Showing papers by "King Faisal Specialist Hospital & Research Centre published in 2022"

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

Abstract: Background. To evaluate clinical characteristics and factors associated with survival among liver transplantation (LT) recipients with Budd-Chiari syndrome (BCS), with or without transjugular intrahepatic portosystemic shunt (TIPS), in the post–Model for End-stage Liver Disease era. Methods. We extracted data from the United Network for Organ Sharing database on all adult (≥18 y old) waitlisted candidates and recipients of LT with BCS in the United States between 2002 and 2019. Multivariable Cox regression was used to determine predictors of mortality and hazard ratios (HRs). Results. A total of 647 BCS patients were waitlisted between 2002 and 2019. BCS was an indication for LT in 378 (0.2%) of all adult LT recipients during the study period. Of BCS patients who received LT, approximately three-fourths (72.3%) were alive for up to 10 y. We found no significant difference in LT outcomes in BCS patients with or without TIPS. Longer length of hospital stay following LT (HR, 1.32; 95% confidence interval [CI], 1.19-1.47), Black/African American race (HR, 2.24; 95% CI, 1.38-3.64), diabetes (HR, 3.17; 95% CI, 1.62-6.21), donor risk index (HR, 1.44; 95% CI, 1.05-1.99), and lower albumin levels at the time of transplantation (HR, 0.66; 95% CI, 0.50-0.88) were negatively associated with survival after LT. Interestingly, neither the Model for End-stage Liver Disease nor prior TIPS showed a significant association with survival after LT. Conclusions. These findings demonstrate good comparable survival among TIPS versus no TIPS in LT recipients with BCS. The decision for TIPS versus LT should be individualized on a case-by-case basis.

The Practices and Attitudes of Saudi Plastic Surgeons in Managing Contaminated Autologous Grafts

Abstract: The use of autologous grafts is a standard reconstructive option in plastic surgery. The absence of a well-established protocol for decontamination after accidental contamination increases the risk of postoperative infection. We aimed to explore the current practice and decontamination methods among Saudi plastic surgeons. This would help develop a well-established, unified method of decontamination intraoperatively.A validated self-administered questionnaire cross-sectional study was conducted in February 2022. The questionnaire was distributed through social media to all board-certified plastic surgeons in Saudi Arabia. The questionnaire was designed to obtain data on incidents, treatment preferences, and management of autograft contamination.A total sample size of 61 participants was included, with an overall response rate of 64.58%. Out of the 61 respondents, 73.8% (n = 45) had previously experienced graft contamination. Regarding the methods of graft contamination, the most common way was accidentally dropping the graft on the floor (39.7%, n = 25). The majority of the surgeons answered that they decontaminated the graft using povidone-iodine (44.6%, n = 29) and then used it (45.9%, n = 28). The lower extremity area was the most common anatomical location having surgery at the time of the graft contamination, accounting for 32.5% of the cases (n = 25).Our study indicates that graft contamination is a common occurrence among our population, but we lack national guidelines on dealing with these situations. Although most responders used adequate decontamination methods, the lack of standardization could pose a risk to patients.

Toward Zero Harm: Mackenzie Health’s Journey Toward Becoming a High Reliability Organization and Eliminating Avoidable Harm

Abstract: In response to an organizational survey revealing low safety culture scores, we implemented a "zero harm" approach to eliminate preventable harm across a wide variety of clinical areas. We aimed to achieve this objective within 3 years.We developed a 5-part strategy for cultural and process redesign that included (1) engaging leadership; (2) developing an organization-specific patient safety framework; (3) monitoring specific quality aims based on high-risk, high-volume, high-cost, and problem-prone areas; (4) standardizing a 3-part review process that includes a root cause analysis for moderate and critical patient safety incidents; and (5) communicating progress to staff in real time via unit-specific electronic dashboards.In less than 1 year, we increased patient safety incident reporting by 37% while simultaneously decreasing falls with injury by 39%, pressure injury rates by 37%, and central line-associated blood stream infections by 34%. We also improved medication reconciliation rate by 3.3% and decreased our irretrievable specimen rate to 0. Finally, we noted increased awareness around patient safety within clinical teams, with open discussions about patient safety becoming a routine part of patient care.This study describes an initiative that sought to introduce system-wide changes to practice and patient safety culture in a rapid time frame. Results suggest that our 5-step approach to transformation may confer substantial gains in patient safety for peer institutions. Next steps include continuing to expand and monitor quality aims as we progress through our journey to eliminating preventable patient harm in our healthcare system.

