University (KFHU), Khober, KSA on all adult patients admitted to the hospital through the ED. The visual triage checklist comprises two main sections, with one focused on the risk of exposure and the other related to patient clinical signs and symptoms, each with a defined score where any score ≥ 4 will need to isolate and assessed by the physician while a score of less than 4 means that the patient can be admitted with other patients. The hospital swabbed all admitted patients regardless of their score. We compared their PCR result with their case definition score. The collected data was entered and analyzed using the Statistical Package for the Social Science (SPSS Inc. Chicago, IL, USA) version 23. Results: The study included 7258 participants. 20% of participants aged between 21 to 30 years old, 52.2% of sample were females, and 78% were Saudi nationality. Visual triage score was less than 4 in n= 4745 participants (65.4%) and 4 or more in n= 2513 (34.6%). The test had sensitivity of 75% and specificity 21%. Conclusion: Most studies shows that COVID 19 has an infectivity rate of 18 to 30%. Based on this low sensitivity result, using the screening tool alone puts patients and HCWs at risk of getting infected with COVID 19.

Incidental finding of asymptomatic non-traumatic pericardial effusion in a trauma patient: a case report.

Pericardial effusion can either be an incidental finding or a manifestation of systemic or cardiac disease. It has a wide range of presentations, from asymptomatic small effusion to rapidly progressive fatal tamponade. In a trauma setting, pericardial effusion is usually attributed to hematoma collection, with the concern of clinical evidence of tamponade that can lead to cardiopulmonary collapse. The Focused Assessment with Sonography for Trauma (FAST) is a widely used tool to diagnose pericardial effusion in trauma patients. We published this case report to emphasize that the presence of pericardial effusion alone in a trauma patient does not indicate the presence of tamponade. This case concerns a 39 years old male patient who presented to ER as a trauma case after a fall from two meters height and landing on his feet. ATLS protocol was followed, and FAST showed an incidental finding of massive pericardial fluid. The trauma team was consulted, and the patient was hemodynamically stable without clinical evidence of tamponade. Echocardiography showed mitral valve stenosis and large pericardial effusion. The close observation did not suggest the presence of cardiac tamponade. The pericardial catheter was inserted during admission with drainage of 900cc of serous fluid. The presence of pericardial fluid in a trauma setting does not confirm the diagnosis of tamponade. The mechanism of injury, clinical presentation, and the patient's stability are essential factors in determining further management of such patients.

Post-COVID-19 non-traumatic iliopsoas hematoma: A case report.

Background: Critically ill COVID-19 patients have an elevated risk of experiencing hypercoagulable conditions. Currently, many COVID-19 patients have been administered anticoagulation or antiplatelet therapies to lower the risk of systematic thrombosis. Iliopsoas hematoma is a potentially fatal and rare complication of bleeding disorders or anticoagulation therapy which sometimes grows to become clinically significant. The main purpose of this case review is to emphasize the importance of diagnosing iliopsoas hematomas and the possibility of antiplatelet contribution to its development. Case Presentation: We are reporting a rare presentation of non-traumatic iliopsoas hematoma in a non-anticoagulated patient. The patient is a 59-year-old male, with known type-2 diabetes, on oral hypoglycemic medications, 3-weeks post-COVID-19. He had started aspirin 81 mg orally, once daily, to prevent thrombotic events associated with COVID 19 infection, with no anticoagulant use and no other medications. He came in through the ED, presenting with two weeks history of progressive right lower limb weakness in which an iliopsoas hematoma diagnosis was confirmed based on radiological investigation. Conclusion: The possibility of iliopsoas hematoma should be considered in non-anticoagulated patients with no inherited or acquired coagulation disorders presenting with limb weakness. The link between antiplatelet use in a COVID-19 patient and the development of soft tissue bleeding (e.g., iliopsoas hematoma) must be studied further.

Prevalence of COVID-19 Among Patients Arriving in Pre-arrest/Cardiac Arrest, at a Tertiary Hospital's ED in the Eastern Province of Saudi Arabia During the COVID-19 Pandemic.

