Central Hospital Research Articles

Frequency of Uropathogenic Bacteria among Patients Visited to the National Reference University Hospital Center of N'Djamena (CHAD)

Frequency of Uropathogenic Bacteria among Patients Visited to the National Reference University Hospital Center of N'Djamena (CHAD)

Cardiometabolic effect of switching from an efavirenz-based therapy to a dolutegravir-based therapy on clinical and virological outcomes among people living with HIV at the Yaoundé Central Hospital

Cardiometabolic effect of switching from an efavirenz-based therapy to a dolutegravir-based therapy on clinical and virological outcomes among people living with HIV at the Yaoundé Central Hospital

Prediction of Seven Artificial Intelligence-Based Intraocular Lens Power Calculation Formulas in Medium-Long Caucasian Eyes

Purpose: To compare the accuracy of seven artificial intelligence (AI)-based intraocular lens (IOL) power calculation formulas in medium-long Caucasian eyes regarding the root-mean-square absolute error (RMSAE), the median absolute error (MedAE) and the percentage of eyes with a prediction error (PE) within ±0.5 D. Methods: Data on Caucasian patients who underwent uneventful phacoemulsification between May 2018 and September 2023 in MW-Med Eye Center, Krakow, Poland and Kyiv Clinical Ophthalmology Hospital Eye Microsurgery Center, Kyiv, Ukraine were reviewed. Inclusion criteria, i.e., complete biometric and refractive data, were applied. Exclusion criteria were as follows: intraoperative or postoperative complications, previous eye surgery or corneal diseases, postoperative BCVA less than 0.8, and corneal astigmatism greater than 2.0 D. Prior to phacoemulsification, IOL power was computed using SRK/T, Holladay1, Haigis, Holladay 2, and Hoffer Q. The refraction was measured three months after cataract surgery. Post-surgery intraocular lens calculations for Hill-RBF 3.0, Kane, PEARL-DGS, Ladas Super Formula AI (LSF AI), Hoffer QST, Karmona, and Nallasamy were performed. RMSAE, MedAE, and the percentage of eyes with a PE within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 were counted. Results: Two hundred fourteen eyes with axial lengths ranging from 24.50 mm to 25.97 mm were tested. The Hill-RBF 3.0 formula yielded the lowest RMSAE (0.368), just before Pearl-DGS (0.374) and Hoffer QST (0.378). The lowest MedAE was achieved by Hill-RBF 3.0 (0.200), the second-lowest by LSF AI (0.210), and the third-lowest by Kane (0.228). The highest percentage of eyes with a PE within ±0.50 D was obtained by Hill-RBF 3.0, LSF AI, and Pearl-DGS (86.45%, 85.51%, and 85.05%, respectively). Conclusions: The Hill-RBF 3.0 formula provided highly accurate outcomes in medium-long eyes. All studied AI-based formulas yielded good results in IOL power calculation.

The future of personalized medicine in Saudi Arabia: Opportunities and challenges.

Personalized medicine is a healthcare approach that designs treatment plans of each patient, considering genetic, environmental, and lifestyle factors. This model leverages genomic information, advanced diagnostics, and data analytics to predict disease risk, optimize prevention strategies, and provide customized treatments. In Saudi Arabia, personalized medicine is gaining momentum, driven by the country's Vision 2030 initiative, which aims to transform the healthcare sector by integrating advanced medical technologies and improving healthcare delivery. The Kingdom has made significant strides in genomics and bioinformatics, with initiatives such as the Saudi Human Genome Program and advancements in institutions i.e.,King Faisal Specialist Hospital and Research Centre. Continued investment in research, education, and technology, alongside international collaborations, will be crucial in overcoming these challenges and realizing the full potential of personalized medicine. This review explores the current state, challenges, and future prospects of personalized medicine in Saudi Arabia, highlighting its transformative impact on healthcare delivery and patient outcomes.