Prenatal Diagnosis of Ductus Arteriosus Aneurysm: A Case Report and Literature Review

Abstract: Abstract The ductus arteriosus (DA) is a vascular shunt between the main pulmonary artery and the proximal descending aorta, allowing the oxygenated blood from the placenta to bypass the fetal pulmonary circulation and supply oxygen-rich blood to the systemic circulation. Anomalies within the ductus arteriosus can compromise fetal circulation. Ductus arteriosus aneurysm (DAA) is a localized saccular or tubular dilation of the DA and is considered a rare lesion. However, many reports in the literature describe DAA in the infancy period, with limited reports describing the lesion prenatally. We diagnosed a case of ductus arteriosus aneurysm with mild hypoplasia of the transverse arch prenatally at a 37-week gestational age. Both resolved spontaneously in the third week of life without complication.

Study of Rotating Arc Welding Process for Joining of Pipes: An In-Depth Review

Abstract: Circumferential welding is most commonly used for joining of pipes in construction, fuel transportation, firefighting, automobile and power plant industry. This study is carried out for better understanding of a newly developed technique used for performing circumferential welding of tubes and pipes. The technique is termed as rotating arc welding or magnetically impelled arc butt (MIAB) welding. It is a unique welding process where an electric arc rapidly rotates on the periphery of the pipes because of electromagnetic force produced by the interaction of magnetic field and the arc current. This rotating arc is sufficient enough for generating uniform heat all around the periphery of the adjoining pipes. When welding temperature is reached on the faying surfaces, the upsetting pressure is applied on the pipes end to form a rigid joint. The joint will be formed in few seconds, which exhibits the strength similar to that of parent material. The joint is formed without the use of filler metal, flux material and shielding gases and is free from weld inclusions because of upsetting force which pushes out the impurities. Having many benefits, the process is under vast research to correctly identify and set the process parameters for welding of different materials. This paper explores an in-depth review of previous works carried out by the researchers that would provide information for the further development of the process to obtain quality weld.

Frontalis Suspension in Muscular Dystrophy: 16-years Follow-up

Abstract: Acquired eyelid ptosis in adults, with complete loss of levator palpebrae superiosis function, can be a challenging problem to diagnose and treat. A 48-year-old woman with chronic bilateral severe blepharoptosis of 10 years duration is presented, whose neurological investigations excluded myasthenia gravis. The patient was preliminarily diagnosed with chronic progressive external ophthalmoplegia. The levator excursion was negligible, and a frontalis suspension procedure was considered using a conventional autogenous fascia lata graft. An optimal outcome was achieved with over 16-years follow-up. Although the patient was healthy otherwise upon first presentation, 10 years later, she developed other neurologic manifestations, including dysphagia and oral dryness. The fact that blepharoptosis did not recur over the years in this case differentiates an oculo-pharyngeal type of muscular dystrophy in this patient from other types and from the more frequent condition of chronic progressive external ophthalmoplegia.

Goat Milk: Compositional, Technological, Nutritional and Therapeutic Aspects: A Review

Abstract: Since the 1980s, a growing interest in goat milk was noticed due to the nutritional values and health benefits of this milk, which resulted in increasing goat populations and milk production worldwide. This comprehensive review elaborates on goat milk composition compared to other types of milk. It is also an overview of goat milk production, properties, nourishment value, applications in dairy products and potential health benefits. Goat milk composition and its characteristics are slightly different from other types of milk and can be utilized to manufacture many dairy products. Fresh goat milk and goat milk products (e.g., yogurt and kefir) were found to provide various potential health benefits, such as anti-inflammatory, preventing cardiovascular disease, anti-diabetic and antihypertensive, strengthening bones, boosting immunity and improving metabolism.

Challenging the Subcostal Incision Scar with the Two-staged Abdominoplasty: An Innovative Approach

Abstract: Abdominoplasty is a commonly sought-after procedure due to its life-transforming results, but is limited, as in any other operation, by a number of contraindications. One of these contraindications is a subcostal scar, which may jeopardize blood supply to the upper flap of the abdominoplasty, resulting in skin necrosis. Herein, we challenge this dogma by introducing the two-staged abdominoplasty with the utilization of a delayed flap in a 48-year-old multiparous woman presenting with a Kocher incision of open cholecystectomy, with good results and a complication-free course of 3 postoperative months. We recommend this approach in patients with subcostal scars. However, more research into the utilization of delayed flaps in abdominoplasty should be done to have a more well-founded conclusion.

