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2018| January-March | Volume 6 | Issue 1
January 8, 2018
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Pancreatic tuberculosis causing biliary obstruction and mimicking pancreatic malignancy
Noura Abdulaziz Al Najdi, Basim Abdulrazzak Felemban, Ahmed Haroun Abou Issa
January-March 2018, 6(1):39-44
Tuberculosis (TB) is a bacterial infection which can affect any part of the body from head to toe and has various presentations depending on the site of the infection. Pancreatic TB is very rare and usually happens as a part of disseminated or miliary TB, whereas isolated pancreatic TB is even rarer. Here, we present a case of pancreatic TB at a TB endemic zone which presented with obstructive jaundice and pancreatic lesions mimicking pancreatic malignancy. A 46-year-old Saudi female patient presented with right upper quadrant abdominal pain associated with dark coloured urine and pale stool. The patient had been admitted to the surgical ward as a case of acute cholecystitis for further evaluation. On abdominal ultrasound (US), findings demonstrated dilated common bile duct (CBD), but the distal part was difficult to be visualised; hence, further evaluation by magnetic resonance cholangiopancreatography (MRCP) was recommended to look for CBD stones. The MRCP showed two focal pancreatic lesions causing the distal CBD obstruction with no stones at CBD. Based on these findings, malignancy was considered and computed tomography-guided fine-needle aspiration biopsy from the pancreatic neck lesion was performed. This demonstrated multiple granulomas and lymphocytes with no malignant cell which indicated pancreatic TB. The patient became well after a course of anti-TB medications. pancreatic TB should be included in the differential diagnosis of pancreatic masses, especially in those patients who live in an endemic area of TB. A biopsy is necessary to establish the diagnosis and start the appropriate treatment for this curable disease as soon as possible.
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Residents and teaching physicians' perception about bedside teaching in non-clinical shift in the emergency department of King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
January-March 2018, 6(1):1-13
Bedside teaching (BT) is teaching in the presence of the patients which allows direct observation of the learner. It is a very crucial educational modality, which has declined significantly over the last decades. It is under-utilised and under-studied in Emergency Medicine. Although time constraints in the emergency department (ED) is associated with efficient and effective patient management; it exerts a negative influence on the time spent on bedside teaching.
To determine the residents' and teaching physicians' (TPs') perception about BT in non-clinical shift regarding: Clinical knowledge, data gathering, procedure performance, communication and constructive feedback.
Quantitative, cross-sectional study was done at King Abdulaziz Medical City, ED. Two groups were formed: (learners
=30) and (TP
=50. We used self-administered questionnaire and then the data was analysed using SPSS version 20.0. Demographic data and results were expressed by mean ±SD and percentage. Comparison was then made between the two groups by using
There were 50 participants in this study and 100% filled the questionnaires. All 20 (100%) of TP have previous experience with BT vs. only 17 (58%) of the learners. The residents and TPs responded to benefits of the BT: on clinical knowledge with mean values of (4.63±0.41 vs. 4.76±0.37) respectively and on data gathering with mean values of (4.73±0.51 vs. 4.24±0.97) respectively. Forty-six percent of the learners and 20% of the TPs responded to the benefits on procedures; however, the mean values of (4.93±1.0 and 5.0±0.01) were reported from the residents and TPs respectively. Regarding communications, we got mean values of (4.65±1.25 vs. 4.18±0.46) respectively. In regards to giving constructive feedback, the two groups' perceptions gave mean values of (4.58±1.01 vs. 4.57±0.8) in the residents group vs. TPs.
Based on the review of the learners and the TPs' perception, we concluded that BT in non-clinical shift is very effective to improve the learners' clinical knowledge, data gathering, communication skills and facilitates giving constructive feedback. However, the benefits regarding procedure performance is still an area that needs further investigation.
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Clinical characteristics and outcomes of acute lymphoblastic leukaemia in children treated at a single tertiary hospital in Riyadh, Saudi Arabia
Ali S Al Omari, Talal Alshareef Hussein, Khaled Abdullah Albarrak, Abdulrahman Khalid Habib, Alzubeir Anas Sambas, Nagham Sheblaq, Aamir Omair
January-March 2018, 6(1):14-18
Acute lymphoblastic leukaemia (ALL) is the most common paediatric cancer worldwide, and it accounts for 30% of all cancer cases in children of Saudi Arabia.
This study aims to describe the clinical characteristics and outcomes of paediatric ALL.
Settings and Design:
This case series study was conducted at a single tertiary hospital in Saudi Arabia.
Clinical data and outcomes of all patients diagnosed between 2000 and 2010 were collected from medical charts using a custom data collection sheet.
Data were analysed using SPSS. Mann–Whitney test was used to compare the median age of diagnosis between different categories as the age was not normally distributed.
This study included 50 patients (median age, 4 years; 58% male). The majority (82%) had pre-B-cell ALL and 18% had T-cell ALL. Thirty-one (62%) patients were in the standard risk category, 18 (36%) in the high-risk category and one (2%) in the very high-risk category. Forty-nine (98%) patients achieved complete remission. The remission status was M1 marrow status in 46 (94%) patients. The overall survival and event-free survival rates were 92% and 74%, respectively, with 4 (8%) deaths due to different complications.
