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Article ; Online: Warfarin Woes: A Rare Case of Hemoperitoneum with Intramural Small Bowel Hematoma.

Hassan, Ali / Habbash, Zainab / Aljawad, Mahdi / Alnemer, Faris / Alzayer, Ali / AlZaher, Aqil

2024 Volume 25, Page(s) e943519

Abstract: BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, ...

Abstract	BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, perforation, and even hemorrhagic shock. The etiology of intramural small bowel hematoma is diverse, encompassing factors such as anticoagulant therapy, coagulopathies, vascular disorders, trauma, and underlying systemic conditions. CASE REPORT We present the case of a 67-year-old man with a history of aortic valve replacement who presented with intense abdominal pain. Physical examination revealed generalized abdominal tenderness and black stools upon rectal examination. Laboratory tests indicated coagulopathy with a prolonged thrombin time. A computed tomography scan confirmed the presence of an intramural small bowel hematoma and hemoperitoneum. The patient's condition significantly improved within 48 h under conservative management, including nasogastric tube insertion, continuous monitoring of gastric aspirate, nil per os status, intravenous fluids, and analgesics. Warfarin was temporarily stopped, and fresh frozen plasma was administered for anticoagulation reversal. Heparin infusion was initiated once the INR became within the therapeutic level. CONCLUSIONS The occurrence of spontaneous intramural small bowel hematoma, although rare, demands rapid diagnosis and prompt, well-coordinated management. This case underscores the pivotal role of multidisciplinary collaboration in providing a comprehensive assessment and a tailored approach to treatment. While conservative measures, including careful monitoring and supportive care, have demonstrated favorable outcomes, the consideration of surgical intervention remains crucial, particularly in severe cases.
MeSH term(s)	Male ; Humans ; Aged ; Warfarin/adverse effects ; Anticoagulants/adverse effects ; Hemoperitoneum/chemically induced ; Gastrointestinal Hemorrhage ; Hematoma/chemically induced ; Hematoma/complications ; Hematoma/therapy ; Abdominal Pain/etiology
Chemical Substances	Warfarin (5Q7ZVV76EI) ; Anticoagulants
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.943519
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Navigating the Challenges of Delayed Subdural Hemorrhage and COVID-19: A Case Report.

Al Qahtani, Saleh S / Alfaraj, Dunya / Alzayer, Mohammed O / Juma, Zainab / Abdulla, Mohamed / Faraj, Husain / Juma, Abdulla / Moussa, Mohamed M

Cureus

2024 Volume 16, Issue 2, Page(s) e54853

Abstract: The delayed onset of posttraumatic subdural hemorrhage (SDH) represents non-specific clinical features, complicating the diagnostic process, especially in individuals predisposed due to pre-existing risk factors and comorbidities. This case report ... ...

Abstract	The delayed onset of posttraumatic subdural hemorrhage (SDH) represents non-specific clinical features, complicating the diagnostic process, especially in individuals predisposed due to pre-existing risk factors and comorbidities. This case report delineates the medical trajectory of a 61-year-old female patient who sustained a traumatic fall, initially displaying neither clinical nor radiological signs indicative of hemorrhage. However, three weeks post-injury, she developed altered mental status, cephalgia, and emesis. Diagnostic imaging unveiled a significant bilateral acute-on-chronic subdural hemorrhage exerting pronounced mass effect and leading to obliteration of the basal cisterns. Complicating her clinical picture was a concurrent SARS-CoV-2 infection and a medical history of hypertension. Emergent neurosurgical intervention was undertaken, encompassing the creation of bilateral burr holes for drainage and the placement of subdural drains. The patient was managed with the requisite medical therapies. Post-operatively, the patient regained consciousness and exhibited significant neurological improvement. Follow-up imaging demonstrated complete resolution of the subdural hemorrhage, and the patient achieved a full recovery of cognitive function. This case underscores the critical necessity for vigilant surveillance for delayed SDH in patients lacking initial radiographic findings and advocates for individualized therapeutic approaches in patients with concurrent pathologies. Prompt recognition, timely neurosurgical management, and care are pivotal to optimizing outcomes in delayed posttraumatic SDH cases.
Language	English
Publishing date	2024-02-25
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.54853
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Blood Transfusion Predictors in Cesarean Sections for Pregnancies With Placenta Accreta and Placenta Previa: A Monocentric Tertiary Experience.

Alhashim, Zainab G / Alzayer, Zainab A / Alensaif, Alwi A / Al Darwish, Hussain A / Almomen, Mohammed A / Alnsaif, Jawad M

Cureus

2023 Volume 15, Issue 10, Page(s) e47648

Abstract: Objective The objective of this study was to analyze the possible predictors of the need for intraoperative blood transfusion in cesarean sections for pregnancies with abnormal placentation. Methods This was a retrospective study based on data from ... ...

