Aseer Central Hospital

Abhā, Saudi Arabia

Aseer Central Hospital

Abhā, Saudi Arabia
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Paul E.,King Khalid University | Abdelkareem M.,Aseer Central Hospital | Malik S.,Aseer Central Hospital
Australasian Medical Journal | Year: 2017

Background Brucellosis is a common zoonotic disease of the Middle Eastern countries. Acute cases of brucellosis are often treated as cases of Pyrexia of unknown origin. Aims The main aim of this study is to compare the epidemiological, clinical and laboratory findings of the 42 culture positive cases of Brucella. Methods Forty two culture positive cases of Brucella were obtained from both in -patients and outpatients with a history of pyrexia over a period of two years (Nov 2014-Nov 2016). The patients' files were examined retrospectively for the history, clinical features, and lab findings. Results The prevalence of brucellosis was calculated to be 11.1 per cent as 42 cases were positive for brucellosis out of 377 of PUO cases Of the 42 cultures positive patients the percentage of males (57.1 per cent) were almost equal to the females(42.8 per cent). The mean±S.D age was 28.5±13.65. 28.5 per cent had a history of livestock associations (Chi-square 3.8889, a p-value of 0.048607) which was statistically significant. 26.2 per cent had a history of raw milk and dairy produce intake (Chi-Square 2.6276, p-value of 0.105023) this was not statistically significant. 9.5 per cent had a family history of brucellosis; this association was not statistically significant as well (chi-square statistic 1.8651, p-value of 0.172034). 61.9 per cent presented as acute cases, 30.9 per cent of sub-acute cases and 7.1 per cent as chronic cases respectively. The predominant clinical symptom was Fever (100 per cent) with the commonest clinical signs being the osteoarticular signs (30.9 per cent). Raised ESR and CRP positives were seen in 34 cases (80.9 per cent) and 23 cases (55 per cent) respectively followed by Anaemia in 22 cases (52.3 per cent). Forty two cases were blood culture positive. All the cases were sensitive to the recommended regimen of Doxycycline and streptomycin. Conclusion Brucellosis is still a major health problem in the Middle Eastern countries especially in the Kingdom of Saudi Arabia. Although latest diagnostic equipment are available lacunae in the skill and knowledge prove to be a disadvantage. This scenario may lead to blind treatment which in turn can lead to the development of antibiotic resistance which is another problem altogether. © 2017, Australasian Medical Journal Pty Ltd. All rights reserved.

Babtain F.A.,King Khalid University | Babtain F.A.,Aseer Central Hospital
Seizure | Year: 2013

Purpose Epilepsy can develop at any age for reasons that remain poorly understood. The aim of this study was to determine the impact of a family history of epilepsy (FHE) on the incidence and recurrence of seizures. Methods This retrospective study was conducted in Aseer central hospital, Abha, Saudi Arabia between January and June 2012. The medical records of 420 patients were analyzed to test the impact of FHE on the risk factors, etiology and diagnosis of epilepsy determined by magnetic resonance imaging (MRI) and electroencephalography (EEG). Results 420 patients were studied. Idiopathic epilepsy was seen in 140 patients (33%), symptomatic in 152 (36%), and cryptogenic in 128 patients (30%). FHE was seen in 113 patients (27%), which was associated with younger at the disease onset (15 years vs 20 years, p < 0.05). Idiopathic epilepsy was seen more in patients with FHE (43% vs 30%, p value <0.05), and generalized seizures (primary or secondary) were also seen more in patients with FHE (51% vs 36%, p value <0.05). Abnormal EEG was also seen more in patients with FHE (79% vs 66%, p < 0.05). Multivariate regression analysis showed that temporal epileptic discharges were the best predictor for the presence of FHE (p < 0.05, OR = 3.1, 95% CI 1.7-5.8), more than idiopathic epilepsy or younger age at epilepsy onset. Conclusions FHE has a significant impact on epilepsy, its classifications, and the EEG findings, and may underlie the presence of a genetic etiology, which could be related to a high incidence of consanguinity seen in our population. Temporal epileptic discharges were the best predictor for FHE, which may suggest the presence of familial TLE. © 2013 British Epilepsy Association.

