Jamal Al Wakeel

Hepatitis C in Chronic Renal Failure Patients

The occurrence of hepatitis C virus (HCV) infection amongst chronic renal failure (CRF) patients in our Nephrology Unit was investigated over a period of 1 year. A total of 71 patients was studied comprising 26 chronic haemodialysis (CHD) patients, 6 acute haemodialysis patients, 4 peritoneal dialysis patients and 35 CRF patients not on dialysis. Patients were screened before and after haemodialysis, and their baseline and postdialysis values of liver enzymes were determined. Eleven (15.5%) of the total 71 patients were HCV antibody positive. Analysis of the individual patient groups showed that 8 (30.7%) of the 26 CHD patients were positive for HCV. Our data showed a statistically significant relationship between seroconversion and duration of dialysis (p < 0.05). A high statistically significant (p < 0.0001) correlation was observed between the HCV antibodies and CRF. The relative risk of hepatitis C was about 22 times greater for those with CRF compared with the normal controls, which makes CRF an important risk factor. A high proportion of the HCV seroconverters had elevated liver enzyme (serum glutamic pyruvic transaminase). The data presented show a positive correlation between HCV seroconversion, CRF, duration on dialysis and elevated serum liver enzymes.

Predictors of quality of life in hemodialysis patients.

Quality of Life (QoL) is a consistent and powerful predictor that affects the out-come in end-stage renal disease (ESRD) patients on dialysis. This study was undertaken to identify the factors that might predict QoL scores among ESRD patients on hemodialysis (HD). The study was conducted at three HD units in Saudi Arabia from January 2007 to January 2008. We studied 100 HD patients (53 males and 47 females) and used the SF-36 and KDQoL-SF forms covering six domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. The mean age of the study patients was 47.5 ± 13.8 years and the mean duration of dialysis was 77.2 ± 75.5 months. The QoL scores were 45.8 ± 17.1 for general health, 53.1 ± 32.0 for physical QoL, 50.5 ± 14.8 for emotional QoL, 54.9 ± 18.1 for social QoL, 46.5 ± 13.7 for illness impact, and 45.9 ± 12.2 for the medical and financial domain. The total QoL score was 49.5 ± 13.7. The male patients had statistically significantly reduced QoL and younger patients had better QoL scores. The QoL scores revealed a decreasing trend with decreasing level of education; they were elevated among employed patients. Multiple linear regression analysis demonstrated that age, dialysis duration, and male sex were negative predictors of QoL score. We conclude from our study that QoL is reduced in all the health domains of HD patients. Older age, male gender, unemployment, and duration of dialysis adversely affected the QoL scores. Adequate management of some of these factors could influence patient outcomes.

Recommendations for Fasting in Ramadan for Patients on Peritoneal Dialysis

♦ Introduction: The month of Ramadan holds great religious and social significance for Muslims all over the world. The aim of the present study was to provide a modified dialysis schedule for peritoneal dialysis (PD) patients that allows for fasting and that minimizes the effect on the patient’s general health and volume status. ♦ Methods: We observed 31 patients under treatment at the PD unit of King Khalid University Hospital, King Saud University, Riyadh. During the 3 - 4 weeks before the start of Ramadan, all patients were counseled individually and in detail about the possibility of fasting. They were also provided with clear instructions about fluid intake (up to 1 L daily) and avoiding a high-potassium diet. Of the 31 patients, 18 (10 women, 8 men) elected to fast during the month of Ramadan. The mean duration of fast in the study year (2009) in Riyadh, Saudi Arabia, was about 14 hours: from 0415 h (before sunrise) to 1800 h (after sunset). Depending on membrane type and patient preference, the fasting group was shifted to one of two regimens: Modified continuous ambulatory PD (8 patients): 3 exchanges during the night (1.36% or 2.27%), and icodextrin for a long dwell during the day. The first dialysis exchange was performed immediately after breaking the fast (1900 h), and the next at 2300 h. The final exchange was performed in the early morning before sunrise (0300 h), when the icodextrin was infused. Modified continuous cycling PD (10 patients): exchanges (1.36% or 2.27%) were performed over 6 - 7 hours, and icodextrin was infused for a long dwell during the day. The patient connected to the cycler at 2000 h or 2100 h, and therapy finished at nearly 0300 h, with icodextrin as the last fill. ♦ Results: Of the study patients, 2 were admitted because of peritonitis (1 in each modality group), and the modified therapy was discontinued. In the modified CCPD group, 1 patient (on PD for 1 month before Ramadan) developed PD-related pleural effusion (proved by pleural fluid analysis), and PD was consequently discontinued. Hypotension developed in 2 patients of the CAPD group and 1 of the CCPD group during the first 2 weeks. In the CCPD group, 1 patient presented with lower limb edema and mild fluid overload. Overall, PD patients that opted to fast during Ramadan did not experience any serious morbidity or deterioration in renal function during their period of observance. No biochemical parameters or clearance studies showed a statistically significant p value. ♦ Conclusions: In view of the study findings, we conclude that most stable patients on PD can fast, provided that they strictly adhere to their medications and dialysis therapy in addition to the dietary restrictions. These patients should be followed closely to detect any complications and to ensure that adequate fluid and electrolyte balance are maintained.