Abstract	Objective The objective of this study was to analyze the possible predictors of the need for intraoperative blood transfusion in cesarean sections for pregnancies with abnormal placentation. Methods This was a retrospective study based on data from patients' electronic medical records. A total of 44 patients who were diagnosed as placenta previa or placenta accreta who delivered through cesarean section at King Fahad University Hospital, Al-Khobar, Saudi Arabia, from June 1997 to January 2021 were included in the study. Seventeen patients received intra-operative blood transfusion. The other 27 patients did not receive any blood transfusions and served as controls. Demographic data, antepartum profiles, and obstetric history were compared between the two groups. Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors and the need for intraoperative blood transfusion. Results Univariate analysis (χ2 test) has shown multiple factors that correlated significantly (p<0.05) with blood transfusion requirement. These factors include the presence of placenta accreta, general anesthesia, preoperative hematocrit < 33%, preoperative hemoglobin ≤ 10 g/dL, and preterm delivery at 35-36 weeks of gestation. None of these factors showed any statistical significance in multivariate analysis (logistic regression). Conclusion General anesthesia, placenta accreta, delivery at 35-36 weeks of gestation, and pre-operative anemia are possible risk factors for blood transfusion during cesarean sections for abnormal placentation. Identifying patients at increased risk is necessary to optimize pre-operative and intraoperative management.
Language	English
Publishing date	2023-10-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.47648
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Patient-rated physicians' empathy and its determinants in Riyadh, Saudi Arabia.

Alzayer, Zainab M / Abdulkader, Rizwan S / Jeyashree, Kathiresan / Alselihem, Ahmad

Journal of family & community medicine

2019 Volume 26, Issue 3, Page(s) 199–205

Abstract: Background: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated ... ...

Abstract	Background: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated with it. Materials and methods: This hospital-based cross-sectional study enrolled adult (≥18 years) patients attending the outpatient clinics of the departments of family medicine, internal medicine, and surgery. We measured patients' rating of their physician's empathy using the Jefferson Scale of Patient's Perception of Physician Empathy questionnaire. Data were analyzed using SPSS v 23.0; categorical variables were presented as frequencies and percentages, and all quantitative variables were presented as mean and SD. Associations were explored by Chi-square test and Student's Results: Of a total of 390 patients with a mean (standard deviation [SD]) age of 40.5 (13.6) years, 189 (48.5%) were male. The mean (SD) total patient-rated physician empathy score was 26.6 (6.0). Multilevel linear regression modeling revealed that having a health professional in the family, suffering from an acute illness (as compared to chronic illness), consulting a physician recommended by relatives/friends, trusting the physicians' expertise, shorter (<10 min) waiting time, and perceived adequate consultation time were associated with higher empathy ratings. Conclusions: Patients' perception of physicians' empathy is indispensable for the success of a clinical consultation. It is influenced by patient-level social and clinical factors. On-the-job physician training in empathy, effective monitoring, and feedback mechanisms should be an integral component of the quality control of hospital services.
Language	English
Publishing date	2019-09-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2580509-5
ISSN	2229-340X ; 1319-1683
ISSN (online)	2229-340X
ISSN	1319-1683
DOI	10.4103/jfcm.JFCM_66_19
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Article: Prevalence of Anxiety and Depression in Patients With Multiple Sclerosis in Saudi Arabia: A Cross-Sectional Study.

Aljishi, Rahaif H / Almatrafi, Rahaf J / Alzayer, Zainab A / Alkhamis, Bayan A / Yaseen, Esraa E / Alkhotani, Amal M

Cureus

2021 Volume 13, Issue 12, Page(s) e20792

Abstract: Introduction Multiple sclerosis (MS) is a chronic disease of progressive demyelination in the central nervous system and carries a significant risk for depression and other psychological difficulties associated with low quality of life. There is a ... ...

