Hamdan Al-jahdali - Academia.edu (original) (raw)

Papers by Hamdan Al-jahdali

Advances in Medical Education and Practice, 2015

Outcome-focused, competency-based educational curricula have become the norm in residency trainin... more Outcome-focused, competency-based educational curricula have become the norm in residency training programs. The Canadian Medical Education Directives for Specialists (CanMEDS) framework is one example of such a curriculum. However, models for incorporating all the competencies in everyday clinical practice have been difficult to accomplish. In this manuscript, a CanMEDS, competency-structured, acute case discussion in a regular morning meeting was undertaken. All the diagnostic and therapeutic interventions were explicitly organized and discussed under their respective CanMEDS competency headings. Post exercise, the majority of residents felt that they were more competent in all the competencies and indicated their willingness to continue having similarly structured acute case discussions in the future.

D103. ETHICS AND END-OF-LIFE IN THE ICU, 2010

... 265-266 (Second Level), Morial Convention Center Advanced Directive Preferences Among Patient... more ... 265-266 (Second Level), Morial Convention Center Advanced Directive Preferences Among Patients With Chronic Illness , S. Baharoon , H. Alzahrani , H. Tamim , Y. Babgi , A. Al-Sayyari HH AL-Jahdali1 2 2 2 2 2 King Saud University for health science, Riyadh. ...

Journal of epidemiology and global health, Jan 11, 2016

Middle East respiratory syndrome coronavirus (MERS-CoV), is an emerging virus respiratory infecti... more Middle East respiratory syndrome coronavirus (MERS-CoV), is an emerging virus respiratory infection. It has a high mortality rate and a wide spectrum of clinical features. This study describes the clinical characteristics and outcome of MERS infected patients. A retrospective study was conducted of all confirmed MERS-CoV infections from March 2014 to May 2014 at two tertiary care hospitals in Medinah region (Saudi Arabia). We gathered data about demographic, clinical presentation, and factors associated with severity and mortality. A total of 29 cases were identified; 20 males (69%) and nine females (31%), age 45±12years. The death rate was higher for men (52%) than for women (23%). Initial presentation was fever in 22 (75%) cases, cough in 20 (69%) cases, and shortness of breath in 20 (69%) cases. Associated comorbidities were diabetes mellitus in nine (31%) patients and chronic kidney disease (CKD) in eight (27%) patients. Duration of symptoms before hospitalization ranged from 2....

Annals of Transplantation, 2016

Hepatopulmonary syndrome (HPS) is commonly encountered in the setting of end-stage liver disease ... more Hepatopulmonary syndrome (HPS) is commonly encountered in the setting of end-stage liver disease (ESLD). Past studies have reported conflicting results in terms of demonstrating an association between HPS and mortality. The aim of this study was to determine the prevalence of HPS in patients with ESLD referred for assessment of transplantation suitability. In addition, we investigated survival rates in the setting of HPS, with and without liver transplantation. The medical records of 524 consecutive patients with ESLD evaluated for potential liver transplantation were retrospectively reviewed. HPS was defined by a reduced partial pressure of oxygen or an elevated alveolar-arterial oxygen gradient and the presence of intrapulmonary vascular dilatation on contrast-enhanced echocardiography. In total, 57 subjects (12%) fulfilled the diagnostic criteria of HPS; 88% of these had mild to moderate HPS. For patients with HPS, the overall survival rates at 1 and 3 years were 95% and 92%, respectively. Liver transplants were received by 245 patients (53%), 26 of whom had HPS. For transplant recipients with HPS, the overall survival rates at 1 and 3 years were 96% and 91%, respectively, compared to 85% and 80% in subjects without HPS. Post-transplantation survival in patients with and without HPS did not differ significantly (HR=0.489, 95% CI: 0.153-1.564; p=0.228). This study demonstrated a high prevalence of IPVD and HPS among patients who were potential candidates for liver transplantation. HPS was mild to moderate in the majority of those affected and had no significant effect on overall survival.