Isolated Congenital Left Ventricular Diverticulum of the Fetal Heart in a Twin Pregnancy: Case Report and Literature Review

Abstract: Abstract We report a rare congenital heart disease in the form of isolated fetal left ventricular diverticulum in a spontaneous twin pregnancy, detected at 30 weeks of gestation. The diagnosis was confirmed postnatally with Echocardiography and Cardiac MRI. The case highlights the relevance of antenatal screening in detecting cardiac anomalies as early as possible to allow early postnatal work up and intervention if needed. The patient is currently 6 years old, and is followed regularly and is completely asymptomatic with no intervention required

Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry

Abstract: The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG).The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality.A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF.CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.

Skin Preservation in the Debridement of Necrotizing Fasciitis: A Demonstrative Case Report

Abstract: Necrotizing fasciitis (NF) is a rare yet potentially fatal soft-tissue, polymicrobial infection. Aggressive debridement of the fascia and overlying skin as well as antimicrobial coverage constitute the mainstay of management, often leaving large skin defects. However, we demonstrate in this paper a case of a young woman who developed NF after liposuction and was treated by fascial debridement with minimal skin excision. Skin preservation will reduce the morbidity and improve the final aesthetic outcome.

Biotechnology applications in regenerative medicine

Abstract: Regenerative medicine is the branch of medicine that develops methods to regrow, repair, or replace damaged or diseased cells, organs, or tissues. Organ replacement for several chronic diseases is the need of the hour and the advantages of microengineered organoid systems may contribute to resolving some of these issues. Creating functional human organs outside the body with the ability to support living human tissues via embedded three-dimensional bioprinting is able to create personalized organ-specific tissues with embedded vascular channels for therapeutic applications. The fast-evolving tissue engineering technologies such as 3D printing, organoids-on-a-chip, single and multiple organs-on-a-chip may serve as more versatile and predictive preclinical models that are broadly applicable to conventional and emerging drug discovery processes and reduce the dependency on animal models. Tissue construction through the combined technical advances in different disciplines such as biology, engineering, and medicine is able to recreate physiologically viable organs to understand the disease process.

Genotype-Phenotype Correlation of a Rare Transthyretin Variant Causing Amyloidosis

Abstract: Left ventricular hypertrophy is a common entity with a broad differential diagnosis. We present a case of a middle-aged woman with left ventricular hypertrophy and neuropathy caused by a rare transthyretin variant in the absence of a family history or regional reports of hereditary transthyretin amyloidosis. This report outlines the diagnosis and management of patients with a mixed phenotype of hereditary transthyretin amyloidosis and enriches clinical data supporting the pathogenicity of a rare variant of transthyretin.L’hypertrophie ventriculaire gauche est une entité clinique fréquente pour laquelle le diagnostic différentiel est vaste. Nous décrivons le cas d’une femme d’âge moyen présentant une hypertrophie ventriculaire gauche et une neuropathie, causées par un variant rare de la transthyrétine en l’absence d’antécédents familiaux ou de cas régionaux déclarés d’amylose héréditaire à transthyrétine. Le présent article décrit le diagnostic et la prise en charge des patients qui présentent un phénotype mixte d’amylose héréditaire à transthyrétine, et il alimente le bassin de données cliniques sur la pathogénicité d’un variant rare de la transthyrétine.

First Experience in Living Liver Donation From Donors With Sickle Cell Trait

Abstract: Living donor liver transplantation is the main source of organs in the Middle East. Therefore, well balanced criteria are needed to avoid unnecessary exclusion of potential donors, while prioritizing donor safety. We face a high incidence of sickle cell trait (SCT; and disease). Therefore, there is vast experience in general and cardiac surgeries in SCT carriers at our center. After studying their management in detail, we considered accepting SCT carriers as living liver donors, on an exceptional basis. This the first single-center case series of living donor liver transplantation with SCT.Between January 2012 and September 2021, 20 donors with SCT were reviewed for age, gender, relation to the recipient, hemoglobin, hemoglobin S (HbS), surgical approach, intensive care unit stay, donor and recipients' complications, and graft and recipient survival.Average age of donors was 28.4 y. Sixteen donated the left lateral segment, 4 the left lobe. Recipients were related children or adults. HbS ranged from 21.2% to 39.9%, being ≥30% in 14 donors. HbS was reduced by phlebotomy or exchange transfusion. We performed 7 open, one laparoscopic, and 12 robotic donor surgeries. Operating room time, blood loss, and intensive care unit stay were comparable to non-SCT donors. There was no SCT-related complication. All donors are alive and free of thromboembolic events. Graft and recipient survival is 100% until follow-up.Our experience should encourage other countries with high incidence of SCT to report their experience with this donor population.