Walid Baddoura

Chronic kidney disease as a risk factor for Clostridium difficile infection

Introduction:  Clostridium difficile‐associated diarrhoea (CDAD) is the most common cause of nosocomial diarrhoea in the USA. In this study, we sought to determine the association between chronic kidney disease (CKD) and CDAD.

Diabetes mellitus as a risk factor for recurrence of Clostridium difficile infection in the acute care hospital setting

BACKGROUND Clostridium difficile-associated diarrhea (CDAD) is increasingly encountered in the acute care setting with rates of infection increasing dramatically since 2001. Reoccurring episodes are being seen with increasing frequency. The purpose of this study was to examine risk factors specifically associated with CDAD recurrence in an urban medical center. METHODS This study was conducted in a 651-bed, acute care teaching hospital in an urban community in northeastern New Jersey. We examined the medical records of subjects discharged from the institution with a diagnosis of CDAD over the 6-year period January 1, 2003, to December 31, 2008. Inclusion in the study required clinical signs and symptoms of CDAD and the presence of C difficile toxins A/B. This cohort of 247 subjects was divided into 2 groups: those who were not readmitted with CDAD within 6 months (n = 171) and those who required readmission for CDAD within 6 months of discharge from their last admission (n = 76). RESULTS Both hypoalbuminemia (odds ration [OR], 1.74, 95% confidence interval [CI]: 1.10-2.77; P = .02) and diabetes (P < .0001; OR, 3.04; 95% CI: 1.84-5.03; P < .0001) were considered as independent risk factors. After adjustment for potential confounders, hypoalbuminemia was found to be race dependent (OR, adjusted for black race: 1.62; 95% CI: 0.93-2.82; P = .09); however, diabetes was found to be a significant independent risk factor for CDAD recurrence (adjusted OR ranged from 3.79 to 5.46, minimum lower 95% confidence level: 2.01, all P values <.0001). CONCLUSION We have demonstrated that diabetes is an important risk factor for recurrence of CDAD. Although previous have concluded that hypoalbuminemia is associated with CDAD recurrence, our data suggest that this association may have some dependence on race or ethnicity.

Acute Pancreatitis with Normal Serum Lipase: A Case Series

CONTEXT Acute pancreatitis is diagnosed on the basis of clinical features, biochemical tests and imaging studies. Normal serum amylase level has been reported in the setting of acute pancreatitis but normal serum lipase level in acute pancreatitis is extremely rare. CASE REPORT Herein, we present a case series of acute pancreatitis with normal serum lipase levels along with a review of the topic. CONCLUSION In appropriate clinical setting, the diagnosis of acute pancreatitis should be entertained even with normal serum amylase and lipase levels.

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in Strongyloides stercoralis Hyperinfection.

Strongyloides stercoralis (S. stercoralis) is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH). The patients symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.

Losartan-induced Ischemic Hepatocellular Hepatotoxicity: A Case Report and Literature Review.

With the increasing use of various medications and supplements nowadays, the incidence of abnormal liver function tests and frank hepatic injury is has been increasing. Medications are now considered one of the most common causes of acute hepatic failure in the United States. Losartan was the first angiotensin 1 (AT1) receptor blocker approved by FDA for the treatment of arterial hypertension. It is a well-tolerated medication with few significant adverse effects. However, losartan-related hepatotoxicity has been reported rarely. We report a case of acute hepatic injury in an adult patient treated with losartan as a monotherapy for arterial hypertension.