Validation of the postgraduate hospital educational environment measure at a Saudi university medical school

The English version of the postgraduate hospital educational environment measure [PHEEM] was evaluated to determine its psychometric properties, validity, and internal consistency. The instrument was used to measure the clinical learning environment in the hospital setting of a Saudi university medical school. This cross-sectional study was performed in a Saudi medical school between June and August 2012. The postgraduate hospital educational environment measure was administered to interns [house officers] and residents rotating at a Saudi university hospital. Means and mean ranks were calculated. The effects of training stage [intern versus resident] and gender [male versus female] on the PHEEM scores were estimated. Construct validity was measured using exploratory factor analysis, and internal consistency was measured using Cronbach's alpha. In this study, 193 interns and residents responded to the PHEEM. The response rate was 100%. The internal consistency of the 40-item questionnaire was 0.936 [Cronbach's alpha] with a maximum score of 160. The PHEEM mean score was 89.21 +/- 21.6. The PHEEM is a valid and highly reliable instrument that can be applied to measure the educational environment among interns and residents in hospital-based clerkships. The hospital training environment was positive, and the interns were more satisfied than the residents. Gender had no influence on the perceptions of the hospital's educational environment

Association of NOD2/CARD15, DLG5, OCTN1 and toll-like receptor 4 gene polymorphisms with inflammatory bowel disease: a university hospital experience

Background: Both genetic and environmental factors play major roles in the development of inflammatory bowel disease [IBD]. Recent studies have identified a number of genetic susceptibility loci for Crohn's disease [CD] and ulcerative colitis [UC]

Objectives: The present study aimed at examining the association of nine polymorphisms in four different genes with the development of CD and UC in a sample of Saudi patients with IBD

Materials and Methods: All gene polymorphisms were identified by polymerase chain reaction and by direct sequencing. Allele and genotype frequencies of polymorphisms of NOD2/CARD15 [R702W, G908R, L1007finsC], Toll-like receptor 4 [TLR4] [D299G, T399I], OCTN promoter [C1672, G207C] and DLG5 [G113A, C4136A] genes were determined in Saudi subjects with CD [51], UC [26] and in 75 normal controls

Results: Out of the nine polymorphisms studied in four loci, only two polymorphisms in two different loci were found to have increased in patients compared with the control subjects. The CT genotype of TLR4 T3991 was over represented in patients with CD or UC compared to that in controls [odds ratios [OR], 5.63:95% confident interval [CI], 1.19-26.69; P = 0.03]. In addition, the GA genotype of DLG5 G113A was over represented in patients with CD or UC compared with that in controls [OR, 4.72:95% CI 2.30-9.66; P = 0.0001]. However, there were no significant associations found between all other polymorphisms studied and the susceptibility of CD or UC found in the Saudi population

Conclusion: Our finding indicates that association of IBD with nine gene polymorphisms was only significant in two of these polymorphic variants

Prediction of sustained virologic responses to combination therapy of pegylated interferon-alpha and ribavirin in patients with chronic hepatitis C infection

Hepatitis C virus [HCV] infection is a major health problem worldwide. Genotype-4 is the most common genotype in Saudi Arabia. The response to treatment with pegylated interferon-alpha combined with ribavirin in chronic HCV infection varies. This study aimed at investigating the pre- and on-treatment predictors of sustained virologic response [SVR] in patients with chronic hepatitis C [CHC] infection. Clinical data of 48 patients with CHC treated with standard HCV antiviral combination therapy, between January 2005 and December 2010, at a Saudi University hospital, were retrospectively reviewed for age, sex, body mass index, liver enzymes, HCV-RNA viral load, liver biopsy, and response to treatment. The primary end point was SVR defined as undetectable HCV-RNA by polymerase chain reaction [PCR] 24 weeks after the end of treatment. Univariable logistic regression was used to explore the association between the different variables and SVR. These independent predictors of SVR were then analyzed with multivariable logistic regression analysis. Of the 48 treated patients, 25 [52%] were females and 27 [56%] were Saudi. The mean age was 43 years [43 +/- 10 years]. Twenty-four [50%] had genotype-4, and 26 [54%] had liver biopsy. The overall SVR rate was 75% [36/48] and was 83.3% [20/24] among genotype-4 patients. Baseline factors associated with SVR identified by univariate logistic regression were genotype-4 and early viral response [EVR], defined as a drop of >/= 2 log in serum HCV viral load after 12 weeks of initiation of combination therapy [P = 0.001]. However, in stepwise regression analysis, the independent factor associated with the effect of antiviral therapy was genotype-4. When on-treatment variables were included, EVR [P = 0.003] and low baseline viral load [P = 0.048] were highly predictive of SVR. Of our HCV-treated patients, 75% had SVR. HCV genotype-4, EVR, and low baseline viral load were predictive of SVR

Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease

Metabolic bone disease is common in patients with inflammatory bowel disease [IBD]. Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors. We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density [BMD] determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008. Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines. Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses. Ninety-five patients were included; 46% had Crohn's disease [CD] and 54% had ulcerative colitis [UC]. The average age was 30.9 +/- 11.6 years. Using T-scores, the frequency of osteopenia was 44.2, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index [BMI] [P=0.042 and P=0.018, respectively]. On regression analysis BMI, age, and calcium supplementation were found to be the most important dependent predictors of BMD. Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD