ABSTRACT
BACKGROUND: Percutaneous radiologic gastrostomy (PRG) is the method of choice for patients incapable of ingesting nutrition orally. The complications related to PRG are classified into major and minor complications. This article presents the prevalence of major and minor complications of PRG among adult patients admitted to King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia between 2017 and 2018. METHODS: This was a retrospective cross-sectional study, which included adult patients who underwent a new PRG intubation between 2017 and 2018 in KAMC in Riyadh, Saudi Arabia. The variables reviewed were the demographics, comorbidities, indications of tube insertion, major and minor complications, and mortality rates. RESULTS: A total of 105 patients who underwent PRG were covered in this study with a mean age of 69.2 + 20.4 years. The most common indications were neurogenic pharyngeal dysphagia (31%) and dementia (29%). Most of the complications reported were minor (40%) and major complications were found in 2%. The percentage of patients with both minor and major complications was 37%. The patients who had no complications made up 21%. Major skin complication was reported in 19 patients (18%), while leakage was the most occurring minor complication found in 49 patients (47%). The 30-day mortality was observed in five patients (5%) and one-year mortality was observed in 21 patients (20%), and none of them were related to the PRG tube. CONCLUSION: This study found that the PRG procedure had low rates of complications in KAMC. The majority were minor complications, and the mortality rate was low with none being related to the tube itself. So PRG may be considered to be a relatively safe procedure.
ABSTRACT
BACKGROUND: The increase in extended-spectrum ß-lactamase (ESBL) producing microbes in recent years represents a major challenge. AIM: To study the risk factors for urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli in patients requiring hospitalization for treatment. MATERIALS AND METHOD: Electronic health records were used to identify 616 inpatients over the age of 18 who had UTI symptoms and/or signs and an ESBL-producing E. coli strain cultured on urine culture between January 1 and December 31, 2018. The electronic health care records of these patients were searched to identify those patients with previous UTIs due to an ESBL-producing E. coli grown on urine culture. Patients with cancer or those taking prophylactic antibiotics or immunosuppression were excluded. RESULT: Risk factors for the acquisition of ESBL-producing E. coli included male sex (P = 0.0032), age over 66 years (P < 0.0001), renal stones (P = 0.0021), urology intervention within six months of presentation (P = 0.0360), pressure sores (P = 0.0002), feeding tubes (P = 0.0076), and urinary catheter (P = 0.0023). Comorbidities (e.g., diabetes mellitus and duration of antibiotic therapy were not associated with an increased risk of recurrence of ESBL-producing E. coli UTI (P = 0.4680, P = 0.3826, respectively). CONCLUSION: Antimicrobial stewardship programs may have reduced the development of antimicrobial resistance in E. coli. However, the recognition of risk factors for UTI caused by ESBL-producing E. coli may facilitate the early detection of high-risk cases and guide treatment decisions. This can improve patient outcomes while decreasing the length of the hospital stay.
ABSTRACT
Background Diabetic ketoacidosis (DKA) is a life-threatening condition with high morbidity and mortality rates. It should be diagnosed immediately and managed intensively to prevent its significant complications. Objectives The aim of this study to assess DKA treatment outcome and associated factors among adult patients at King Abdulaziz Medical City Emergency Department and Medical Wards, Riyadh, Saudi Arabia. Materials and Methods A retrospective cross-sectional study was conducted using a chart review to assess DKA treatment outcome and associated factors. All patients who were admitted as DKA cases from September 2017 to August 2019 were selected by simple random sampling except those with incomplete charts or younger than 14 years. Data were entered and analyzed using SAS Version 9.4 (SAS Institute, Cary, NC, USA). Results A total of 223 reviewed charts were collected. The frequency of DKA recurrence in most of the patients was once per year (126 [56.5%]). The most common precipitating factor was inappropriate insulin therapy (104 [46.64%]). More than half of the patients (120 [53.81%]) got out of DKA management protocol within 24-72 hours with a hospital stay of less than or equal to five days. The mortality rate was 1.83%. Patients with two or more DKA episodes per year tended to be admitted to ICU more frequently than those with one episode (p=0.001). It was found that patients who had a duration of one to five years of diabetes mellitus were almost five times more likely to get out of DKA in more than 72 hours when compared with those who had a duration of more than five years (adjusted OR: 4.7; 95% CI: 1.34-16.60; p=0.01). Conclusions The findings of this study highlight that majority of DKA patients showed improvement and discharged with a very low mortality rate. Inappropriate insulin therapy was the most common precipitating factor; thus, educating diabetic patients about the complications of treatment non-compliance is an important part of management.
