Introduction: Blood transfusion practices affect both patient’s outcomes and utilization of institutional resources. Evidence shows that liberal blood transfusion has a detrimental effect on patient’s outcome. A restrictive approach of blood transfusion is recommended by current clinical guidelines. Aim: The aim of this study was to evaluate the attitudes, knowledge, and practices of general surgery (GS) staff and residents regarding peri-operative blood transfusion and anemia management. Material and Methods: A self-administered, web-based questionnaire was developed, and its link was sent to the emails of all general surgeons at King Abdul-Aziz University Hospital (KAUH), Jeddah city, Saudi Arabia. The questionnaire included four parts: 1) background of surgeons; 2) preoperative assessment and management of anemia; 3) post-operative blood transfusion and alternatives; and 4) enablers and barriers. Results: 56 surgeons responded to the questionnaire. We found variations in blood transfusion practices, notably the hemoglobin threshold. For stable non-cardiac cases, 7 g/dL was considered the threshold by 50% of respondents. For stable patients with past cardiac disease, a higher threshold was chosen by most (9 g/dL by 43% and 10 gm/dL by 21%). Most respondents believed that transfusion had no effect on the risk of survival (73%) and on the risk of cancer recurrence (55%) after oncologic surgical resection. Recognized facilitators were the availability of scientific evidence (84%), medicolegal concerns (57%), preference (52%), and institutional protocols (50%). Conclusion: Although current clinical guidelines recommend a restrictive transfusion practice, most respondents tended to over-order blood for elective procedures and were not aware of the potential complications of liberal blood transfusion. To implement the restrictive transfusion policies, health institutions should improve the awareness of surgeons and incorporate a strong supporting evidence in formulating local institutional guidelines.
IntroductionCongenital nasolacrimal duct obstruction (CNLDO) is one of the most common congenital abnormalities encountered by pediatric ophthalmologists, occurring in 20-30% of all neonates (range: 6-84%). The majority of the cases (up to 90%) resolve within the first year of birth. Many syndromes, such as Down syndrome, are associated with congenital lacrimal anomalies. The prevalence of nasolacrimal anomalies in Down syndrome has been reported to be 22%. MethodsThis was a retrospective study of all children diagnosed with Down syndrome
Occurrence of early nephrotic syndrome in type 1 diabetes mellitus patients is extremely rare. Herein, we report the case of a 12-year-old boy who presented to our pediatric nephrology clinic with generalized edema. He had been diagnosed with type 1 diabetes mellitus at age 9 and had been treated with regular insulin. Examinations revealed normal kidney function, hypoalbuminemia, proteinuria (4+), hyperlipidemia, and low protein-to-creatinine ratio. The patient was diagnosed with idiopathic nephrotic syndrome and was empirically administered prednisolone for 12 weeks. Subsequently, prednisolone was tapered over 10–12 weeks. The patient showed good response to treatment. In conclusion, co-existence of nephrotic syndrome and type 1 diabetes mellitus may suggest an immunological basis; therefore, further studies are needed to investigate the relationship between these two conditions.
Background With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective.
BACKGROUND In head and neck squamous cell carcinoma patients (HNSCC), post treatment surveillance for distant disease is mostly focusing on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of the cases and a high rate of primary of the lungs can be expected due to field cancerization of the entire upper aero digestive tract. OBJECTIVE The survey aimed to evaluate the current beliefs and pulmonary screening practices among otolaryngology-head & neck surgeons across Saudi Arabia in the post treatment surveillance of head and neck squamous cell carcinoma. METHODS This is a nation-wide cross sectional survey was conducted among Head and Neck surgeon members of the Saudi Society of Otolaryngology. Data Collected During The Period From 1– 30 July , 2020. Predesigned questionnaire including all the relevant questions to fulfill the study objectives. Questions inquired about characteristics of routine lung screening during the post treatment follow-up of head and neck cancer. The questionnaire distributed on all head and neck surgeon of the Saudi Society of Otolaryngology, of Saudi Arabia. RESULTS As regards the methods of routine lung screening during the post treatment follow-up of head and neck cancer, our study found that the majority 40% 9 out of 22 participants used lung radiography followed by 31% 7 out of 22 participants used low dose CT and 27 % 6 out of 22 participants used PET/CT. Regarding to duration of lung screening in head and neck cancer during follow up in physician's practice, the majority 77 % 17 out of 22 participants reported 5 years, 13% 3 out of 22 participants 10 years and only 9 % 2 out of 22 participants performed lung screening lifelong. As regards frequency of lung screening; 77 % 17 out of 22 participants reported annually screening,18% 4 out of 22 participants half-yearly and 4% 1 out of 22 participants biennially. According to believed effectiveness of the screening procedures listed in question 1 in reducing lung cancer mortality during the follow-up of head and neck cancer; 6% 8 out of 22 participants believed to be very effective or somewhat effective, 18% 4 out of 22 participants don’t know and only 9% 2 out of 22believed that it was not effective. CONCLUSIONS The majority used lung radiography, low dose CT and PET/CT as a routine lung screening during the post treatment follow-up of head and neck cancer for mainly 5 years, 10 years and only small percent performed lung screening lifelong. lung screening was mostly annually or half-yearly. The screening believed to be very effective or somewhat effective.
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