Factors associated with tuberculosis treatment default

This study was carried out at Azad Kashmir Combined Military Hospital [AK CMH]/Sheik Khalifa Bin Zyad [SKBZ] Muzaffarabad [MZD] designed for patients defaulting from tuberculosis treatment from 1.1.2013 to 31.12.2013. This study included 110 adults with diagnosis of TB treatment default. The study protocol incorporated structured questionnaire, physical examinations, radiological, laboratory investigations and potential factors for TB treatment defaults. The statistical analysis was performed using SPSS-20, the chi square test was done and p<0.05 was considered as statistical significance. PLUM-Ordinal regression analysis revealed that many clinical variables have statistical significant association with tuberculosis treatment defaults. Factors identified to be associated with treatment default were male gender [p<0.007], distance from the health post [p<0.007], displacement [p<0.024], financial Constraints [p<0.00 1], no body at home to bring medicine or take patients to hospital [p = 0.001], route closed in winters [p = 0.001], improvement from symptoms [0.009] and went abroad [0.001]. Determinants of treatment defaults and associated factors should he considered in treatments plan and Policy actions to tuberculosis control programs. Information on disease, treatment plan and education of the individual along with population should be done in order to minimize treatment default and spread of multi drug resistance to anti-TB drugs

Risk factors for acute myocardial infarction

Objective of the study is to identify risk factors for Acute Myocardial Infarction [AMI]. Prospective cross sectional study. This study was carried out at AK CMH/SKBZ Muzaffarabad from August 2012 to September 2013. This study of first ever AMI patients was carried out in a tertiary care teaching hospital. Standard methods were followed to elicit risk factors. Chi-square and Fishers exact tests on SPSS 20 were done for analysis of risk factors. A total of 210 patients [male [M] = 118 and female [F] = 92] with age range from 30 to more than70 years were included. The mean age of patients was 56.30 +/- 13.79 years. The risk of developing AMI was statistical significantly in both males and female [<0.001]. The significant risk factors for all AMI were: Hypertension [p=0.039], diabetes [p=0.001], Hypercholesterolemia [p=0.05], smoking [p=0.001] and family history of AMI [p=<0.001]. Age [p=<0.001 and age category [p=0.045] were also identified as statistical significance risk factor for AMI. Mortality was 24 [11.4%]. Thus we conclude that CAD is more common in adult and has significant association with modifiable major risk factors in our population. Targeted interventions that reduce/modify these modifiable CAD risk factors could substantially reduce the mortality and morbidity of AMI. Health educations on life style modification, programs to diagnose, control of diabetes, hypercholesterolemia and hypertension have to be initiated at community level in order to reduce the occurrence

Hypertension as independent risk factors for acute stroke

The stroke is leading cause of death in world and many patients die of an acute stroke. This study was conducted to determine whether the hypertension is independent risk factor for acute stroke. Prospective cross sectional. This study was carried out at AK CMH/SKBZ Muzaffarabad from May 2012 to May 2013. In this study 220 patients having first ever acute stroke. Many clinical variables have been investigated as risks factors for stroke.The hypertension was investigated as a risk factor for stroke. The evaluation of patients included structured questionnaire, clinical, neurological examinations, laboratory tests, and computed tomogram scan [CT] brain. The follow-up at 14 days was done for all patients. Out of 220 cases of acute stroke, 171 [[77.73%] were hypertensive, and 49[22.27] % were normotensive. The statistical significant risk factors for stroke were: hypertension [p=0.04] and Hypercholesterolemia [p=0.05]; for cerebral infarction [CI]: [p=<0.001] and hypertension [p = 0.05] and Hypercholesterolemia [p=0.001]; for intracerebral hemorrhagic [ICH] stroke [p = 0.001]. The low Glasgow coma scale [GCS] score [p=0.05] on admission was associated with high mortality and worst outcome in hypertensive patients. Thus hypertension has statistical significant association for both CI and ICH stroke patients. This study confirms the statistical significant association of hypertension with acute stroke and emphasizes the need in preventing and controlling of hypertension in order to avoid stroke and its mortality

