Al-Shifa Hospital Research Articles

Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 Patients: A Retrospective Observational Study.

Background Proton pump inhibitors (PPIs) increase the risk of pneumonia secondary to PPI-induced hypochlorhydria. We aim to investigate the association between PPI and disease severity in coronavirus disease 2019 (COVID-19)-positive patients and the risk of hospitalizations in Muscat, Oman. Methodology COVID-19-positive patients aged 18 years and above at the time of diagnosis were included in this retrospective observational study. The details of the patients were retrieved from the electronic health records of the Al Shifa Hospital Information Management System and Tarassud. The composite primary endpoint was COVID-19 admission to a government tertiary hospital ward or intensive care within 14 days of diagnosis. Results A total of 506 COVID-19-positive patients were identified during the specified period. The mean age was 44 ± 15 years. The majority of the patients were Omani, and a female preponderance was observed. Overall, 104 (20.4%) patients were current PPI users. Admission due to COVID-19 was significantly associated with the presence of comorbid conditions such as diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic kidney disease (p < 0.001). However, current PPI use (p = 0.140) was not significantly associated with an increased risk of hospitalization. Conclusions This data suggests that the use of PPIs during COVID-19 infection did not increase the risk of severe COVID-19 infection and poor outcomes leading to hospitalization in Muscat, Oman. However, the presence of other medical comorbidities, such as diabetes and hypertension, was associated with a higher risk of adverse clinical symptoms that resulted in hospitalization.

Presupposition as a Manipulation Strategy in President Biden's Reference to the War on Gaza

Political communication is a complex process of sharing concepts and beliefs to gain control over power and manipulate the mass population. In the face of heightening conflict and humanitarian issues, the US President Joe Biden’s communication occurred when the Gaza War was underway in the October of 2023. This study examines three hypotheses: Biden’s utilization of presuppositions for influencing perception and gaining approval on Israel’s behalf, for causing self-derogatory effect, and blaming Hamas alongside constructing an element of predestination regarding the United States foreign policy. In the present study, the researcher relied on a content analysis model and identified various presupposition types in Biden’s speeches in order to categorize them based on different manipulative strategies. The article concluded that Biden’s language often justified Israeli actions while attributing all harm to Hamas, thus aligning the audience with the U.S. and building a narrative of pure justice. Presuppositions were most detectable in Biden’s discourse about the IDF strike on al-Shifa Hospital, where he assumed that Hamas must have been operating out of the hospital. These findings therefore present presupposition as a major political resource in the construction of discourses, people, and policy reforms.

The impact of strategic knowledge on strategic improvisation: an exploratory study of some private hospitals in the city of Baghdad

The current study aimed to know the role that strategic knowledge plays on strategic improvisation in private hospitals (the Royal Hospital, Al-Salama Hospital, Al-Karkh Al-Ahli Hospital, and Al-Shifa Hospital). To achieve the objectives of the study, the descriptive analytical approach was adopted, where the researchers developed a questionnaire consisting of (30) items. A random sample was drawn so that the study sample consisted of (103) workers in private hospitals, and the results were analyzed based on the (SPSS) program and descriptive statistics tools. It was concluded that private hospitals currently have a great interest in the strategy of strategic knowledge and strategic improvisation, and provide services It is of high quality and attracts highly experienced doctors. Strategic knowledge is closely linked to strategic improvisation. It has been concluded that private hospitals’ use of strategic knowledge contributes to increasing strategic improvisation

Relationship of ACE1 and ACE2 genetic polymorphisms on SARS-CoV-2 infection and severity of symptoms in different regions of Iraq

