Clinical presentation and outcomes of acute diverticulitis in a Middle Eastern population.

BACKGROUND AND STUDY AIMS: There is lack of literature describing the presentation of diverticulitis in the Middle East population. The aim of this study is to provide an analysis of the epidemiological indicators, patterns of presentation and outcomes of acute diverticulitis in a Middle Eastern population. PATIENTS AND METHODS: A retrospective review of all adult patients over the age of 17 who were admitted to the surgical service with a diagnosis of acute diverticulitis between January 2010 and May 2018 at a major university affiliated government hospital in the state of Kuwait. Data collected included patients' demographics, clinical presentation, management and outcome. RESULTS: Between January 2010 and May 2018 there were 132 patients admitted with a diagnosis of acute diverticulitis. The mean age was 49.2 [±14.3] years. There were 89 (67.4%) men and 43 (32.6%) women. One-hundred and fifteen patients (87.1%) were Arabs, of which Kuwaiti citizens represented 58.3%. Most patients (76.5%) presented with uncomplicated diverticulitis. One hundred and twelve patients (84.8%) had sigmoid colon diverticulitis. There were nine patients that were readmitted within thirty days. The mean length of hospital stay was 5.3 days [±4.5]. The median follow-up period was 15.6 weeks (IQR 1.8, 118.4), during which time recurrent attacks occurred in 25 patients (18.9%). CONCLUSIONS: It appears that there is a low prevalence of acute diverticulitis in Arabs living in Kuwait, and that when they do present with acute diverticulitis the majority present at a relatively younger age with uncomplicated disease.

Retrospective Clinical and Microbiologic Analysis of Patients with Anorectal Abscess.

BACKGROUND: We conducted a clinical and microbiologic analysis of patients presenting with anorectal abscess. METHODS: A total of 505 adult patients presenting from January 2011 to December 2017 were analyzed retrospectively. Microbiologic data were available for 211 patients. RESULTS: The mean age at presentation was 39.5 (standard deviation 12.4) years, and 81.4% of the cohort were men. One hundred fifteen patients (22.8%) had diabetes mellitus, and 15 patients (3.0%) had inflammatory bowel disease. There were 184 patients (36.4%) who required admission for more than 24 hours with a median length of stay of two days (interquartile range 2, 4) days. The most common microorganism was Escherichia coli (37.6%), followed by Bacteroides spp. (13.2%) and Streptococcus spp. (13.2%). Escherichia coli accounted for 34.9% of the microorganisms cultured from patients with diabetes mellitus followed by Streptococcus spp. (27%) and Klebsiella pneumoniae (20.6%). CONCLUSIONS: Escherichia coli is the most common micro-organism cultured from patients presenting with anorectal abscess. Despite an increase in community-acquired multi-resistant strains, our results show a low overall incidence of such isolate. Our study provides a large microbiologic sample of patients with anorectal abscess to expand the present knowledge of the etiology of a common surgical condition.

Medical students' logbook case loads do not predict final exam scores in surgery clerkship.

Purpose: To investigate the reliability of medical student logbook data in assessing student performance and predicting outcomes in an objective standardized clinical exam and a multiplechoice exam during surgery rotation. In addition, we examined the relationship between exam performance and the number of clinical tutors per student. Materials and methods: A retrospective review of the logbooks of first and third clinical year medical students at the Faculty of Medicine, Kuwait University, was undertaken during their surgery rotation during the academic year 2012-2013. Results: Logbooks of 184 students were reviewed and analyzed. There were 92 and 93 students in the first and third clinical years, respectively. We did not identify any correlation between the number of clinical encounters and clinical exam or multiple-choice exam scores; however, there was an inverse relationship between the number of clinical tutors encountered during a rotation and clinical exam scores. Conclusion: Overall, there was no correlation between the volume of self-reported clinical encounters and exam scores. Furthermore, an inverse correlation between the number of clinical tutors encountered and clinical exam scores was detected. These findings indicate a need for reevaluation of the way logbook data are entered and used as an assessment tool.