Factors Affecting Length of Stays in the Emergency Department of a Teaching Hospital: A Retrospective Study From Najran, Saudi Arabia.

BACKGROUND:  Reducing the frequency of emergency department (ED) patient visits for treatment, particularly in urgent instances, is a global healthcare objective. Additionally, a more extended stay in the ED can harm a patient's prognosis during later hospitalization. This study aims to investigate the factors affecting the length of stay in the ED in a teaching hospital. METHODS: A retrospective chart review study was done between January 1, 2021, and February 31, 2021, involving 122 adult patients who had delayed ED visits to King Khalid Hospital in Najran, Saudi Arabia. Data on the patient's characteristics, visit time, and the causes for the delay based on the Canadian Triage and Acuity Scale (CTAS) were gathered and analyzed. Factors associated with more than six hours of delay were investigated in a univariate analysis. RESULT: The mean age was 52.3 ±13.5 years, and 42 (34.4%) were more than 65 years of age. More than half of the study population were female (n=66; 54.1%). Most delays occurred among CTAS 4 and 5 cases (47.5%), and 22 (18.0%) occurred during holidays. The mean delay time was 6.1 ±1.8 hours. The leading delay causes were multiple consultations with further investigations (37.7%) and conflict between the teams (36.1%). In univariate analysis, ED visiting at holiday time (OR: 0.14; 95% CI: 0.04-0.40, p <0.001) and CTAS 4 and 5 (OR: 2.22; 95% CI: 0.95-5.30, p = 0.003) significantly had more delay. Factors associated with delay in univariate analysis were multiple consultations with further investigations (OR: 2.82; 95% CI: 1.32-6.26, p = 0.013), various assessments in different ED areas with a late arrival of the specialist (OR: 0.43; 95% CI: 0.20-0.91, p = 0.042), and conflict between the teams (OR: 2.50; 95% CI: 1.17-5.54, p = 0.031). CONCLUSION: In this study, multiple assessments in different ED areas and conflict between the teams were the main factors that caused delays in ED. Implementing a timeframe monitoring system for consultations while emphasizing accelerated decision-making and disposition for patients and understanding teamwork collaboration may reduce patients' length of stay in the ED. Implementing these strategies and evaluating their impact on the length of stay in the ED requires further investigation.

The Pathological Pattern of Breast Cancer in the Najran Region of Saudi Arabia: A Retrospective Study.

Background Breast cancer (BC) is the most widespread cancer on a global scale, and its prevalence is likewise significant in the Kingdom of Saudi Arabia. Nevertheless, the data accessible regarding the epidemiology and histopathological characteristics of BC in clinical practice is restricted and primarily confined to research endeavors. Aim This study aims to investigate the histopathological profile of women diagnosed with BC seeking treatment at King Khalid Hospital in the Najran region of the Kingdom of Saudi Arabia. Methods In this retrospective study, BC biopsies performed on Saudi patients at King Khalid Hospital between January 2018 and December 2022 were examined. All records of breast biopsies from this timeframe were extracted from the hospital's histopathology laboratory computer database after written permission from the head of the laboratory department. For all neoplastic lesions, the World Health Organization's 2012 categorization of breast tumors was applied. Results A total of 61 women with BC were included. Women's age ranged from 30 to 89 years, with a mean age of 49.6 ± 12.3 years. The most reported BC was invasive ductal carcinoma (IDC; 70.5%). Other types reported included invasive papillary carcinoma (8.2%), ductal carcinoma in situ (4.9%), and invasive lobular carcinoma (3.3%). A total of 14 (23%) of the study women had multifocal cancer. Ki-67 was high in 19 cases (31.1%); six (9.8%) had BRCA1 mutations, and six (9.8%) had BRCA2 mutations. Conclusion The current study revealed that BC was frequent among young females, mainly IDC, which was reported on both sides at different sizes and grades. Breast lump was the most commonly presented symptom and had a high representation in women with hormonal receptors, mainly estrogen receptors, but positive genetic testing was infrequent.

Pancreatic Cancer: A Retrospective Study From the Najran Region of Saudi Arabia.

BACKGROUND: Despite advances in treatment, pancreatic cancer frequently has a low survival rate due to its advanced-stage diagnosis. Treatment focuses on prolonging survival and maintaining quality of life. This study investigates the characteristics associated with survival in advanced pancreatic cancer patients treated at a single academic cancer center in Najran, Saudi Arabia. METHOD: A retrospective chart review study covering the period January 1, 2015, and December 31, 2023, involved 80 adult patients with pathologically confirmed pancreatic cancer (ductal adenocarcinoma) at King Khalid Hospital in Najran, Saudi Arabia. Clinicopathological characteristics, therapy, response, and survival outcomes were all gathered and analyzed. The chi-squared test, Kaplan-Meier, and Cox proportional hazards method with hazard ratios (HR) and 95% confidence intervals (CI) were used for statistical analysis. RESULT: The mean age was 65.7±14.1 years and 54 (67.5%) cases were male. The main symptom was abdominal pain (n=54, 67.5%), while jaundice was presented in 17 (21.2%) of cases. The baseline serum carbohydrate antigen 19-9 (CA 19-9) level varied among cases, with 35 (43.8%) having normal levels. The majority of cases (n=59, 73.8%) had distant metastases at the initial presentation, while 12 cases (15%) had localized disease (resectable), and 22 (27.5%) were locally advanced at the first presentation. The most commonly reported pathologic grade was poorly differentiated ductal adenocarcinoma in 39 (48.8%). FOLFIRINOX was used as first-line chemotherapy in 54 (67.5%) cases, while gemcitabine alone was used in 15 (18.8%) cases. First-line chemotherapy resulted in progressive disease in 30 (37.5%), stable disease in 30 (37.5%), and partial response in 14 (17.5%). With a mean follow-up time of 14.8±8.6 months, 57 (71.2%) were dead, where the main cause of death was disease progression (n=51, 89.5%). The median overall survival was 13.5 months, with a 12-month survival rate of 56% and a 36-month survival rate of 17%. The median cancer-specific survival was 16 months (95% CI: 13-22 months). The 12-month median cancer-specific survival was 61% (95% CI: 51-73%), and the 36-month median cancer-specific survival was 19% (95% CI: 10-34%). In univariate analysis, initial metastasis presentation (HR: 35.46; 95% CI: 4.90-256.83, p<0.001), poor Eastern Cooperative Oncology Group Performance Status (ECOG-PS) (3-4) (HR: 2.34; 95% CI:1.34-4.09, p=0.003), and presence of multiple metastases (HR: 1.33; 95% CI: 1.09-1.62, p=0.004) were associated with worsened survival. Patients who received the first chemotherapy were associated with better survival (HR: 0.53; 95% CI: 0.29-0.98, p=0.043). Furthermore, the response rate in patients who received FOLFIRINOX was better than that of those who received gemcitabine alone, which was statistically significant (p=0.002). CONCLUSION: Our study showed that initial metastatic presentation, poor ECOG-PS, and the occurrence of numerous metastases were all linked with poor survival of patients with pancreatic adenocarcinoma. Additionally, FOLFIRINOX as a first-line treatment showed better survival rates than gemcitabine alone. Raising awareness among healthcare providers on the alarming signs of pancreatic cancer and the introduction of personalized oncology might improve the outcome of this fatal malignancy.

Cancer Care During the COVID-19 Pandemic: A Retrospective Study From a Najran Oncology Center.

Background The COVID-19 pandemic significantly impacted healthcare systems globally, with cancer patients representing a particularly vulnerable group. This study aims to evaluate the influence of COVID-19 on cancer, focusing on infection rates, types of care, therapy adjustments, and factors associated with COVID-19 infection. Materials and methods This single-center retrospective analysis included adult cancer patients who underwent anticancer therapy at King Khalid Hospital in Najran, Saudi Arabia, from December 20, 2020, to January 23, 2022. Data on patient and cancer characteristics, COVID-19 specifics, treatment delays, outcomes, and factors associated with COVID-19 were collected and analyzed. Results A total of 257 chemotherapy recipients were interviewed. The mean age was 52.6 ± 14.4 years, with 44 (17.1%) over 65 years old. Females comprised 160 (62.3%) of the patients. The most common malignancies were gastrointestinal (71, 27.6%), breast (70, 27.2%), and hematological (50, 19.5%). Metastasis was present in 116 patients (45.1%). Common comorbidities included diabetes (68, 26.5%) and hypertension (55, 21.4%). Most patients (226, 87.9%) were vaccinated against COVID-19. COVID-19 tested positive in 22 patients (8.6%), with a lower infection rate in vaccinated patients (7 vs. 15, p < 0.001). Most cases were mild (18, 81.8%), with fever (19, 7.4%) and cough and fatigue (17, 6.6%) being the most common symptoms. The median time to resume treatment post-infection was 30 days. Factors associated with higher infection rates included diabetes (OR: 4.73, 95% CI: 1.94-12.03, p = 0.001), coronary artery disease (OR: 4.13, 95% CI: 1.07-13.30, p = 0.049), chronic lung disease (OR: 15.58, 95% CI: 5.37-45.79, p < 0.001), chronic liver disease (OR: 7.64, 95% CI: 2.38-22.98, p < 0.001), and multiple comorbidities (OR: 2.04, 95% CI: 1.46-2.90, p < 0.001), cancer patients who received chemotherapy (OR: 1.02, 95% CI: 0.12-12.79, p = 0.027), and immunotherapy (OR: 3.37, 95% CI:1.27-8.43, p = 0.012). Conclusion The incidence of COVID-19 in cancer patients is proportional to the prevalence in the general population of similar geographic areas. Diabetes, coronary artery disease, chronic lung disease, chronic liver disease, receiving chemotherapy or immunotherapy, and multiple comorbidities were associated with higher COVID-19 infection rates.

Cardiotoxicity in Cancer Patients: The Prevalence, Risk Factors, and Cardioprotective Measures in a Cancer Centre in Saudi Arabia.

BACKGROUND: Chemotherapy-related cardiotoxicity can exhibit several patterns of functional, structural, and vascular complications. This study aims to identify the patterns and the factors associated with cardiotoxicity in cancer patients. METHOD: A retrospective cross-sectional analysis of 96 adult cancer patients undergoing anticancer therapy was investigated at King Khalid Hospital in Najran, Saudi Arabia, from May 2022 to April 2023. The data on patient and cancer characteristics, treatment, and outcomes were collected and analyzed. Factors associated with cardiotoxicity were investigated through univariate analyses using odds ratio (OR) and 95% confidence interval (CI). RESULTS:  Among the 96 cancer patients in the study, cardiotoxicity occurred in 12 individuals (12.5%). The mean age was 57.0 ± 13.3 years (range: 32-81 years), with 32 (33.3%) being above 65 years. The most common comorbidities were diabetes (n=48; 50%), followed by hypertension (n=32; 33.3%), and dyslipidemia (n=20; 20.8%). The most common cancers were gastrointestinal cancer (n=32; 33.3%), followed by breast cancer (n=22; 22.9%) and lymphoma (n=14; 14.6%). Females were disproportionately affected (64.6%), with 57.3% of them in the metastatic stage. The majority of patients (90.6%) had normal ejection fraction before chemotherapy initiation. In univariate analysis, current smoking (OR: 7.00; 95%CI: 1.94-25.25, p= 0.003), history of percutaneous cardiac intervention (OR: 40.24; 95%CI: 1.80-896.26, p= 0.019), diabetes (OR: 6.05; 95%CI: 1.24-29.32, p= 0.025), renal failure (OR: 8.20; 95%CI: 0.91-74.88, p= 0.046), dyslipidemia (OR: 5.00; 95 CI: 1.38-18.32, p=0.012), anthracycline use (OR: 18.33; 95%CI: 4.36-126.55, p <0.001), trastuzumab use (OR: 25.00; 95%CI: 6.25-129.86, p < 0.001), and increased chemotherapy cycles number (> 10 cycles) (OR: 73.00; 95%CI: 8.56- 622.36, p < 0.001) were associated with cardiotoxicity. Additionally, beta-blocker use was associated with lower rates of cardiotoxicity (OR: 0.17; 95%CI: 0.036-0.84, p= 0.029). CONCLUSIONS: The incidence of cardiotoxicity among cancer patients treated with chemotherapy is modest, difficult to predict, and independent of baseline cardiac systolic functions. Factors associated with cardiotoxicity include smoking, history of percutaneous cardiac intervention, diabetes, renal failure, dyslipidemia, anthracycline or trastuzumab use, and increased chemotherapy cycle numbers. A combination of various anticancer drugs and chemotherapy may dramatically raise the risk of cardiotoxicity in cancer patients. As a result, patients receiving high-risk cardiotoxic drugs should be monitored with caution to avoid drug-related cardiotoxicity. Furthermore, proactive treatment techniques aiming at reducing the possible cardiotoxic effects of anticancer therapy are critical.

Clinical and Therapeutic Characteristics of Hospitalized Patients with Advanced Lung Cancer in Najran, Saudi Arabia: A Retrospective Study.

BACKGROUND: Lung cancer is one of the top causes of cancer deaths globally, including in Saudi Arabia. Although several prognostic markers have been established, the clinical features and outcomes of lung cancer in Saudi Arabia are not well understood. This study aimed to describe the clinical and therapeutic characteristics of advanced lung cancer in Najran, Saudi Arabia. METHOD: A retrospective chart review of 44 patients diagnosed with advanced lung cancer between June 2018 and September 2021 and treated at the Oncology Center of King Khalid Hospital in Najran City, Saudi Arabia. The clinicopathological features, treatment used, response, and survival outcomes were collected and analyzed. RESULT: The mean age was 69.3 ± 10.7 years, most of them (n = 35, 79.5%) were male and older than 70 years (n = 24, 54.5%). Adenocarcinoma was the most observed cancer (n = 35, 79.5%), followed by squamous cell carcinoma in six (13.6%). Most cases (n = 42, 95.5%) were in stage IV. Epidermal growth factor receptor (EGFR) mutations were positive in two (4.5%) cases and ALK mutation was positive in two (4.5%) cases. Metastasis to pleura with pleural effusion was the common presentation (n = 41, 93%). Chemotherapy was administered as the first line in 19 cases (43.2%) while 25 cases (56.8%) received chemoimmunotherapy. The commonest chemoimmunotherapy regimen used was carboplatin-pemetrexed-pembrolizumab in 16 (36.4%), followed by carboplatin-paclitaxel-pembrolizumab in 9 (20.5%) cases. The response to initial systemic therapy was as follows disease progression, stable disease, and complete remission in 10 (22.7%), 33 (75.0%), and 1 (2.3%), respectively. Median progression-free survival was 8.7 months (interquartile range (IQR): 5.7-11.4), and the median overall survival was 12.3 months (IQR: 11.1-13.4). Among the total documented 36 (81.8%) dead cases, disease progression was the main cause of death in 25 cases (56.8%). Using chemoimmunotherapy as the first-line therapy was associated with numerical survival improvement compared to using chemotherapy alone (HR: 0.75; 95% CI: 0.39-1.46) however, it was not statistically significant (p = 0.397). CONCLUSION: In this study, the majority of lung cancer patients were male and over 70 years old. Adenocarcinoma was the most common histological type. Metastasis to pleura with pleural effusion was the common presentation. The most common treatment used was chemoimmunotherapy with a regimen of carboplatin-pemetrexed-pembrolizumab. Addressing the possible causes of delayed diagnosis of lung cancer is crucial for improved survival outcomes.

The Prevalence and Risk Factors of Postpartum Depression among Mothers in Najran City, Saudi Arabia.