This is the first 10-year case series study in a single tertiary institution in Saudi Arabia. The clinical characteristics of children with ALL were similar to those reported in the literature. The use of well-defined treatment protocols improved the survival rates to levels that are comparable to those of developed countries.
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A grounded theory pilot study: Exploring the perceptions of patient advocacy in a Saudi Arabian critical care context
Manfred Mortell, Chean Ahmad, Khatijah L Abdullah
January-March 2018, 6(1):19-22
The purpose of this pilot study was to determine the applicability, feasibility and practicality of a constructivist-grounded theory design to explore the perceptions of patient advocacy amongst Saudi Arabian Intensive Care Unit (ICU) nurses and to assess the effectiveness of the data collection methodology.
Patient advocacy for all patients in a critical care setting is essential as a component of patient safety. However, data, information and knowledge pertaining to Saudi Arabian ICU nurses' perceptions of patient advocacy in the critical care setting are currently non-existent.
The pilot study used a constructionist-grounded theory approach with a purposive sample of five Saudi Arabian ICU nurses. The data were collected using single participant semi-structured interviews which were guided by the individual participant's responses. A reflective participant journal and a follow-up focus group interview were also employed.
The findings of the study confirmed that a constructivist-grounded theory design was a feasible and logical approach to explore the perceptions of patient advocacy amongst Saudi Arabian ICU nurses. It also highlighted important implications for all Saudi Arabian nurses and their indigenous patients, which would ultimately enhance patient outcomes and safety. The pilot study also validated the efficacy of the data collection strategies, with the participants' approval that data collection transpired without prompting or forcing the data by the researcher.
As novice researcher, the pilot study provided a discerning introduction to grounded theory as a research methodology. It also confirmed that a grounded theory approach was apt to explore the perceptions of patient advocacy amongst Saudi Arabian ICU nurses, in addition to being an effective participant recruitment strategy and a data collection and analysis tool.
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Career choices of final year medical students and interns at King Abdulaziz University: Where does orthopaedics stand?
Abdullah Ashour, Abdolrahman Ashour, Mohammed Asiri, Mohammed Alghamdi, Amna Jamjoom, Ahmed Alghamdi, Ali Chaudhary
January-March 2018, 6(1):23-29
An extensive variety of medical specialities challenge medical students, owing to the numerous factors in choosing a profession or area of specialisation. Understanding the factors that lead to their choice of speciality is important to address the job market requirements.
To determine graduating medical students' aptitude in making a career choice from King Abdulaziz University (KAU). To identify the factors affecting their career choices and determine where Orthopedic Surgery stands as a career choice amongst other specialities; and to assess whether trends and perceptions change once the students graduate and are near completing their internship.
A cross-sectional study was conducted amongst 6
year medical students and medical interns at KAU, Jeddah, Saudi Arabia, during the period of February to April 2015. A self-administered questionnaire was formulated and converted electronically and sent to the respondents through E-mail. Responses were recorded in Google spreadsheet and data analysis was done using SPSS version 23.
It was found that amongst the 232 respondents, Internal Medicine was the most prevalent speciality chosen by both 6
year students and interns while Orthopaedic sits at the sixth rank. Personal interest was the most important factor in choosing a speciality followed by positive experience during undergraduate elective rotation. Future job opportunity was also a consideration in addition to previous positive clerkship experience along with the desire to serve the community.
The medical students' speciality of choice at KAU did not lean or was not affected by fixed factors, such as their grade point average, level of education or gender. Instead, their choice of speciality was greatly affected by their personal interest which is considered to be subjective by nature.
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Defensive practice among psychiatrists in middle East Countries: A questionnaire survey
Abdulrahman A Al-Atram
January-March 2018, 6(1):30-38
Increasing medicolegal litigations, claims and compensation have forced doctors to make some defensive changes in their practice. This study was conducted to examine the prevalence of defensive practice among psychiatrists in Middle Eastern countries along with examining the relationship of defensiveness with seniority and previous medicolegal experiences.
A questionnaire with thirteen questions was shared among 215 psychiatrists practicing in Middle Eastern countries. The collected data were analysed statistically using SPSS version 21.
Ninety-two valid responses were received and analysed, out of which sixty-two of them were from Saudi Arabia. An overall 30% (
= 28/92) of the psychiatrists have taken a defensive action in their practice in the past one month. Nearly 28% (
= 26/92) of them approved unwanted patient admission, 30% (
= 28/92) kept the patient on a higher observation. Both these defensive actions are less prevalent among the senior psychiatrists. While 24% (
= 22/92) and 30% (
= 28/92) of psychiatrists had written specific remarks such as “not suicidal” and dictated letters more than necessary for managing patient's illness, respectively, and this behaviour was more prevalent among senior psychiatrists.
An overall 30% (
= 28/92) of the psychiatrists have taken a defensive action in their practice over the past one month. Knowledge and experience of previous medicolegal issues were important factors influencing the defensive practice. The propensity of junior psychiatrists to practice defensively may be attributed to decreased confidence. More systematic problem-based training, proper guidelines for practice insurance and more clarity and transparency in the investigation and handling of medicolegal issues may help reduce the defensive practice and improve better patient care.
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