Diabetic nephropathy in the Arab Gulf countries.

While the prevalence of diabetes mellitus is increasing worldwide, one third of the diabetic patients will eventually develop chronic kidney disease. The aim of this review is to present the available data on diabetic nephropathy and its complications in the Arab Gulf countries. This will eventually help to raise the awareness of both government and healthcare systems towards the substantial value of prevention, early detection as well as proper management of both diabetes mellitus and chronic kidney disease. This could be achieved by funding large-scale longitudinal studies, improving training programs (both research and clinical) and increasing the role of media in fighting this epidemic.

Cardiovascular and cerebrovascular comorbidities in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcome and practice pattern study phase 5 (2012-2015)

To determine the prevalence of cardiovascular comorbidities and their active risk factors in the selected hemodialysis centers in the Gulf Cooperation Council (GCC) countries, the Dialysis Outcome and Practice Pattern Study (DOPPS) was performed on 40 dialysis centers in the six GCC countries from June 2012 to May 2015. There were 21 dialysis centers from Saudi Arabia, nine from the United Arab Emirates (UAE), four from Kuwait, four from Oman, two from Qatar, and one from Bahrain. There were 922 patients participating in the study; 419 patients from Saudi Arabia, 144 from the UAE, 164 from Kuwait, 89 from Oman, 58 from Qatar, and 25 from Bahrain. Baseline data and laboratory investigations were obtained from every study patient, and the patients with any new events, change of dialysis prescription, or death were reported to the DOPPS main center during follow-up. The median age of the patients in the GCC centers was 55 years (range 32- 80 years), and the median percentage of males was 57%. The most common cause of chronic kidney disease among the study patients was diabetes mellitus (median: 43%) followed by hypertension (median: 29%) and glomerulonephritis (median: 9%). Hypertension (median 90%) and diabetes mellitus (median 52%) were the most common predisposing comorbidities to cardiovascular events in the study patients. The median ratios of patients with coronary artery disease, peripheral vascular disease, and congestive heart failure were 34%, 23%, and 24%, respectively. The median ratio for cerebrovascular comorbidities was 9%. The median prevalence of the factors that may predispose to the cardiovascular and cerebrovascular comorbidities such as gender of the patients, adequacy of dialysis, diabetes, hypertension, hypercholesterolemia, levels of anemia, parathormone levels, and calcium and phosphorus levels in the GCC countries were comparable with those in the previous DOPPS in other countries.

The dialysis outcomes and practice patterns study phase 5 in the Gulf Cooperation Council countries: Design and study methods

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort study of the relationships between hemodialysis (HD) care practices and HD patient outcomes. The DOPPS began in 1996, in the United States, and has since expanded to 21 countries, collecting detailed data from >75,000 HD patients, with >200 scientific publications, focused on describing HD practices associated with improved HD patient outcomes. The goal of DOPPS is to help HD patients live better and live longer. Starting in 2012, the DOPPS was able to expand to all six of the Gulf Cooperation Council (GCC) countries, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The DOPPS study design consists of selecting HD facilities for study participation in each country to represent the different types of HD facilities and geographic regions within each GCC country. Within each study site, HD patients were randomly selected for detailed data collection to represent the HD practices within each participating HD facility. Altogether, 41 HD facilities have participated in the GCC-DOPPS Phase 5 study including 20 facilities from Saudi Arabia, nine from the United Arab Emirates, four each from Kuwait and Oman, two from Qatar, and one from Bahrain. Herein, we provide a detailed description of the study design and methods, data collection, study management, scientific investigator oversight and guidance, and study governance and support for the GCCDOPPS Phase 5 study.