Abstract	Introduction Multiple sclerosis (MS) is a chronic disease of progressive demyelination in the central nervous system and carries a significant risk for depression and other psychological difficulties associated with low quality of life. There is a paucity of data on the prevalence of anxiety and depression in Saudi Arabia among patients with MS. We conducted a cross-sectional study to determine the prevalence of anxiety and depression in Saudi Arabia among patients with MS by age, disease severity, compliance to medication, and social support. Methods This cross-sectional study measured the prevalence of anxiety and depression in 184 adult patients with MS. The patients were selected through a random sampling method from a pool of MS societies in Saudi Arabia. The participants completed self-administered questionnaires that included demographic variables. The participants also completed the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) questionnaire. Results Depression was detected among 139 (75.5%) patients with MS, with most participants having mild depression (31%). More women (83.1%) experienced depression than men (62.1%; p = 0.002). Anxiety disorder was present in 123 (66.8%) patients with MS, and most had mild anxiety (n = 56; 30.4%). Conclusion We found a very high rate of depression and anxiety among patients with MS in Saudi Arabia. Our results highlight the need for periodic screening and examination of patients with MS by psychiatrists to facilitate the early detection and treatment of these comorbidities, potentially improving patient quality of life and health outcomes.
Language	English
Publishing date	2021-12-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20792
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patient-rated physicians' empathy and its determinants in Riyadh, Saudi Arabia

Zainab M Alzayer / Rizwan S Abdulkader / Kathiresan Jeyashree / Ahmad Alselihem

Journal of Family and Community Medicine, Vol 26, Iss 3, Pp 199-

2019 Volume 205

Abstract: BACKGROUND: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated with ...

Abstract	BACKGROUND: Patients' perception of their physician's empathy influences their compliance with treatment and the resulting quality of life. We aimed to measure the patient-rated empathy of physicians and to determine patient-level factors associated with it. MATERIALS AND METHODS: This hospital-based cross-sectional study enrolled adult (≥18 years) patients attending the outpatient clinics of the departments of family medicine, internal medicine, and surgery. We measured patients' rating of their physician's empathy using the Jefferson Scale of Patient's Perception of Physician Empathy questionnaire. Data were analyzed using SPSS v 23.0; categorical variables were presented as frequencies and percentages, and all quantitative variables were presented as mean and SD. Associations were explored by Chi-square test and Student's t-test. Regression analysis was performed to identify factors significantly associated with the empathy score; P< 0.05 was considered statistically significant. RESULTS: Of a total of 390 patients with a mean (standard deviation [SD]) age of 40.5 (13.6) years, 189 (48.5%) were male. The mean (SD) total patient-rated physician empathy score was 26.6 (6.0). Multilevel linear regression modeling revealed that having a health professional in the family, suffering from an acute illness (as compared to chronic illness), consulting a physician recommended by relatives/friends, trusting the physicians' expertise, shorter (<10 min) waiting time, and perceived adequate consultation time were associated with higher empathy ratings. CONCLUSIONS: Patients' perception of physicians' empathy is indispensable for the success of a clinical consultation. It is influenced by patient-level social and clinical factors. On-the-job physician training in empathy, effective monitoring, and feedback mechanisms should be an integral component of the quality control of hospital services.
Keywords	Patient satisfaction ; patient rated ; physician empathy ; Saudi Arabia ; Public aspects of medicine ; RA1-1270
Subject code	616
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Orthodontic Treatment Consideration in Diabetic Patients.

Almadih, Ahmed / Al-Zayer, Maryam / Dabel, Sukainh / Alkhalaf, Ahmed / Al Mayyad, Ali / Bardisi, Wajdi / Alshammari, Shouq / Alsihati, Zainab

Journal of clinical medicine research

2017 Volume 10, Issue 2, Page(s) 77–81

Abstract: Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the ... ...

Abstract	Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the prevalence of systemic diseases facing dentists during orthodontic procedures, especially diabetes mellitus. This necessitates that dentists should be aware of the diagnosis of diabetes mellitus and its early signs particularly in teeth and oral cavity. It is also essential for them to understand the implications of diabetes on orthodontic treatment and the measures to be considered during managing those patients. In this review, we focused on the impact of diabetes mellitus on orthodontic treatment. We also summarized the data from previous studies that had explained the measures required to be taken into consideration during managing those patients. We included both human and animal studies to review in depth the pathophysiological mechanisms by which diabetes affects orthodontic treatment outcome. In conclusion, this review emphasizes the need to carefully identify early signs and symptoms of diabetes mellitus in patients demanding orthodontic treatment and to understand the considerations to be adopted before and during treating these patients.
Language	English
Publishing date	2017-12-30
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	2548987-2
ISSN	1918-3011 ; 1918-3003
ISSN (online)	1918-3011
ISSN	1918-3003
DOI	10.14740/jocmr3285w
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Metformin-related acidosis in a woman while performing Haj: a conservative approach.