Jetley N.K.,Aseer Central Hospital | Al-Assiri A.H.,King Faisal Specialist Hospital And Research Center | Al-Helal A.S.,Aseer Central Hospital | Al-Bin Ali A.M.,King Khalid University
Journal of Pediatric Surgery | Year: 2011

Purpose: The purpose was to study the impact of Down's syndrome (DS) in the diagnosis, management, and outcomes of patients with Morgagni hernia (MH). Methods: Twenty-two (22) patients with MH treated at a tertiary center were retrospectively studied for history, findings, associated anomalies, referral diagnoses, hospital admissions, radiological procedures for diagnosis, age at which operated on, operative procedure, complications, and recurrences. Eleven did not have DS (group 1); 11 others had associated DS (group 2). The ages at operation were compared in the 2 groups using the Mann-Whitney test. More than 3 hospital admissions for symptoms and signs relevant to MH before a diagnosis of MH were considered a "delayed diagnosis." Results: Twenty-two patients (7 females, 15 males) aged 3 months to 10 years were seen. They presented with respiratory distress (n = 16), with vomiting (n = 5), with intestinal obstruction (n = 1), by serendipity (n = 2), and with recurrence from another hospital (n = 1). The mean age of group 1 was 14.5 months, and that of group 2 was 29.18 months; the difference was not significant (P = .621). Nine patients of group 2 were "delayed diagnosis" compared with 2 in group 1. Both delays from group 1 had severe associated anomalies. All patients underwent operative correction (17 open and 5 laparoscopic repairs). Two had recurrences, one operated on by the open method by us and another laparoscopically by the Lima technique at another center. Both had DS. Both were reoperated on by the open method. Conclusions: The diagnosis of MH may be strikingly delayed when associated with DS or other severe congenital anomalies. Morgagni hernia should be strongly considered in patients with DS admitted repeatedly for chest infections. Chest x-rays in 2 planes may avoid misdiagnosis of MH. Both open and laparoscopic methods have proven satisfactory as operative treatment of MH. Recurrences were seen in patients with DS, which may be corrected by laparotomy or laparoscopically. We feel that resecting the sac and approximating the posterior lip of the defect to the anterior abdominal wall, whether in open or laparoscopic methods, may give stronger repairs, which may avoid recurrence. © 2011 Elsevier Inc. All rights reserved.

Al Amer N.A.,Aseer Central Hospital | Abd El Maksoud W.M.,King Khalid University
Journal of Biomedical Research | Year: 2013

We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography (CT) guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in planning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyogenic liver abscess, but is it applicable also for caudate lobe abscess?. © 2013 by the Journal of Biomedical Research.

Untreated or sub-clinical hypothyroidism is associated with insulin resistance, obesity, adverse effects on cardiovascular system, hypertension and in turn risk of nephropathy. However, these changes are reversible with thyroxine replacement therapy (TRT). Current research studied 4235 diabetic patients, divided into two groups, those with clinical hypothyroidism /on TRT, compared to those without thyroid disease or undiagnosed. BMI, blood pressure, creatinine, urine microalbumin and spot urine protein levels were compared between these two groups. Study finding demonstrated that for hypothyroid cases, BMI was higher (32.2 ± 7.44 versus 29.4 ± 5.7; p < 0.0001), serum creatinine was on lower levels (0.75 ± 0.27 versus 1.0 ± 0.74; p = 0.001), systolic BP was on lower side (123.7 ± 15.9 versus 128.13 ± 16.8; p= 0.015); spot urine microalbumin was on lower side (52.58 ± 71.65; versus 87.77 ± 140.86; p=0.010) and spot urine protein had lower levels (25.3 ± 38.3 versus 44.28 ± 123.58; p < 0.0001). Current research also demonstrated that Pearson's x2 and odds/protective odds for hypothyroidism (on TRT) was strongly associated with obesity (p <0.0001; odds ratio 2.28, 95% CI 1.47 to 3.56). However, they were protected from HTN (p= 0.272; protective odds ratio 1.28, 95%CI 0.824 to 1.98), nephropathy (p=0.386; protective odds 1.36, 95% CI 0.861 to 2.14) and chronic renal disease (p= 0.112; protective odds 3.42, 95% CI 0.83 to 14.13). In conclusion, TRT itself has protective effects on cardiovascular and renal system. Hence, thyroid screening is essential among diabetics to detect sub clinical or clinical hypothyroidism. © 2016 Bentham Science Publishers.