Risk factors for stroke; a prospective hospital based study

The stroke is third leading cause of death in world and most patients die with an acute event in stroke. Various clinical variables have been investigated as risks factors of stroke. The study was aimed to identify these risks factors for stroke. This prospective study included 205 consecutive patients of stroke admitted in Combined Military Hospital/Sheik Khalifa Bin Zyad Hospital Muzaffarabad Azad Kashmir. The risk factors of stroke were investigated. Examination included clinical, neurological evaluation, laboratory tests, and brain CT. The follow-up at 14 days were done for all patients. Patients included were with acute first ever stroke onset of 48 hours of hospital admission. All patients completed a structured questionnaire and a physical examination and most provided blood for relevant investigations. Two hundred and five cases stroke sub-types were [n=156, 76%, with ischemic stroke [CI]; n=49, 24%, with intra-cerebral hemorrhagic stroke [ICH]. The significant risk factors for all stroke were: Hypertension [p=0.003], diabetes [p=<0.001], Hypercholesterolemia [p=0.686]; atrial fibrillation [p=0.445], cardiac diseases [p=0.938], smoking [p=0.926] for brain infarction and hypertension [p=0.002], diabetes [p=<0.001], Hypercholesterolemia [p=0.018]; atrial fibrillation [p=0.449], cardiac diseases [p=0.749], smoking [p=0.829] for hemorrhagic stroke. Age significance [CI; p=0.247 vs. ICH; p=0.013] and age category significance were [CI; p=<0.001 vs. ICH; p=0.871] for subtype of stroke. High mRS [p<0.001] low GCS score [p<0.001] on admission were associated with worst outcome for both stroke subtype. These risk factors were all significant for CI as well as ICH. This study signifies the association of risks factors with acute stroke. Targeted interventions that reduce these risk factors could substantially reduce the burden of stroke

Predictors of in-hospital mortality in acute myocardial infarction

Acute myocardial infarction is the leading cause of death. This study was conducted to identify the predictors of in-hospital mortality in acute myocardial infarction. Prospective cross sectional study. This study was carried out at AK CMH/SKBZ MZD from January 1[st] 2011 to 31[st] December 2012. This prospective cross sectional study was carried out at AK CMH/SKBZ MZD from January 1[st] 2011 to 31[st] December 2012 of 151 patients having acute first ever acute myocardial infarction [AMI]. Of these 151 patients 133 were discharged from the hospital and 18 died. Both categories were analyzed regarding sex: age; time elapsed from onset of the symptoms of myocardial infarction to assistance at the hospital; family history of AMI; use of streptokinase; risk factors for atherosclerosis and electrocardiographic location of myocardial infarct. Among 151 patients, 114 [75.5%] were males and 37 [24.5%] were females. Mean age was56.59 +/- 14.47. Out of theses 67 [44.3] received streptokinase. Hospital mortality was 12% [18/151] within 14 days. Age and age category has impact and gender has no impact on mortality. Age category [p=0.02], Hypercholesterolemia [p=0.043], Time of onset of chest pain to SK given [p=<0.001], left ventricular failure [p=0.001] asystole [p=0.001] and ventricular septal defect [VSD] [p=0.007]. on admission were important prognostic predictors of mortality in AMI. Mortality associated with AMI needs control and prevention of modifiable risk factors. Mean time of onset of chest pain to SK given was 2.62 +/- 1.46 hours. In-hospital mortality in SK was 8[1 1.9%] [p=0.002]. Complication of AMI such as asystole 6[75%], VSD 3[50%] and LVF 13[27.7%] has statistically significant predictors of higher in-hospital mortality. General Linear Model [GML], Multivariate statistical analysis revealed that topical presentation of AMI, test between the subject effect association of hypertension with age p=0.036 vs. age category p=0.030] [hypertension p=0.059 vs. mortality p=0.018], hypertension level [SBP level p=0.000 1vs DBF p=0.137], cholesterof level with mortality [p=0.006], AF with mortality [p=0.047], duration of chest pain with mortality [p=0.002] and streptokinase with in-hospital mortality [p=0 .01] and anteroseptal or extensive anterior infarction [p:=0.034] had statistical significant association with in-hospital mortality. Age category, Time of onset of chest pain to SK given, left ventricular failure, asystole and ventricular septal defect [VSD] on admission were statistically significant predictors of mortality in AMI. Mortality associated with AMI needs prompt management and its prevention by control of modifiable risk factors