Background: COVID-19 pandemic has thrown the healthcare systems into confusion worldwide, resulting in major modifications on the practice due to fear of exposure to this virus and its fatal consequences. Objective: the study aimed to establish the prevalence of COVID-19 in cardiac arrest patients. Methods: single-centered, Retrospective, observational cohort study that included all patients who presented to ED during the period of the pandemic from January 2021 to May 2022 and documented to have either IN-hospital cardiac arrest (IHCA), specifically within the ED, or OUT-hospital cardiac arrest (OHCA). Results: This study analyzed 177 patients. Out of which, 30.5% of the patients were aged more than 70 years old. Those with associated comorbidities, the most frequently mentioned comorbidity was hypertension (40.7%). It was found that the prevalence of positive COVID-19 infection was significantly more common among non-Arab (p=0.019), patients with associated chronic kidney disease (p=0.019) and those who had an in-hospital cardiac arrest (p=0.010). No significant associations were observed between COVID-19 infection in terms of age, gender, nationality, associated comorbidities, symptoms, and trauma (all p>0.05). Conclusion: This study showed the prevalence of COVID-19 among cardiac arrest patients within ED and outside the hospital in our study population. Based on the study's results, the major adjustments in practice were not absolutely needed. Also, this study could help in establishing a good mitigation strategy for at-risk patients.

Epidemiology, Etiology, Timing and Severity of Open Fracture - a Five Years Review From a Tertiary Trauma Center, Eastern Province, Saudi Arabia.

Background: Open fractures are severe injuries resulting from the bone breaking through the skin, and they have a negative impact on patients' physical, mental, and financial well-being as well as that of the healthcare system. The incidence of open fractures varies globally. These injuries can lead to prolonged disability, increased healthcare costs, and psychological distress. The Gustilo-Anderson classification system is used to classify open fractures into three categories which surgeons use as an index for the severity of an injury and as a prognostic tool. Management involves a multidisciplinary approach, focusing on preventing infection, promoting wound healing, and restoring function. Objective: The objective of this study is to provide statistics on the epidemiology of open fractures presented to the emergency department to be used later to create management protocols. Methods: This 5-year retrospective observational analysis of open fracture patients at King Fahad Hospital, a tertiary trauma care institute in Alkhobar from 2018-2023, aimed to understand socio-demographics, injury mechanisms, fracture patterns, and timing. Data were collected electronically, and found 373 cases which were reviewed, and only 138 open fractures fit our inclusion and exclusion criteria and were added to the study. Results: The study analyzed 138 openly fractured bones in 132 patients aged 2 to 68. Most bones affected were in the lower extremities, the most common being the forefoot bones. The most common mode of injury was a motorbike, followed by MVA. The most common Gustilo type was type 2, with no significant correlation between gender and severity. Musculoskeletal system injury was the highest associated system. Furthermore, we observe a slight increase in cases in Winter/Fall weather seasons. Conclusion: Total amount of 84.8% of patients with open fractures are men, compared to 15.2% of women. The average age of patients is 25.6 ± 15.6 years. Motorbike accidents, then MVA, are the two leading causes of open fractures. Weather seasons, especially in fall and winter, may also contribute to an increase in open fractures. We found that type 2 is the most common Gustilo type among the injured bones (59.1%).

Level of Awareness and Attitude Toward Cerebral Palsy Among Parents in Al-Baha City, Saudi Arabia.

Background Cerebral palsy (CP) is a chronic disorder of motion, posture, and tone which occurs due to brain insult during the period of brain growth. It is a disabling disorder in both motor and intellectual aspects. Fortunately, CP is a manageable disease that can be managed in part by increasing the knowledge and understanding of the parents. Methodology This cross-sectional, prospective, community-based study aimed to assess the level of parents' knowledge and their attitude toward CP using an electronic questionnaire. The parents' knowledge was classified as good or poor based on an adopted scoring system. The parents' attitude was categorized as positive or negative. Results Our study results showed that good knowledge (those with a score more than 60% of the total score) was noted in 275 (61.1%) participants, whereas 175 of the participants had poor knowledge (38.9%), especially regarding awareness of the diagnosis of CP. Conclusions Most participants had an overall good knowledge of CP although they had insufficient knowledge of some aspects of the disease such as causes, disease course, clinical presentations, diagnosis, and prognosis. Although the results showed a positive attitude concerning playing with a child with CP, unfortunately, there was a negative attitude toward hiring a CP patient and a strongly negative attitude toward marrying a patient with CP.