BACKGROUND: Postpartum depression (PPD) is a significant mental health concern affecting mothers globally. However, research on PPD prevalence and risk factors in Najran City, Saudi Arabia, is limited. STUDY AIM: this cross-sectional study aimed to determine the prevalence and risk factors associated with PPD among mothers in Najran City. METHODOLOGY: A questionnaire-based study was conducted from September 2023 to January 2024, involving 420 mothers aged 16-50 years with newborns (2-10 weeks after delivery). The questionnaire included demographic information and the Arabic version of the Edinburgh Postnatal Depression Scale (EPDS). Statistical analysis utilized SPSS software v. 26, including descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and logistic regression. RESULTS: The majority of participants were aged 20-35 years (61.4%), Saudi nationals (87.6%), and had university education (51.4%). EPDS scores indicated that 66.7% of mothers screened positive for possible depression. Significant associations were found between higher EPDS scores and factors such as unemployment (p = 0.004), younger age (p = 0.003), caesarean delivery (p = 0.043), mental illness (p = 0.0001), lack of adequate family support (p = 0.0001), and higher stress levels (p = 0.0001). CONCLUSION: The study revealed a high prevalence of PPD among mothers in Najran City, with sociodemographic, obstetric, and psychosocial factors significantly influencing PPD risk. These findings emphasize the need for targeted interventions and support systems to address maternal mental health needs effectively.

The Prevalence of Risk Factors for Cardiovascular Diseases in Najran Region, Saudi Arabia.

The primary goal of this study was to investigate the knowledge, prevalence, and risk factors of cardiovascular diseases among individuals in the Najran region of Saudi Arabia. In the Najran region of Saudi Arabia, an online cross-sectional survey was conducted. Between September and October 2023, a self-administered questionnaire was distributed to a random sample of the general population aged 18 and up. The survey instrument asked about history and exposure, physician-diagnosed illnesses, cardiovascular diseases (CVDs), medication use, and other risk factors. This research had a total of 2046 individuals. Around one-fifth of the study participants reported that they or a family member suffered from CVD, and arrhythmia was the most commonly reported; blood tests, cardiac catheterization, and ECG were the most commonly reported tests performed for CVD patients, around one-tenth of CVD patients reported that they do not have any chronic diseases other than CVD, and the vast majority of the patients confirmed their regular medical appointments. This is one of the first studies to investigate the knowledge, prevalence, and use of CVD drugs among individuals in the Najran region of Saudi Arabia. The study participants' lack of knowledge about CVD could lead to ineffective preventive measures and poor patient outcomes. The study's findings underscore the crucial need for more extensive and efficient educational initiatives that consider the targeted population's talents, attitudes, and perceptions.

Prevalence of Depression and Anxiety Symptoms Among Patients With Cancer in Najran, Saudi Arabia.

BACKGROUND: Depression and anxiety are associated with poor health consequences in patients with cancer, and these mental health issues may affect cancer treatment. They are frequently triggered by stress, and cancer is among the most stressful conditions experienced by a person. Depression and anxiety are related to several sociodemographic variables in patients with cancer. However, only a few studies have examined the prevalence of depression and anxiety symptoms in patients with cancer in Saudi Arabia. OBJECTIVES: To detect the prevalence of depression and anxiety symptoms among patients with cancer at the Najran Oncology Center in Najran, Saudi Arabia, and determine the risk factors associated with these symptoms. METHODS: A cross-sectional study was conducted from April 1, 2023, to September 30, 2023, on a convenience sample of patients diagnosed with cancer who were receiving chemotherapy at Najran Oncology Center, King Khalid Hospital, Najran, Saudi Arabia, and who agreed to participate in the study. The Hospital Anxiety and Depression Scale was used. Data on the demographic characteristics of the patients were collected using a self-administered questionnaire. Moreover, medical data were collected from the medical records of the patients. RESULTS: In total, 92 patients with various cancer diagnoses were recruited in this study. Among them, 51 and 41 were women and men, respectively. Moreover, 81 were married and 11 were either single, widow, or divorced. The mean age of the participants was 51.24 ± 15.15 years. The prevalence rates of depression and anxiety were 42.4% and 23.9%, respectively. There were significant associations between depression and marital status in patients with cancer-associated pain and those with a current history of chemotherapy. Furthermore, the association between anxiety and cancer-associated pain was significant. However, marital status was not associated with anxiety. Age, sex, family history of mental disorders, cancer duration, current cancer stage, and surgical interventions were not associated with the prevalence of depression and anxiety. CONCLUSIONS: Our findings underline the importance of identifying depression and anxiety in patients with cancer. Marital status, presence of pain, and current chemotherapy history were significantly associated with depression and pain with anxiety. RECOMMENDATIONS: Further studies with a higher number of patients with cancer should be conducted in Saudi Arabia and other Arab countries. Screening for depression and anxiety symptoms should be a part of the comprehensive evaluation of patients with cancer. Appropriate treatment interventions must be provided to patients with cancer who present with mental disorders.

Clinical Characteristics and Survival of Hepatocellular Carcinoma: Insights from Single-Centre Experience in Saudi Arabia.

