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Biomedical subjects

Khaled Saleh

Publications and source records attributed to Khaled Saleh.

7 recordsLinked to original sources
PubMed2006

Acute sciatic neuritis following total hip arthroplasty: a case report.

Nerve injuries after total hip arthroplasty are relatively uncommon, but a higher prevalence has been reported in revision arthroplasties, in women and in patients with dysplastic hips. We report a case of a patient who had a painful neuritis of the sciatic nerve after primary arthroplasty, without any objective evidence of motor or sensory deficit and had complete relief of pain after the limb lengths were matched to the contra-lateral side after revision arthroplasty.

Acute Disease↗
PubMed2005

Hypocapnia is not a predictor of central sleep apnea in patients with cirrhosis.

During sleep, maintenance of rhythmic breathing is critically dependent on the level of PCO(2), such that if the prevailing spontaneous PCO(2) decreases below the apneic threshold, central sleep apnea (CSA) occurs. Several studies have shown that in patients with systolic heart failure (SHF), presence of a low, awake arterial PCO(2) (Pa(CO(2))) increases the likelihood of developing CSA during sleep. We therefore sought to determine if a low Pa(CO(2)) is a predictor of CSA in patients with cirrhosis of the liver and with normal left ventricular systolic function. In 13 hypocapnic (Pa(CO(2)) < 36 mm Hg, mean = 33 mm Hg) patients with SHF and a mean left ventricular ejection fraction of 23%, the mean apnea-hypopnea index, was 28/hour. CSA accounted for most of the breathing disorders. In 10 hypocapnic (Pa(CO(2)) < 36 mm Hg, mean = 32 mm Hg) patients with cirrhosis and a normal left ventricular ejection fraction (60%), the mean apnea-hypopnea index was 2/hour. The maximum central apnea index was 0.2/hour. There were no significant differences in age, demographics, pulmonary function tests, Pa(O(2)), Pa(CO(2)), minute and alveolar ventilation, and ventilatory responses to CO(2) between the two groups. We conclude that, in contrast to SHF, presence of hypocapnia does not predict CSA in cirrhosis.

Aged↗
PubMed2005

Visual Analog Scale pain reporting was standardized.

BACKGROUND AND OBJECTIVE: Whereas pain is frequently measured using a visual analog scale (VAS) that can examine change over short time intervals in the same subject, such ratings are not useful in analyzing differences across subjects. We created a method for normalizing VAS pain reporting to control for the variation between different populations due to the differences in subjective perception or objective evaluation of pain. METHODS: A list of 226 pains was gathered from a convenience sample of persons on the street and patients waiting at medical and orthopedic clinics. These pains were ranked according to severity by health professionals and 19 pains with the most stable rankings were selected. These 19 pains were then rated by a sample of community-dwelling persons and a method of VAS standardization was developed, based on six selected pains. RESULTS: Individual variations in pain ratings were found to be independent of respondent age and gender, but were correlated with experience of the event or behavior and with self-reported health status. A new scoring method that takes into account these correlations is proposed. CONCLUSION: It is possible to standardize VAS pain ratings to compare pain between different populations.

Age Factors↗
PubMed2004

Total knee arthroplasty in patients on workers' compensation: a matched cohort study with an average follow-up of 4.5 years.

Little information in the literature exists regarding the outcome of total knee arthroplasty (TKA) in patients who are on workers' compensation (WC). Twenty-one WC patients who underwent 23 TKA procedures (cases) were compared with 16 randomly selected, age-matched control patients (controls) undergoing 21 TKA procedures. The mean follow-up was 56 months (34-112 months) for both groups. The results were evaluated using the scoring system of the Knee Society (KSS). Significant improvements in KSS were noted in both groups, and all subjects indicated that they would undergo the procedure again. The KSS were statistically better in the control group relative to the WC group. There was no difference in range of motion, stability, or radiographic alignment. Despite high satisfaction with the results of surgery in both groups, only 5 of 21 patients in the WC group returned to their previous occupation. TKA improves pain and function scores in WC patients with end-stage knee disease. Understanding how WC issues affect the results of TKA is critical to the selection of appropriate surgical candidates.

