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Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. We considered 1874 patients enrolled in the International Collaboration on Endocarditis - Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single-episode IE and 91 (4.8%) had repeat IE: 74/91 (81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p 0.002), HIV (p 0.009), injection drug use (IDU) (p < 0.001), Staphylococcus aureus IE (p 0.003), healthcare acquisition (p 0.006) and previous IE before ICE enrolment (p 0.001). On adjusted analysis, independent risk factors were haemodialysis (OR, 2.5; 95% CI, 1.2-5.3), IDU (OR, 2.9; 95% CI, 1.6-5.4), previous IE (OR, 2.8; 95% CI, 1.5-5.1) and living in the North American region (OR, 1.9; 95% CI, 1.1-3.4). Patients with repeat IE had higher 1-year mortality than those with single-episode IE (p 0.003). Repeat IE is associated with IDU, previous IE and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk of repeat IE.

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Methods:In this retrospective epidemiological study, we analyzed the medical records of the patients with the diagnosis of epilepsy during the study period )January 1st 2016-December 2016( Results:The study included 184 patients, 91 )49.5%( were males and 93 )50.5%( females. Age ranged between 12 and 85 years )mean 35.4±19.5 SD years(. Most of the patients 150 )82%( had Generalized tonic clonic seizures followed by focal onset in 27 )14%( of the patients. Main EEG abnormality was focal to bilateral was recorded in 53 )41%(, idiopathic/ cryptogenic epilepsy was diagnosed in 61% of the patients. The most common abnormalities on brain imaging were temporal/hippocampal atrophy/stroke. The most common cause of symptomatic epilepsy was stroke found in 20)11%( followed by post infectious epilepsy and head trauma. Conclusion:Seizure types, EEG characteristics and etiologies of symptomatic epilepsy in our cohort of patients are in accordance with the current literature. Slight discrepancy observed in gender distribution and etiologies for symptomatic epilepsy compared with other studies from Saudi Arabia need to be studied further by prospective and population base studies.

Objective: To investigate the clinical and angiographic characteristics of coronary artery ectasia (CAE) and its relation with the inflammatory marker, HsCRP.

Context:Medication nonadherence is a significant barrier in achieving seizure freedom in patients with epilepsy. There is a deficiency of data about the reasons for nonadherence in Saudi population.Aims:The aim of this study is to prove the existence of nonadherence to antiepileptic drugs (AEDs) in patients with epilepsy and identify the responsible factors.Setting and Design:This is a prospective, cross-sectional study carried in the Department of Neurology at King Fahd Hospital of the University affiliated with Imam Abdulrahman Bin Faisal University.Subjects and Methods:Patients of all ages diagnosed to have epilepsy as mentioned in their medical record and taking antiepileptic medications were interviewed using a questionnaire.Statistical Analysis Used:Statistical analysis was performed using IBM Statistical Package for the Social Sciences version 21 (IBM Corp., Armonk, NY, USA). Statistical significance was defined as two-tailed with a P ≤ 0.05.Results:Among 152 participants, 52.6% were male and 47.4% were female. Mean age of the patients was 28 ± 14.3 (mean ± standard deviation) years. Of 152 patients, 48.7% were found to be nonadherent to their AED therapy. The most commonly identified factor was forgetfulness. Nonadherence was significantly associated with poor seizure control (P = 0.002).Conclusion:Nonadherence to the AED is common among patients with epilepsy and affects seizure control adversely.

Objectives: To assess the COVID-19 associated fatalities with respect to demographics, comorbidity, critical illness, and length of hospital stay in tertiary care hospitals. Subjects & Methods: A retrospective hospital data-based research was done among 216 COVID-19 associated mortalities registered in 4 tertiary care hospitals Holy Family Hospital (HFH), Benazir Bhutto Hospital (BBH), District Head Quarters Hospital (DHQ) and Rawalpindi Institute of Urology & Transplantation (RIU & T) affiliated with Rawalpindi Medical University from 29th March-15th June 2020. The data was gathered by consecutive sampling pertinent to demographics, hospital stay, comorbidity, critical illness, and ventilator or oxygen support. The length of hospital stay among fatalities with and without comorbidity was compared by an independent sample z-test. Data were analyzed by using SPSS version 25.0. Results: Of the total 216 COVID-19 related mortalities, 150(69.4%) were males and 66(30.6%) were females. The mean age of fatalities was 55.66 ± 13.97 years. About 76.7% of dying males were 41-70 years old while 56.1% of females dying of COVID-19 were 41-60 years old. Most (60.8%) of study subjects had hypertension followed by diabetes (53.8%), Ischemic Heart Disease (17.5%), and respiratory disorders (12.3%). About 75% of the critically ill patients needed a ventilator for respiratory support. Length of hospital stay was determined to have a statistically insignificant association (P > 0.10) with the presence or absence of comorbidity among COVID-19 patients. Critical illness had a highly significant association (P < 0.000) with ventilator support among COVID-19 related mortalities. Conclusion: People 41-70 years should preferably adopt stringent precautions for protection against COVID-19. Comorbid states chiefly hypertension, diabetes, cardiac and respiratory diseases need special consideration amid COVID-19 pandemic to abstain from adverse health outcomes.

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