Ahmed al-Badr | King Fahad Medical city Riyadh SaudiArabia (original) (raw)

Papers by Ahmed al-Badr

International Urogynecology Journal, Jul 9, 2016

Introduction and hypothesis The prevalence of pelvic floor disorders (PFD) and their impact on qu... more Introduction and hypothesis The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. Methods Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. Results The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m 2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. Conclusions In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly u... more Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short-and intermediate-term outcomes of preemptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD:-0.89 (95% CI:-1.19,-0.59) and non-steroidal anti-inflammatories SMD-1.04 (95% CI:-1.64,-0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD:-0.82 (95% CI:-5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block.

“I have been sent from the oncology clinic to see you, since my periods have stopped for 6 months... more “I have been sent from the oncology clinic to see you, since my periods have stopped for 6 months. I have received chemotherapy to treat my lymphoma a year ago and the doctor told me that you can help.” This statement was said by one of my patients, that has visited the Reproductive Endocrinology (RE) clinic in 2013. In the back of my mind, I was frustrated and livid. First, because I felt helpless since I knew that this young patient had chemotherapy that had affected her gonadal function. Second, I was wondering why the patient was not sent to the RE clinic before she received chemotherapy. Unfortunately, there are no standard protocols in our hospital to oblige oncologists to refer these patients to reproductive endocrinologists. Patients who are treated for cancer, and especially those who receive chemotherapy, get referred to reproductive endocrinologist depending on the treating physician’s perspective. So, it really depends on the oncologists’ preference whether to refer these patients or not.

International journal of gynaecology and obstetrics, Sep 1, 2003

Objectives: This paper reviews the literature on the prevalence of urinary incontinence (UI) and ... more Objectives: This paper reviews the literature on the prevalence of urinary incontinence (UI) and demonstrates its impact as a worldwide problem. Methods: A MEDLINE search was performed to review population-based studies in English. Studies were grouped according to demographic variables and type of incontinence. Risk factors, helpseeking behavior, and quality of life measures were analyzed. Results: The median prevalence of female UI was 27.6% (range: 4.8-58.4%) and prevalence of significant incontinence increased with age. The commonest cause of UI was stress (50%), then mixed (32%) and finally urge (14%). Risk factors included parity, obesity, chronic cough, depression, poor health, lower urinary tract symptoms, previous hysterectomy, and stroke. Although quality of life was affected, most patients did not seek help. Conclusion: UI is a prevalent cross-cultural condition. Future studies should rely on universally accepted standardized definitions to produce meaningful evidence-based conclusions, as well as project the costs of this global healthcare problem.

PubMed, Aug 1, 2013

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are two common health-related ... more Pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are two common health-related conditions, each affecting up to 50% women worldwide. Stress urinary incontinence only observed after the reduction of co-existent prolapse is called occult SUI (OSUI), and is found in up to 80% of women with advanced POP. Although there is no consensus on how to diagnose OSUI, there are several reported methods to better diagnose. Counseling symptomatically continent women with POP concerning the potential risk for developing SUI postoperatively cannot be overstated. Evidence suggests that positive OSUI in symptomatically continent women who are planning to have POP repair is associated with a high risk of POSUI, furthermore, adding continence procedure is found to reduce postoperative SUI. Therefore, adding continence surgery at the time of POP surgery in patients who are found to have OSUI preoperatively is advocated.