This study was conducted in the laboratories of the Biology Department - College of Science - Tikrit University, the laboratories of the Food Science Department - College of Agriculture - University of Anbar, and the Public Health Laboratories - Anbar for the period from December 2021 AD until February 2022 AD, study involved taking samples from hospitalized COVID-19 patients of both sexes, after a confirmed positive PCR test result. As well as those lying in quarantine in three Iraqi governorates (the isolation unit in Karkh, Yarmouk and Kadhimiya hospitals, the Al-Shifa quarry hospital in Anbar, the public health laboratory in Anbar, and the quarantine hospital for thousands in Erbil), in addition to outpatient clinics. They were distributed by 30 patients and 20 healthy subjects from each governorate, with ages ranging from 18-80 years, randomly to men and women in order to determine the role of genetic polymorphisms in the ACE inhibitor gene in the study samples. The results of the genetic polymorphisms of ACE-1rs4646994, ACE-2rs2106809, and ACE-2rs4240157 showed that there were non-significant differences between the frequency of alleles and genotypes in the patient's group compared with the healthy group. The DD mutant genotype of ACE-1rs4646994 appeared in the patient's group in Baghdad and Anbar with a high percentage, while patients in Erbil showed the highest percentage of the heterozygous genotype ID compared to healthy subjects, with an OR= 0.922, OR= 2.750, and OR= 1.118, respectively, for the mutant allele D. Therefore, it is not considered a risk factor for the disease in Baghdad, in contrast to Anbar and Erbil. The polymorphism of ACE-2rs2106809, the homozygous genotype CC was dominant in patients in the aforementioned provinces and may not be considered a risk factor for the disease. The results of ACE-2rs4240157 gene polymorphism, the heterozygous CT genotype showed a high percentage in patients in Baghdad and, while in Anbar patients, the normal genotype TT appeared to be the highest percentage compared to healthy subjects. The C mutant allele in Baghdad, Anbar, and Erbil patients reached OR= 1.306, OR= 4.333, and OR= 9.00, respectively, so this allele is considered a risk factor for the disease. We can conclude from this study the role of each of the polymorphisms rs4646994 ACE-1 and rs4240157 ACE-2 in infection with COVID-19 and the severity of its symptoms according to the geographical region and race, in contrast to rs2106809 ACE-2, as it is possible to conduct clinical studies to demonstrate the role of genetic polymorphisms with Relationship to diseases depending on the region and race.

Trends of Antibiotic Resistance among Uropathogens in Medical vs. Non-Medical Departments of Al-Shifa Medical Complex in Gaza Strip: A Retrospective, Cross-Sectional Study

Antibiotic resistance is a growing global crisis, straining healthcare systems and leaving us with limited options to combat drug-resistant bacteria. This retrospective, cross-sectional study examines the prevalence of antibiotic resistance patterns among urinary tract infections (UTIs) in Al-Shifa Hospital’s medical departments in comparison with non-medical departments using data from microbiology laboratory archives over a one-year period. From the examined urine cultures about 25% were obtained from internal medicine departments and double the number was obtained from non-medical departments. The positive rate was around 35% and about two-thirds of the samples were collected from female patients. Among all departments, Enterobacteriaceae spp. were found to be the most frequently isolated uropathogens, accounting for 80% of cases. However, resistance rates varied depending on the specific organism and antibiotic used. For instance, E. coli showed a resistance rate of only 5% against meropenem, while amoxicillin-clavulanic acid exhibited a resistance rate exceeding 95%. Importantly, the study revealed a significant disparity in resistance rates between medical and non-medical departments, specifically concerning third-generation cephalosporins. In internal medicine departments, resistance rates were alarmingly high, with cefotaxime, ceftriaxone, and ceftazidime showing resistance rates of 75%, 75% and 66.5% respectively. In contrast, non-medical departments displayed lower resistance rates, approximately 60%, 60% and 40%, respectively. In summary, this research sheds light on the escalating problem of antibiotic resistance in UTIs and emphasizes the discrepancy in resistance rates between medical and non-medical departments. Urgent efforts are required to address this issue and find effective solutions to prevent the rise of untreatable bacterial infections.

Rosuvastatin plus N Acetylcysteine to Prevention of Contrast Induced Acute Kidney Injury in Patients with Low Mehran Risk Score

Objective: Contrast induced acute renal injury is the third leading cause of hospital-acquired acute kidney injury, several protective treatments options have been developed among patients undergoing percutaneous coronary intervention (PCI). Our trial aimed to comparison between high dose rosuvastatin versus rosuvastatin plus N acetylcysteine to prevention of contrast induced acute kidney injury in patients undergoing elective PCI at Alshifa hospital in Gaza. Methods: Randomize control trial included 100 patients who undergoing elective PCI at Alshifa hospital in Gaza, Group A: (N:50) patients received 40 mg rosuvastatin orally once daily for 3 days, on dose before undergoing PCI and two dose after PCI. Group B (N: 50) patients received 40 mg rosuvastatin orally once daily for 3 days, on dose before PCI and two dose after PCI plus N-acetylcysteine 1200 mg orally twice daily every 12 hours for two days, the first dose before PCI and other 3 doses after PCI. All patients were measuring serum creatinine level, creatinine clearance and blood urea nitrogen (BUN) before PCI and (2-3) days after procedure. Result: In Group A: nonsignificant reduction of serum creatinine level (P: 0.90), creatinine clearance (P: 40) but significant reduction of BUN was seen after treatment (P: 0.017). In Group B: Significant reduction of serum creatinine level, and BUN (P; 0.001). But creatinine clearance not significant changes were seen after treatment (P:0.72). On other hand comparison between two group was significant reduction of serum creatinine level (P: 0.046) in group B, but not significant changes in creatinine clearance and BUN were not significant (0.41, 0.34) respectively. Conclusion: High dose rosuvastatin plus N-acetylcysteine compared rosuvastatin had significant reduction of creatinine level among patients undergoing PCI.

