Eslam G. Ali

Factors Predicting Recurrence of Clostridium difficile Infection (CDI) in Hospitalized Patients: Retrospective Study of More Than 2000 Patients

Background Clostridium difficile infection (CDI) has increased in incidence and severity worldwide, causing direct costs estimated to range from US

Airway observations during upper endoscopy predicting obstructive sleep apnea

3.2 billion to

Impact of Weight Loss in Overweight Patients Enrolled in Weight Management Program Prior to Hepatitis C Treatment on Early Virological Response

4.8 billion. The aim of this study was to investigate and identify factors that predict recurrence of CDI. Methods This was a retrospective case-control study between 2007 and 2013 on patients admitted with CDI. Recurrent CDI is defined as a new episode of diarrhea within 90 days confirmed by a positive stool C. difficile toxin assay or polymerase chain reaction, after resolution of the initial CDI episode for at least 10 days and after discontinuation of the CDI therapy. Results Three thousand twenty patients were diagnosed with CDI between January 2007 and December 2013. Two hundred nine of 2019 patients in the study had a recurrence of CDI within 90 days of the end of the initial CDI episode (10.3%). Multivariate analysis showed that most of the recurrences occurred in patients with comorbidities, particularly chronic kidney disease (odds ratio, 1.3; 95% confidence interval [CI], 1.0–2.4; P = 0.039). In addition, a higher percentage of patients in the recurrence group were prescribed proton-pump inhibitors (odds ratio, 1.65; 95% CI, 1.0–1.7; P = 0.002) and steroids (odds ratio, 1.65; 95% CI, 1.0–1.5; P = 0.047). Conclusions Our data suggest that the use of glucocorticoids, use of proton-pump inhibitors, and having end-stage renal disease are significant risk factors associated with recurrent CDI.

Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea

Background This pilot study examined airway characteristics during upper endoscopy to determine who is at high risk for obstructive sleep apnea. Methods Patients undergoing routine upper endoscopy were divided into 2 groups according to the Berlin Questionnaire (high and low risk for sleep disordered breathing). Patients underwent routine upper endoscopy using propofol sedation. The airway was then evaluated for no, partial, or complete collapse at the levels of the palate/uvula/tonsils, the tongue base, the hypopharynx, and the larynx. They were given a score of 0 for no collapse, 1 for partial collapse, and 2 for complete collapse. The score for each of these levels was added to give a total score or severity index. The larynx was also evaluated for lateral pharyngeal collapse (minimal, up to 50%, >50%, or 100%). Results We found that patients with a partial obstruction at the level of the palate/uvula/tonsils, tongue base, hypopharynx, or larynx, or complete obstruction at any level more often had a positive Berlin questionnaire. Patients with a positive Berlin questionnaire were more often of increased weight (mean 197 vs 175 lbs, P=0.19), increased body mass index (31.2 vs 27.42 kg/m2, P=0.11), increased neck circumference (36.7 vs 34.7 cm, P=0.23), and had a higher total airway score (2.61 vs 1.67, P=0.09). Conclusions The results of our pilot study represent preliminary data regarding the use of upper endoscopy as a potential tool to evaluate patients for obstructive sleep apnea.

An Unusual Cause of Large Bowel Obstruction

Background: Obesity is a risk factor for non-response to interferon-based hepatitis C therapy. We studied the effect of weight management program to induce weight loss in overweight patients prior to starting antiviral therapy on treatment response. Methods: Overweight patients received a weight loss brochure and a 6-week nutrition and exercise program prior to PEG-IFN + Ribavirin therapy (n=25). Early virological response rates (EVR) were compared between overweight subjects with and without ≥ 3% weight loss and control lean subjects (n=11). Results: Moderate to severe fibrosis was present in 41.7% and moderate to severe steatosis in 16.7% of patients. Most were Caucasians (90% and 72% for lean and overweight group, respectively). There was no statistical difference in age, sex or race between those who lost ≥ 3% of their body weight and those who didn’t among overweight group. Overweight subjects who lost ≥ 3% of body weight at week 12 of CHC therapy had higher EVR vs. those without ≥ 3% weight loss, 69.2% vs. 33.3%, p=0.036. Conclusion: Overweight patients enrolled into weight management program who achieved ≥ 3% body weight loss at 12 weeks of CHC therapy had higher EVR compared to those without 3% weight loss.