Background Hepatocellular carcinoma (HCC) represents the most common primary liver malignancy, with a high fatality rate. Relatively, Saudi Arabia has a high incidence of HCC, which is detected in later stages with a poor prognosis. This study aims to investigate the patterns, outcomes, and mortality predictors of HCC in Saudi Arabia. Method A retrospective study from April 2018 to June 2022 included patients with HCC who were diagnosed and managed at the Najran Oncology Center, Saudi Arabia. Through our cancer registry, the patients' clinical, laboratory, radiological, and survival profiles were extracted and analyzed to assess factors associated with mortality using a univariate analysis. The overall survival was calculated by the Kaplan-Meier method. Results The study involved 52 patients with an average age of 74.6 years, predominantly male (the male-to-female ratio is 2.25:1). Viral infections were the primary cause of liver disease in 40.3% (n=21) of patients. At diagnosis, the Child-Pugh class distribution included 23.1% (n=12) patients in class A, 36.5% (n=19) patients in class B, and 40.4% (n=21) patients in class C. Uninodular tumors with ≤50% liver extension were observed in 65.4% (n=34) of cases, and 30.8% (n=16) had portal vein thrombosis. Elevated alpha-fetoprotein (AFP) levels were noted in 48.1% (n=25) of patients, with 23.1% (n=12) exceeding 400 ng/mL. Curative resection was performed in 32.7% (n=17) of patients. The mean survival time was 23±11.8 months (median of 22.5 months, minimum of six, and maximum of 49 months). Relapse occurred in seven (13.5%) cases, while new metastasis occurred in 20 (38.5%) cases. During the study period, 26 (50.0%) patients died. The main cause of death was disease progression in 15 (28.8%) patients. Univariate analysis showed that AFP>400 ng/mL (OR: 4.68; 95% CI: 1.87-11.66, p=0.001), presence of relapse (OR: 0.16; 95% CI: 0.03-0.78, p=0.023), abdominal ascites (OR: 3.38; 95% CI: 1.25-9.14, p=0.016), advanced the Cancer of the Liver Italian Program (CLIP) score (OR: 0.60; 95% CI: 0.41-0.88, p=0.009) were associated with higher mortality rate and were statistically significant. Conclusion Most cases of HCC in our patients were attributed to viral hepatitis, with the majority having liver cirrhosis. Higher AFP (>400 ng/mL), relapse, abdominal ascites, and a higher cancer CLIP score were associated with poorer outcomes. Targeted screening and health education should be advocated; in addition, social determinants should be proactively addressed.

Relationship between placental location and fetal gender using ultrasonography: A prospective study from the Maternity and Children's Hospital, Najran, Saudi Arabia.

The study was a prospective cross-sectional design and was carried out at the Maternity and Children's Hospital in Najran, Saudi Arabia on 142 pregnant women . The objective of the study was to establish, utilising ultrasound scan , whether there is any link between the site of the placenta and the gender of the fetus. A higher percentage of female fetuses were identified. The majority of placentas (73, 51.4%) were found to be anterior, of which 66 (46.5%) and 7 (4.9%) were present in female and male fetuses, respectively. 58 (40.8%) placentas were noted to be posterior, i.e. females, 10 (7.0%); males, 48 (33.8%). 10 (7.0%) placentas were high, a position which was equally prevalent in both genders, i.e. females, 5 (3.5%); males 5 (3.5%), and 1 (0.7%), in a male fetus, was low-lying. A significant correlation between placental site and the gender of the fetus was revealed by the chi-squared test (p < 0.05) the sensitivity of ultrasound in predication fetal gendar was 95.1%. The outcome reveals a noteworthy association between the position of the placenta and the gender of the fetus.

L'étude était une conception transversale prospective et a été réalisée à l'hôpital de maternité et pour enfants de Najran, en Arabie Saoudite, sur 142 femmes enceintes. L'objectif de l'étude était d'établir, par échographie, s'il existe un lien entre la localisation du placenta et le sexe du fœtus. Un pourcentage plus élevé de fœtus féminins a été identifié. La majorité des placentas (73, 51,4 %) étaient antérieurs, dont 66 (46,5 %) et 7 (4,9 %) étaient présents respectivement chez les fœtus féminins et masculins. 58 (40,8 %) placentas étaient postérieurs, soit 10 femmes (7,0 %) ; hommes, 48 (33,8%). 10 (7,0 %) placentas étaient hauts, une position également répandue chez les deux sexes, c'est-à-dire chez les femmes, 5 (3,5 %) ; chez les mâles, 5 (3,5 %) et 1 (0,7 %), chez un fœtus mâle, étaient de faible hauteur. Une corrélation significative entre le site placentaire et le sexe du fœtus a été révélée par le test du chi carré (p < 0,05) ; la sensibilité de l'échographie en prédication du genre fœtal était de 95,1 %. Le résultat révèle une association remarquable entre la position du placenta et le sexe du fœtus.

The Level of Knowledge Among Nurses Regarding Care of Patients with Hepatic Encephalopathy at Najran Hospitals, Saudi Arabia.

Background/Aim: Hepatic encephalopathy (HE) is a significant complication of acute and chronic liver disease. It is crucial for nurses to have knowledge of encephalopathy symptoms to enable prompt and effective responses when caring for such patients. Therefore, this study aimed to evaluate nurses' HE knowledge in Najran hospitals in Saudi Arabia. Methods: This cross-sectional analytical study was conducted with nurses at the Najran Hospital in Najran City, Saudi Arabia. The sample size was determined using Epi-Calc 2000, resulting in a final sample of 125 nurses from intensive care units (ICU), cardiac surgical ICU and pediatric ICU, and they were selected by convenience sampling technique. Data were collected using a self-administered questionnaire, and 125 nurses participated in knowledge assessment. The data were coded and entered into SPSS version 21.0 for descriptive and inferential statistics. Information letters and consent forms were obtained from all the participants. Results: The majority of nurses (88.8%) were female, and 59.2% were married. The age range of participants was 20-30 years (50.4%). Approximately 36.8% had 4-6 years of work experience. The majority of the nurses (87.2%) held a bachelor's degree. More than half (56%) of the nurses demonstrated moderate HE knowledge, whereas over a quarter (28%) exhibited good knowledge. There was a highly statistically significant association between marital status, level of education, nationality, and level of nurses' knowledge regarding HE (P-value = 0.01, 0.02, and 0.02, respectively). Conclusion: The study concludes that nurses in Najran hospitals have an adequate knowledge levels, ranging from moderate to good. This highlights the importance of tailored educational programs to enhance nurses' understanding of HE symptoms and management. Furthermore, the marital status, education level, and nationality have significant association with nurses' knowledge.

