Saudi Med J
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To evaluate the rates of third- and fourth-degree tears and related predisposing factors for the tears in singleton vaginal deliveries. Methods: This was a retrospective study of third- and fourth-degree perineal tears in all women who underwent vaginal delivery in a tertiary hospital in Assir region between January 2014 and December 2019. There are approximately 5000 deliveries per year at the Abha Maternity and Children Hospital. The total number of deliveries during the study period was 31,788, of which 19,374 were delivered vaginally. Results: A total of 85 women (0.43% of all vaginal deliveries) had third-degree (n=81) or fourth-degree (n=4) perineal tears. The mean age of the women was 31 years (range: 16-46 years). Fifty-two of the 85 women (61%) were primiparous. Of the various obstetric parameters, episiotomy, occipitoposterior presentation, primigravida, multipara, and a previous episiotomy were found to be significant predisposing factors to third- and fourth-degree tears in our patients. ⋯ The low incidence of obstetric anal sphincter injuries in this study is likely the result of proactive manual protection of the perineum, valid indications for episiotomy, and attendance of senior staff members at all difficult deliveries.
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To describe the patterns of cervical spine injuries in an adult population in a major trauma center in Riyadh, Saudi Arabia. Methods: A retrospective cohort study including all adults with cervical spine injuries from 2014 to 2018 was conducted. All patient data with radiological evidence of injury involving the cervical spine were collected. Results: The final sample size realized as 257 patients. Majority of the sample (85.6%) were male and the age ranged from 14-90 years (mean of 36.6 years±18.5 SD). Motor vehicle accidents were the most frequent mechanism of injury (92.6%, n=238). Single level of injury of the cervical spine was encountered in 52.9% (n=136) and 2 or more levels of injury were encountered in 47.1% (n=122) of patients. In total, 442 cervical spine injury levels were identified. At these levels, 559 fractures were observable radiologically. Associated head injury was present in 125 patients (48.6%). Only a small proportion (22.2%, n=57) had neurological sequelae. ⋯ It reflects the impact of this injury on younger male patient population.
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To determine the factors associated with the development of methicillin-resistant Staphylococcus aureus (MRSA), hospital stay and mortality, and early versus late MRSA infection. ⋯ Admission with sepsis (case: 46% vs. control: 2%, p less than 0.001) and having at least one comorbid condition (case: 95% vs. control: 46%, p less than 0.001) were significantly associated with the development of MRSA. Age (mean ±SD: case: 65±18, control: 64±18, p=0.7) and gender (% male, case: 52%, control: 56%, p=0.70) were not associated with the development of MRSA. Approximately 73% of all MRSA cases developed within the first 2 weeks of admission. Among the early cases, 44% died during their ICU stay; the corresponding percentage among the late cases was 42% (p=0.69). There was no difference between early and late MRSA cases in terms of non-sepsis admissions (50% vs. 67%, p=0.32) or comorbid status (at least one: 97% vs. 92%, p=0.17). Conclusion: Sepsis and comorbid conditions were significant risk factors for MRSA development among hospital patients.
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[No Abstract Available].
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Breast metastases from extra-mammary neoplasms are rare, accounting for less than 2% of breast cancer cases. A 43-year-old female patient presented with a mass in her left breast and swelling in her left axillary region. ⋯ As she was a known case of nasopharyngeal carcinoma, and based on the histopathology ndings and IHC profile, the patient was diagnosed with breast metastasis from NPC. The patient was deceased 3 months after refusing the recommended medical intervention.