Safety and efficacy of semaglutide in post kidney transplant patients with type 2 diabetes or Post-Transplant diabetes.

Objective: Type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) are common in renal transplant recipients. Semaglutide has demonstrated efficacy and safety in patients with T2DM. To date, only a limited number of studies have investigated its use in renal transplant patients. This study assessed the safety and efficacy of semaglutide in post-renal transplant patients. Methods: A retrospective study was conducted at king Abdulaziz Medical City-Riyadh, Saudi Arabia. The subjects of the study were adults and adolescents (>14 years) who had undergone a kidney transplant and had pre-existing T2DM or PTDM. The study subjects were given semaglutide during the study period, from January 2018 to July 2022. The data were collected over a period of 18 months. Results: A total of 39 patients were included, 29 (74 %) of whom were male. A significant decrease in hemoglobin A1c (HbA1c) was observed during the follow-up period when compared to baseline (8.4 %±1.3 % at baseline vs. 7.4 %±1.0 % at 13-18 months (p < 0.001). A significant reduction in weight was also noted at follow-up as compared to baseline (99.5 kg ± 17.7 vs 90.7 kg ± 16.8 at 13-18 months (p < 0.001). No significant changes were found in renal graft function markers. Conclusion: Semaglutide was found to significantly reduce HbA1c levels and weight in post renal transplant patients with diabetes. No significant changes in markers of renal graft function were observed.

Why psychiatry as a career: Effect of factors on medical students' motivation.

CONTEXT: The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3]. AIMS: To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty. SUBJECTS AND METHODS: Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for Social Sciences (SPSS)® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant. RESULTS: It was noted that 85% did not choose psychiatry, with the most important deterrent being "Family member is psychologically ill" and "Available job position" being the most common motivator for choosing a specialty. CONCLUSION: In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUND: Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children's falls during hospitalization. OBJECTIVES: Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. DESIGN: Descriptive, cross-sectional prevalence study. SETTING: Specialized children's hospital. PATIENTS AND METHODS: Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children less than or equal 14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. MAIN OUTCOME MEASURES: Prevalence and possible risk factors for fall events. SAMPLE SIZE: 48. RESULTS: The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03). CONCLUSION: Risk factor identification is required to prevent falls and their severe outcomes. LIMITATIONS: Underreporting and single-centered study. CONFLICT OF INTEREST: None.

Characteristics of pediatric diabetic ketoacidosis patients in Saudi Arabia.

OBJECTIVES: To evaluate the clinical and biochemical characteristics of children with diabetic ketoacidosis (DKA). METHODS: In this retrospective study conducted between June 2012 and November 2013 at the King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, we evaluated pediatric DKA admissions from 1995-2008 (Phase 1). From the case files, we obtained information related to patients' age, gender, weight, presenting complaints, serum biochemical profile, and management. RESULTS: This study included 373 DKA admissions with a median age of 11 years (interquartile range [IQR]: 8-13). The patients in the subgroup of age more than 10 years old had the highest proportion of admissions (n=250, 67%, p<0.000). The median duration of diagnosis of diabetes mellitus (DM) was 3 years (IQR: 2-6). New-onset DM was 47%. Predominant precipitating cause was acute illness, mostly viral syndrome in 22% of all cases, and non-compliance to insulin regimen was in 79% of  the diagnosed diabetic cases. Blood glucose, pH, anion gap, serum osmolality, serum potassium, and serum phosphate showed the highest change during the initial 6 hours of management, while trends of serum bicarbonate and blood urea nitrogen demonstrated a predominant change in the initial 12 hours. CONCLUSION: The notable findings in this study, such as, higher mean age of presentation, high rate of non-compliance to insulin as the cause of precipitation, and a high prevalence of abdominal pain at presentation should be followed up with further comparative studies.

Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents.

CONTEXT: "Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. AIMS: The aim of this study was to assess medical residents' perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. MATERIALS AND METHODS: A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. RESULTS: A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9) compared to emergency medicine, which had 70.7 (16.2), P value (0.03). The reliability of the questionnaire was Cronbach's alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability); thus, accounting for 51% variance in the data. CONCLUSION: Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training.

"Liverscore" is predictive of both liver fibrosis and activity in chronic hepatitis C.