Clinical outcome and humoral immune responses of β-thalassemia major patients with severe iron overload to SARS-CoV-2 infection and vaccination: a prospective cohort study

COVID-19 has raised special concern for patients with β-thalassemia major (β-TM) due to frequent comorbidities, regular blood transfusions, and iron overload. However, the exact implications of COVID-19 for patients with β-TM remain uncertain. We aimed to explore the COVID-19 incidence and severity, and the serological response to SARS-CoV-2 infection and vaccination in patients with β-TM. Patients with β-TM (n=105) and age-matched healthy controls, all individuals of all control groups were health care workers of the hospital, were prospectively enrolled at the haematology department of Al-Shifa hospital in the Gaza Strip from January 1st, 2021 to December 31st, 2021. Data on COVID-19 incidence and severity were analysed, with Alpha, Beta, and Delta SARS-CoV-2 variants dominating at that time. Anti-SARS-CoV-2 IgG antibody levels were measured and compared between study groups. Patients with β-TM showed a higher incidence of SARS-CoV-2 infection than the general population (61.9% vs. 7.1%, p<0.0001). Most patients with β-TM had asymptomatic (70.8%) or mild disease (26.1%), with no fatalities recorded. COVID-19 illness was more severe among female than male patients with β-TM. Anti-SARS-CoV-2 IgG antibodies were significantly higher in symptomatic patients with β-TM than controls post-infection (geometric mean÷geometric standard deviation 1299.0÷3.3 vs. 555.7÷2.4 AU/mL, p=0.009) and post-vaccination (8404.0÷3.9 vs. 2785.6÷5.0 AU/mL, p=0.015). Similar responses were observed when comparing splenectomised to non-splenectomised (both asymptomatic and symptomatic) patients with β-TM post-infection (595.4÷3.9 vs. 280.7÷3.5 AU/mL, p=0.005) and post-vaccination (13,778.2÷3.2 vs. 4961.8÷4.1 AU/mL, p=0.045). This distinctive β-TM cohort exhibited a high susceptibility to SARS-CoV-2 infection but mild disease course. Our findings support favourable serological responses to SARS-CoV-2 infection and to vaccination in patients with β-TM, indicating a potential interplay between iron availability and COVID-19-related immunity. This study was funded by Mr. Hosam and Wasim s. El Helou.

Identification and antibiotics Sensitivity of Secondary Bacterial Infection in COVID-19 (SARS-CoV-2) Pneumonia patients in Kirkuk/Iraq

Abstract: The unusual virus, now known as Coronavirus 2 (SARS-CoV-2), spread fast throughout China and other regions of the world due to its remarkable ability for human-to-human transmission. Patients with COVID-19 commonly experience significant morbidity and mortality from subsequent bacterial infections. Aim: To determine the incidence of typical bacterial infections in COVID-19 pneumonia, including Klebsiella pneumoniae, Pseudomonas aerogenusa, Escherichia coli, and Staphylococcus aureus. Hundred sputum samples were taken from individuals who had been identified as having the developing Coronavirus and were dwelling in intensive care units in Hospitals (Al Shifa hospital) in Kirkuk city/Iraq. The BDph Phoenix m50 procedure was used to test the antibiotic sensitivity of samples collected on various culture mediums, then transferred to pure cultures and diagnosed. The total of 100 patients, 60% of them had a secondary bacterial infection, whereas 40% of them did not. The most common isolated species was Staphylococcus aureus identification at (40%) followed by K. pneumoniae (33%), Pseud. aeruginosa (22%), and E. coli (5%). The majority of the identified strains were resistant to the study's antibiotics. This study demonstrates that SARS-CoV-2 infected critically sick individuals had a very high frequency of subsequent bacterial infection. The pathogenic bacteria that were identified for this investigation were resistant to the majority of the antibiotics that were utilized.

