Demographics and Characteristics of Acutely Decompensated Heart Failure (ADHF) Patients in a Tertiary Care Center in Saudi Arabia.

BACKGROUND: Acute decompensated heart failure (ADHF) has been defined as the gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. Patients with ADHF usually have multiple comorbidities that contribute to the severity of exacerbation at admission, including diabetes mellitus and chronic kidney disease. The prognosis for these individuals is generally poor, with a high risk of readmission and death after discharge. Unfortunately, there are limited studies in Saudi Arabia reporting the characteristics of such patients. We aim to study the demographics and characteristics of ADHF patients admitted to King Abdulaziz University Hospital (KAUH) and analyze gender discrepancies and in-hospital mortality. METHODS: This retrospective record review was conducted at KAUH. The study included 425 patients diagnosed with ADHF. The New York Heart Association (NYHA) classification, underlying etiology of HF, comorbidities, left ventricular ejection fraction (LVEF), vital signs, comprehensive metabolic panel at admission, and in-hospital mortality were evaluated and analyzed. RESULTS: The majority of the patients were males (52.5%), and the average age was 63 ± 13.75 years. The most prevalent etiology of HF was hypertensive heart disease (51.8%), followed by ischemic heart disease (42.8%). The most common comorbidity was diabetes mellitus (73.6%), and the most common medication administered was diuretics (95.5%). The mean LVEF was 37.9% ± 16.0. In-hospital mortality occurred in 10.4% of patients. The mean length of hospitalization was 16.7 ± 86.2 days. The mean blood urea nitrogen (BUN) (17.18 ± 11.16) and creatinine (243.34 ± 222.27) were higher in patients with in-hospital mortality. The mean difference was statistically significant (P = 0.003 and P = 0.014). A higher length of hospitalization was significantly associated with in-hospital mortality (P = 0.036). CONCLUSION: We found more than half of our sample to be males and diabetes mellitus to be common among ADHF patients. Elevated BUN and creatinine levels at the time of presentation, as well as patients who had been in the hospital for a more extended period of time, were found to be associated with an increased risk of in-hospital mortality.

Inflammatory bowel disease in the elderly: A focus on disease characteristics and treatment patterns.

Background: As the population ages, the number of elderly inflammatory bowel disease (IBD) patients is expected to increase. The clinical features and therapeutic options for young and old patients may differ, as elderly IBD patients are likely to have different comorbidities and disease characteristics. The goal of this study was to examine the clinical aspects and therapeutic choices for elderly Saudi IBD patients. Methods: We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD in elderly patients (≥60 years) who followed up at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data was extracted from the KAUH inflammatory bowel disease information system (IBDIS) registry. The primary outcome was to describe disease characteristics in accordance with the Montréal classification and the secondary outcomes were to describe treatment patterns and identify significant clinical associations. Results: Our data were collected from 76 patients who fulfilled the study inclusion criteria. Females outnumbered males (53.9% vs 46.1%) and the mean age was 51.5 ± 9.7 years. Essential hypertension (26.3%) was the most common comorbidity followed by diabetes mellitus (23.6%), and malignant neoplasms (9.21%). More than half of the patients with Crohn's disease (CD) had disease onset after forty years of age. The most common form of disease distribution was ileocolonic disease (64.7%). Less than 17% of patients had a penetrating disease phenotype. About 88 percent of patients with UC presented >40 years of age. Approximately, half of the cohort had left-sided ulcerative colitis (UC) (48%), followed by pancolitis (40%). The most prescribed medication class for IBD was 5-aminosalicylic acid (5-ASA) derivatives (56.58%) followed by corticosteroids and immunosuppressive drugs. Conclusions: In Saudi Arabia, age-specific concerns including comorbidities and polypharmacy remain the major challenges in the management of elderly IBD patients.

Impact of Early Nephrology Referral on the Outcomes of Patients with Acute Kidney Injury.

Background: Acute kidney injury (AKI) is associated with an increase in patient mortality and high rates of renal/non-renal complications. Late detection of the disease has been associated with worse prognosis, but no such study has been conducted from Saudi Arabia. Objectives: To assess the impact of early nephrology referral on the outcomes of patients with AKI. Methods: This retrospective record review included all adult patients (≥18 years) with AKI who were referred to the Nephrology Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2019 and July 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. AKI patients evaluated by nephrologists were stratified into early referral group (i.e., referral in <48 h from the first detection of AKI) and late referral group (referral ≥48 h after the first detection of AKI). Results: A total of 400 patients met the inclusion criteria, of which 264 (66%) were early referrals. A significant association was found between delayed referral and mortality rates and length of hospital stay (for both,P= 0.001). Late referral was also significantly associated with increased likeliness of the need for renal replacement therapy (P = 0.037) and sepsis (P = 0.005). Conclusions: The outcomes were worse for patients with AKI receiving late referrals to nephrologists. Raising the awareness of AKI among non-nephrologists would likely increase the proportion of earlier referrals.

Preterm Assessment at Birth and Its Association With the Development of Retinopathy of Prematurity (ROP): A Tertiary Care Center Experience.

BACKGROUND: Prematurity is a leading cause of neonatal morbidity and mortality and is associated with insufficient development of multiple body structures, including neurovascular and retinal tissues. Retinopathy of prematurity (ROP) is an abnormal vaso proliferation of the neonatal retina that results from an arrest in the normal development of the retinal nerve and blood supply. Incidence has been increasing due to advancements in intensive care and survival of preterm neonates, as well as improvements in screening methods for ROP. OBJECTIVES: The objective is to assess the initial clinical and laboratory characteristics of preterm infants at the time of birth to identify population-specific risk factors for the development of ROP in a tertiary care center in western Saudi Arabia. METHODS AND MATERIALS: This was a retrospective record review conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. The study included 37 patients diagnosed with ROP. Their ROP staging, complete blood count, appearance, pulse, grimace, activity and respiration (APGAR) score, and birth characteristics were all analyzed. RESULTS: Thirty-seven neonates diagnosed with ROP and who met the study inclusion criteria were included. our results showed a female predominance of 51.4%, the mean age of the pregnancy was 27.18 ± 2.29 weeks, the mean birth weight was 0.8 ± 0.26, and 66.7% of our sample was delivered by the cesarean section. A significant association was found between the birth weight and the development of ROP in the right eye (p = 0.026); another significance was found between gestational age and the development of ROP in the same eye (p = 0.016). CONCLUSIONS: A low birth weight and gestational age show a significant association with the development of ROP. Early identification and treatment of ROP are important to preserve a neonate's eyesight.

Immunoglobulin A (IgA) Nephropathy: A Clinicopathologic Study in a Tertiary Care Center in Saudi Arabia.

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common primary aetiology of glomerulonephritis worldwide, and it is the most important type in terms of morbidity and mortality. IgAN involves the deposition of immune bodies in the mesangial cells of the kidney, which causes renal glomerular damage, haematuria, proteinuria, and various other symptoms. Previous studies have mainly focused on the East Asian population, with few studies conducted in Saudi Arabia, particularly in the western region. The diagnosis requires a biopsy, which should be examined by an expert and classified according to the Oxford classification system. OBJECTIVES: Analyze the clinical, pathological, and laboratory features of male and female patients diagnosed with IgAN at King Abdulaziz University Hospital (KAUH). METHODS AND MATERIALS: This was a retrospective record review conducted at KAUH in Jeddah, Saudi Arabia between May-June 2021. The study included 18 patients diagnosed with IgAN by biopsy, and their clinical, laboratory and pathological data were evaluated and classified according to the Oxford classification system. RESULTS: Demographic data revealed a male predominance of 66.7%. The most common pathological finding was mesangial proliferation, and the most common presentation was haematuria. For treatment options, corticosteroids were the most prescribed drugs. A significant relationship was found between IgAN with increased serum creatinine and male sex (P = 0.017). Additionally, a significant relationship was observed between decreased estimated glomerular filtration rate (eGFR) in IgAN and the male sex (P = 0.006). CONCLUSIONS: We found a difference in terms of pathological, clinical and laboratory presentations of IgAN between males and females. Men generally had worse kidney function at presentation and advanced Oxford classification in their kidney biopsies compared to women.