AIM: To formulate a noninvasive index predictive of severity of liver fibrosis and activity in chronic hepatitis C. METHODS: This cross sectional study was conducted on polymerase chain reaction positive, treatment naïve patients. Fibrosis was staged on a five point scale from F0-F4 and activity was graded on a four point scale from A0-A3, according to the METAVIR system. Patients were divided into two overall severity groups, minimal disease (< F2 and < A2) and significant disease (≥ F2 or ≥ A2). Eleven markers were measured in blood. Statistically, the primary outcome variable was identification of minimal and significant overall disease. Indices were formulated using ß regression values of different combinations of nine statistically significant factors. Diagnostic performance of these indices was assessed through receiver-operating characteristic curve analysis. RESULTS: A total of 98 patients were included and of these 46 had an overall clinically significant disease. Our final six marker index, Liverscore for Hepatitis C, consisted of age, alanine transaminase, gamma-glutamyl transpeptidase, apolipoprotein A-1, alpha-2 macroglobulin and hyaluronic acid. The area under the curve was found to be 0.813. On a 0-1 scale, negative predictive value at a cutoff level of ≤ 0.40 was 83%, while positive predictive value at ≥ 0.80 remained 89%. Altogether, 61% of the patients had these discriminative scores. CONCLUSION: This index is discriminative of minimal and significant overall liver disease in a majority of chronic hepatitis C patients and can help in clinical decision making.

Sonographic foetal measurements in a cohort of population of Karachi, Pakistan.

The purpose of this cross-sectional study was to establish reference intervals for sonographic measurements of foetal parameters in women with normal singleton pregnancies in a cohort of population of Karachi, Pakistan. It was conducted at the Ultrasound Clinic, and Ziauddin Memorial Hospital, Nazimabad, Karachi, from January 2003 to July 2004. The measurements of foetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were carried out on commercially available ultrasound machines using a convex probe of 3.5 MHz frequency. Four hundred women were enrolled; 358 women completed the study. Mean +/- SD, reference intervals and 5th and 95th centiles for the foetal parameters were computed. Regression equations calculated were BPD = -0.36 + 0.27 x GA, (R2 = 0.97); HC = -0.96 + 0.05 x GA, (R2 = 0.95); AC = -0.345 + 0.33 x GA, (R2 = 0.95) and for FL = -1.50 + 0.24 x GA, (R2 = 0.97). [GA = gestational age in weeks, R2 = coefficient of determination]. In this cross-sectional study, predominantly of Urdu-speaking "mohajirs" (67.9%) the reference intervals of commonly used foetal parameters for assessing gestational age i.e. BPD, HC, AC and FL, were established. A larger, multi-centered study to encompass the different ethnic groups of the population is required.

Students' opinion regarding application of Epidemiology, Biostatistics and Survey Methodology courses in medical research.

OBJECTIVE: To assess students' opinion regarding the application of Epidemiology, Biostatistics and Survey Methodology courses in medical research. METHODS: A cross-sectional study was conducted to assess the opinion of the third and fourth year students regarding the relevance of Epidemiology, Biostatistics and Survey Methodology courses, which are taught in the first two years, to medical research through a pre-tested, self administered questionnaire. The questionnaire was filled by 126 students of third and fourth year MBBS through convenience sampling. RESULTS: The majority (76%) of the students agreed that the Epidemiology, Biostatistics and Survey Methodology courses were relevant in the first two years of MBBS curriculum. Epidemiology and Survey Methodology were termed as most useful courses for critical reading sessions, literature review and medical writing. No significant difference was observed in the opinion of third and fourth year medical students (p > 0.05) CONCLUSION: Research methods courses conducted in the first two years of MBBS are considered relevant and useful by the medical students. The application of these courses should be encouraged by involving the students in research projects during their undergraduate years.

Diagnostic efficacy of 0, 30, 45, 60, 90 and 120 min growth hormone samples in insulin tolerance test: utility of growth hormone measurement at different time-points and a cost-effective analysis.

OBJECTIVE: To determine the utility of growth hormone (GH) measurement with the insulin tolerance test (ITT), and to carry out a cost-effective analysis of the diagnosis of GH deficiency. MATERIAL AND METHODS: Ninety-nine patients clinically suspected of GH deficiency were evaluated over a period of 14 months (January 2005 to April 2006). Post-insulin samples of GH and blood glucose (BG) samples were drawn at six different time-points. Serum GH levels of <10 microg/L (prepubertal) and <6.1 microg/L (adolescents) were taken as cut-off for the normal response. RESULTS: Ninety-nine ITTs were carried out during the study period, and GH levels were found to be deficient in 47 subjects. Specificities at different time-points were 0%, 54%, 77%, 62%, 39% and 23% for 0, 30, 45, 60, 90 and 120 min, respectively, in the prepubertal group, and 5%, 41%, 80%, 87%, 77% and 46% at the same time-points for the adolescent group. Accuracy was highest at 45 and 60 min in both the prepubertal and adolescent groups. The receiver operating characteristic curve showed that the highest area under the curve was found in samples drawn at 45, 60 and 90 min in both the prepubertal and adolescent groups. CONCLUSION: Our data suggest that 0, 45, 60 and 90 min samples are sufficient for diagnosing GH deficiency, which could lead to potential cost reductions of up to 29.8%.