Critical Care Nurse’s Practice Regarding Medication Administration Safety in Intensive Care Units at Governmental Hospitals in Gaza Strip

Background: Administration of medications is primarily the nurse’s responsibility. This study aimed to assess intensive care nurses’ practice of safe medication administration in governmental hospitals in the Gaza Strip. Methods: This study utilized descriptive, cross-sectional, analytical design. The sample of the study consisted of 116 ICU nurses from five governmental hospitals (Al Shifa Hospital, Indonesy Hospital, Shohada Al Aqsa hospital, European Gaza Hospital, and Nasser Hospital). For data collection, the researcher used Patient Safety Assessment in Medication Administration Questionnaire and Observation Checklist. A pilot study was conducted on 20 nurses, and reliability of the Patient Safety Assessment in the Medication Administration Questionnaire was 0.908. Results: The results showed that 66.4% of study participants were male nurses and 33.6% were female nurses, mean age was 28.97 years, 85.4% have bachelor degree, mean experience was 4.18 years, mean income was 1431.64 New Shekel, and 67.2% are working mixed shifts (morning, evening, and night). The practice of safety medication administration indicated that the highest score was in right route (93.8%), the right time (91.8%), right patient (90.7%), right way (89.5%), right recording of administered medication (88.9%), right answer (86.7%), right guidance (86.5%), right dose (86%), right medication (85.3%), and the overall score was 88.6%. Also, observation of nurses indicated high practice of safe medication administration with an average score of 83.6%. There were statistically insignificant differences in the practice of safe medication administration related to the hospital, gender, qualification, age, experience, and income. Conclusion: The study concluded that intensive care nurses handling medication safely at a moderate level and more. The authors demonstrated the need to provide adequate number of qualified nurses in Intensive Care Units, and encouraged nurses to participate in training programs about safe medication preparation and administration.

Outcomes of intervention treatment for concurrent cardio-cerebral infarction: a case series and meta-analysis

Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear. Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment. The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment.

Willingness to pay for treatment of complications associated with high blood pressure among hypertensive patients in Pakistan: A cross-sectional study

Background: Hypertension is the leading cause of cardiovascular mortality and morbidity around the globe. Willingness to pay (WTP) is the technique to evaluate the health care program from the consumer’s perspective. This technique is measured and valued for future perspective. The objective of this study is to investigate WTP for treatment of complications associated with high blood pressure among hypertensive patients in Pakistan. Methods: A cross sectional observational study was conducted for 6 months from April to September 2019. Well-designed questionnaires were developed to collect information on socio-demographic characteristics, medical belief and hypothetical scenario of willingness to pay. We distributed 320 questionnaires to hypertensive patients in Kashmir institute of cardiology linked with District Head Quarter hospital, Al-shifa hospital Mirpur, Noor memorial hospital &amp; Mohi-ud-Din hospital in Mirpur city, Pakistan. Results: We analyzed 280 questionnaires which were correctly and completely filled giving a response rate of 87.5% in which 69.6% were males and 30.4% were females. Around 39.6% of participants were 51-60 years old. About 81.8% were willing to pay for life time. Almost half 52.5% were willing to pay for stoke more than three thousand rupees. Occupation and monthly income had significant effects on WTP for the treatment of complications of hypertension. Conclusion: Majority of participants were willing to pay from their monthly income for the management of complications associated with hypertension. This indicates the awareness of patients about the importance of disease management for better healthcare.

Acute ischemic stroke for alteplase or medical care alone or intervention with/without alteplase in Palestine (AIS-AMI Palestine)

Background: Stroke is the most common cause of permanent disability and the third most common cause of death in Palestine. We aimed to examine patterns of stroke presentation, causes, management and outcomes at the largest public Mistry of health hospitals in Palestine. Methods: Comprehensive data from all patients with acute ischemic stroke who were admitted to al-Shifa hospital between November 2021 and July 2022 and treated with alteplase alone or endovascular intervention with or without alteplase were prospectively collected and compare with acute ischemic stroke patients who were treated with medical care alone at Palestine medical complex hospital at 2018. Acute ischemic stroke presentation patterns, in-hospital evaluation and management, mortality, and morbidity were evaluated. Results: Medical care alone group: 138 patients with acute ischemic stroke, mean age was 65 ± 14 years and 49% were women. Most of the patients received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In-hospital mortality was 13%, and a modified ranking score of 0 -2 was in 44 patients (32%). Endovascular intervention with/without alteplase group: 56 patients with acute ischemic stroke. The mean age was 61 ± 12 years and 41% were women. All patients received brain computed tomography scans, although few received other investigations such as carotid Doppler (13%). Most patients with ischemic stroke received antiplatelet therapy (99%), although 39 patients (70%) received thrombolysis. Only 61% received physical therapy evaluation. In-hospital mortality was 7%. The modified ranking score 0 - 2: 32 patients (57%). Conclusion: This study conducted in Palestine showed that among patients with acute ischemic stroke, functional outcomes according to modified ranking score 0 - 2 were better by endovascular therapy with/without alteplase than with medical care alone.

Cancer and COVID-19 in Gaza strip-Palestine: What do we know?