Urology Annals, 2019

Aims: Female patients often seek physical therapy (PT) for chronic low back pain (CLBP). This stu... more Aims: Female patients often seek physical therapy (PT) for chronic low back pain (CLBP). This study aimed to evaluate the prevalence of pelvic floor disorder (PFD) and the association between PFD and neuropathic pain (NP) in a population of women referred to PT for CLBP, as these parameters are rarely investigated in this context. Materials and Methods: This cross-sectional survey study included women aged 30–60 years who were referred to PT for CLBP. In addition to demographic and clinical information, the patients completed structured assessment questionnaires such as the validated Pelvic Floor Distress Inventory (PFDI-20), which was used to determine the prevalence of PFD, and the self-completed Leeds Assessment of Neuropathic Symptoms and Signs to differentiate nociceptive pain from NP. Results: Among the 225 women included in the study, the mean body mass index was 31.6 ± 4.7 and the mean age was 46.7 ± 7.7 years (~79% were older than 40 years). The majority were not employed (i.e., homemakers), currently married, and sexually active. In addition, almost all had children (approximately 69% were grand multiparous), the majority of whom had been delivered through spontaneous vaginal delivery. Approximately 33% of women were postmenopausal and only 3% used hormone replacement therapy. Slightly more than half suffered from NP and approximately 43% experienced at least one PFD. Notably, patients with NP had significantly higher PFDI-20 overall and subscale scores, compared to those without NP. Conclusions: Although PFD and NP are not routinely assessed in PT practice, both conditions are prevalent among and may interact in women with CLBP.

Saudi Medical Journal, 2010

Page 1. 86 Saudi Med J 2010; Vol. 31 (1) www.smj.org.sa Characteristics of women attending a urog... more Page 1. 86 Saudi Med J 2010; Vol. 31 (1) www.smj.org.sa Characteristics of women attending a urogynecology clinic in Riyadh Ahmed H. Al-Badr, FRCS(c), FACOG, Aneela G. Kamil, MCPS, FCPS, Ehab F. Wahbah, MBBS, SSCOG ...

Saudi Medical Journal, Dec 1, 2016

The study took place in Riyadh, the capital of Saudi Arabia. We used a questionnaire to describe ... more The study took place in Riyadh, the capital of Saudi Arabia. We used a questionnaire to describe sleeping characteristics in relation to existing chronic diseases, smoking status, obesity, daily performance and sociodemographic variables. Results: The response rate was 79.6%)1369 participants), 61.6% have or may have sleeping disturbances of which 18.6% claimed either slowed or stopped breathing during sleep. Women reported a higher prevalence of sleep disturbances)65.2%). Feeling tired was significantly associated with sleep disturbance)49% versus 19.7%))p<0.001). Approximately 78.4% of those with sleep disturbance significantly believed that their ability to perform daily tasks is affected)p=0.005). Moreover, smoking and obesity were significantly associated with sleep disturbances)p<0.01). Participants with asthma, hypertension, chronic heart disease, and diabetes mellitus reported significantly more sleeping disturbance)p=0.016 to p=0.001). Conclusions: Sleep disturbances are associated with obesity, smoking, chronic health conditions, and lower performance among Saudi adults.

Journal of pharmaceutical research international, Oct 11, 2022

This work was carried out in collaboration among all authors. Author SMAK was greatly involved in... more This work was carried out in collaboration among all authors. Author SMAK was greatly involved in project development and manuscript writing. Author ASA majorly contributed to manuscript writing, data collection and data analysis. Author SAA was involved in writing the manuscript, data collection and data analysis. Author AAB majorly contributed to manuscript editing. Authors BAF and RAM played a major role in data collection and data analysis. Author MMA was mainly involved in data collection and data analysis. All authors read and approved the final manuscript.

Prensa médica argentina, 2016

Beliefs of Nutrition and Healthy Lifestyle among Women in a Hospital Setting Objective: Evaluate ... more Beliefs of Nutrition and Healthy Lifestyle among Women in a Hospital Setting Objective: Evaluate beliefs of nutrition and healthy lifestyle among a cohort of women. Methods: Between May and October 2012, women approached at a tertiary care Centre, completed a voluntary questionnaire regarding eating habits, nutritional intake and physical activity. Results: One thousand women completed questionnaire, majority were pregnant (73%). Only 45% consumed three meals per day, 70% did not eat breakfast, 48% ate dessert every day, 74% did not partake in any exercise and 62% took vitamins. Only 54% of the participants read the ingredients on food labeling. The majority (78%) of participants believed that pregnant women were required to double their food intake, and 59% did not know they need specific dietary requirements. Fifty-nine percent of the participants also believed that a healthy diet consisted of regular meals of fruit, vegetables, proteins and grains, and 60% believed that the five food groups were fat, protein, grains, dairy products, and fruit and vegetables. The vast majority (98%) of participants wanted to learn more about healthy eating and lifestyle habits. Conclusions: Significant proportions of women exhibit an unhealthy lifestyle habits, and had misconceptions regarding the constituents of a healthy lifestyle, and the additional dietary requirements that are recommend during pregnancy.