Current Pulmonology Reports, 2015

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2012

Sleep apnea (SA) and excessive daytime sleepiness (EDS) are common sleep disorders among patients... more Sleep apnea (SA) and excessive daytime sleepiness (EDS) are common sleep disorders among patients with end-stage renal disease (ESRD). This cross-sectional study, carried out in two dialysis centers in Saudi Arabia, assessed the prevalence of sleep apnea and sleepiness in Saudi patients with ESRD who are on maintenance dialysis with either peritoneal or hemodialysis. We used questionnaires to assess the prevalence of SA and EDS. The association between sleep apnea, EDS, and other sleep disorders, the underlying causes of renal failure, and other demographic data were also examined. Among 227 enrolled patients, the mean patient age was 55.7 years ± 17.2 years; 53.7% were male, and 46.3% were female. The overall prevalence of SA as defined by the Berlin questionnaire (BQ) was 37% in males and 34% in females, which was not a statistically significant difference (P = 0.459). Sleep apnea was significantly associated with age, neck size, afternoon and evening hemodialysis shift, obesity, ...

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2011

Studies have shown that sleep disorders are common among dialysis patients; however, few studies ... more Studies have shown that sleep disorders are common among dialysis patients; however, few studies have compared the prevalence of different sleep disorders in patients on peritoneal dialysis (PD) and hemodialysis (HD). We used questionnaires to assess the prevalence of common sleep disorders in dialysis patients. We compared the prevalence of sleep apnea (SA) risk, restless legs syndrome (RLS), insomnia, and excessive daytime sleepiness (EDS), as well as sleep quality, in both groups. Of the 227 patients who were enrolled in the study, the total number of patients on HD was 188 (82%), while the total number of patients on PD was 39 (18%). There were no significant differences between the two groups regarding age, neck size, or duration on dialysis (all P >0.05). The estimated overall prevalence of SA was significantly higher in PD patients in comparison with HD patients (92% and 67%, respectively; P <0.05). The prevalence of insomnia was similar in both groups. The prevalence o...

Portopulmonary hypertension (POPH) is rarely encountered in the setting of end-stage liver diseas... more Portopulmonary hypertension (POPH) is rarely encountered in the setting of end-stage liver disease (ESLD) and, if severe, may preclude patients from undergoing liver transplantation. The aim of the present study was to determine the prevalence of POPH in the setting of ESLD for patients who were referred to King Abdulaziz Medical City-Riyadh (Riyadh, Saudi Arabia) for assessment for liver transplantation. The medical records of all patients evaluated for liver transplantation between 1993 and 2009 were retrospectively reviewed. Pulmonary hypertension (PH) was defined as an echocardiographically estimated right ventricular systolic pressure ≥40 mmHg and a mean pulmonary arterial pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25 mmHg measured using right heart catheterization. A total of 542 consecutive subjects with ESLD who underwent assessment for liver transplantation were identified; however, medical records for 18 were missing. The final cohort, therefore, consisted of 524 subjects with a mean (±SD) age of 49±13.9 years, 60% were male, and 70% had viral hepatitis. PH was detected by echocardiography in 64 (12%) of the 524 subjects. Hemodynamic data obtained from intraoperative right heart catheterization or as part of the pre-transplantation evaluation were available for 248 subjects, including 57 of the 64 who had echocardiographically defined PH. PH was confirmed in 30 subjects and ruled out in 27, and only 4 (0.76%) subjects fulfilled the criteria for POPH. The prevalence of POPH determined in the present study was lower than previously reported. Further prospective research is needed to confirm this finding and to explore possible clinical, genetic, and environmental factors that contribute to the low prevalence of POPH in regions highly endemic for viral hepatitis.