Aziz K.M.A.,Aseer Central Hospital
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | Year: 2015

Diabetes management during Ramadan fasting is challenging to the physician in terms of minimizing the risk of hypoglycemia. As compared to oral hypoglycemic agents (OHAs) and sulfonylureas (SUs), which carry a higher and significant risk of hypoglycemia, newer antidiabetic agents such as dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated lower risk of hypoglycemia during Ramadan fasting, with better patient compliance. In addition to diabetes education and pre-Ramadan assessments, the physician should also consider use of DPP-4 inhibitors (such as vildagliptin) during Ramadan fasting to minimize the risk of hypoglycemia in type 2 diabetic subjects. Severe episodes of hypoglycemia have been demonstrated in recent research and clinical trials with OHAs/SUs. Conversely, these research observations have also demonstrated comparative safety and efficacy with lower risk of hypoglycemia associated with vildagliptin. Current research review has collected evidence-based clinical trials and observations for the drug vildagliptin to minimize the risk of hypoglycemia during Ramadan fasting, while at the same time focusing the role of diabetes self-management education (DSME), pre-Ramadan assessments, and patient care. © 2015 Aziz.

Alzarei A.H.,Aseer Central Hospital | Assiri K.S.,Aseer Central Hospital
Bahrain Medical Bulletin | Year: 2016

Background: Allergic fungal rhino-sinusitis (AFRS) is a benign non-invasive sinus disease related to hypersensitivity to fungal inhalation which occurs in young immunocompetent individuals. AFRS could present with serious orbital complication. Objective: To evaluate the common features of orbital complications due to allergic fungal rhinosinusitis. Design: A Retrospective Study. Setting: Aseer Central Hospital, Abha, Saudi Arabia. Methods: Sixty patients were diagnosed and treated for allergic fungal rhino-sinusitis from 2010 to 2013. The diagnosis was based on Bent-Kuhn criteria and CT scan report; the data was coded, edited and analyzed using SPSS IBM version 22. Results: Twenty-seven (45%) orbital complications were encountered: 16 (26.7%) eye proptosis, 7 (11.7%) diplopia and 4 (6.7%) unilateral complete blindness. Fungal hyphae were not demonstrated histopathologically in any of these patients. The presence of fungal mucin was prevalent in all patients. Eye proptosis had good response to surgical and postoperative treatment while diplopia took longer to improve after surgical and medical treatment. Conclusion: Allergic fungal rhino-sinusitis (AFRS) could present with serious orbital complications: eye proptosis, diplopia and/or unilateral complete blindness. All patients with orbital involvement should be evaluated clinically and radiologically for sinus disease even in the absence of the stigma of rhino-sinusitis. Early diagnosis and immediate treatment is extremely essential to prevent serious complications such as visual loss. © 2016, Bahrain Medical Bulletin. All rights reserved.