Cancer Therapy-Related Cardiotoxicity: A Comprehensive Retrospective Analysis at Najran Cancer Center, Saudi Arabia.

Background Cardiotoxicity, produced as an adverse effect of anticancer therapy, is a common issue during cancer treatment. Acute coronary syndrome, myocarditis, arrhythmias, or heart failure can all be symptoms of this issue. Little is known about its occurrence among Saudi Arabian cancer patients. This study aims to investigate factors linked to anticancer therapy-related cardiotoxicity. Methods A retrospective study was conducted from April 2020 to May 2022 at the King Khalid Hospital, Najran, Saudi Arabia. The study included adult cancer patients receiving anticancer therapy, regardless of their cardiovascular disease history. Univariate analysis was used to investigate factors associated with the occurrence of cardiotoxicity related to anticancer therapy. Results Of 78 patients receiving anticancer therapy, cardiotoxicity occurred in 12 (15.4%) patients. The mean age was 56.5 ± 13.4 years, with 33.3% aged over 65 years. Comorbidities included hypertension (44; 56.4%), diabetes (41; 52.6%), dyslipidemia (13; 16.7%), smoking (16; 20.5%), heart disease (6; 7.7%), trastuzumab use (9; 11.5%), and chronic kidney disease (2; 2.6%). The most common cancers were breast cancer and gastrointestinal cancer (27.6% each). Monoclonal anticancer agents 35 (46.1%) and alkylating agents 29 (38.2%) were commonly used chemotherapies. Cardiac protective agents were used in 16 (21.1%) of patients, with angiotensin-converting enzyme (ACE) inhibitors 15 (19.7%) and statins (13; 17.1%) being the most prescribed. Baseline ejection fraction (EF) was normal in 69 (90.8%) of cases. The follow-up duration was 1.93 ± 1.90 years. A drop in EF occurred in five (6.6%) of cases. Dyslipidemia (OR: 0.12; 95% CI: 0.03-0.47, p=0.002), previous heart disease (OR: 0.14; 95% CI: 0.02-0.81, p=0.029), and impaired baseline EF (p=0.029) were associated with increased risk of cardiotoxicity. Statin (OR: 0.22; 95% CI: 0.05 to 0.84, p=0.028) and antiplatelet agents (OR: 0.19; 95% CI: 0.03 to 1.01, p=0.051) were protective agents against cardiac toxicity. Conclusion Effective anti-cancer therapy may be accompanied by an increased risk of cardiotoxicity. In this study, a history of prior heart disease, dyslipidemia, low baseline ejection fraction, and the administration of multiple anticancer therapy agents was associated with cardiotoxicity. Proactive management strategies aimed at mitigating the potential cardiotoxic effects of anti-cancer therapies are crucial.

Clinical and Therapeutic Profile of Non-Hodgkin's Lymphoma: A Retrospective Study From a Najran Oncology Center.

Background Non-Hodgkin lymphomas (NHL) represent a group of lymphoproliferative disorders, with a limited understanding of their clinical spectrum, primary extranodal variety, histopathology, and immunohistochemistry, particularly in developing countries. The objective of this study was to evaluate the clinicopathological characteristics and survival rates of NHL patients treated at King Khaled Hospital in Najran City, Saudi Arabia. Method In this retrospective chart review of NHL cases that received chemotherapy at the Oncology Center of King Khaled Hospital in Najran City, Saudi Arabia, between 2014 and 2021, we evaluated the clinicopathological features, survival rate, and associated factors. Using standardized data collection sheets, we extracted information on patients' age, gender, tumor type, stage, baseline laboratory evaluations, disease status, cancer treatment, and survival from electronic medical records. Univariate analysis was employed to identify factors associated with mortality and relapse. Results We included 43 NHL patients with a mean age of 59.23 ± 20.17 years, with a higher frequency among females (65.1%). B symptoms were present in 32 (74.4%) cases. The common primary site was peripheral lymph nodes (79.1%). Diffuse large B-cell lymphoma was the most common morphologic type (67.4%), and 46.5% of the patients had advanced-stage disease (stages III-IV). All patients received the first line of treatment, with the most common chemotherapy used being the RCHOP regimen (67.4%). Additionally, radiotherapy was performed in seven (16.3%) cases. Relapse occurred in eight (18.6%) cases with a median period of 47.5 months (Min: 20 - Max: 77 months). The mean overall survival time was 43.25 ± 2.98 months (range 12-168 months), and the one, three, and five-year survival rates were 91%, 58%, and 38%, respectively and the mortality rate was 32.6%. Univariate analysis showed that Burkitt lymphoma had (odds ratio (OR): 11.87; 95% confidence interval (CI): 1.58-89.09, p=0.016) and elevated lactate dehydrogenase (LDH) ((OR: 1.26; 95% CI: 0.35-4.54), p=0.014) were associated with mortality. Moreover, advanced age and the total number of first chemotherapy cycles were associated with relapse (p< 0.05). Conclusion The study highlights the variability of NHL cases, with a significant proportion presenting with advanced-stage disease and in middle age. The results suggest poor survival rates for patients with Burkitt lymphoma subtypes and elevated LDH levels.