As we know cancer patients are considered very vulnerable in the current COVID-19 pandemic. Our study aimed to determine the association between the prognosis of COVID-19 patients with and without cancer. Patients and methods: We retrospectively analyzed a total of 60 adult patients with and without a history of cancer and with confirmed COVID-19 infection recruited in Al Shifa hospital of Gaza strip as a case-control study from Mars 12, 2022 to Mai 20, 2022. Logistic regression models were performed to explore the risk factors of mortality. Results: Thirty cancer patients (cancer group, mean age 57.9± 19.9; median age 60 years; 43.3% were female) and 30 non-cancer patients were identified (non-cancer group, mean age 42.17±14.8; median 40 years; 46.7% were female). Intensive care unit admission was higher in the non-cancer group (63.3%) than in the cancer group (26.7%). The mortality rate was higher in the cancer group (40.0%) than in the non-cancer group (33.3%) and the admission to Intensive care unit remains the strongest risk factor for mortality for cancerous patients (OR= 11.9;95%CI:2.26-62.59, p=0.003). Conclusion: Cancer patients with COVID-19 infection reported a poor prognosis, a closed care, management, and monitoring can improve the outcome of the disease.

First complex maxillofacial reconstruction with free flaps in the Gaza Strip, occupied Palestinian territory: case series from an area under conflict

BackgroundLarge mandibular and maxillary defects are repaired by maxillofacial reconstructive microsurgery (MRM) using free flaps, which is challenging to perform in austere settings owing to its demanding nature in terms of time, equipment, and trained personnel. Humanitarian missions refrain from performing MRM procedures in the host country and instead transfer patients to their home country to perform surgery. We report on the first nine MRM procedures in Gaza. MethodsA French medical mission performed the surgical operations at Al Shifa Hospital, Gaza, occupied Palestinian territory. Fibula free flap, radial forearm free flap, scapular free flap, and thoracodorsal perforator free flap were performed. We recorded the patients’ demographics, diagnoses, and immediate postoperative and follow-up status. We also report the special considerations required to perform the surgery in Gaza's austere and resource-poor environment. FindingsNine patients (five female, four male; mean age 22 years) underwent ablative head and neck surgery from January, 2017, to March, 2019. Before arrival, the missions closely coordinated with local surgeons, who assisted in performing the surgeries and followed the patients postoperatively. Essential surgical equipment needed for the surgery (such as loupes, microvascular sutures, and titanium plates) were donated by the foreign missions. Patients were followed up by local surgeons for a period ranging from 5 to 12 months. No complications occurred at the donor or recipient sites. There was no extrusion of hardware or breakage of the titanium mini plates or reconstructive plates. Patients remained in the intensive care unit postoperatively for at least 48 h. Owing to financial restraints, removable prostheses were used. Rehabilitation was provided by a local dental team despite the lack of professional dental rehabilitation services. Patients had stable bony union and acceptable facial contour. Patients regained satisfactory masticatory function, resumed their normal diets after 6 months without weight loss, and maintained intelligible speech. InterpretationMRM can be successfully performed in conflict settings such as Gaza. Although the study population was small, the study suggests that further investigation into the conditions and elements needed to perform complex surgeries in conflict settings is warranted. Selection of health-care professionals in the surgical and postoperative care teams, effective coordination with local doctors, availability of essential equipment, and postoperative follow-up protocols could all be carefully considered to optimise the results of surgery. In addition, starting rehabilitation as soon as possible following surgery may restore and improve functional and aesthetic outcomes. FundingThe Palestine Children's Relief Fund (PCRF).

Adherence to US Center for Disease Control and Prevention infection control guidelines in the haemodialysis care unit at Dar Al-Shifa Hospital in the Gaza Strip: a clinical audit