Current study has invented a new method for utilizing spot urine protein among diabetic patients. There have been various efforts and strategies in research internationally to detect, diagnose and monitor nephropathy/DKD. Although 24-hour urine studies are gold standard, however, there exist some controversies about microalbuminuria and spot urine protein. The current study was designed to utilize spot urine protein among diabetic patients and to find its association with routine dipstick urine test for albumin, and microalbuminuria. The study demonstrated significant association of spot urine protein with urine dipstick albumin, and has demonstrated increasing spot urine protein with increasing albumin in urine (p-value < 0.0001). This study also demonstrated significantly higher levels of spot urine protein between the groups with nephropathy/DKD as compared to those without nephropathy/DKD (p-value < 0.0001). Similarly, spot urine protein and spot urine protein/creatinine were also significantly associated with microalbumin and microalbumin/creatinine in urine. Significant regression models for spot urine protein and microalbuminuria were also developed and proposed to detect and estimate microalbumin in urine while utilizing spot urine protein (< 0.0001). Synthesized regression equations and models can be used confidently to detect, rule out and monitor proteinuria and DKD. ROC curves were utilized to detect spot urine protein cutoff points for nephropathy and DKD with high specificity and sensitivity. Some important patents were also discussed in the paper regarding albuminuria/proteinuria detection and management. Current study has demonstrated and concluded, for the first time, that there exists a significant association of spot urine protein with routine dipstick albumin in urine and microalbuminuria. It is also essential to detect early, monitor and manage proteinuria, hypertension and dyslipidemia with good glycemic control to prevent diabetes complications. © 2015 Bentham Science Publishers.

Ramadan fasting is an obligatory duty for Muslims. Unique physiologic and metabolic changes occur during fasting which requires adjustments of diabetes medications. Although challenging, successful fasting can be accomplished if pre-Ramadan extensive education is provided to the patients. Current research was conducted to study effective Ramadan fasting with different OHAs/insulins without significant risk of hypoglycemia in terms of HbA1c reductions after Ramadan. ANOVA model was used to assess HbA1c levels among different education statuses. Serum creatinine was used to measure renal functions. Pre-Ramadan diabetes education with alteration of therapy and dosage adjustments for OHAs/insulin was done. Regression models for HbA1c before Ramadan with FBS before sunset were also synthesized as a tool to prevent hypoglycemia and successful Ramadan fasting in future. Out of 1046 patients, 998 patients fasted successfully without any episodes of hypoglycemia. 48 patients (4.58%) experienced hypoglycemia. Test for CRD/CKD with hypoglycemia was also significant (p-value < 0.001). Significant associations and linear regression were found for HbA1c and sunset FBS; RBS post-dawn with RBS mid-day and FBS at sunset. The proposed regression models of this study can be used as a guide in future for Ramadan diabetes management. Some relevant patents are also outlined in this paper. © 2013 Bentham Science Publishers.

Aziz K.M.A.,Aseer Central Hospital
Recent Patents on Endocrine, Metabolic and Immune Drug Discovery | Year: 2012

Better control of the diabetic metabolic state will prevent the diabetes complications. However in current clinical practice, it is sometimes difficult to achieve this goal. Additionally, physicians find themselves in an equivocal position to initiate insulin therapy, its selection, combining with Oral agents and further management. The current article was written to focus on diabetes pathogenesis at molecular level, its classification and management by insulin injections. Knowledge of basic biochemistry, pharmacology with kinetics of Insulin is essential for diabetes management. Nonetheless, it should be a priority to search for evidence based clinical methodologies for selecting the patients for initiating, modifying or combining the insulin therapy. Type-1 diabetic patients are best controlled on basal bolus insulin regimens. However in type-2 diabetes, metformin with lifestyle modifications should be the first line therapy, thereafter combined with oral hypoglycemic agents or shifting to insulin gradually if diabetes remains uncontrolled. Metformin is recommended to be prescribed with insulin as compared to oral hypoglycemic agents which should be discontinued while starting insulin. Monitoring the insulin therapy on regular visits to diabetologist and diabetes multidisciplinary team remains the integral part of diabetes management. The review also outlines relevant and recent insulin analogue patents for the management of Diabetes. © 2012 Bentham Science Publishers.

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