Knowledge, Attitude, and Perception of Parents in the Najran Region Toward the Use of Herbal Medicine in the Treatment of Asthma in Their Children.

BACKGROUND: Asthma is a prevalent and persistent condition affecting the respiratory system, defined by the presence of fluctuating and reversible symptoms associated with the restriction of airflow, heightened sensitivity of the bronchial tubes, and inflammation within the airways. Saudi Arabia has a high prevalence of this chronic illness, making it one of the most often seen conditions in the country. A popular therapeutic approach within the realm of complementary and alternative medicine for individuals with asthma is the use of herbal medications. Nevertheless, the efficacy of these medicines in treating asthma is often supported by inadequate data. OBJECTIVES: This study aimed to determine the knowledge, attitude, and perception of parents toward the use of herbal medicines in the treatment of asthma in their children in the Najran Region. METHODS: In this cross-sectional study, the participants received an electronic self-administered survey via social media channels. The survey instrument comprises a set of questions that have been gathered from prior studies that have comparable research aims. The questionnaire sheet will contain three parts. Data were analyzed with IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). The sample and outcome variables were summarized using the descriptive statistics of frequencies, percentages, means, and standard deviations. Data were analyzed by type of provider as appropriate, and the Pearson chi-square test was used to compare the observed data; the paired sample t-test was used to test the difference between the means of the pretest and post-test. RESULTS: Fifteen percent of the respondents personally suffer from asthma, while 85.0% do not. Additionally, 25.7% of the respondents indicated that one of their children suffers from asthma, while 74.3% stated that their children do not suffer from asthma. The data also show that the statement "Asthma symptoms are dry cough, shortness of breath, and wheezing" received a 51.4% "Strongly Agree" response, 37.9% "Agree," 9.3% "Neutral," 0.9% "Disagree," and 0.5% "Strongly Disagree." The majority of respondents (51.4%) reported obtaining information about asthma from doctors. A notable portion of respondents (35.5%) reported using herbs or folk medicines to treat asthma in their children. A substantial portion of respondents (44.9%) reported not using medicinal herbs at all. Despite this, 41.6% of respondents expressed belief in the idea of taking herbs as a treatment. CONCLUSION: In conclusion, the knowledge, attitude, and perception of parents toward the use of herbal medicine in the treatment of asthma in their children are multifaceted and influenced by cultural, social, and individual factors. Understanding these dynamics is essential for developing culturally sensitive healthcare interventions and policies that align with the beliefs and practices of the community.

Short-Term Solar Irradiance Prediction Based on Adaptive Extreme Learning Machine and Weather Data.

Concerns over fossil fuels and depletable energy sources have motivated renewable energy sources utilization, such as solar photovoltaic (PV) power. Utilities have started penetrating the existing primary grid with renewable energy sources. However, penetrating the grid with photovoltaic energy sources degrades the stability of the whole system because photovoltaic power depends on solar irradiance, which is highly intermittent. This paper proposes a prediction method for non-stationary solar irradiance. The proposed method uses an adaptive extreme learning machine. The extreme learning machine method uses approximated sigmoid and hyper-tangent functions to ensure faster computational time and more straightforward microcontroller implementation. The proposed method is analyzed using the hourly weather data from a specific site at Najran University. The data are preprocessed, trained, tested, and validated. Several evaluation metrics, such as the root mean square error, mean square error, and mean absolute error, are used to evaluate and compare the proposed method with other recently introduced approaches. The results show that the proposed method can be used to predict solar irradiance with high accuracy, as the mean square error is 0.1727. The proposed approach is implemented using a solar irradiance sensor made of a PV cell, a temperature sensor, and a low-cost microcontroller.

D-dimer as a predictive and prognostic marker among COVID-19 patients.

OBJECTIVES: To examine D-dimer, coagulation profile, and platelet count among patients hospitalized with coronavirus disease-19 (COVID-19) and compare them to findings from non-COVID-19 subjects. METHODS: The participants in this retrospective hospital-based observational study design included 112 confirmed diagnosed with COVID-19 who were admitted to King Khaled Hospital, Najran, Saudi Arabia, and another 112 non-COVID-19 subjects as a comparative group. Laboratory investigations, demographic and clinical records were obtained from participants' electronic indexed medical records. Coronavirus disease-19 diagnosis was confirmed according to positive real time polymerase chain reaction assay carried out at the hospital's central laboratory, where samples were extracted from a nasopharyngeal swab. Pneumonia related to COVID-19 is classified as critical, severe, moderate, mild, and asymptomatic whereas thrombocytopenia was marked when the platelet count was <150.00×109/L. Suitable statistical analysis was applied to determine possible differences between the findings from the 2 groups. RESULTS: The D-dimer and activated partial thromboplastin clotting time mean values were significantly elevated (p<0.001). The international normalized ratio and platelet count mean values confirmed a significant decrease (p<0.001). Thrombocytopenia was found 9 times in COVID-19 higher than in the non-COVID-19. D-dimer and prothrombin time mean values increased significantly among the COVID-19 patients with all patterns of symptoms on admission (p<0.001). CONCLUSION: D-dimer mean values increased significantly in deceased COVID-19 and in hospitalized intensive care unit (ICU) wards patients (p<0.001), indicating a potential predictive and prognostic severity marker, particularly among COVID-19 patients in the ICU.