Do diabetic dialysis patients require more or less of erythropoietin

BACKGROUND AND OBJECTIVES To evaluate differences in erythropoietin requirements between diabetic and non-diabetic patients on hemodialysis and peritoneal dialysis. DESIGN AND SETTINGS This was a retrospective, cross-sectional study conducted between January 2010 and December 2011, at King Khalid University Hospital Riyadh, Saudi Arabia, with 47 peritoneal and 57 hemodialysis patients. METHODS A total of 24 (51%) peritoneal dialysis and 30 (52.6%) hemodialysis patients were suffering from diabetes. We compared demographics, hemoglobin, ferritin, transferrin saturation, C-reactive protein, parathyroid hormone, and weekly erythropoietin dose. RESULTS The mean weekly dose of erythropoietin was 5391.3 (4692.7) units in peritoneal dialysis (diabetic and non-diabetic) patients compared to 9869.7 (5631.7) units in hemodialysis (diabetic and non-diabetic) patients, with a difference of 4478.3 (6615) units (P=.001). The mean weekly dose in diabetic peritoneal dialysis patients was 3818.2 (4489.5) units, compared to 8814.8 (5121.9) units in hemodialysis (P=.001) patients. The mean weekly dose in non-diabetic peritoneal dialysis patients was 6545.4 (3863.5) units compared to 12 222 (6210) units in non-diabetic hemodialysis patients (P=.02). Diabetic peritoneal dialysis patients required a lower dose of erythropoietin compared to non-diabetic peritoneal dialysis patients (3818.2 [4489.5] units vs 6545.4 [3863.5] units per week) (P=.036). In hemodialysis patients, the mean erythropoietin dose was lower in diabetic patients compared to non-diabetic patients (8814.8 [5121.9] units vs 12 222 [6210] units per week) (P=.043). CONCLUSION The diabetic patients in both groups (hemodialysis and peritoneal dialysis) required less erythropoietin than non-diabetic patients. Diabetic patients on peritoneal dialysis required less erythropoietin diabetic patients on hemodialysis.

Gulf Cooperation Council-dialysis outcomes and practice patterns study: An overview of anemia management trends at the regional and country specific levels in the Gulf Cooperation Council countries

The Gulf Cooperation Council-Dialysis Outcomes and Practice Patterns Study (GCC-DOPPS) marks the joining of the six Gulf region countries including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates to the main DOPPS study in 2012. The current review is a descriptive reporting on results related to the management of anemia from these countries. Our data demonstrate consistent anemia management patterns across the GCC countries allowing the achievement of international treatment levels. Overall, the majority of hemodialysis patients were prescribed appropriate erythropoiesis-stimulating agents (ESAs) and supplemental iron, enabling the attainment of mean hemoglobin (Hb) level of 10.9 g/dL. Comparisons of the individual country profiles reveal individual differences in the choice and mode of ESA and iron administration. However, all countries displayed good compliance with guideline recommendations. The same challenges as elsewhere are faced in the GCC, with respect to optimizing Hb levels and judiciously using ESA and iron supplements. Some opportunities exist for focused efforts to fine tune inter-facility variability in anemia management based on continued data tracking. The latter is vital in enabling adopting new trends to further improve not only anemia management but also the wholesome care of dialysis patients.

Benefits of interdiayltic exercise program on quality of life for haemodialysis patients in Saudi Arabia

