Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube [QFT-G] test for the diagnosis of latent tuberculosis infection in dialysis patients

Dialysis patients are more likely than the general population to develop active tuberculosis [TB]. In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube [QFT-G] test was compared with the tuberculin skin test [TST] for the diagnosis of latent tuberculosis infection [LTBI] among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 [13%] were TST positive, and 65 [32.5%] were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% [k = 0.34] being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 [66.7%] were positive by the QTF-G test, resulting in an overall agreement of 33.3% [k = 0]. A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve [AUC] obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis

Characteristics of Saudi patients with congestive heart failure and adherence to management guidelines in a tertiary hospital in Riyadh

There is limited data available on the characteristics of local Saudi patients diagnosed with congestive heart failure [CHF] and on their adherence to guidelines for managing the disease. This study aimed to fill this gap. Retrospective study of patients treated at King Abdulaziz Medical City from 20022008. The records were reviewed of subjects admitted secondary to heart failure [defined as systolic heart failure [ejection fraction < 55%] and/or heart failure with preserved ejection fraction diagnosed either clinically and/or by echocardiogram and/or cardiac catheterization] or who visited the outpatient department for the same complaint. Of 392 CHF cases, the mean age was 67.8 [12.8] years and the majority were males [53.1%]. Hypertension was the predominant comorbid illness, accounting for 84.9% of cases, followed by diabetes mellitus type 2 and hyperlipidemia. Almost three-fourths [73.7%] of the subjects had mild to severe left ventricular dysfunction, with 68.5% of the cases having right ischemic cardiomyopathy. Spironolactone, exercise and vaccination were the the least least adhered to recommendations [30.0%, 20.5% and 15.2%, respectively]. The study highlights the need for proper education of patients and caregivers to increase compliance to medications. Physicians are also encouraged to undergo continuing medical education and training courses to properly implement current recommendations in the management of heart failure. Further studies are needed on a larger scale in order to formulate an effective management scheme that will address the current challenges faced by both clinicians and CHF patients.

Global hospital bed utilization crisis. a different approach

To test the effect of improved physician availability on hospital bed utilization. A prospective cohort study was conducted from 1 st January 2009 to 31 st March 2009 in the Division of Internal Medicine [DIM], King Abul-Aziz Medical City [KAMC], Riyadh, Kingdom of Saudi Arabia. Two clinical teaching units [CTU]were compared head-to-head. Each CTU has 3 consultants. The CTU-control provides standard care, while the CTU-intervention was designed to provide better physician-consultant availability. Three outcomes were evaluated: patient outsourcing to another hospital, patient discharge during weekends, and overall admissions. Statistical analysis was carried out by electronic statistics calculator from the Center for Evidence-Based Medicine. Three hundred and thirty-four patients were evaluated for admission at the Emergency Room by both CTU's. One hundred and eighty- three patients were seen by the CTU-control, 6 patients were outsourced, and 177 were admitted. One hundred fifty-one patients were seen by the CTU-intervention: 39 of them were outsourced, and 112 were admitted. Forty-eight weekend patient discharges occurred during this period of time: 21 by CTU-control, and 27 by CTU-intervention. Analysis for odds ratio in both the rate of outsourcing, and weekend discharges, showed statistical significance in favor of the intervention group. The continuous availability of a physician-consultant for patient admission evaluation, outsourcing, or discharge during regular weekdays and weekends at DIM, KAMC proved to have a positive impact on bed utilization