Correlation of Pleural Fluid Analysis with Thoracoscopy Guided Biopsy in Undiagnosed Exudative Pleural Effusion

Abstract Background: Despite having a high burden of tuberculosis (TB) and thus pleural effusions, there is very little data or studies available based in India on pleural fluid analysis and thoracoscopic-guided biopsy, and their correlation with each other. The aim of this study was to compare and correlate various parameters of pleural fluid analysis with thoracoscopic-guided biopsy especially in undiagnosed pleural effusions in Indian setting. Patients and Methods: This prospective observational study was carried out in a total of 40 patients above 18 years of age after obtaining institutional ethics committee clearance and written informed consent who were admitted in the Department of Pulmonary Medicine, Sarvodaya Hospital and Research Centre, from August 2022 to January 2024 covering a total duration of 18 months. The data were entered into MS excel and analyzed by SPSS statistical software. Descriptive statistics such as frequency, standard deviation, and t-test was used to determine level of statistical significance which was set at 0.05. Results: The mean age of the study participants was found to be 53.23 ± 19.95 years, male-to-female sex ratio was 1.6:1. The most common cause of exudative pleural effusion was tuberculous pleuritis (40%) followed by malignancy (22.5%). Shortness of breath (67.5%) and chest pain (50%) were the predominant clinical symptoms. Malignant pleural effusions showed a polymorphic predominant cytology while lymphocytic predominant cytology was present in chronic inflammatory effusions predominantly tubercular. Parapneumonic effusions exhibited elevated adenosine deaminase (ADA) levels and more neutrophils in pleural fluid, whereas tubercular effusions demonstrated increased ADA levels with abundance of lymphocytes. Metastatic adenocarcinoma was the most common type of malignancy found on histopathology. Necrotizing granulomatous inflammation and granulomas were the predominant findings on histopathological examination and imprint cytology, observed in 40% and 35% of the study participants, respectively. Pleural biopsy has a significantly higher diagnostic yield for TB as well as malignancy (P < 0.05). Conclusion: Medical thoracoscopy serves as an effective, safe, and well tolerate diagnostic tool for pulmonologists in assessing undiagnosed pleural effusions postthoracentesis.

EFFECTIVENESS OF HERBAL AND CONVENTIONAL MANAGEMENT INTERVENTIONS OF HEPATITIS B VIRUS.

Liver inflammation caused by the Hepatitis B virus (HBV) could become chronic and unresolved if untreated. Prevention and management of the disease are through vaccination and other conventional interventions. This study evaluated the cost-effectiveness of herbal management (HM) and conventional pharmaceutical management (PM) interventions in treating HBV. A purposive sampling technique was used to administer questionnaires at the University College Hospital (UCH) and Total Healthcare Diagnostic Centre (THDC). Data collection was according to a EuroQol (EQ -5D), while descriptive and inferential analyses were performed. Findings revealed a high prevalence of HBV among females from ages 26 to 50. The majority discovered their health status through free HBV tests. Other than cost-effective interventions, about 73% of cases adopted HM to manage the disease. A significant difference (P<0.00) was observed in the correlation analysis of the current health status of respondents and the intervention management adopted. correlation analysis of the current health status of respondents was significantly different (P<0.01) against the intervention management adopted (P<0.00). The minister of health should emphasize HBV regular screening, subsidized viral load test and free vaccination in both public and private healthcare centres.

Fecal Microbial Dysbiosis Is Associated with Colorectal Cancer Risk in a Korean Population.

The association between the fecal microbiota and colorectal cancer (CRC) risk has been suggested in epidemiologic studies. However, data from large-scale population-based studies are lacking. In this case-control study, we recruited 283 CRC patients from the Center for Colorectal Cancer, National Cancer Center Hospital, Korea to perform 16S rRNA gene sequencing of fecal samples. A total of 283 age- and sex-matched healthy participants were selected from 890 cohort of healthy Koreans that are publicly available (PRJEB33905). The microbial dysbiosis index (MDI) was calculated based on the differentially abundant species. The association between MDI and CRC risk was observed using conditional logistic regression. Sparse Canonical Correlation Analysis was performed to integrate species data with microbial pathways obtained by PICRUSt2. There is a significant divergence of the microbial composition between CRC patients and controls (permutational multivariate analysis of variance p=0.001). Those who were in third tertile of the MDI showed a significantly increased risk of CRC in the total population (odds ratio [OR], 6.93; 95% confidence interval [CI], 3.98 to 12.06; p-trend < 0.001) compared to those in the lowest tertile. Similar results were found for men (OR, 6.28; 95% CI, 3.04 to 12.98; p-trend < 0.001) and women (OR, 7.39; 95% CI, 3.10 to 17.63; p-trend < 0.001). Bacteroides coprocola and Bacteroides plebeius species and 12 metabolic pathways were interrelated in healthy controls that explain 91% covariation across samples. Dysbiosis in the fecal microbiota may be associated with an increased risk of CRC. Due to the potentially modifiable nature of the gut microbiota, our findings may have implications for CRC prevention among Koreans.

Distribution and Treatment of Hepatitis C in Libyan Population

Viral hepatitis refers to inflammation of the liver that is caused by viral infection. It is a major public health issue in the world wide. Not only does viral hepatitis carry a high morbidity, but it also stresses medical resources and can have severe economic consequences. The majority of all viral hepatitis cases are preventable. HCV infection is rarely diagnosed during the acute phase of infection. Although a variety of host-factors play a role in eradication of HCV, only 15%-25% of adults spontaneously clear the infection. The objective: Distribution of hepatitis C virus and the incidence rate between males and females in Libya. What are causes, symptoms and complications of hepatitis C virus infection. How to diagnose hepatitis C virus infection in the lab. A total of 64 anti-HCV positive serum samples from individuals of physical examination were recruited from the Tripoli central Hospital infectious department Tripoli from January 2023 to June 2023. 64 samples with a positive PCR for HCV RNA. The age of anti-HCV positive individuals of physical examination ranged from 20 to 90 years old. Through the results, we find that the number of male cases is 42 for 65.62%, and the number of female cases is 22; with a rate of 34.37%. The age group (50-59) year was 23 cases with a rate of 35.93%. No cases of a Decrease of WBC, and we found that most of the cases had normal rate of WBC 19 cases by 86.3%, and 3 cases had increase rate of WBC by 13.6%. In conclusion, we conclude that men are more infected with hepatitis C. Also, the most age group infected with hepatitis C is (50-95), and this is not a good indicator and should be alerted. Acronyms HCV: Hepatitis C virus. PCR: Polymerase chain reaction. ALT: Alanine aminotransferase. AST: Aspartate transferase. BIL: Total bilirubin.

Profile of female survivors of sexual violence in the first 6 months of the COVID-19 quarantine in the city of Campinas, Brazil: A cross-sectional retrospective study.

Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID-19 pandemic in a Brazilian city. This is a cross-sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%. Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months. The COVID-19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic.

Hospital Prevalence of Foot Amputations in Diabetic Subjects and Their Associated Factors at the Medical Clinic II of the Abass Ndao Hospital Center

Hospital Prevalence of Foot Amputations in Diabetic Subjects and Their Associated Factors at the Medical Clinic II of the Abass Ndao Hospital Center

Emergency stock in a resource-constrained acute care unit: analysis of the medication management process

Introduction: The research is based on the evaluation and analysis of drug stock management in the Emergency Department of Peltier University Hospital Center in Djibouti. Methods: An observational, longitudinal and descriptive study was conducted from December 1, 2023 to April 30, 2024. The aim was to describe the diseases with the highest incidence in the emergency department and to organize a stock of medicines. Results: the health problems that contributed the greatest number of patients were cerebrovascular diseases and renal failure with a length of stay of 27 and 66 hours respectively. In relation to the stages of drug acquisition management, it was possible to analyze that, although there are most of the drugs in the institution, their use and consumption is deficient since there is no physical or documented existence of a stock of drugs in the emergency department, which is expressed in the prolongation of the stay in the service. A medication guide was developed to improve the emergency stock and better patient management. Conclusions: The lack of a stock of medicines in the emergency department affected the stage (use - consumption), which is the most important for the adequate management of the patient, thus prolonging the stay in the service

Identifying specific subgroups of older patients at risk of repeated hospital readmissions and death after discharge in a prospective multicentre cohort in France

ObjectiveTo identify specific subgroups of older patients at risk of repeated hospital readmissions and death.DesignProspective, multicentre, DAMAGE (Patient Outcomes After Hospitalization in Acute Geriatric Unit) cohort of adults aged 75...

Association between the intensity of statin therapy and physical activity 1 year after acute coronary syndrome: a multicentre prospective cohort study in Switzerland

ObjectivesTo assess the association between the intensity of statin therapy and the level of physical activity in patients 1 year after an acute coronary syndrome (ACS).DesignProspective cohort study from the...

Establishing a differential diagnosis model between primary membranous nephropathy and non-primary membranous nephropathy by machine learning algorithms

Context Four algorithms with relatively balanced complexity and accuracy in deep learning classification algorithm were selected for differential diagnosis of primary membranous nephropathy (PMN). Objective This study explored the most suitable classification algorithm for PMN identification, and to provide data reference for PMN diagnosis research. Methods A total of 500 patients were referred to Luo-he Central Hospital from 2019 to 2021. All patients were diagnosed with primary glomerular disease confirmed by renal biopsy, contained 322 cases of PMN, the 178 cases of non-PMN. Using the decision tree, random forest, support vector machine, and extreme gradient boosting (Xgboost) to establish a differential diagnosis model for PMN and non-PMN. Based on the true positive rate, true negative rate, false-positive rate, false-negative rate, accuracy, feature work area under the curve (AUC) of subjects, the best performance of the model was chosen. Results The efficiency of the Xgboost model based on the above evaluation indicators was the highest, which the diagnosis of PMN of the sensitivity and specificity, respectively 92% and 96%. Conclusions The differential diagnosis model for PMN was established successfully and the efficiency performance of the Xgboost model was the best. It could be used for the clinical diagnosis of PMN.

&lt;b&gt;Activities limitation in patients with rheumatoid arthritis: A cross sectional study&lt;/b&gt;

Background: Rheumatoid arthritis (RA) is an auto immune disease leads to progressive destruction of synovial membrane of joints, causing pain, deformity and functional limitation, which results in severe disability in performing daily and professional activities. The burden of rheumatoid arthritis RA in general population varies high in females. The most common cause of rheumatoid arthritis in individual life is activities limitations. Rheumatoid arthritis is a disease that should be examined and assessed carefully in the general peoples as well as in patients , because if this disease is identified later can lead to a state of irreversible damage of the articular cartilage of the joints , which can lead further disability and increases activities limitation . Objective: to asses activities limitation in patients with rheumatoid arthritis Methodology: Total of 132 patients in the study. Data was collected at rheumatology OPD at arif diagnostic hospital and research center Hayatabad Peshawar. Data from patients were collected through health assessment questionnaire (HAQ) convenient sampling technique was used, data was analyzed using SPSS version 26. Result: total of 132 participated, ranging in age from 25-60 years, mean age was 47.6±10.3. Female patients were more than male patients. Out of 132 patients 2 67.4% have female patients and 32.6% were have male patients with rheumatoid arthritis Conclusion: most of the patients with rheumatoid arthritis were having activities limitations in their daily life. in term of severity most patients were have moderate pain . Keywords: activities limitation, rheumatoid arthritis, HAQ

Factors influencing survival outcomes in patients with stroke at three tertiary hospitals in Zimbabwe: A 12-month longitudinal study.

In this longitudinal study, we aimed to determine factors influencing survival outcomes among patients with stroke at three tertiary hospitals over a 12-month period. The investigation sought to uncover influential determinants to enhance the precision of prognostic assessments and inform targeted interventions for individuals affected by stroke. Employing a longitudinal study design, participants were observed for 12 months from baseline, censoring survivors at the endpoint. The dataset originated from a comprehensive study involving stroke patients treated at three referral hospitals in Zimbabwe: Parirenyatwa, Sally Mugabe, and Chitungwiza Central Hospitals. The primary outcome variable, the duration of survival until death, was measured in days from the initiation of stroke treatment. Gompertz parametric regression analysis was utilized for data modeling following AFT model diagnostics. In our study, 188 stroke patients were enrolled at baseline. However, 51 patients were excluded from the analysis due to either missing information or loss to follow-up. Among the remaining 137 patients who were tracked over a 12-month period, 42% were censored, and 58% were deceased. Individuals utilizing 'Free Service (older than 65/pensioners/retirees/social welfare)' hospital bill payment methods showed a decreased risk of death, (adjusted hazard ratio; aHR: 0.4, 95% CI: 0.20, 0.80), suggesting a protective effect compared to cash paying patients. Those who had attained a secondary school level education displayed a significantly lower risk of death (aHR: 0.4, 95% CI: 0.24, 0.79) compared to those with primary level education. Age was a significant risk factor, with individuals aged 45-65 and those over 65 years showing higher adjusted hazard ratios 3.4 (95% CI: 1.42, 8.36) and 3.7(95%CI:1.44, 9.36), respectively, relative to those below 45 years of age. Housing status revealed a protective effect for those residing with parents/relatives (aHR: 0.4, 95% CI: 0.20, 0.64). Total functional outcome demonstrated significantly lower hazards for individuals with mild or moderate (aHR: 0.2, 95% CI: 0.09, 0.40) and severe outcomes (aHR: 0.2, 95% CI: 0.10, 0.46) compared to those with very severe outcomes. The study findings demonstrate that hospital bill payment methods, housing status and staying with relatives, educational attainment, functional outcome, and age significantly affect survival outcomes among stroke patients. This highlights the need to consider socio-demographic and clinical variables in the development of prognostic assessments and targeted interventions for individuals recovering from stroke.

The Incidence of Nosocomial Bloodstream Infections in Children With Congenital Heart Disease Undergoing Cardiac Surgery: A Retrospective Study

Congenital heart disease (CHD) is the most common congenital abnormality in children and often requires surgical intervention. These children are vulnerable to nosocomial infections (NIs), particularly bloodstream infections (BSIs), after surgery. In this study, we aimed to investigate the incidence of bloodstream infections BSIs after cardiac surgery. This retrospective study was conducted on pediatric patients refered to Children’s Medical Center Hospital, affiliated with Tehran University of Medical Sciences, from March 2022 to March 2023 for cardiac surgery. The records of 449 patients were reviewed, with 436 meeting inclusion criteria. Data were extracted from medical records, including age, weight, gender, clinical diagnoses, and blood culture results. Statistical analysis was performed using descriptive statistics (including frequency, percentage, mean, and standard deviation) and inferential statistics (including Chi-square and Independent t-test) in SPSS version 23. The results showed that the incidence of BSIs in pediatric CHD patients after cardiac surgery was 3.21%. Postoperative blood cultures revealed that Klebsiella pneumoniae was the most common pathogen (42.9%), followed by Escherichia coli and Staphylococcus epidermidis (14.3% each). No significant association was found between BSIs and gender (P=0.70), weight (P=0.06), or diagnosis (P=0.44). However, age was significantly associated with BSI incidence (P&lt;0.001). This study provides important insights into the incidence of nosocomial BSIs in pediatric CHD patients after cardiac surgery. Our results highlight the need for stronger infection control measures and targeted antibiotic therapies to effectively manage BSIs. Further research is recommended to validate these results and improve preventive measures in pediatric cardiac units.

Determination of Diagnostic reference levels (DRLs) for frontal chest radiology of adult patients at Regional Hospital Center of Daloa, Côte D'Ivoire

Although, diagnostic radiology is important in medical field, it significantly contributes to the irradiation of patients. One of the major goals of medical imaging is to minimize the radiation dose to the patient without compromising the image quality needed to produce an accurate diagnosis. Therefore, it is necessary to establish the diagnostic reference levels (DRLs) in radiology in order to achieve this goal. This study aimed to determine the DRLs for the chest radiological examination at the Regional Hospital of Daloa. A DAP meter was used to acquire the dose-area product (DAP) and air kerma data of 127 adult patients (≥ 18 years) undergoing chest examinations in the radiology room. Then the Entrance Surface Dose (ESD) calculated by weighting the dose in air by the BSF backscatter factor and DRLs in DAP and ESD were determined with the 75th percentile statistical method. The key findings showed a variation of 2.69 to 500.47cGy.cm2 and 0.388 to 10.104 mGy respectively for DAP and ESD with means of 52.314 cGy.cm2 and 2.279 mGy respectively. The respective values of DRL in DAP and ESD found in this work were 60.91 cGy.cm2 and 2.658 mGy. The comparison of the DRL values in DAP and ESD found in this work with others values has shown that they were lower than the national and international values of DRLs. This study was essential for RHC of Daloa because it has evaluated the patient doses and indicated that these doses are quietly optimized.

Prevalence of Thyroid Disorders in the Patient Visiting Tertiary Care Hospital in Jhapa District, Nepal

Background Thyroid dysfunction is a leading global endocrine disorder, affecting 30-40% of endocrine patients. Thyroid hormones regulate metabolism, growth, and cardiovascular health. Both hyper- and hypothyroidism are linked to serious health issues. Undiagnosed cases are common, with 42 million affected in India. Screening programs, especially for women, are vital for early detection and treatment. Methods This is a prospective hospital based study was conducted in the central laboratory at B&amp;CMedical College Teaching Hospital and Research Centre Birtamode, Jhapa from March 2022 to January 2023.Venous Blood samples was collected and fT3,fT4 and TSH was estimated by Chemiluminescence Immunoassay (CLIA) method using Backman Coulter Access 2 analyser. Thyroid statuses were categorized as euthyroid, hypothyroid, subclinical hypothyroid, hyperthyroid, and subclinical hyperthyroid based on test results. Results The most common thyroid disorder in female was sub-clinical hypothyroidism (14.7%) and the least common was hypothyroidism (0.8%). The most common thyroid disorders was sub-clinical hypothyroidism (11.8%) and the least common was hypothyroidism (1.2%) in male. Among the thyroid disorders, subclinical hypothyroidism was most prevalent in all the age groups. Hyperthyroidism and its subclinical type (0.6%) were the least prevalent in the age group less than 15 years. Conclusions The prevalence of subclinical hypothyroidism was more significant and it increased with the age. Cross-sectional study comparing with different etiological factors like stress levels, geographic, environment, auto immunity, drugs, iodine status etc. may be required.

A Study of Vitamin B12 Deficiency in Type-II Diabetic Patients on Metformin Therapy in Eastern Reason of Nepal

Background Diabetes mellitus, a metabolic disorder marked by elevated blood glucose level, requires effective management to prevent complications. Metformin, a common frontline treatment for type -II diabetes, is linked to Vitamin B12 deficiency, which may trigger severe health disorders like anemia and neurological problems if remain undiagnosed for a longer duration. This study aims to assess the prevalence of Vitamin B12 deficiency among type 2 diabetic patients on metformin therapy. The objective is to assess the distribution of patients affected by this deficiency and understand how metformin therapy influences B12 levels among these patients. The Study was conducted at B&amp;C Medical College Teaching Hospital and Research Center, Birtamod, Jhapa, Nepal. Methods A total of 200 diabetes patients on metformin were included in the study. Patients were included if they were diagnosed with type -II diabetes, were currently undergoing metformin therapy, and had been on the medication for at least 6 months. Data collected comprised patient age, gender, duration of metformin use, and serum vitamin B12 levels measured using chemiluminescence immunoassay (CLIA). Vitamin B12 deficiency was defined as serum levels &lt;200 pg/mL, insufficiency as 200-300 pg/mL, and sufficiency as &gt;300 pg/mL. Statistical analysis involved descriptive statistics and Chi-square tests. Results Out of the 200 diabetic patients taking metformin, 45% exhibited Vitamin B12 deficiency based on serum levels (&lt;200 pg/mL), 30% had insufficient Vitamin B12 levels (200–300 pg/mL), and 25% had sufficient levels (&gt;300 pg/mL) Deficiency rates were similar across genders but higher in patients over 47 years. A significant correlation was observed between longer metformin use and lower Vitamin B12 levels. Conclusion The results highlight a prominent rate of Vitamin B12 deficiency among diabetes patients prescribed metformin, especially in older patients and those on long-term therapy. Routine monitoring of vitamin B12 levels is recommended for these patients to prevent serious complications and improve health outcomes