Background: Needle stick injuries (NSIs) are considered a major problem facing healthcare workers, especially, nursing students who are more vulnerable to the risks of NSIs. The study aims to identify the incidence of NSIs and evaluate its circumstances among university nursing students in four Arab countries. Method: A cross-national study employs a descriptive comparative design. Five universities in four Arab countries, two in Egypt and one each in three Arab countries: Jordan, Iraq, and Kingdom of Saudi Arabia (KSA) were conducted. Undergraduate nursing students (1,320) from second to fourth year were participated in the study. Selfadministered questionnaire were provided and indicating NSIs at clinical settings; frequency (number, nature and reason); and other circumstances including the places where the NSIs occurred. Results: There were significant relationships indicating that there is a high incidence of NSIs due to lack of knowledge toward needle sticks among university nursing students. Data shows that the students are vulnerable to contracting infections and are at risk. Percentage of those who have been exposed to injury was 40%. About half of the study subjects answered that they did not notify anyone of their NSI experiences. Conclusion: Universities should emphasize on evidencebased regulation and standards of infection control, occupational health and safety, to promote student awareness and prevention of NSIs. Infection control standards and nursing regulatory issues must be inculcated in the training and education programs of nursing students especially in dealing with needle sticks incidents. Nursing students should undergo mandatory vaccination program prior to enrolment.Pain is a human experience that affects overall quality of life. Nurses play a crucial role in assessing and managing patients’ pain. Effective pain management requires precise knowledge, attitudes and competent assessment skills. Knowledge deficits andT recent dramatic explosion in the US geriatric population is associated with increased complications, cost and trauma death rates. Geriatric trauma management strategies which had been previously developed during an era when the census of the elderly was comparatively low are now seen by many as woefully inadequate to meet present-day challenges. Presented with this challenge we must now cease the opportunity to develop innovative interventions designed specifically to address the enormous unmet health quality and economic needs of the elderly. Innovation in geriatric trauma will require thought leaders who are not only prepared to lead but must champion the cause of the elderly and function as catalysts to transform the New Trauma Culture. This presentation will describe services we developed in response to intervention gaps we identified in geriatric trauma care through research. Several of these projects include: Geriatric G-60 service, falls and deaths, rib plating, femoral iliaca nerve blocks for hip fractures. We have tested-driven a number of these strategies to see how well they perform and we plan to share these findings with you including lessons learned. Finally we suggest research needs to advance the field of geriatric trauma. We believe these plans may improve outcomes for the ever increasing number of geriatric patients.Introduction: Asthma affects an estimated 300 million people worldwide. The estimated prevalence of asthma among adults in Malaysia is 4.2%. One of the important factors in poor asthma control is non-adherence to treatment. Evidence has indicated prevalence and severity of symptoms and rates of hospital admission for adults with asthma are increasing in many countries due to non-adherence to prescribed medication.B Disease (BD) is a chronic, relapsing, systemic vasculitis of unknown aetiology with clinical features of mucocutaneous lesions, ocular, vascular, articular, gastrointestinal, urogenital, pulmonary and neurologic involvement. In BD, symptoms are varied and all these symptoms negatively affect the biopsychological and social life of the patients and reduce their quality of life. In a study by Canbolat et al. (2010), it was determined that, of the patients, 75.5% had pain, 31.9% had sleep problems and 23.4% suffered from fatigue. While bodily pains affected the daily lives of 59.6% of the patients, fatigue affected the daily lives of 69.1% of them. In a study conducted by Karlidag et al. (2001) it was determined that patients with Behcet’s disease experienced fear, sadness, anxiety, hopelessness and ambiguity (74.9%), that they often used active relaxation strategy (36.1%), distraction strategy (25%) and avoidance strategy in order to cope with the disease and that those who had difficulty in coping suffered psychiatric symptoms. Nursing care is for these people who need a qualified nursing care team available to them 24 hours a day. That might include people who need intensive rehabilitative care, for example, people who need oral care, people with physical disabilities and people with long-term conditions. Nursing care is based on the use of personalized care plans. Individual nursing care plan is important for these patients.W bullying has become increasingly prevalent in healthcare and there is significant data to support bullying befalls and carries destruction. The zone of silence that surrounds and insulates this surreptitious behavior is real. In an environment in which bullying is not addressed, it often spreads. Many ramifications of workplace bullying affect employees as well as patients and can lead to decreased reimbursement, unsafe conditions and increases in errors in addition to an overall negative reputation for an organization. Recently, studies have suggested there is a direct correlation between professional nursing educational programs and decreased incivility in the workplace. Research studies support that when bullies in the workplace are held accountable, staff are more empowered to come forward and report these events. Through education, prevention and awareness, nursing educational