Extremely elevated erythrocyte sedimentation rate: etiology at a tertiary care center in Saudi Arabia

To evaluate the etiology of extremely elevated erythrocyte sedimentation rate [ESR] in adolescents and adults at a tertiary care center. This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Wetergren method of determining ESR in adolescents and adults aged >/= 12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/= 100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient. During the study period, out of the 44,366 ESR tests carried out at this center, 1864 [4.2%] had an ESR >/= 100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections [38.6%], autoimmune diseases [15.9%], malignancy [15.4%], miscellaneous causes [10.2%], ischemic tissue injury or trauma [8.7%], and renal diseases [8.4%]. Ten common individual causes included: rheumatoid arthritis [7.3%], osteomyelitis [6.9%], tuberculosis [5.5%], trauma [5.3%], lymphoma and sepsis of unknown origin [5.1%] each, urinary tract infection [4.7%], septic arthritis [3.1%], abscesses [2.8%], and pregnancy [2.2%]. Fourteen [2.4%] patients had no known cause. Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis

Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia

Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia. A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital [KFNGH] between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method. The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem [55% to 10%], meropenem [33% to 10%], ciprofloxacin [22% to 10%], and amikacin [12% to 6%]. E coli susceptibility was markedly decreased [from 75% to 50% or less] to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime [100% to 32%], ceftazidime [100% to 35%], and cefepime [100% to 66%]. Enterobacter susceptibility was markedly decreased to ceftazidime [34% to 5%], cefotaxime [34% to 6%], and pipracillin-tazobactam [51% to 35%]. Respiratory samples were the most frequently indicative of multidrug-resistant pathogens [63%], followed by urinary samples [57%]. Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future

attitude and perception of hospital doctors about the management of psychiatric disorders

To determine perception and the attitude of non-psychiatric doctors about psychiatric problems working in a tertiary care hospital. Cross-sectional survey. Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. The questionnaires distributed were returned within one week duration. All the doctors working in Lady Reading Hospital, Peshawar for more than one year except house officers and those working in Paediatrics, Radiology and Administration Block were given anonymous questionnaires. Two hundred and ten doctors returned the questionnaires. One hundred and eighty-three [87%] of respondents were male. Ninty-eight percent of doctors agreed that psychological factors were important in the cause and outcome of physical disorders but only 26.7% agreed that management of emotional issues is medical responsibility. There was no statistically significant difference between physicians and surgeons in their attitude towards importance of psychological factors in the physical disorders. Doctors working in tertiary care hospital have adequate awareness about the psychological and emotional factors in medical and surgical patients. However, some barriers against the provision of bio-psychosocial care seem to be present

Use of nucleic acid testing for blood donor screening of human immunodeficiency virus and hepatitis C virus in the Saudi population

To determine the risk of transfusion associated infection for human immunodeficiency virus and Hepatitis C virus using nucleic acid testing. During March 1998, 400 donor blood samples from the Saudi population that were negative by serology were further tested for human immunodeficiency virus 1 and 2 and Hepatitis C virus using nucleic acid testing. A total of 400 were tested by nucleic acid testing, 381 of these were negative, 4 were indeterminate but were found to be negative on repeat testing and one seronegative sample was found to be positive for Hepatitis C virus. Due to the low prevalence of human immuno-deficiency virus in the Kingdom of Saudi Arabia, nucleic acid testing of blood donors by serology is adequate for screening. But the higher prevalence of Hepatitis C virus and increased risk of transmission would indicate that nucleic acid testing may be warranted for Hepatitis C virus in the near future

