Impact of sodium-glucose cotransporter-2 inhibitors on kidney outcomes in type 2 diabetes: A tertiary center experience.

BACKGROUND: Diabetic nephropathy (DN) is a complication of chronic hyperglycemia associated with diabetes mellitus (DM). Several studies have demonstrated the positive impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney outcomes. The objective of the study was to evaluate the effects of dapagliflozin, an SGLT2 inhibitor, on kidney outcomes in Saudi patients with type 2 DM. MATERIALS AND METHODS: Study included all Saudi patients with type 2 DM who visited our center from August 1, 2021, to July 31, 2022, and had been on dapagliflozin for at least 3 months. Data was abstracted through chart review for all patients included in the study. Paired t-test or Wilcoxon signed-rank test were used to compare the results before and after treatment for continuous variables and the McNemar test was used to compare the results for categorical data. RESULTS: Study included 184 Saudi patients with type 2 diabetes with a mean age of 61.32 years (SD=9.37). Dapagliflozin 10 mg/day significantly reduced hemoglobin A1C (HbA1C) from a mean (SD) of 9.00 to 8.40 (P < 0.001). Among a subgroup of patients with significant proteinuria (n = 83), dapagliflozin significantly reduced ACR from a median of 93.1 to 64.9 mg/g (P = 0.001). Following treatment, the estimated glomerular filtration rate improved from a mean of 69.83 to 71.68 mL/min and the mean arterial pressure (MAP) fell from 90.03 to 89.06 mmHg, both were not statistically significant. Despite a statistically insignificant increase in the episodes of urinary tract infections (UTIs), the hospitalization rate declined. No episodes of amputations or ketoacidosis occurred during the study period. CONCLUSION: SGLT2 inhibitors had beneficial effects among Saudi patients with type 2 diabetes by improving diabetic control and lowering proteinuria. Dapagliflozin did not result in significant harm, including UTIs, amputations, and ketoacidosis.

Prevalence of sleep duration among Saudi adults.

OBJECTIVES: To examine the associations between sleep duration and a variety of demographic and clinical variables in a sample of Saudi adults.  Methods: A cross-sectional study among 2,095 participants was conducted at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between May and October 2014. A questionnaire was administered to collect data related to clinical health outcomes and demographic characteristics. Participants were asked to report their average sleep duration per night in hours.  Results: One-third (33.8%) reported short sleep duration of less than 7 hours/night. Short sleep duration was more prevalent in females (37.3% versus 31.4%, p=0.004). The most common medical problems reported were obesity with body mass index of greater than 30 Kg/m2 (39.1%), hypertension (33.9%), diabetes mellitus (20.8%), depression (4.3%), asthma (17.3%), COPD (6.6%), and hyperlipidemia (2.7%). Diabetes mellitus was associated with long sleep of more than 9 hours/night (25.4%, p=0.011) and hypertension (54.2%, p=0.001). The linear regression model tend to reduce their sleep duration by roughly 22 minutes in female gender, 66 minutes in participants with hyperlipidemia, and 70 minutes in participants with poor sleep quality.  Conclusions: Short sleep duration per night was prevalent, it affects one in every 3 Saudi adults. Long sleep duration of more than 9 hours was associated with increased comorbid conditions.

Monitoring activity of inpatient lower limb prosthetic users in rehabilitation using accelerometry: Validation study.

PURPOSE: Due to limited accuracy of self-reported activities of lower limb prosthetic users, there is increasing interest in providing accurate walking time for those who are mobilising using their prosthesis in the rehabilitation ward. The aim of this study was to test the accuracy of a tri axial accelerometer (ActivPAL) in measuring walking activity of amputee patients while using their prosthetic limb. METHOD: For the study, 21 subjects wore accelerometer devices taped to the thigh on both the amputated and non-amputated side. Each subject was asked to perform a set of activity routines: walking with prosthesis for 5 minutes, self-propelling in a wheel chair for 3 minutes and being pushed in a wheel chair for 3 minutes. Each activity was observed and timed by a physiotherapist and the observed times were compared with the output from accelerometer monitoring. RESULTS: Using the Bland-Altman method, the mean difference between observed and ActivPal monitor for total time spent walking for the non-amputated side was 0.004 seconds (limits of agreement -0.09 to 0.10 seconds) and for amputated side was 0.11 seconds (limits of agreement -0.43 to 0.66 seconds). An analysis between monitored and observed time found the sensitivity for the non-amputated side was 90.5% and 86% for the amputated side. CONCLUSION: The use of ActivPAL accelerometers in measuring walking time for an individual using a prosthesis is within acceptable levels of accuracy for continuous ambulation monitoring. It has potentially important clinical application for prescribing prostheses.

Using the International Classification of Functioning, Disability and Health framework to categorise goals and assess goal attainment for transition care clients.

AIM: To classify goals according to the International Classification of Functioning, Disability and Health (ICF) and to examine factors associated with goal attainment for transition care program (TCP) clients. METHODS: Recorded goals at admission were rated at discharge as achieved, partially achieved or not achieved. Two researchers independently linked each statement to the most closely corresponding ICF categories. RESULTS: Of 268 TCP clients, 215 had 851 goal statements recorded. Of these, 794 (93%) statements were linked to 12 different ICF categories. A total of 515 (61.4%) were attained at discharge, 117 (14%) were partially attained and 207 (24.6%) were not attained. Multivariate analysis identified number of goals, TCP length of stay and high or very high case manager perception of goal attainment to be significant predictors for goal attainment. CONCLUSIONS: The ICF framework can be used to identify and structure clients' goals in transitional care. Goal attainment can be used to determine overall functional improvement.

Medical grand rounds in Riyadh, Saudi Arabia: Current attitudes and barriers.

BACKGROUND: Medical grand rounds (MGRs) are considered key educational tools in most academic medical institutions. In this multi-center cross-sectional survey, we tried to determine the current attitudes of local medical practitioners to MGRs, as well as perceived barriers. METHODOLOGY: A total of 120 physicians from the National Guard Hospital, King Fahad Medical City, King Khalid University Hospital and King Faisal Specialist Hospital participated in the survey. The questionnaire consisted of statements on attitudes and perceived barriers against participating in MGRs, as well as participants' levels of agreement. RESULTS: Most participants attend MGRs regularly (94.2%), claiming that it is mandatory (88%). Participants also agreed that MGRs were important tools for continuing medical education (89.2%) and that they provided an opportunity to both present materials and interact with their colleagues in other divisions (86.7% and 81.6%, respectively). The vast majority of respondents agreed that "topic review/update" and "inviting guest speakers" were the two most preferred suggestions for improving MGRs (94.2% and 92.5%, respectively). Major barriers included constraints of time (43.3%) and topics that were not patient-related (40.8%). CONCLUSION: MGRs in the major Tertiary Hospitals in Riyadh are well attended, and the majority of the local practitioners believe in the positive effect of MGRs in delivering quality and up to date medical knowledge. Time and physician-specific issues were identified as major barriers that needed to be addressed in order to maximize participation of medical staff.

Rehabilitation of the older vascular amputee: a review of the literature.

The aim was to review the literature on factors affecting prosthetic rehabilitation of older vascular lower extremity amputees. A search of the literature was carried out using the MEDLINE, EMBASE and CINAHL databases up to September 2010. Only original English language articles were accepted. Relevant studies were reviewed and selected based on prespecified inclusion criteria namely: age more than 65 years; vascular cause for the amputation; amputation level of below knee, through-the-knee or above knee; and discussed factors affecting rehabilitation. Age alone is not an absolute contraindication to prosthetic limb prescription; however, it does influence the potential success of gait retraining. Other factors influencing prosthetic fitting and use include comorbidities, premorbid function, level of amputation, status of the remaining limb and patient motivation. Prosthetic gait retraining is not possible in every older dysvascular amputee; however, almost all amputees will benefit from a rehabilitation program to increase independence in transfers and learn wheelchair skills. The MESH key words were: "aged" "diabetes complications" "peripheral vascular diseases" "amputees" "amputation" "rehabilitation" and "artificial limbs".

Monitoring ambulation of patients in geriatric rehabilitation wards: the accuracy of clinicians' prediction of patients' walking time.

The aim of this study is to determine whether clinicians' estimates of patients' walking time agree with those determined by accelerometer devices. The walking time was measured using a waist-mounted accelerometer device everyday during the patients' waking hours. At each weekly meeting, clinicians estimated the patients' average daily walking time in the previous week. Twenty-eight clinicians completed 176 estimates of the average daily walking time for 13 patients (78.5 ± 6.6 years old) over 31 weeks. The average daily walking time measured by the accelerometers was 36.4 ± 16.2 min and that estimated by clinicians was 61.3 ± 38.4 min. Clinicians overestimated the amount of walking time by 24.8 min on average (mean% error=165.8%). Most estimates were between an hour less to 2 h more than the accelerometer measurements. Only 38.6% of the estimates agreed with the accelerometer measurements. Therefore, clinician assessment of the level of patient activity in a rehabilitation setting is highly inaccurate and unreliable.

Clinical characteristics of patients with atrial fibrillation at a tertiary care hospital in the central region of Saudi Arabia.

OBJECTIVE: To report on the clinical presentation, etiology, and laboratory features of acute and chronic atrial fibrillation (AF) in a tertiary hospital in Riyadh, Saudi Arabia. MATERIALS AND METHODS: We retrospectively studied records of 720 patients with AF seen in outpatients and inpatients departments at King Abdulaziz Medical City, Riyadh, during the period of 1 January 2002 to 31 August 2008. RESULTS: Documented acute and chronic AF was present in 157 (21.8%) and 563 (78.1%) patients, respectively. Palpitations, dizziness and syncope were the most frequent symptoms in acute AF, while dyspnea and palpitations were the most common symptoms in the chronic type. Acute respiratory problems and acute myocardial infarction were significantly more common in acute AF, while congestive heart failure and acute respiratory problems (chest infection, bronchial asthma, and pulmonary embolism) were significantly more common in chronic AF. The most common causes of both types of AF were diabetes mellitus (DM) in 68.8%, hypertension (HTN) in 59.3%, chronic lung diseases (bronchial asthma, chronic obstructive pulmonary disease and interstitial lung disease) in 31.8%, valvular heart disease in 23.6%, and ischemic heart disease (IHD) in 23.1%. In 9 (1.3%) patients, no cause was detected. The echocardiographic findings of left ventricular hypertrophy, valve lesions, and depressed left ventricular function were significantly more common in chronic AF (P<0.01). CONCLUSIONS: Nowadays, DM, HTN, and IHD are becoming the most common predisposing factors for AF in the central region of Saudi Arabia and require prevention and control.

The validity of video clips in the diagnosis of gait disorder.

We investigated the accuracy and validity of clinical gait assessment, performed by experienced geriatricians viewing video clips of 10 s duration. Nineteen patients with normal or characteristic abnormal gait patterns were studied. The treating physician's diagnosis served as the gold standard. Another live assessment was then performed by a geriatrician blinded to the medical record to establish inter-rater reliability of live assessments. Subsequently, each gait video clip was examined by two independent geriatricians without any background clinical documentation. Diagnostic accuracy was tested at two levels -- whether the gait was abnormal, and the specific gait diagnosis. The agreement of the video clip examination with the gold standard to identify abnormal gait from normal gait ranged from substantial to excellent among assessors (kappa = 0.68-0.85), although low agreement with the gold standard was achieved in the detection of specific gait diagnosis (average agreement between both viewing geriatricians 50%). The technique appears to be a valid screening procedure for detecting gait abnormalities (average sensitivity 100%, specificity 70%).

Acute myeloblastic leukemia in a patient with primary antiphospholipid syndrome.

Antiphospholipid syndrome is characterized by venous and arterial thrombosis, recurrent pregnancy loss and the presence of the lupus anticoagulant, anticardiolipin antibodies or both. Antiphospholipid syndrome may occur as a primary disease or in patients with systemic lupus erythematosus or other autoimmune, infectious or neoplastic disorders. In this paper we report a 29-year-old Saudi female, a known case of antiphospholipid syndrome, presented with complaints of fever, breathlessness and generalized fatigue. Further investigations confirmed her as a case of myeloblastic leukemia (M1, French-American-British classification). Acute myeloblastic leukemia is not described to be associated with primary antiphospholipid syndrome in the literature to date. This is the first case report of such association.