Pituitary height on magnetic resonance imaging observation of age and sex related changes.

OBJECTIVE: To establish measurements of selected pituitary parameters in cases with normal pituitary gland in < or = 30 year old selected samples from Karachi. METHODS: A total of 220 subjects of < or = 30 years of age with normal pituitary morphology were evaluated by using T2 weighted Magnetic Resonance (MR) Imaging. Pituitary height (PH) and shape of the superior surface of the gland was observed on midsaggital sections. Data was stratified into six groups on the basis of age and sex to observe the differences. RESULTS: After the second month of life, the pituitary height increased gradually to achieve its peak in the second decade of life in the females (6.3 +/- 1.4 mm, n = 43) and the third decade of life in the males (5.9 +/- 1 mm, n = 41). PH decreased gradually there after. Significant difference was observed in PH in different age groups in both genders. Gland was significantly higher in females than males in the second decade. Higher frequencies of convex superior surface followed the same pattern. CONCLUSION: This study provided the reference values for the Pituitary height and the shape of the superior surface of the pituitary gland, which may contribute to establish credible reference values.

Erythrocyte sedimentation rate in healthy first year medical students.

OBJECTIVE: To determine the reference value of erythrocyte sedimentation rate (ESR) in young healthy individuals following the standardized criteria of the International Committee for Standardization in Hematology. METHODS: The ESR was determined in a sample of 422 medical students of Karachi, Pakistan from the year 1998 to 2004. After considering exclusion criteria, the data of 311 students (132 males and 179 females) were analyzed. RESULTS: The reference values found in this study are 0-13 in the 1st hour for healthy young males and 0-40 mm in the 1st hour for healthy young female students. CONCLUSION: We suggest that the reference values for ESR should be determined for various segments of the local population.

Risk factors assessment for hypertension in a squatter settlement of Karachi.

OBJECTIVE: To assess the risk factors for hypertension in adults (age more than 15 years) in a squatter settlement of Karachi. METHODS: Cross-sectional survey of adults more than 15 years old in a squatter settlement of Karachi through random sampling method. RESULTS: A total of 327 adults were approached, 165 (50.5%) were males and 162 (49.5%) females. Blood pressure was measured in 63 (38%) males and 135 (83%) females. Out of which, 11 (17.5%) males and 19 (14%) females were screened hypertensive. Hypertensives were older as compared to normotensives (p < 0.001). The mean BMI of hypertensives (25.6 +/- 4.5 kg/m2) was significantly higher (p = 0.008) than normotensives (22.9 +/- 5.0 kg/m2). Hypertensives were 9.7 times more likely to be diabetic as compared to normotensives in this study (p < 0.001). On analyzing the relationship of hypertension with other variables, no significant difference was noticed for education (p = 0.68), smoking status (p = 0.46), family history (p = 0.31) and occupation (p = 0.27). CONCLUSION: Prevention and control of hypertension is essential as the life expectancy is increasing in developing countries as well. The main emphasis according to this study, should be on controlling the BMI through weight reduction and regular exercise. Awareness about the risk factors for hypertension among the population is required to decrease the double burden on the society.

Relation of body mass index with lipid profile and blood pressure in young healthy students at Ziauddin Medical University.

BACKGROUND: This study was conducted to assess serum lipids in healthy young subjects in relation with their BMI. METHODS: Students of Ziauddin Medical University were assessed for anthropometric measures, blood pressure and lipid profile at the time of their admission for MBBS program. RESULTS: Out of 426 students all parameters were available for 301 students and they were selected for analysis in this study. Mean serum cholesterol in 301 students was 149.3 +/- 31.3 mg/dl, mean LDL-C was 91.3 mg/dl +/- 27.7, mean HDL-C was 40.0 mg/dl +/- 42.2. mean triglycerides were 89.9 mg/dl +/- 42.2. mean systolic blood pressure was 113.1 mmHg +/- 13.5 and mean diastolic blood pressure was 74.0 mmHg +/- 8.1. The mean BMI of students was 21.6 Kg/m2 +/- 4.2. Among 301 students, 88 were underweight, 175 were normal and 38 were overweight according to their BMI. We found no significant difference in mean serum cholesterol and LDL-C while there were significant difference in mean serum HDL-C, triglycerides, systolic and diastolic blood pressure among the three BMI groups. CONCLUSION: In our study, there are high numbers of at-risk individuals. Therefore, strategies should be designed for weight reduction in children and adults to prevent cardiovascular disease.