Current status and changing trends of antimicrobial resistance in Saudi Arabia

Due to modern travel and ease of spread of infections, it is desirable to widen knowledge of susceptibility of common bacterial isolates from different parts of the world for optimal clinical management and control programs. Over the past decades, antimicrobial resistance has emerged in all kinds of micro-organisms worldwide including Saudi Arabia. this phenomenon is primarily due to increasing antibiotic use and misuse in humans, animals and agriculture. Additionally, the presence of a large expatriate population and a significant number of visitors to the Kingdom annually for pilgrimage and/or work from all over the world may have also facilitated the importation to Saudi Arabia of drug resistant micro-organisms from other countries. Saudi Arabia has witnessed an increase of drug resistant Mycobacterium tuberculosis, Streptococcus pneumoniae, Staphylococcus aureus and some Enterobacteriaceae in the last decade. We describe the status of antimicrobial resistance in Saudi Arabia which is an important focus of antimicrobial resistance for the Gulf Region

Serodiagnosis of parasitic infections at a tertiary care centre in Saudi Arabia

The application of control measures, particularly population based chemotherapy has in many countries greatly reduced the incidence of serious parasitic disease manifestations. Therefore, a restrospective study was carried out to determine the prevalence of parasitic infections, as detected by serological markers at a referral center in Riyadh. A total of 1179 were tested for the following parasitic diseases; 172 for E. histolytica, 219 for echinococcus, 81 for leishmania, 624 for schistosoma and 83 patients for malaria. The prevalence rate for these infections were found to be 24.7% for echinococcus,.2.3% for E. histolytica, 4.9% for leishmania, 38.9% for schistosoma, and 30% for malaria

Hospital based incidence of clostridium difficile enterocolitis and cross reactivity of the latex agglutination test

In order to determine the prevalence and characteristics of antibiotic-associated Clostridium difficile enterocolitis, a total of 2476 specimens from 2356 patients were examined. Of these 224 [9.5%] were positive, 158 [70%] of them occurring in organ transplant, bone marrow transplant or neutropenic patients. Antibiotic-associated colitis due to enterotoxigenic C. difficile was diagnosed by use of cytotoxin assay [CTA]. During a previous study, CTA was compared with a commercial latex agglutination [LA] test and gave a high frequency of false positives. Sixteen of these 31 false positive specimens also had a bacterial pathogen or parasite present. Since a wide range of microbial pathogens/parasites are found in Saudi patients, we also tested stool supernatants from a further 107 patients harboring enteric microbial pathogens/parasites to determine the cross-reactivity of a rapid latex agglutination kit [LA] with these organisms. Only one specimen which grew Salmonella enteritidis gave a false-positive reaction. Since the reagents in the LA test also react with non-toxigenic strains of C. difficile and other anaerobes, the method could be used only as a rapid screening procedure and positive findings should be confirmed by a specific test. Running title: C. difficile toxin enterocolitis

Etiology of viral diseases in a tertiary care center in Saudi Arabia

In order to establish the prevalence and etiology of viral diseases at a tertiary care hospital in Saudi Arabia, clinical specimens from 38.978 patients were retrospectively evaluated over a 7 year period [1988-1994]. Virus particles were detected in clinical specimens from 3434 [8.8%] patients. The most common virus was herpes simplex [1646 patients], followed by cytomegalovirus [798 patients] and rotavirus [593 patients]. There were also 202 patients positive for adenovirus, 60 for respiratory syncytial virus, 29 for influenza, 8 for parainfluenza, 75 for enterovirus and 23 for varicella-zoster virus. The trends and characteristics of these findings in a specific Saudi population are discussed