Infection and Immunity, Aug 1, 1998

Antibody responses during tuberculosis were analyzed by an enzyme-linked immunosorbent assay with... more Antibody responses during tuberculosis were analyzed by an enzyme-linked immunosorbent assay with a panel of 10 protein antigens of Mycobacterium tuberculosis. It was shown that serum immunoglobulin G antibodies were produced against a variety of M. tuberculosis antigens and that the vast majority of sera from tuberculosis patients contained antibodies against one or more M. tuberculosis antigens. The number and the species of serologically reactive antigens varied greatly from individual to individual. In a given serum, the level of specific antibodies also varied with the antigen irrespective of the total number of antigens recognized by that particular serum. These findings indicate that person-to-person heterogeneity of antigen recognition, rather than recognition of particular antigens, is a key attribute of the antibody response in tuberculosis.

The Indian Journal of Medical Research, Mar 1, 2011

Latent tuberculosis infection (LTBI) can be detected with immune based tests such as the tubercul... more Latent tuberculosis infection (LTBI) can be detected with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA). Therapy for those with positive tests can reduce the subsequent risk of re-activation and development of active TB. Current standard therapy is isoniazid (INH) which reduce the risk of active TB by as much as 90 per cent if taken daily for 9 months. However, this lengthy duration of therapy discourages patients, and the risk of serious adverse events such as hepatotoxicity, discourages both patients and providers. As a result completion of INH therapy is less than 50 per cent in many programmes. However, programmes that offer close follow up with supportive staff who emphasize patient education, have reported much better results. The problems with INH have stimulated development and evaluation of several shorter regimens. One alternative was two months daily rifampin and pyrazinamide; this regimen has been largely abandoned due to unacceptably high rates of hepatotoxicity and poor tolerability. The combination of INH and rifampin, taken for 3 or 4 months, has efficacy equivalent to 6 months INH albeit with somewhat increased hepatotoxicity. Four months rifampin has efficacy at least equivalent to 6 months INH but there are inadequate trial data on efficacy. The safety of this regimen has been demonstrated repeatedly. Most recently, a regimen of 3 months INH rifapentine taken once weekly under direct observation has been evaluated in a large scale trial. Results have not yet been published, but if this regimen is as effective as INH, this may be a very good alternative. However, close monitoring and surveillance is strongly suggested for the first few years after its introduction. Evidence from several randomized trials has shown that the benefits of LTBI therapy is only in individuals who are tuberculin skin test (TST) positive even among those with HIV infection. Hence, LTBI therapy should be given only to those with positive tests for LTBI. We conclude that LTBI therapy is considerably underutilized in many settings, particularly in low and middle income countries.

Gut, 1994

A 40 year old woman with known Crohn's disease of the ileum but no abscess was found to have ... more A 40 year old woman with known Crohn's disease of the ileum but no abscess was found to have hepatic portal venous gas by computed tomography. Aggressive antibiotic treatment led to recovery and the ileum was resected two weeks later.

Tuberculin skin test (TST) interpretation can be confounded by Bacillus Calmette-Guérin (BCG) vac... more Tuberculin skin test (TST) interpretation can be confounded by Bacillus Calmette-Guérin (BCG) vaccination and infection with nontuberculosis mycobacteria (NTM). However, a wealth of epidemiologic information has allowed the formulation of recommendations for reasonably informed interpretation of the TST in most clinical situations. In the Middle East, the TST remains a useful test. BCG vaccination is given at birth, which should have minimal effect on TST reactions in adolescents or adults. In countries of the Middle East with moderate to high incidence of active smear-positive pulmonary TB (.20 per 100,000 per year), a positive TST will almost always indicate true TB infection. However, in Middle East countries with very low incidence of active TB (,10 per 100,000 per year), a positive TST will more likely be false positive because BCG vaccination is still routinely given; until BCG vaccination is abandoned, the TST will be less useful in these countries. These findings are applicable to countries in other regions of the world, and the utility TST will also be increased where the likelihood of TB infection is higher and lowered where TB infection is unlikely, yet BCG vaccination is still given. (Am J Infect Control 2005;33:151-6.)

