Assessment of Hepatic Fibrosis Using Non-Invasive Aspartate Aminotransferase to Platelets Ratio Index Compared to Hepatic Stiffness Measurements Using Transient Elastography FibroScan®

Background: Transient Elastography FibroScan® and aspartate aminotransferase to platelets ratio index have frequently been evaluated in comparison to liver biopsy for the assessment of liver fibrosis. Methods: Cross-sectional study to correlate between Aspartate transaminase to platelets ratio index and liver Transient Elastography FibroScan® among patients with liver diseases. Aspartate transaminase to platelets ratio index (in IU/L) and platelet count (expressed as K/ul) were calculated. Transient Elastography FibroScan® scores were obtained and then the patients were categorized into four stages of fibrosis. Baseline characteristic data were obtained for each patient. IBM SPSS V.20 was used to perform a correlation analysis of stiff ness score and Aspartate transaminase to platelets ratio index. Moreover, one-way ANOVA was performed to test for differences in Aspartate transaminase to platelets ratio index, Platelets, and Aspartate Aminotransferase among different stages of fibrosis. Results: 235 patients were included: 141 (60%) males and 94 (40%) females. Th e most common cause of liver disease was chronic viral hepatitis C (38.3%). The majority of patients had mild fibrosis (F0-F1, n = 117 (49.8%)). Eighteen (7.6%) patients had F3, and 62 (26.4%) had cirrhosis (F4). Age > 40 years was associated with higher liver stiff ness compared with age ≤ 40 years. There was a profound relationship between stiffness score and Aspartate transaminase to platelets ratio index. Conclusion: Aspartate transaminase to platelets ratio index is strongly correlated with Transient Elastography FibroScan® in patients with advanced fibrosis and cirrhosis and can effectively categorize mild from advanced fibrosis or cirrhosis.

Clinical Profile of Acute Myocardial Infarction at King Abdulaziz University Hospital in Jeddah, Saudi Arabia

Objectives: This study aimed to assess the clinical profile of myocardial infarction in a tertiary care hospital in Saudi Arabia, and to determine the differences in presentation, risk factors, complications, and mortality between old and young patients. Methods: Retrospective analysis of demographic and clinical data of adult myocardial infarction patients treated in King Abdulaziz University Hospital between 2010 and 2018. Results: A total of 543 acute myocardial infarction patients (79.4% males) were included in the analysis. There were 64 patients aged ≤ 45 years and 479 patients aged > 45 years. The most common presenting symptom was chest pain in both groups. Current smoking was the most common risk factor in the younger group, whereas diabetes mellitus and hypertension were the most common risk factors in the older group. On electrocardiography, ST-elevation myocardial infarction was more common in the younger group. Mitral regurgitation, followed by congestive heart failure, were the most common complications in both groups. The overall mortality rate was low, but it was higher in the older group. Conclusion: Risk factors and electrocardiogram findings differ significantly between younger (≤ 45 years) and older (> 45 years) patients. Smoking cessation must be stressed in young adults. Population awareness regarding the modifiable risk factors of myocardial infarction could help in decreasing its incidence.

Prevalence of Sleep Disorders among Staff Workers at a Tertiary Health Care Center

Background: Due to a demanding modern work style, many people sacrifice sleep by intentionally or unintentionally decreasing the number of sleeping hours or by overlooking their sleep disorders. This study aimed to screen university hospital workers in Saudi Arabia for sleep disorders and estimate their prevalence using a cross-sectional study conducted in 2016. Methods: This study used the Pittsburgh Sleep Quality Index, International Restless Legs Syndrome Study Group diagnostic criteria, Epworth Sleepiness Scale, Berlin Questionnaire, and SLEEP-50 Questionnaire. 116 participants were interviewed (56% males; mean age, 30.9 years (SD: 8.5; range: 21 to 58); mean body mass index, 25.79 (SD: 6.10); 40.5% classified as overweight or obese). Results: Only 6.9% reported good sleep quality. Insomnia was the most common sleep disorder (72%); sleepwalking was the least common disorder (5%). Women had a higher risk of insomnia, nightmares and circadian rhythm disorders (P = 0.024, 0.015, and 0.009, respectively). A strong relationship between smoking and insomnia was found (P = 0.04). Conclusion: The population had much lower sleep quality than other populations. The bidirectional relationship between insomnia and smoking presents an opportunity and emphasizes the need for insomnia management to decrease health and economic burdens.