A Liraglutide Injection Superimposing a Starvation Acidosis: a Case Report.

Background: Metabolic acidosis is defined by reduced serum bicarbonate level; this reduction can be from the addition of acid, reduced acid excretion, or loss of alkali. Starvation acidosis is one of the differential diagnoses of high anion gap metabolic acidosis (HAGMA). Objective: We report a rare case presentation of HAGMA associated with Liraglutide and low carbohydrates diet. Case presentation: A 27-year-old female patient presented to the Emergency Department (ED) with a complaint of nausea and vomiting for two days. She was following a strict low carbohydrate diet for three months to reduce her weight as her body mass index (BMI) was 30 kg/m3. Her bedside investigations were significant for HAGMA. The patient was seen by the endocrine service and was admitted as a case of starvation ketoacidosis (SKA) vs. euglycemic diabetic ketoacidosis (DKA). The patient was treated with D10W 250 cc/hr with insulin infusion, her the anion gap was closed after 5 hours. She was discharged home as SKA secondary to diet with the possibility of drug superimposing the starvation state. She was given a follow-up clinic regularly to monitor her clinical status. Conclusion: This case highlights the possibility of a HAGMA as a rare complication of a low carbohydrate diet with the possibility of Liraglutide injection attribution in developing such critical complication. Further studies are needed to evaluate the safety of a low carbohydrate diet and the effect of Liraglutide injection on these patients following this diet.

Knowledge and Awareness of Syncope Among the Population of Riyadh: A Cross-Sectional Study.

Background Although syncope is a common emergency in medical settings, no research has yet evaluated the general population's awareness regarding it. This study investigated the general population's knowledge and awareness of syncope and if they could differentiate syncopal and non-syncopal causes of transient loss of consciousness (TLOC). Methodology A cross-sectional study was conducted in Riyadh through a validated, self-administered Arabic questionnaire that was distributed to the general population through social media using Google Forms (convenience sampling). Participants younger than 18 or not from Riyadh were excluded from the study. Two cardiologists validated the questionnaire, following which forward and backward translation was done. The questionnaire contained three sections. The first section included demographic data and chronic conditions. In the second section, participants were asked if they or one of their relatives had ever experienced syncope. The third section had eight scenarios assessing the participants' syncope knowledge. Subjects with ≥five correct answers were considered to be aware. Results The number of total responses was 405 participants. Regarding demographic data, 53% of the participants were female, 33% had a medical background, and 76% had a university degree (n = 214, n = 134, and n = 306, respectively). The mean age of the participants was 33.2 ± 13.3 years. Participants who were aware of syncope represented 55% (n = 221). Among the syncope cases, orthostatic syncope had the highest number of correct answers (79%, n = 319), followed by vasovagal syncope (61%, n = 246). Males performed better in cases one (p = 0.001), two (p = 0.004), and seven (p = 0.01). Conclusions The results of this study showed that most participants were considered aware of syncope. Gender, marital status, and having a medical background had a significant influence on the results.

Prevalence, Causes, and Adverse Clinical Impact of Delayed Presentation of Non-COVID-19-Related Emergencies during the COVID-19 Pandemic: Findings from a Multicenter Observational Study.

Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies. Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention. Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients (n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296−16.520), p = 0.038). Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.

Ketamine for Sickle Cell Vaso-Occlusive Crises: A Systematic Review.