International Urogynecology Journal, Sep 27, 2016

A valid and reliable Arabic version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Ques... more A valid and reliable Arabic version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) is needed. Of 238 Saudi Arabian women who fulfilled the inclusion criteria, 227 were recruited. A detailed history was obtained and pelvic examination was performed in all participants. An Arabic version of the PISQ-IR was administered with three quality of life measures. Reliability was assessed by factor analysis, and internal consistency was measured with Cronbach&amp;amp;amp;amp;amp;#39;s α. Face validity was established with translation, back-translation, and cognitive reviews. Criterion validity was determined by analysing the correlations between the responses and the clinical examinations and by comparing the responses with those to other validated measures of incontinence and prolapse. Overall, 67 % of the women were categorized as sexually active and 33 % as sexually inactive. The overall frequency of urinary incontinence was highest (85.5 %), followed by prolapse (59 %) and fecal incontinence (53.3 %). The average score in the factor analysis for dimensions of sexual inactivity was 2.7 and Cronbach&amp;amp;amp;amp;amp;#39;s α was 0.61; an item-by-item assessment of the majority of the scales showed an α value of &amp;amp;amp;amp;amp;gt;0.75, suggesting a moderate-to-high internal consistency. Regarding external validity, strong negative correlations were found with the Pelvic Organ Prolapse Distress Inventory, the Colorectal-Anal Distress Inventory (CRADI), and the Pelvic Floor Impact Questionnaire (PFIQ) in the sexually active group, and positive correlations were found with the CRADI and PFIQ in the sexually inactive group. The Arabic version of the PISQ-IR is reliable and valid for assessing sexual function in Arabic-speaking women with pelvic floor disorders.

Luts: Lower Urinary Tract Symptoms, Nov 21, 2012

Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic... more Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic organ prolapse (POP) has become a standard part of most clinical studies. Investigators have attempted to correlate QOL scores with objective findings and treatment efficacy and as outcome measures in comparing different treatment modalities. Many of the QOL questionnaires are available in short forms, making them easier to adapt to clinical settings. This article includes an overview of several validated QOL questionnaires and their application in studies whose results provide useful guidelines for health care professionals who diagnose and manage women with POP.

International Urogynecology Journal, May 5, 2011

Clinical and Experimental Obstetrics & Gynecology, Feb 10, 2018

Introduction: Association between hypothyroidism and infertility has been demonstrated, but its p... more Introduction: Association between hypothyroidism and infertility has been demonstrated, but its prevalence in subfertile women is not well documented. Objective: To estimate the prevalence of hypothyroidism in a cohort of subfertile women. Materials and Methods: Retrospective chart of 200 women aged 17 to 40 years with infertility attending the Reproductive Endocrine and Infertility Medicine Department between April 2008 and October 2010 was reviewed. Rate of established or newly diagnosed hypothyroidism was measured, as well as the associations between TSH > 4.2 mIU/L and patient characteristics, causes of infertility, and laboratory parameters. Results: Fourteen percent had established and 14.5% had newly diagnosed hypothyroidism. Subclinical hypothyroidism was determined for 42 (21%) women. Hypothyroidism associated significantly with both increased LH and anovulatory related infertility: LH (8.49 IU/L vs. 6.86 IU/L; p = 0.036) and anovulation in 47.8% vs. 27.3% (p = 0.009) of women with TSH > 4.2 mIU/L and TSH ≤ 4.2 mIU/L, respectively. Conclusion: This study confirms an association between hypothyroidism and infertility and highlights the need to check thyroid hormone levels prior to infertility treatment.