Knowledge, attitude and practice of hospital pharmacists towards pharmacovigilance and adverse drug reaction reporting in Najran, Saudi Arabia.

Introduction:  Pharmacovigilance (PV) is critical in determining the risk-benefit ratio of medicines and encouraging their safe, rational, and effective use, hence enhancing patient safety and care. Pharmacists, as drug experts, share responsibility for ensuring that medicines remain safe. Objective:  The study aimed to assess the knowledge, attitude, and practice of hospital pharmacists towards PV and adverse drug reaction (ADR) reporting and to know factors that discourage them from reporting ADRs in Najran, Saudi Arabia. Methods: A pre-tested self-administered questionnaire was distributed to all the pharmacists working in government hospitals who consented to participate in the study. Data was collected over three months, from 01 June 2018 to 31 Aug 2018. Data were analyzed using Statistical Package for Social Science (SPSS) software for Windows, version 23. Descriptive statistics such as frequency and percentages, mean ± standard deviation (SD) were calculated, and the Pearson's Chi-square test was used to examine the relationship between different variables. Results: A total of 145 questionnaires were distributed, and the response rate obtained was 70.3%. The definition of PV and ADR were correctly identified by 42% and 68.3% of participants, respectively. A noteworthy finding is that 95% of participants were aware of the existence of the ADR reporting system, and 88.9% knew the responsible regulatory agency. Participants showed a positive attitude towards PV and ADR reporting; 90.1% considered ADR reporting a part of professional obligation, and 94.1% believed that there should be collaboration between pharmacists and other healthcare professionals. A majority of participants (86.1%) had identified an ADR during their practice, and 71.3% had reported an ADR. The unavailability of a professional environment to discuss ADR and insufficient pharmacotherapy/clinical knowledge was cited as the main factors discouraging from reporting ADRs. Conclusions: Overall, the pharmacists had an average to good knowledge of and positive attitude towards PV and ADR reporting and a good ADR reporting practice. The concept of PV and ADR reporting should be further strengthened, and there is a vast potential for the same.

Medication errors in Najran, Saudi Arabia: Reporting, responsibility, and characteristics: A cross-sectional study.

Background: Medication error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient. Disclosure of medication errors and improvement of patient safety are inexorably related, and they provide one of the strongest reasons to report and disclose errors, including near misses in which no harm comes to the patient. This study aimed to identify medication errors at the southern province of Saudi Arabia. Methods: A cross-sectional retrospective study was conducted by reviewing all medical records in the King Khaled Hospital in Najran, Saudi Arabia. Medication errors related information were extracted from the electronic medical system for the duration between 2018 and 2020. Results: During the study period of 2018 to 2020, a total of 4860 medication errors were identified. More than half of the reported medication errors (66.9%) were linked to ordering, prescribing, or transcribing medications. The most commonly reported medication errors connected to ordering/prescribing/transcribing were inappropriate dosage, dosage units, and therapeutic duplication of medication. The most commonly reported medication errors linked to administration were missing documentation during administration, not performing independent double-checks during the administration of high alert medications, and the administration of look-alike sound-alike (LASA) medications. The intensive care unit (ICU), female medical ward, and male medical ward were the most commonly reported locations for medication errors. Pharmacists detected more than half of the reported medication errors. Physicians were found to be responsible for 66.0% of reported medication errors, followed by nurses. Conclusion: Medication errors are common in hospital settings in Saudi Arabia's southern provinces. Efforts should be made to improve drug ordering, prescribing, and transcription in hospital settings. To guarantee optimum practices, the entire medical team should take responsibility for the patient's optimal medication administration.

Cephalometric comparison of Eastman standards among caucasians and saudi population in the Najran region.

Caucasian norms derived from the European-American population are often applied in the diagnosis and treatment planning of Saudi orthodontic patients. Minor differences in cephalometric values can be considered routine and normal, but significant differences indicate a structural deviation. The objective of this study was to establish the cephalometric norms of normal and pleasant soft tissue profiles of adult Saudi living in the Najran region of Saudi Arabia and compare them with the Eastman standards derived from the Caucasian population. A total of 60 lateral cephalometric radiographs (30 males and 30 females) of Najran adults aged between 18-30 years with pleasing, acceptable, harmonious and well-balanced soft tissue profile and Class I molar relationship with no history of previous orthodontic treatment, no crowding or spacing, normal overjet and overbite were selected for the study. Descriptive analysis and Student t-test were performed to evaluate the male and female gender differences and compare the Najran mean with Eastman standards. On evaluating the gender differences, Najran females tend to have more ANB angle and L1 to A-Pog linear distance than Najran males(p<0.05). On comparing with the Eastman Caucasian standards, the Najran population tends to have more SNA, ANB, UI to MxP and L1 to A-Pog (p<0.05). The U1 to L1 angle tends to be less in Najran population than the Caucasians (p<0.05). The Najran population has more protrusive skeletal bases, bimaxillary protrusion, more proclined upper and lower incisors and reduced interincisal angle than Caucasians. The Najran females have more protrusive skeletal bases and more proclined lower incisors compared to Najran males. The cephalometric findings of this study can be useful in the diagnosis and treatment planning of orthodontic patients belonging to the Najran region of Saudi Arabia.