Ansari, Riyazuddin S H / Mady, Ahmed Fouad / Qutub, Hatem Othman / Althomaly, Eidah / Alzayer, Zainab Abdulaziz / Moulana, Amna A R

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

2015 Volume 26, Issue 1, Page(s) 125–127

Abstract: Metformin is a first-line oral anti-hyperglycemic agent. It decreases insulin resistance, decreases hepatic glucose output and enhances peripheral glucose uptake. Metformin is used as a monotherapy in combination with other oral hypoglycemic agents. A ... ...

Abstract	Metformin is a first-line oral anti-hyperglycemic agent. It decreases insulin resistance, decreases hepatic glucose output and enhances peripheral glucose uptake. Metformin is used as a monotherapy in combination with other oral hypoglycemic agents. A major side-effect of metformin is lactic acidosis. The elimination of metformin is mainly through the kidneys, and raised plasma concentrations can cause lactic acidosis. Provided there is no overdose, metformin associated lactic acidosis rarely develops in patients without co-morbidities such as renal or hepatic insufficiency, acute infection or severe dehydration. Herein, we report a case of metformin-induced metabolic acidosis occurring in a woman who was severely dehydrated after performing Haj and treated conservatively.
MeSH term(s)	Acidosis, Lactic/chemically induced ; Acidosis, Lactic/therapy ; Dehydration/complications ; Diabetes Mellitus, Type 2/drug therapy ; Female ; Humans ; Hypoglycemic Agents/adverse effects ; Islam ; Metformin/adverse effects ; Middle Aged ; Travel
Chemical Substances	Hypoglycemic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2015-01-12
Publishing country	Saudi Arabia
Document type	Case Reports ; Journal Article
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
DOI	10.4103/1319-2442.148759
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Metformin-related acidosis in a woman while performing Haj

Riyazuddin S. H. Ansari / Ahmed Fouad Mady / Hatem Othman Qutub / Eidah Althomaly / Zainab Abdulaziz Alzayer / Amna A. R. Moulana

Saudi Journal of Kidney Diseases and Transplantation, Vol 26, Iss 1, Pp 125-

A conservative approach

2015 Volume 127

Abstract	Metformin is a first-line oral anti-hyperglycemic agent. It decreases insulin resistance, decreases hepatic glucose output and enhances peripheral glucose uptake. Metformin is used as a monotherapy in combination with other oral hypoglycemic agents. A major side-effect of metformin is lactic acidosis. The elimination of metformin is mainly through the kidneys, and raised plasma concentrations can cause lactic acidosis. Provided there is no overdose, metforminassociated lactic acidosis rarely develops in patients without co-morbidities such as renal or hepatic insufficiency, acute infection or severe dehydration. Herein, we report a case of metformin-induced metabolic acidosis occurring in a woman who was severely dehydrated after performing Haj and treated conservatively.
Keywords	Medicine ; R
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: A case series of different anesthesia approaches for single ventricular physiology patients in various stages of palliation underwent noncardiac procedures.

Alatassi, Abdulaleem / Mulero, Silvia Fernández / Massoud, Nancy / Alzayer, Zainab / Mahmoud, Ahmed Haroun

Saudi journal of anaesthesia

2001 Volume 12, Issue 4, Page(s) 629–633

Abstract: Patients with single ventricle physiology (SVP) are a particularly challenging population with congenital heart disease (CHD); they will go for staged, palliation ending in the Fontan circulation. Nowadays, with improvement in surgical procedures for CHD, ...

Abstract	Patients with single ventricle physiology (SVP) are a particularly challenging population with congenital heart disease (CHD); they will go for staged, palliation ending in the Fontan circulation. Nowadays, with improvement in surgical procedures for CHD, these patients become growing population, and noncardiac surgeries become not uncommon. The authors report different anesthesia approaches for four pediatric patients with SVP underwent ten noncardiac procedures done under general anesthesia following the different stages of palliation at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between 2009 and 2015 and do a brief review of the literature on this topic. The aim of this study is to highlight that anesthesia approach for patients with SVP varies according to the patient physical situation at the time of the procedure, stage of palliation, and type of surgery. Therefore, every anesthesiologist should have thorough knowledge about SVP, different stages of palliative surgery, anesthesia concern in each one and risk factors associated with perioperative morbidity before anesthetizing patients for a noncardiac procedure to keep patient safety as well as avoiding unnecessary cancellation, rescheduling, and admissions to the ward or the Intensive Care Unit.
Language	English
Publishing date	2001-07-22
Publishing country	India
Document type	Case Reports
ZDB-ID	2562174-9
ISSN	0975-3125 ; 1658-354X
ISSN (online)	0975-3125
ISSN	1658-354X
DOI	10.4103/sja.SJA_36_18
Database	MEDical Literature Analysis and Retrieval System OnLINE

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