International Urogynecology Journal, Jul 8, 2016

Journal of Minimally Invasive Gynecology, Mar 1, 2013

Although the use of vaginal mesh kits in treatment of pelvic organ prolapse (POP) has decreased t... more Although the use of vaginal mesh kits in treatment of pelvic organ prolapse (POP) has decreased the number of surgical failures, mesh exposure can occur. When conservative management fails, removing the exposed material is associated with the risk of recurrence of POP and could be challenging. We report a successful outcome of treatment of exposed mesh via use of a Martius bulbocavernosus fat pad. A 46-year-old woman had urinary incontinence and POP, which was treated using a vaginal mesh kit and tension-free vaginal tape. At 2 months after the procedure, the mesh was found to be exposed. After failed conservative management, use of a Martius graft was used, with preservation of the mesh. At 2-, 5-, and 10-month follow-up, the patient was completely asymptomatic and continent. This procedure may be a practical alternative in patients with synthetic mesh-induced vaginal erosion after failed conservative management.

Saudi Medical Journal, Apr 1, 2018

Objectives: To review the etiology and management of urogenital fistulas at a tertiary care refer... more Objectives: To review the etiology and management of urogenital fistulas at a tertiary care referral center. Methods: We retrospectively identified all patients with urogenital fistula referred to the King Fahad Medical City, Riyadh, Saudi Arabia, between January 2005 and July 2016 from electronic records. We collected data on age, parity, etiology and type of fistula, radiologic findings, management, and outcome. Results: Of the 32 patients with urogenital fistula identified, 17 (53.1%) had vesicovaginal fistula. The mean parity was 5.9 (0-15). Obstetric surgery was the most common etiology, accounting for 22 fistulas (68.8%). Twenty of these (90.9%) were complications of cesarean delivery, of which 16 (80%) were repeat cesarean delivery. Forty surgical repair procedures were performed: 20 (50%) via an abdominal approach, 11 (27.5%) via a vaginal approach, 7 (17.5) via a robotic approach, and 2 (5%) using cystoscopic fulguration. The primary surgical repair was successful in 23 patients (74%), the second repair in 5 (16.1%), and the third repair in one (3.1%). One fistula was cured after bladder catheterization, and 2 patients are awaiting their third repair. Conclusion: Unlike the etiology of urogenital fistulas in other countries, most fistulas referred to our unit followed repeat cesarean delivery: none were caused by obstructed labor, and only a few occurred after hysterectomy. Most patients were cured after the primary surgical repair.

Journal of clinical trials, 2018

Objective: The start-up phase of a clinical trial (CT) plays a vital role in execution of novel d... more Objective: The start-up phase of a clinical trial (CT) plays a vital role in execution of novel drug development. Hence, this study aims to identify the factors responsible for delaying the CT start-up phase. Further, it focuses on streamlining and reducing the cycle time of the start-up phase of newly sponsored CTs. Methodology: Thirteen sponsored CTs conducted (between 2016 and 2017) in clinical research department at King Fahad Medical City, Riyadh were analyzed to identify the data specific start-up metrics using Find an improvement area-Organize a team-Clarify current practices-Understand source of variation/problem-Select a Strategy-Plan-Do-Check-Act (FOCUS-PDCA) cycle. Five measures incorporated in the metrics were: date of initial contact with site to the signing of confidentiality agreement; date of receiving questionnaire from sponsor to date of its completion; time taken to review protocol and approve investigational drug service (IDS) form; time taken to review protocol and approve pharmacy and pathology and clinical laboratory medicine (PCLM) form and date of receipt of institutional review board (IRB) submission package to final IRB approval. Fishbone analysis was used to understand the potential causes of process variation. Mean time was calculated for each metrics prior to and post implementation of the intervention protocol to analyze and compare percentage reduction in the mean cycle time of CTs. Results: Of the various potential factors of delay identified through Fishbone analysis, the two major ones were lack of well-defined timeline for approval and review of the study protocol; and inconsistent IRB meetings. Post introduction of the new intervention protocol, the entire CT lifecycle was reduced by 45.6% (24.8 weeks' vs 13 weeks, before and after intervention, respectively).

Health care, Oct 29, 2015

BMC Women's Health

The original article has been corrected.