INTRODUCTION: Vaso-occlusive crisis (VOC) is one of the main causes of hospital admission in patients with sickle cell disease (SCD). Ketamine is often used as an adjuvant to opioids to control sickle cell crisis; however, there is a lack of evidence about its safety and efficacy for VOC in SCD patients. OBJECTIVE: To synthesize evidence from published reports about the efficacy and safety of ketamine in the management of acute painful VOC in both pediatric and adult SCD patients. METHODS: A systematic literature search of PubMed, Scopus, Web of Science, EBSCO and Cochrane Library was conducted, up to March 2019. Studies reporting the analgesic effects and side effects of ketamine in the management of acute painful VOC in pediatric and adult SCD patients were included. The primary outcome measure was improvement in pain scale, and the secondary outcomes were reduction in opioid utilization and side effects. Studies were narratively summarized in this review. RESULTS: Fourteen studies (with a total of 604 patients) were included in the final analysis. Several case reports and case series showed that ketamine significantly reduced pain scales and opioid utilization in both populations. The only randomized controlled trial available showed that ketamine was noninferior to morphine in reducing pain scores, but had a higher incidence of nonlife-threatening, reversible adverse effects. However, a retrospective study of 33 patients showed a higher pain score in the ketamine group with an acceptable short-term adverse effect. CONCLUSION: Ketamine has a potentially comparable efficacy with other opioids in reducing the pain during VOC in SCD patients. However, it also likely has a higher rate of transient adverse events. Owing to the lack of published randomized controlled trials, current evidence is not sufficient to confirm the safety and efficacy of ketamine. Future well-designed randomized controlled trials are strongly recommended.

Pattern and severity of sleep apnea in a Saudi sleep center: The impact of obesity.

AIM: The aim of this study was to estimate the effect of obesity on the severity of obstructive sleep apnea (OSA) by assessing the relationship between OSA and body mass index (BMI). MATERIALS AND METHODS: A cross-sectional study was conducted in 2017 among patients who had been referred to the sleep center at King Abdulaziz University Hospital (KAUH, Jeddah, Saudi Arabia) for polysomnography between January 2012 and September 2017. The data were abstracted from the medical records of these patients at KAUH. Initial data analysis included descriptive statistics; Chi-square test, t-test, and one-way ANOVA as appropriate were used to assess the associations between the variables. RESULTS: The study included 803 patients; the average age of the patients was 45.9 years and 56.5% were male. About 70.4% were obese, 54% of whom were classified as having Class 3 obesity. Approximately, 75% patients had OSA. The prevalence of OSA was higher among obese patients (77.7%) compared to nonobese patients (22.3%). Moreover, the severity of OSA was higher in obese patients, with 85.3% of obese patients considered as having severe OSA. CONCLUSION: Obesity is a considerable risk factor for developing OSA and could play a major role in increasing the severity of the disease. We encourage further studies on the impact of sedentary lifestyle and its association with OSA in Saudi Arabia, with an emphasis on the evaluation of the cost-effectiveness and burden of the disease.

Assessing Patient Confidence and Satisfaction about the Shared Decision-making Meetings for Planning Cancer Chemotherapy.

Background Patients increasingly express the desire to be involved in their treatment decisions, especially in critical situations, such as cancer chemotherapy that increase a doctor's responsibility toward fulfilling these needs. This process may require more than one meeting with the patient to meet their expectations and satisfaction levels. This study aimed to assess the satisfaction levels in cancer patients, who received chemotherapy, about their decision-making and if they were able to make this decision during the first meeting with their physicians. Methods A cross-sectional study was conducted in 2017 on 106 cancer patients aged 18 years or above who were receiving chemotherapy at the day-care unit of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data were collected by a direct or telephonic interview using a structured questionnaire. The variables were studied across two groups of patients based on the patient's ability to make decision in the first meeting with their physician. Data were expressed as frequencies (percentage) and Pearson Chi-Square test was used to assess the categorical variables. Results Out of the 106 patients, 42 (39.6%) of them were male. Ninety-one (85.8%) patients took the decision by themselves. Regarding the decision-making 90 (84.9%) patients were able to make the decision from the first meeting. Sixty-eight (64.2%) patients felt more satisfied if they had an additional session. There was a significant association between patients with the ability to make the decision during the first meeting and patients who took the decision by themselves (P = 0.033), patients with consideration of changing their decision if they had more meetings (P = 0.005), patients with consideration of withholding from chemotherapy in their mind (P = 0.019) and patients with thought that chemotherapy is affecting their life (P = 0.044). Conclusion The majority of the patients felt that more than one meeting with their doctors would be helpful in improving their satisfaction level during the decision-making process, consideration of withholding from chemotherapy in mind and that chemotherapy is affecting their life style. Future protocol in which the patients will be encouraged to have a confidence role on their treatment decision is recommended.