Extended-Spectrum Beta-Lactamase Producing Bacteria: Epidemiology, Risk Factors, Diagnostic Methodology, and Antimicrobial Susceptibility Profile: A Prospective Study at a University Hospital in Western Saudi Arabia

Objective: To study the prevalence and incidence of extended-spectrum beta-lactamase -producing microorganisms, microbiological characteristics and antimicrobial-susceptibility patterns. Methods: A prospective study involving all cases of extended-spectrum beta-lactamase -producing microorganisms among all bacteriological samples collected over a 1-year period from 11 November 2015 to 10 November 2016, in the Clinical and Molecular Microbiology Laboratory at King Abdulaziz University Hospital, Jeddah. Detection of extended-spectrum beta-lactamase-producing microorganisms and antimicrobial-susceptibility profiles were done using automated Vitek 2 system. Clinical data such as recent use of antibiotics or invasive devices were investigated as risk factors for multidrug resistance. Results: The prevalence of extended-spectrum beta-lactamase-producing microorganisms was 5.4% (95% CI = 4.7% – 6.2%); for an incidence = 54 per 1,000 isolates-years. Distribution by species showed 70.0% Escherichia coli, 28.5% Klebsiella pneumoniae and 1.5% Proteus mirabilis. Vitek 2 system showed 6% of false positive ESBL detections by reference to confirmatory E-test. Antimicrobial- susceptibility tests showed that 86.5% of beta-lactamase-producing strains were resistant to ≥ 1 other antimicrobial class and 20% were multidrug resistant. Univariate logistic regression showed that the presence of multidrug resistance was significantly predicted by age (OR = 1.02; P = 0.026), use of urinary catheter (OR = 2.05; P = 0.046) and number of devices used (OR = 1.60; P = 0.046); only age (OR = 1.02; P = 0.022) was significant in the multivariate model. Conclusion: Clinicians and microbiologists should maintain a high level of alertness and contribute for effective screening and adequate treatment of infections caused by beta-lactamase-producing organisms according to international guidelines and the local epidemiological picture.

Hypercalcemia in a Patient with Rhabdomyolysis. A Case Report and a Literature Review

Calcium kinetics can be challenging during the different phases of rhabdomyolysis. In this case report we illustrate an unusual biphasic calcium behavior in a 27-year-old male patient who was diagnosed with septic shock and rhabdomyolysis complicated with acute kidney injury and oliguria. Initially he had hypocalcemia but as rhabdomyolysis improved, his calcium levels started to rise to above normal levels despite intermittent dialysis sessions. Hypercalcemia later on responded to denosumab and cautious hydration after his urine output improved. In conclusion, hypercalcemia can complicate the recovery phase of rhabdomyolysis. Careful monitoring of calcium levels and management are warranted.

Conduction Abnormalities: Types, Associated Factors and their Effect on Clinical Outcomes of Patients Admitted to the Coronary Care Unit at King Abdulaziz University Hospital

Background: Since conduction abnormalities represent a major cause of sudden death and cardiovascular complications, with a high incidence of increased length of hospital stay, risk of disabilities and healthcare costs, the aim was to discern the influence of conduction abnormalities at the time of admission on the clinical outcomes of patients admitted at the Coronary Care Unit in King Abdulaziz University Hospital. Method: The study adopted a retrospective-record review, episode-based design for a period of 2 years. All patients with sustained conduction abnormalities at the time of admission that had either self-terminated or required intervention were recruited. Statistical analysis was conducted by SPSS. Results: A total of 1763 admissions occurred during the study period, conduction abnormalities represented 11.5% of all these cases. The most common types were left bundle branch block and atrial fibrillation. Types that were significantly associated with the length of stay were atrial fibrillation (p = 0.045), ventricular tachycardia (p = 0.020), and ventricular fibrillation (p = 0.007) and complete heart block (p = 0.004). Right bundle branch block was the only conduction abnormality that was significantly associated with higher mortality (p = 0.011). Conclusion: Patients with right bundle branch block need close monitoring and optimal care to reduce risks of increased hospital stay and death. Further, it is imperative that attention should be directed in general to all patients admitted to the Coronary Care Unit with any kind of conduction abnormality in order to attempt to reduce their stay.

Diabetic Muscle Infarction: A Rare Complication of a Common Disease

Diabetes mellitus is a multifaceted metabolic disease with several serious complications. Diabetic muscle infarction is a rare musculoskeletal diabetic complication that can be frequently misdiagnosed as it shares clinical manifestations with multiple other more common clinical disorders. We present in this report, a case of diabetic myonecrosis with brief discussion about this unusual complication along with its management and expected outcomes.

Knowledge, Attitudes and Practices Regarding Waterpipe Smoking among Health Science Students at King Abdulaziz University, 2016: A Cross-Sectional Study

Objective: Waterpipe smoking is one of many methods of smoking and is a traditional habit in the Middle East. Waterpipe smoking produces toxins similar to those in cigarette smoke and is associated with substantial health risks. Th e aim of the study was to estimate the prevalence of waterpipe smoking among medical students, to evaluate their attitudes, motivations and knowledge about the hazardous effects. Methods: This cross-sectional study of King Abdulaziz University Health Science students required a sample size of 700 participants. Th e participants were selected using the multi-stage stratified random sampling technique, and a validated self-administered questionnaire in English was used. Th e study was conducted from 24 April 2016 to 15 May 2016. Results: Seven hundred twenty-one participants (325 (45.1%) males and 396 (54.9%) females) were selected for analysis. The prevalence of waterpipe smoking was 16.1%. The most common motives for smoking were socialization with friends, relaxation and taste, and most of the students were aware of the effects of waterpipe smoking on health. Conclusion: There is a high prevalence of waterpipe smoking among medical students. Sharing waterpipes with others was common, particularly among males, and the majority of students thought that they could quit this habit.