Arthroplasty, Replacement, Knee↗
PubMed2004

Development and evaluation of an integrated musculoskeletal disease course for medical students.

BACKGROUND: A recent survey of medical and surgical residents in the United States suggested that our current training of physicians may be inadequate to meet the increasing demand for diagnosis and treatment of musculoskeletal disorders. In response, we developed an integrated, multidisciplinary course to teach knowledge and skills related to musculoskeletal disease to second-year medical students. A three-year prospective outcomes study was conducted to evaluate the new course. METHODS: The primary outcomes that were studied during the first year of the new course were the gains in knowledge, changes in levels of confidence, and long-term retention of skills. Secondary outcomes consisted of student and faculty satisfaction. Ten-item pre-tests and post-tests covering core course concepts were administered to students. A matched-pairs t test was used to evaluate the difference between pre-test and post-test scores. Students were also asked to rate, on a 10-point scale, how much confidence they had in their ability to perform the musculoskeletal physical examination before and after the institution of the new curriculum. A general linear model analysis with post hoc pairwise comparisons (F test) was used to evaluate the changes in the confidence levels of the students. Also, a knee examination station was organized to compare students' scores before and after revision of the course. At the conclusion of the course, students rated each aspect of it on a scale of 1 to 5. Instructors were asked to rate the effectiveness of all elements of the course on the same scale. RESULTS: On the basis of student satisfaction and confidence and faculty satisfaction, the most effective changes in the curriculum were the introduction of a physical examination workshop and simulated clinical situations. Students' knowledge increased significantly (p < 0.001), and their level of confidence increased significantly in thirteen specifically targeted areas (p < 0.0001). On the end-of-the-year examination assessing retention of physical examination skills, the scores for the skills emphasized in the revised course increased significantly whereas the scores for a skill not emphasized in the course remained the same. Revisions made in the second and third years after implementation of the course expanded the more successful elements and further improved student ratings. CONCLUSIONS: Integration of the three clinical disciplines related to musculoskeletal disease--orthopaedics, rheumatology, and physical medicine and rehabilitation--resulted in a highly effective introductory course for second-year medical students. The heuristic strategy of introducing core content through lectures and workshops followed by small-group teaching sessions for practice with the new knowledge effectively increased students' knowledge, confidence, and satisfaction.

Curriculum↗
PubMed2002

Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program.

BACKGROUND: Deep wound infection (DWI) in total knee (TKA) and total hip (THA) arthroplasty has been shown to highly correlate with superficial surgical site infection (SSSI). Although several studies have reported hospital factors that predispose to SSSI, patient factors have not been clearly elucidated. METHODS: All patients undergoing TKA (n = 1181) and THA (n = 1124) surgery during the period 1977-1995 at our institution were observed at the end of a 30-day post-operative period. Thirty-three patients that developed SSSI during this period constituted the study group. The control group was composed of 64 matched subjects that did not develop SSSI. A chart review was applied to abstract DWI cases during the first 18 post-operative months for the study group and for an average of 6.7 years for the control group (range 5-18.2 years). Potential risk factors for SSSI were used as predictors of SSSI in a logistic regression analysis. RESULTS: During the 18-month observation period 19 out of the 33 study subjects (58%) developed DWI. No DWI was registered in the control group (the difference was significant, p < 0.0001). Of the nine pre-operative, five intra-operative, and five postoperative factors examined, only hematoma formation (odds ratio = 11.8; p = 0.001) and days of post-operative drainage (odds ratio = 1.32; p = 0.01) were significant predictors of SSSI. The cases consumed more health care resources at all stages of the medical process. CONCLUSIONS: Our results (1) confirm the strong correlation between the probability of developing DWI and SSSI; (2) indicate that hematoma formation and persistent post-operative drainage increase the risk of SSSI. We hypothesize that post-operative monitoring of patients for hematoma and persistent drainage enables earlier intervention that may lower the risk of developing SSSI and subsequent DWI.

Aged↗