Annals of Thoracic Medicine, 2015

With increased exposure of patients to routine imaging, incidental benign intrathoracic masses ar... more With increased exposure of patients to routine imaging, incidental benign intrathoracic masses are frequently recognized. Most have classical imaging features, which are pathognomonic for their benignity. The aim of this pictorial review is to educate the reader of radiological features of several types of intrathoracic masses. The masses are categorized based on their location/origin and are grouped into parenchymal, pleural, mediastinal, or bronchial. Thoracic wall masses that invade the thorax such as neurofibromas and lipomas are included as they may mimic intrathoracic masses. All examples are illustrated and include pulmonary hamartoma, pleural fibroma, sarcoidosis, bronchial carcinoid, and bronchoceles together with a variety of mediastinal cysts on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Sometimes a multimodality approach would be needed to confirm the diagnosis in atypical cases. The study would include the incorporation of radionuclide studies and relevant discussion in a multidisciplinary setting.

Journal of Epidemiology and Global Health, 2015

The aim of this study is to assess whether the effect of gender on the excessive daytime sleepine... more The aim of this study is to assess whether the effect of gender on the excessive daytime sleepiness (EDS) is influenced by two confounders (age and hours of sleep per night). A cross-sectional study was conducted at King Abdulaziz Medical City-Riyadh (KAMC-R). A total of 2095 respondents answered a questionnaire that included questions regarding gender, age, hours of sleep per night, and daytime sleepiness using the Epworth Sleepiness Scale (ESS). The prevalence of EDS was 20.5% (females 22.2%, males 19.5%, p-value=0.136). The EDS did not differ between genders, age groups, or hours of sleep per night (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6 vs. ⩾6h). However, stratified statistical analysis shows that the prevalence of EDS did differ according to gender (25.3% in females, 19.0% in males, p-value=0.036) in respondents with shorter hours of sleep per night. EDS was strongly related to female gender and young age (ages⩽29years) in respondents with short hours of sleep. This study reveals that one out of five of the general Saudi population has EDS. The effect of gender on EDS appeared to be influenced by hours of sleep per night. High EDS strongly related to female gender with short hours of sleep.

Journal of Infection and Public Health, 2015

Sepsis syndrome is a major worldwide cause of morbidity and mortality. While community-acquired s... more Sepsis syndrome is a major worldwide cause of morbidity and mortality. While community-acquired severe sepsis and septic shock constitutes a major cause of admission to the intensive care unit, hospital-acquired severe sepsis and septic shock remain major preventable causes of ICU admission. This study evaluates the rate, etiology, complication and outcome of community- and hospital-acquired sepsis in a tertiary care hospital in Saudi Arabia. This is a retrospective evaluation of all admissions with severe sepsis and septic shock to a general intensive care unit over a period of six months. A total number of 96 patients were included, which represented 15% of the total number of admissions during the study period. The mean age was 57.4 (SD 21). Sixty percent of cases were due to hospital-acquired infections, and 40% were community-acquired. The majority of the infections acquired in the hospital occurred in medical wards and intensive care units (27% and 21%, respectively). At least one co-morbid condition was present in 94% of the sample patients, with cardiovascular disease and diabetes being the most frequently encountered disorders (58%). Both community and hospital-acquired severe sepsis and septic shock carry very high mortality (58%). The ICU length of stay was significantly longer for hospital and ICU acquired infections. Both community and hospital-acquired infections carry high mortality. Hospital-acquired severe sepsis is frequent in medical wards and ICUs, and measures to further evaluate risk factors are prudent.

