Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

The objective of this study was to assess the prevalence of polypharmacy [PP] and the associated factors in medical outpatients. A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of >/= 5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients' age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated [SPSS Inc] Version 18. Out of 766 patients included in the study, 683 [89%] had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age [>/= 61 years], disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care

case of first degree AV block in carbon monoxide poisoning patient

Carbon monoxide [CO] intoxication is one of the most common types of poisoning. Cardiac manifestations of CO poisoning are limited to case reports of Electrocardiogram [ECG] changes, myocardial dysfunction and myocardial ischemia. A 22 year old Saudi male was admitted to the emergency department with decreased level of consciousness after being involved in a fire at home. ECG showed first degree AV block. To the best of our knowledge, this case report is the first CO poisoning case in the literature presented with first degree AV block

Erythrocyte sedimentation rate at diagnosis in culture positive cases of active tuberculosis

To evluate the Erythocyte Sedimentation Rate [ESR] at the time of diagnosis in culture positive cases of different types of active tuberculosis [TB]. In this retrospective descriptive study conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, ESR was done by a modified Westergren method using a rapid test. Cases of active TB [defined as a case of TB up to two weeks from the start of anti-tuberculous treatment], were evaluated for ESR at the time of diagnosis. Of 246 cases of culture positive TB, ESR results during active phase were available in 195 [79.3%] patients. Number [%] of patients with pulmonary, extra-pulmonary and disseminated TB were 69 [35%], 78 [40%] and 49 [25%] respectively. Two [1%] of these patients were HIV positive. ESR was elevated in 169 [87%] and was normal in 26 [13%] patients. Mean ESR in all patients was 67.6 mm/hr with no statistical difference between patients with different TB types. ESR between 1-30, 31-60, 61-90, 91-120 and 121-150 mm/hr represented 19%, 23%, 23%, 19% and 6% of the cases respectively, whereas 44 [22.6%] of the patients had ESR more than 100 mm/hr. In HIV negative patients with suggestive features of TB but without any other underlying disease affecting the ESR, the baseline ESR may be a valuable diagnostic test to suspect TB in resource poor countries

Extremely elevated erythrocyte sedimentation rate: etiology at a tertiary care center in Saudi Arabia

To evaluate the etiology of extremely elevated erythrocyte sedimentation rate [ESR] in adolescents and adults at a tertiary care center. This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Wetergren method of determining ESR in adolescents and adults aged >/= 12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/= 100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient. During the study period, out of the 44,366 ESR tests carried out at this center, 1864 [4.2%] had an ESR >/= 100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections [38.6%], autoimmune diseases [15.9%], malignancy [15.4%], miscellaneous causes [10.2%], ischemic tissue injury or trauma [8.7%], and renal diseases [8.4%]. Ten common individual causes included: rheumatoid arthritis [7.3%], osteomyelitis [6.9%], tuberculosis [5.5%], trauma [5.3%], lymphoma and sepsis of unknown origin [5.1%] each, urinary tract infection [4.7%], septic arthritis [3.1%], abscesses [2.8%], and pregnancy [2.2%]. Fourteen [2.4%] patients had no known cause. Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis