Prevalence of coronary artery disease and its risk factors in Majmaah City, Kingdom of Saudi Arabia

ObjectiveThis study was carried out with an aim to outline the prevalence of coronary artery diseases, its risk of one region of the Saudi Arabia.MethodsA retrospective observational study conducted across five secondary medical centers located in the city of Majmaah. Hospital medical records and ministry of health records were screened over a 6-month period for data on patients admitted for Coronary artery disease (CAD). Data collected included sociodemographic characteristics, medical profile, and laboratory findings.ResultsA total of 327 participants were included in this study with a median age of 64 and the majority being male participants (59.8%). The majority were married, held a primary school degree and earned a salary for living. A large number (82.9%) were hypertensive and diabetic (66.7%) and one-fourth had a previous MI (25.1%). A large number (73.7%) had heart failure with a mean ejection fraction of 44% (SD = 13). The causes of heart failure were mainly ischemic (56.3%) and hypertensive (28.1%). Readmission rates at 30 and 90 days then at 6 and 12 months were 22, 53.8, 68.8, and 75.8%, respectively. The mortality rates at the same time intervals were 5.5, 8.9, 14.1, and 22.9%, respectively. Predictors of readmission are age, CCI, and NYHA class.ConclusionCoronary artery disease is the leading cause of heart failure. End stage CAD can have similar results in terms of readmission and mortality as heart failure. Future research should target patients in different stages of the condition and monitor their comorbidities which may impact the study findings

Sleep Disorders in Inflammatory Bowel Disease: The Forgotten Discussion

The relationship between sleep disturbances and inflammatory conditions is incompletely understood. Studies have shown that inflammatory bowel disease (IBD) patients have poorer sleep quality, prolonged sleep latency and increased use of sleeping pills compared to controls. Furthermore, patients with clinically active IBD have reported significantly worse sleep than patients with inactive disease. IBD patients in remission with abnormal sleep, may be at increased risk for relapse. This study evaluated physicians’ assessment of sleep patterns in IBD patients. A medical record review of consecutive IBD patients seen at a university gastroenterology practice during a 6 months period was performed. Patient age, gender and disease type (Crohn’s disease, ulcerative colitis) were obtained. Records were reviewed for documentation of a sleep assessment, sleep disorder or a formal sleep evaluation. A database was created maintaining patient confidentiality. The study was approved by the university IRB. 268 records (118 men, 150 women; mean age 43; 158 Crohn’s, 109 ulcerative colitis (UC), 1 indeterminate colitis) were reviewed. Eleven patients (4.1%; 7 Crohn\u27s, 4 UC) had a documented sleep disorder; 6 with obstructive sleep apnea, 2 insomnia, 1 circadian rhythm disorder, 1 with snoring. No other patients had documentation of a sleep discussion or assessment. There was no significant difference the rate of sleep assessment based upon gender, age or disease type (p=1.000). Sleep disorders may have an impact upon clinical outcomes in IBD patients. All IBD patients should be screened and treated for sleep disorders if appropriate. This study reveals that few IBD patients have documented discussions with their gastroenterologists about sleep patterns. While this study is limited due to size and single institutional design, it demonstrates a need for increased sleep evaluation in IBD patients, since early intervention for sleep disorders may improve clinical outcomes

A Deeper Look into Medical Foods: Where is the Best Patient-Centered Information?

Background An assortment of medical foods, formulated to be consumed or administered enterally under the supervision of a physician, have established roles in the management of Inflammatory Bowel Diseases (IBD) as adjunctive or stand-alone therapies. The internet is a common method patients use to look for health-related information. Our aim is to evaluate and assess the quality and readability of information about medical foods found on the internet. Methods Using Google search engine, we retrieved the first 100 websites using the search term “Medical Foods and IBD.” Information was categorized by academic (journal/abstract), commercial (products for sale), informational (leaflets) or personal (blogs). Information quality was evaluated using the DISCERN instrument. DISCERN scores were categorized as Excellent 63-75, Good 51-62, Fair 39-50, Poor 27-38, and Very Poor \u3c 26. The readability was assessed using Flesch-Kincaid Grade Level calculation. We conducted a one-way ANOVA between website subcategories of DISCERN and readability level. Results A total of 25 websites were evaluated after the exclusion of inaccurate and duplicate websites. The average DISCERN score for all sites was in the poor category (38) and every subcategory was also poor or fair (Academic 43, Informational 40, Commercial 29, and Personal 33). The average Flesch-Kincaid grade level for all subcategories was at or above high-school level (13). There was no difference between DISCERN scores (P= 0.17) or readability levels (P=0.425) among website subcategories. Conclusion This study demonstrated that the overall quality of websites was poor and the reading level was above the American Medical Association’s recommended sixth grade level. Contrary to expectation, academic websites were only of fair quality. Moreover, non-academic websites traditionally targeting patients were at or above high school reading level. Therefore both health consumers and providers lack access to high quality, easy to understand information regarding Medical Foods in IBD

Missed opportunities for attempts at de-escalation of proton pump inhibitor therapy

Introduction: Proton pump inhibitors (PPI) are amongst some of the most widely prescribed classes of medication in the United States. While long term treatment is appropriate in certain situations, attempts to should be made to reduce, or discontinue their use in many patients. Methods: A retrospective chart review of patients with a PPI listed as a current medication seen by a faculty gastroenterologist at an urban university medical center over a 12-month period was conducted. Data was collected to determine the indication for PPI use, reason for clinic visit, and whether or not there was a documented discussion of de-escalation of PPI therapy. De-escalation was defined as attempts at reduction in dose, reduction in frequency, or complete discontinuation, of the PPI. Patients prescribed PPI’s for Barrett’s esophagus, Helicobacter pylori infection, and gastrointestinal bleeding were excluded. A Microsoft Excel database maintaining subject confidentiality was used. Statistical analysis performed via two-tailed Fisher’s Exact Test, p\u3c0.05. Results: A total of 600 charts were initially reviewed, of which, 324 were included in the analysis. Of the 324 patients , 141 patients were prescribed a PPI by a gastroenterologist. 72 out of 141 were seen for GERD, and 69 seen for non-GERD reasons. 29 patients (40%) seen for GERD had documented discussions of de-escalation, compared to 12 (17%) of patients being seen for non-GERD reasons. A missed opportunity exists for attempts at de-escalation in patients who are prescribed a PPI by a gastroenterologist, yet being seen for a chief complaint unrelated to GERD (p = 0.0031). Discussion: Proton pump inhibitors are amongst the most commonly prescribed medications in the United States. There is evidence to suggest that patients with uncomplicated GERD who have obtained symptomatic relief with PPIs, should be able to successfully de-escalate their therapy. Our data show that when a gastroenterologist is the prescriber of a patient’s PPI, and the patient is being seen for a GERD related chief complaint, the likelihood of a documented de-escalation discussion is much greater than compared to when a patient is presenting for a non-GERD related chief complaint (40% vs 17%, p = 0.0031). While PPI’s are quite safe, and overall, well tolerated, nevertheless, their continued use in a patient should be re-evaluated periodically. There appear to be missed opportunities to for attempts at de-escalation of PPI during non-GERD related visits