Annals of Saudi medicine

Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary opacities ... more Eosinophilic lung diseases are a diverse group of disorders characterized by pulmonary opacities associated with tissue or peripheral eosinophilia. A retrospective study conducted at two tertiary care hospitals from January 1999 to December 2009. All cases with the diagnosis of pulmonary eosinophilia were reviewed over a period of 10 years. Data on demographic, clinical, and radiologic characteristics were collected. Thirty-five patients with a mean age of 33.9 (16.2) years, of which 20 (57.1%) were male and meeting the criteria of eosinophilic lung disease were identified. Cough and dyspnea were the most frequent symptoms at presentation in 29 (82.9%) and 27 (77.1%) patients, respectively. Reticulonodular and airspace patterns were the most common radiographic findings in 17 (48.6%) and 15 (42.9%) patients, respectively. Peripheral eosinophilia was present in 33 (94.3%) patients. Twenty-four patients (68.6%) were labeled as having idiopathic pulmonary infiltrate with eosinophilia. ...

Current pharmaceutical design, 2011

Severe asthma is a complex and heterogeneous phenotype characterized by persistent symptoms and p... more Severe asthma is a complex and heterogeneous phenotype characterized by persistent symptoms and poor control. While some patients respond to high doses of inhaled corticosteroids in combination with long-acting beta-agonists, a significant subset require oral corticosteroids to achieve symptom control. This issue has led to the development of alternative therapeutic strategies for severe asthma. This article provides an overview of current therapeutic strategies and suggests how they can be best applied to the treatment of severe asthma. The article then reviews alternative therapeutic strategies including macrolide antibiotics, biologic agents, modulators of signal transduction pathways and bronchial thermoplasty. The challenge remains to determine the appropriate phenotype for each therapeutic strategy in view of the heterogeneity of severe asthma.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2010

The current cross sectional study is based on a questionnaire database on patients with end-stage... more The current cross sectional study is based on a questionnaire database on patients with end-stage renal disease (ESRD) to determine their preferences about end-of-life care and differences of certainty regarding the application of cardiopulmonary resuscitation and life sustaining measures in case of cardiac arrest. The study was performed on 100 patients on hemodialysis for at least 2 years and not on the transplant list in two tertiary hospitals in Saudi Arabia; King Fahad National Guard in Riyadh and King Faisal Specialist Hospital in Jeddah in March 2007. More than two thirds of the surveyed patients were willing to make decisive decisions. Having more than 5 children was the only factor significantly associated with the ability to make decisive decisions; there was an insignificant association with factors such as marital status or non-Saudi nationality. Factors such as self-perception or disease curability, previous admissions to hospital or intensive care units, prior knowledg...

Saudi medical journal, 2008

Evaluation of asthma control using the Asthma Control Test (ACT). The ACT was used to assess asth... more Evaluation of asthma control using the Asthma Control Test (ACT). The ACT was used to assess asthma control among patients with bronchial asthma visiting pulmonary clinics in 5 major tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia. Each hospital had a target of 300 patients to recruit over the period of the study from the 1st September to 30th November 2006. The total number of patients studied was 1,060 patients. Males constituted 442 (42%) and females constituted 618 (58%), the median age was 38.56 years (range 15-75). One third of patients had no formal education. The ACT score revealed uncontrolled asthma in 677 (64%), well-controlled asthma in 328 (31%), and complete controlled in 55 (5%). There are no significant correlations between the age below 40 and above 40 years and level of asthma control (p=0.12). However, the younger age group less than 20 had better control of asthma in comparison with older patients (p=0.0001). There was a significant correlation between...

Saudi medical journal, 2004

The national protocol for asthma management was released in 1995. There has been no national inve... more The national protocol for asthma management was released in 1995. There has been no national investigation to compare the actual care delivered at the Emergency Department to those recommended by these guidelines: To compare the documented management of acute bronchial asthma at the Emergency Room (ER) with the Saudi National Guidelines Retrospective analyses of a total of 150 ER records, of patients with a diagnosis of asthma over a one year period (January through to December 2000), at King Abdul-Aziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Documentation of the history, indices of severity, treatment given, pre-discharge assessment and prescriptions were compared to the nationally recommended management. History of the present attack, its duration, frequency of b-agonist use and nocturnal symptoms were documented in less than 50% of patients. Previous ER visits and hospitalization, peak flow rate and accessory muscle use were similarly re...