BackgroundInfection is the most common cause of admission to hospital and the second most common cause of mortality in patients requiring renal haemodialysis, who have an increased risk of infection due to frequent use of intravenous cannulas or catheters. This audit aimed to assess current clinical practice at a dialysis unit in the Gaza Strip by use of the US Center for Disease Control and Prevention's guidelines for asepsis when dealing with haemodialysis catheters. MethodsA clinical audit was done at the haemodialysis unit of the Dar Al-Shifa Hospital. Data were collected in four categories: first, haemodialysis catheter connection and disconnection; second, haemodialysis catheter exit site care; third, dialysis station routine disinfection; and fourth, haemodialysis injectable medication preparation and administration. There was no overlap between the four groups. A data collection sheet was adopted from US Center for Disease Control and Prevention guidelines and data were collected prospectively between April and November, 2018, through direct observation of care by ML. FindingsThe total number of patients seen was 250, and the total number of dialysis station routine disinfection sessions observed was 20. In the first category of data (haemodialysis catheter connection and disconnection; n=100 patients), adherence to hand hygiene by the health-care professional was observed in the care of 3 (3%) patients, and adherence to the use of gloves by the health-care professional was seen with 14 (14%) patients. With 74 (74%) of the patients, catheters were connected aseptically from blood lines, and for 58 (58%) patients, catheters were disconnected aseptically from blood lines. After catheter disconnection, adherence to catheter clamping and cap removal was seen for 98 (98%) patients, but only for 34 (34%) patients were catheters attached to new caps aseptically during disconnection. In the second category (catheter exit site care; n=50 patients), adherence to hand hygiene by the health-care professional was seen for the care of one (2%) patient, adherence to the use of gloves was seen for one (2%) patient, and application of skin antiseptics and of antimicrobial ointments was not observed. Moreover, for 35 (70%) patients, procedures were done with no direct contact with the catheter exit site, and for 40 (80%) patients, dressings were applied aseptically. In the third category (dialysis station routine disinfection; n=20 sessions), the adherence to guidelines for catheter disconnection and removal of used blood tubes and dialysers from the machine, disposal in a leak-proof container, and confirmation of patient exit from the dialysis station before beginning routine disinfection of the dialysis station was 100%. However, adherence to confirmation that no visible blood or other contaminants remained on surfaces and that the priming bucket had been emptied was 0%. Additionally, adherence to application of disinfectants to all surfaces in the dialysis station after the patient had left the station was observed after the care of 18 (90%) patients, and adherence to the use of gloves and hand hygiene by the health-care professional was seen after the care of six (3%) patients. In the fourth category (haemodialysis injectable medication preparation and administration; n=100 patients), adherence to the use of new needles and syringes, preparing medications aseptically, and safely discarding vials in the sharp box was done for 100 (100%) patients. During administration, adherence to aseptic attachment of syringes and administration of medication was observed for the care of 80 (80%) patients, and adherence to aseptic disposal was observed for the care of 100 (100%) patients. However, there was no adherence to the use of gloves and hand hygiene. InterpretationHealth-care staff at Dar Al-Shifa Hospital showed good adherence to guidelines in some aspects of care, such as in preparation and administration of medications and in the cleaning of dialysis machine surfaces and stations, but poor adherence to hand hygiene, use of gloves, and application of aseptic dressings was poor. Poor adherence to safety of care can negatively affect overall health outcomes for patients requiring haemodialysis. We recommend staff training on the aseptic aspects of care during and after haemodialysis, and re-audits for the evaluation of the desired optimal outcomes.

Effect of Color Doppler Indices on the Diagnosis of Intrauterine Growth Restriction in High-Risk Pregnancies: A Cross-Sectional Study

Aim: To assess the effect of Color Doppler indices on intrauterine growth restriction diagnosis in high-risk pregnancies Study design: Across-sectional study Place and duration: This study was conducted at Al Shifa Hospital Quetta, Pakistan. from January 2020 to July 2020. Methodology: In this study, 100 patients with suspected intrauterine growth restriction (IUGR) in their 31 to 41 weeks of pregnancy have participated. The patients were studied till the babies were delivered. The Doppler indices and the grayscale results were correlated to the baby's weight. Result: The HC/AC ratio was found to be sensitive (84.4%). Whereas the most specific was oligohydramnios and C/U ratio that was 100% and 68.8% respectively. The lowest sensitivity was of the fetal MCA, which was 7.7%. Conclusion: For the diagnosis of IUGR, the highest specific parameter is oligohydramnios and the HC/AC ratio is very sensitive. However, the MCA PI should not be utilized for screening purposes in IUGR because it has very low sensitivity alone. C/U ratio is notably more specific than HC/AC ratio and more sensitive than oligohydramnios. It is the most appropriate parameter to use for the diagnosis of IUGR in the 3rd trimester. Keywords: IUGR,Fetal Doppler, Placentation and IUGR, C/U pulsatility ratio, Small for gestational age

Depression and Generalized Anxiety disorders among Chronically Ill Middle and Older Adults in Saudi Arabia

