Objective: To identify risk factors related to uncontrolled fasting blood sugar among type 2 diabetic patients.Methodology: A systematic random sampling technique was followed to include 450 diabetic patients attending Al-Qabil Primary Health Care Center in Abha City, Saudi Arabia. Collected data comprised sociodemographic characteristics (age, gender, height, weight, education, employment, body mass index, and smoking), while disease-related characteristics included duration of diabetes, fasting blood sugar control, hypertension, and regularity of follow up visits.Results: Fasting blood sugar was uncontrolled among 76.9% of selected patients with type 2 diabetes mellitus. Overweight and obesity were present among 81.6%.Significant risk factors for uncontrolled blood sugar included older age, male gender (P = .037), illiteracy (P = .020), being employed (P = .003), longer duration of disease (P = .023), hypertension (P = .010), and smoking (P = .001).Conclusions: Prevalence of uncontrolled fasting blood sugar is high among patients with type 2 diabetes mellitus. Risk factors associated with uncontrolled fasting blood sugar include older age, male gender, illiteracy, being employed, longer duration of disease, hypertension, smoking, and obesity. Therefore, for better control of blood How to cite this article: Riaz F, Al Shaikh A, Anjum Q, Mudawi Alqahtani Y, Shahid S. Factors related to the uncontrolled fasting blood sugar among type 2 diabetic patients attending primary health care center, Abha city, Saudi Arabia. Int J Clin

Abstract:Objective: Hepatitis B is the most common viral hepatitis, potentially life threatening, with long term complications. Currently, vaccine is the most effective tool against hepatitis B infection. It is worthwhile mentioning that due to rampant use of hepatitis B vaccine (HBV), there have been concerns about hepatitis B surface antigen (HBsAg) reactivity. This article aims to report the false positive results of HBsAg due to recent HBV among healthy male adults. Subjects and Methods:The subjects were selected from a Community Health Center, under the umbrella of a tertiary care hospital, Saudi Arabia. The data was retrieved from electronic medical records maintained at the clinic. Results:A total of 130 employees were recruited, only 117 records could be retrieved from the system. The mean age of participants was 31.34 + 12.73 years. The administration of HBV and HBsAg test was performed simultaneously. The lab reported three cases of HBsAg positivity, a false positive result of 2.56%. Repeat testing after one week for HBsAg was negative for the three cases. Conclusion:This study confirmed that HBsAg reactivity might be seen in regular screening programs for healthy adults.

Background Patients undergoing coronary artery bypass grafting (CABG) sometimes have critical proximal lesion in left anterior descending (LAD) artery or chronic total occlusion followed by either skip lesions or diffuse disease of late mid to distal LAD artery. Such lesions require endarterectomy or atheroma bridging via long venous or arterial patch (patch-plasty), for which clinical outcomes are conflicting in studies due to a more thrombogenic milieu created by patch-plasty as well as incomplete endarterectomy. We present a hybrid approach with Drug Coated Balloon (DCB) angioplasty of mid to distal LAD through LAD arteriotomy followed by Left Internal Mammary Artery (LIMA) insertion to LAD. Case Summary A 35-year-old man who was thrombolysed for anterior wall myocardial infarction in another city, reported to our hospital 4 weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid to distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up CT scan showing patent LIMA & mid to distal LAD. Discussion This case shows a novel technique, first in the world, of performing angioplasty during CABG through arteriotomy followed by graft insertion.

Objectives: To study the early outcomes of mitral valve replacement with a mechanical prosthesis is patients with rheumatic mitral valvular disease.  Study Design: Retrospective Observational study. Setting: Punjab Institute of Cardiology, Lahore and Rawalpindi Institute of Cardiology, Rawalpindi. Period: From August 2014 to August 2017. Material & Methods: Consecutive patients who underwent mitral valve replacement for a rheumatic pathology were included in the study. Patients undergoing a redo surgery, those with concomitant aortic valve intervention, coronary artery bypass grafting and emergency procedures were excluded from the study. Results: Of the 104 patients included in the study, 58 (56.2%) were female patients. The mean age of the patients was 35 ± 12.36 years (median 33 years). Sixty (58.5%) had hypertension and 22 (21.28%) had diabetes. Mitral valve stenosis was the main pathology in 84 (81.25%). Severe pulmonary hypertension was recorded in 15 (15%) patients. The mean preoperative Tricuspid Valve Pressure Gradient (TVPG) was 55.33 ± 18.35 mmHg. The mean cross clamp time was 45.33 ± 12.32 minutes. The postoperative tricuspid valve pressure gradient came down to 31.5 ± 12.21 mmHg. No patients had acute renal injury, pulmonary complications or re-exploration for bleeding. Perioperative mortality was 4 (3.75%). Conclusion: Rheumatic valvular disease is still prevalent in our part of the world. Most of the patients with rheumatic heart disease will end up with replacement of the valve. Replacement with a mechanical prosthesis has favorable early outcomes.

Objective: Transfusion of residual blood left in the cardiopulmonary bypass circuit is recommended. Whether this blood should be processed or not before transfusion is not known. Study Design: A prospective non-randomized case control study. Place and Duration of Study: A tertiary care heart center, from Jan 2016 to Dec 2018. Methodology: A prospective non-randomized case control study was designed. Consecutive patients operated at a tertiary care hospital were included in the study who underwent different open-heart procedures on cardiopulmonary bypass. Patients were divided into two groups. Those who received the unprocessed residual blood transfusion, residual volume retransfused at the end of cardiopulmonary bypass and those who did not, residual volume not retransfused (RVNR). Important perioperative data was collected from the hospital database andanalyzed using IBM SPSS-statistics 23.0 (IBM, SPSS Inc., Chicago, IL). Results: Of the 120 patients, 56 patients were included in the RVR group and 64 in the RVNR group. Mean age in the RVR group was 49.41 ± 14.38 years and in the RVNR group 49.27 ± 16.36 years (p=0.96). Female patients were 9 (16.07%) in the RVR group and 20 (31.25%) in the RVNR group. Residual blood left in the circuit was 271.43 ± 52 ml in the RVR group and 264.06 ± 54.5 ml in the RVNR group (p=0.45). Hemoglobin measured in ICU was 10.5 ± 1.12 gm/dl in the RVR group and 9.97 ± 1.25 gm/dl in the RVNR group (0.02). Blood products were needed in 27 patients in RVR group and 21 patients in RVNR group (p=0.57). There was no significant difference between the two groups with respect to total drainage in the first 24 hours (p=0.89). Similarly, the re-exploration rates were not different between the two groups (p=0.50). Conclusion: Re-transfusion of residual blood left in the CPB circuit is a safe practiced. If this blood is transfused in an unprocessed form, it does not lead to adverse outcomes.