programs can be instrumental in eradicating this behavior both in the academic world and hospital based settings. Undergraduate nursing students in the academic arena could benefit from evidence-based education on ramifications of buying and how to address it in their practice. Hospital based nursing education programs outlining policies and acceptable behaviors are another forum that could help to prevent workplace violence. Researchers agree additional studies are needed in order to examine the effectiveness of nursing educational programs on eliminating covert bullying.Collaboration in Student’s Simulated Clinical Practice nPresentation Objectives: nShare strategies for collaborative education of students in health Industries. nReinforce the concept and value of experiential learning in education. nHighlight ways of including Inter-professional collaboration in simulation. nAbstract: nBackground /Rationale: nFor many undergraduate students in the health industry, limited numbers of quality clinical placements and variable placement experiences limit learning opportunities. In order to introduce students to the collaborative care and develop communication skills, social work, occupational therapy and nursing students in undergraduate health programmes at Wintec in New Zealand took part in a simulated Inter-professional meeting which was part of a simulated nursing practice programme. nMethod/Methodology: nSelf-selecting participants completed a questionnaire answering five open ended questions and responded to an opportunity to take part in a focus group. Research findings were analysed through a process of thematic analysis whereby each sentence of data was analysed in the first instance and categorised. Categories were then analysed and merged where appropriate to form the overall themes. nKolb’s (1984) Experiential Learning Theory provided a theoretical framework to guide this study. nResults: nOf the 72 participants, (54 nursing students, 8 occupational therapy students and 10 social work students) (n=48) responded to the questionnaire. Nine of these students also took part in the focus group. Themes identified from overall participant responses were: professional role clarification and awareness, preparedness, safety and realism. nConclusions: nResults in this study suggest that the simulated collaborative meeting overall provided a valuable learning experience for students. The study also highlighted the need to ensure that all students involved, receive the same information and are well prepared for the simulated meeting. Further research is required within the professional group to establish the value of including this type of experiential learning into undergraduate health and social practice programmesMethods: Data was derived from 244 pregnant women admitted to the obstetrics and gynecology department of a tertiary care centre for their routine follow-up. Two questionnaires consisting of “Personal Introductory Form” and “Health Practice Questionnaire-II” were applied to gather information about demographics and health related knowledge and attitudes. Cronbach’s alpha has yielded a coefficient of 0.644 indicating a satisfactory level of reliability.I November 2009, during an ice storm in Cleveland an autistic mother brought her two autistic daughters to our Clinic for help. I decided to investigate further on how to help her. The consensus among autism researchers was that genetic and environmental factors were the main causes. Vaccines containing thimersol with mercury were also suspected because parents noticed symptoms around the time of vaccination. With thimersol removal the autism rate increased. Reliable statistics were not available. The CDC set up stations in 14 states to monitor incidence and found an 18% yearly increase. Use of the statistic of 8 year olds was found to be more reliable because by that time the diagnosis of autism has been established. However, dietary intake could not be established and a process called nutritional epidemiology was used. Results showed that the greater the percentage of breast feeding the higher the number of autism cases in the states and the counties of 4 of these states. The amounts of milk that babies drank were determined from the USDA and the amounts of B-vitamins consumed were calculated. Results showed that the minimal daily requirements were not met. Sugar was significantly related directly to the autism rate of eight year olds. In conclusion, it appears that autism may be related to inadequate intake of B-vitamins.The current practice of neonatal medicine has been carved with recent findings based on studies and prospective or follow-up studies of potentially very severe patients who, at birth, are more likely to not survive than grow and develop normally. Thanks to a better understanding of the pathophysiology of specific diseases of the immature newborn and technical and scientific improvements in the care and treatment of these patients. Especially the introduction of antenatal corticosteroids, parenteral nutrition, synchronized mode of ventilations which are patient triggered and non-invasive ventilation, like CPAP (Continous Positive Airway Pressure) for newborns. The better resuscitation care, the knowledge about the golden hour approach and the exogenous surfactant was a dramatic reduction in mortality of these patients over the past 3 decades. Having reached a low neonatal mortality, the focus of Perinatology now also addressing the quality of life in the medium and long-term patients discharged from the Maternity Hospital.Methods: A quasi-experimental intervention design was used, pre-post assessment of the effect of implementation of exercise program for hemodialysis patients at Mohail General Hospitalsouthern of Saudi Arabia. The questionnaires were used to collect data: Physical Fitness Measurement, KDQoL-SFTM 1.3, Borgs 15-point scale for rating of perceived exertion (RPE), vital signs and lab investigation (Hemoglobin, Serum phosphates, Serum albumin, Creatinine, Fasting blood sugar, Kt/v and Urea).