BACKGROUND: Depression and anxiety are common prevalent in patients with chronic disease, and Chronic illness are long-lasting conditions with persistent effects and complications. Depression and anxiety disorders are well known to have a negative but significant impact on the course, outcomes, long-term survival, and treatment efficacy of patients suffering from physical disease. Given the high prevalence and potential negative consequences of this type of comorbidity in elderly patients, there is an urgent need for this study to be conducted due to the scarcity of statistics on the topic among middle and older adults in the Al-Qassim region. On the other hand, early identification of people who are more likely to experience psychological distress is critical in prevention and management strategies.&#x0D; &#x0D; OBJECTIVES: To assess the severity of depression and anxiety, using validated self-report measures of middle-aged and older adults; and to determine the association between anxiety and depression levels and socio-demographic characteristics.&#x0D; &#x0D; METHODS: In February 2021 and for two months, a cross-sectional study of middle- aged and older adults from Al-Shifa hospital at Al-Qassim region was conducted with questionnaires on socio-demographic and clinical characteristics, and validated Generalized Anxiety Disorders (GAD-7), and Patient Health Questionnaire (PHQ-9) anxiety and depression questionnaires. Two hundreds middle- aged and older adults participants of Al-Shifa Hospital participated in this study and agreed to complete the questionnaire.&#x0D; &#x0D; RESULTS: 79% (n=158) of participants had minimal to mild depression and 21% (n=42) had moderate-to-severe depression; the average PHQ-9 score was 7.05 (M =7.05; SD=4.4), while 81.5% (n=163) of participants had minimal to mild anxiety and 18.5% (n=37) had moderate-to-severe anxiety; the average GAD score was 6.6 (M =6.6; SD =4.3). The significant predictors of moderate-to-severe depression in the logistic regression analysis were: male sex (odds ratio (OR):0.0.272; confidence interval (CI):0.101-0.730) and psychiatric disorders (odds ratio (OR):13.131; confidence interval (CI):2.975-57.949). The significant predictors of moderate-to-severe anxiety in the logistic regression analysis were psychiatric disorders (odds ratio (OR):13.080; confidence interval (CI):3.261-52.464). There was a strong significant positive correlation between PHQ-9 score and GAD score.&#x0D; &#x0D; CONCLUSION: The study group had higher prevalence of moderate and severe depression, which was significantly associated with female sex and psychiatric disorders; while the prevalence of moderate and severe anxiety was significantly associated with the presence of psychiatric disorders. Our findings reaffirm the importance of providing appropriate specialized interventions to promote the mental health of chronically ill elderly, with a focus on high-risk groups.

DECOMPRESSIVE CRANIOTOMY IN MANAGEMENT OF ACUTE CEREBRAL ISCHEMIA

Background: Ischemic stroke is a medical emergency and the most common affection of the central nervous system (CNS). This is the second-leading cause of death worldwide and the first causes of morbidity. Ischemic stroke correspond to 85% of all strokes with a mortality of 10-50%. Large space-occupying infarction accounts for 1-10% of all supratentorial infarction with signs of elevated intracranial pressure (ICP) and brain herniation usually in the second to the fifth day leading to a mortality rate of 53% to 89%. Objective: To evaluate the clinical and radiological outcome of decompressive surgery in the setting of cerebral infarctions, and to study its effect in reducing the overall mortality rates of this fatal condition. Patients and methods: This study is descriptive and analytic clinical trial study for evaluating the clinical and functional outcomes of surgical cases with massive cerebral infarction. Over one year, Between January 2018 and January 2019, at Dar Alshifa Hospital, and Al-Azhar University Hospitals in Cairo. Results: Twenty cases with cerebral infarctions were included in this. In our study, there was 12 males (60%) and 8 females (40%) male: female ratio 1.5:1.The age of the cases ranged from 37 to 77 years. The mean age was 57.65 years. Four cases were less than 50 years (20%), 6 cases between 50 and 60 years (30%), 8 cases between 60 and 70 years (40%), and 2 cases above 70 years (10%). Eighteen cases had middle cerebral artery (MCA) infarctions (90/%), while 2 cases had both MCA and anterior cerebral artery (ACA) infarctions. eleven cases were right sided while 9 cases were having left-sided infarctions. Conclusion: The preoperative clinical condition , higher GCS score at presentation were strongly related to a favorable clinical outcome .Some ICU related complications such as contra lateral infarction, hemorrhagic infarction, pulmonary embolism, pneumonia can worse the patient outcome .Other complication related to the surgery such as CSF leak, wound infection did not effect on patient prognosis. Factors like patients’ age, sex, site of infarction, and preoperative midline shift did not affect the final outcome. A study with larger sample size and longer follow-up is recommended for better confirmation of these facts.

Enhancing the quality of maternal and neonatal care by the Safe Childbirth Project in Al Shifa Hospital, Gaza occupied Palestinian territory (oPt): a descriptive retrospective study

BackgroundThe Safe Childbirth Project is a campaign, launched by WHO in 2012, to improve the quality of care for women and babies during childbirth by promoting evidence-based practice and a midwifery-led approach to care. It was intended to contribute towards achieving UN Sustainable Development Goal 3: ensure healthy lives and promote wellbeing for all at all ages. In September, 2015, the project was launched in the maternity ward of Dar Al-Shifa Hospital, Gaza City, to promote midwifery-led care for low-risk deliveries, with de-medicalisation of normal birth, early initiation of breastfeeding, and early detection of complications during the postpartum period. MethodsDar Al-Shifa Hospital is the largest Ministry of Health hospital in the Gaza Strip, is the referral hospital for the whole area, and includes medical, surgical, and maternity departments. Most women who attend the maternity department (70%) have high-risk pregnancies. The caesarean section rate in 2016 was 27%. 88 midwives and 82 doctors are employed on the maternity wards. We did a descriptive retrospective analysis of all women admitted in labour to the maternity hospital from the start of the Safe Childbirth Project on Sept 1, 2015, to June 30, 2018. Data were extracted from patients’ files then aggregated and analysed. Six indicators of quality of care were assessed: risk assessment on admission to the labour ward; use of partograms; oxytocin augmentation of labour; babies delivered by a midwife; breastfeeding initiation within 1 h of birth; and the number of postnatal examinations. Ethics approval was obtained from the Helsinki Committee, at the Palestinian Health Research Council. FindingsOf 16 400 births at Dar Al-Shifa Hospital during the study period, 11 480 (70%) were normal vaginal deliveries. The percentages of women risk assessed on admission increased from 65% at the start of the study to 100% at the end, but the proportions of pregnancies classified as being at low risk or high risk remained at roughly one-third to two-thirds (low risk 20% and high risk 45% at the start of the study vs 30% and 70%, respectively, at the end of the study). Partograms were used in all women throughout the study period. Use of oxytocin augmentation of labour decreased from 24% to 8%. Midwives delivered 53% of low-risk women at the beginning of the study and 100% at the end. The proportion of women who initiated breastfeeding within 1 h of birth increased from 45% to 81% and the percentage of women who had five or more postpartum examinations increased from 27% to 81%. InterpretationImplementation of the Safe Childbirth Project in Dar Al-Shifa Hospital improved most of our indicators of quality of care and was maintained along with regular clinical auditing. Management commitment and close clinical supervision have been the cornerstones of success. FundingNone.

Long-term health effects after conflict-related traumatic amputation among patients in Gaza

BackgroundIn the past 10–15 years, thousands of civilians in Gaza have experienced conflict-related traumatic injuries. How injuries affect survivors’ risks of negative long-term health effects and serious illness is unclear. We report follow-up findings in a group of patients with traumatic amputations. MethodsEligible patients had traumatically amputated limbs and showed signs and symptoms of possible serious illness on standardised clinical examination. The patients were all receiving rehabilitation treatment at the Artificial Limbs and Polio Centre, Gaza, which is the main provider of rehabilitation and protheses. All patients had suffered from at least one amputation during Israeli military incursions between 2006 and 2016. All were offered referral to the Al-Shifa Hospital, Gaza, for further diagnostic clinical, radiological, and laboratory tests. Each patient was examined by CT of the abdomen (or ultrasonography if CT could not be performed) and chest and MRI of the amputation stump or stumps. Laboratory analyses included ESR, complete blood count, kidney and liver function tests, serum glucose, creatine kinase, lactate dehydrogenase, and hepatitis B and hepatitis C virus infections. FindingsOf 254 traumatically amputated patients assessed, 105 had signs and symptoms of possible serious illness, among whom 94 accepted referrals. 88 (93%) of 94 were men and the median age was 31.5 years, mean age 34 years (SD 9·6). Of 90 patients who had imaging, 19 (21%) patients had fatty liver infiltration, three (<1%) had lung nodules, and ten had lung atelectasis. Shrapnel was found in the chest of 12 patients (13%), the abdomen of five patients (6%), the scrotum of one patient (<1%), in the amputation stumps of 26 patients (29%), and the non-amputated limbs of eight patients (1%). Three (<1%) of 90 patients had liver lesions. 32 (34%) of 94 patients had elevated ESR, 19 (20%) had elevated liver enzyme concentrations, and 12 (13%) were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (one with fatty liver changes). Two of the 19 patients with fatty liver infiltration were diagnosed as having type 2 diabetes. A limitation of this study is that, owing to conflict-related supply-chain issues in Gaza, we were unable to collect complete data in four (5%) of patients. InterpretationAs well as residual shrapnel in more than half of patients, a notable proportion of patients had fatty liver infiltration, for which we have no clear hypothesis. We recommend close medical follow-up for trauma patients in injured by explosives. FundingThe Norwegian street-artist AFK provided €1,500 to this project, which was used to cover patients’ transportation costs.