Medical City Hospital Research Articles

Nurses’ Knowledge toward Prevention of Pneumothorax at Intensive Care Unit in AL-Hussein Medical City Hospital in Holy Karbala/Iraq

Aims: The study aims at assess nurses knowledge towards Pneumothorax and determine the relationship ofthose knowledge with their demographic characteristics.Methodology: To investigate nurse information relevant to Pneumothorax at Intensive Care Unit, aquantitative descriptive analysis used to assess approach with questionnaire items is performed. Throughoutthe non-probability sampling method, a purposive random sample of (30) nurses is chosen. A constructedquestionnaire includes (socio-demographic data and knowledge questionnaire items), data was collectionthrough the use of a questionnaire and self report nurses. Through the application the descriptive statistic,data were analyzed.Results: According to the analysis mean, the findings indicate that the majority (96.7 %) of nurses werepoor knowledge. As well as, there were no significant relationship between nurses knowledge and theirdemographic characteristics at p-value more than 0.05.Conclusion: This research found knowledge in terms of Pneumothorax, nurses were poor knowledge. Moreyears of experience in training the staff in intensive care unit and provide the health resources and exploitingyoung energies of nurses which indeed helps to develop their knowledge.

Psychological Impact of Covid-19 Pandemic on the Healthcare Workers of a Tertiary Care Hospital of Lahore

Background: The psychological stress associated with the COVID-19 pandemic can have long-term effects on the health and coping abilities of HCWs. COVID 19 has exhausted the healthcare workers globally both physically and mentally. This article focuses on the Psychological stresses faced by the healthcare workers of a tertiary setup. Objective: To determine the psychological impact of the COVID-19 pandemic on the healthcare workers (HCWs) of a tertiary care hospital of Lahore. Study Design: Descriptive, cross-sectional study. Settings: Sharif Medical City Hospital, Lahore Pakistan. Duration: From July 2020 to August 2020. Methodology: A total of 82 healthcare workers were enrolled in the study on a voluntary basis by convenient sampling technique and filled an online questionnaire including demographic information, informed consent, validated Depression, Anxiety and Stress Scales (DASS-21) and the factors causing psychological distress. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Results: Out of 82 HCWs, 47(57.3%) had stress, 42(51.2%) had depression and 29(35.4%) had anxiety. Most of the HCWs with stress had mild and moderate stress. The majority of the HCWs were suffering from moderate depression and moderate anxiety. The most common factor causing psychological stress among HCWs was the fear of getting infected with COVID-19 followed by chances of spreading the disease to family members and the non-availability of personal protective equipment. Conclusion: The COVID-19 pandemic has a great psychological impact on the healthcare workers in Pakistan. A large proportion of HCWs suffered from stress (57.3%), depression (51.2%) and anxiety (35.4%). The most common factors causing psychological distress in HCWs were the fear of getting infected with COVID-19 (80.5%), chances of spreading the disease to family members (65.9%) and the non-availability of personal protective equipment (59.8%).

Assessment of Competencies’ Level of Critical and Intensive Care Unites Nurses at King Abdulaziz Medical City and King Abdullah Specialized Children Hospital

Critical Care Nursing reflects a holistic approach in caring of patients, critical care nurses are registered nurses who are trained and skilled to practice critical care nursing for critically ill patients, she carries out independent interventions and collaborates patient care activities to address life-threatening situations that will meet patient’s physical, psychological, cultural and spiritual needs. The aim of the study was to explore competence levels of intensive care unit nurses and related socio demographic characteristics. Setting: the study was conducted at all Intensive and Critical Care Units, King Abdulaziz Medical City and King Abdullah Specialized Children Hospital. Sample: Representative convenient sample of 233 intensive and critical care unit nurses were included in the study. Tools: Intensive and Critical Care Nursing Competence Scale (ICCN- CS-1) was used for the purpose of the study, it is a self-assessment questionnaire consisting of two main basic competence; clinical competence and professional competence with a total of 140 items; each basic competence comprises four essential sub domains; knowledge, skills, attitude and value and experience base. Results of the study revealed that majority of the studied nurses has excellent total level of competency, with highest percent of the studied nurses who have good competency level related to knowledge base and there was a significant difference between total competency level of the studied nurses and their working unit and years of experience in the current Unit. Recommendation: Adding of more than one data collection method to avoid subjectivity of self-assessment scale results.

Endoscopic Reconstruction of Skull Base Defects Using Tutoplast.

BackgroundVarious graft materials that are classified as autografts, xenografts, and allografts based on their origin have been used to endoscopically repair skull base defects. Tutoplast® (Tutogen Medical GmbH), an allogeneic natural collagen matrix, is processed through chemical sterilization that preserves tissue biocompatibility and structural integrity.ObjectiveTo study the safety and efficacy of Tutoplast Fascia Lata and Tutoplast Temporalis Fascia® as primary graft materials in the endoscopic reconstruction of skull base defects of different sizes and etiologies and to compare the outcomes with those of other traditional graft materials based on our experience.MethodsThis is a multi-center retrospective chart review of patients who underwent cerebrospinal fluid leak (CSF) endoscopic reconstruction with Tutoplast Fascia Lata or Tutoplast Temporalis Fascia as either a stand-alone reconstruction material or a part of a multilayer reconstruction depending on the defect at Prince Sultan Military Medical City and King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between 2017 and 2020. Our inclusion criteria were CSF leak repair with Tutoplast and a transnasal endoscopic approach. We reviewed demographic data, intraoperative and postoperative complications, repair materials, repair failure, defect size and location.ResultsTutoplast® was used as the primary graft material in 33 cases. Our main outcome was repair success with lack of post operative CSF leak, observed in 30 cases (90.9%). There was no significant association between postoperative CSF leaks and factors including different defect sizes, defect sites, demographic data, hospitalization duration, or postoperative radiation in oncological cases.ConclusionTutoplast alone or in combination with other materials can be used safely and effectively for skull base defects repair.

Sleeve gastrectomy versus mini-gastric bypass and their effects on type II diabetes mellitus and weight loss outcome.

Bariatric surgeries such as sleeve gastrectomy; mini-gastric bypass surgery are successful weight reduction surgeries which significantly impact metabolic syndrome. The purpose of this research was to assess the impact of laparoscopy gastrectomy and mini-gastric bypasses on weight decrease and diabetes remission of diabetic mellitus type 2 through two years of monitoring. Furthermore, this study looked at the difference between the two procedures regarding their efficacy and identify which one is proper for patients according to their comorbidities. A prospective study was held in Al Sadder Medical City and Al-Gadeer private hospitals in Al-Najaf city, Iraq, from January 2016 to February 2018. The study included 35 obese and morbidly obese patients with a known history of diabetes mellitus type 2, diagnosed from at least two years before surgery. 15 patients undergo uneventful laparoscopic sleeve gastrectomy (6 females and 9 males). 20 patients underwent uneventful laparoscopic gastric mini bypass surgery (6 females and 14 males). In addition, the patients were followed in the short-term postoperatively (3, 6, 12, 24 months) by monitoring their BMI, weight loss, and HbA1c. There was a decrease in BMI of about 45% from the baseline BMI in sleeve gastrectomy surgery and a decrease in HbA1c of about 45%, less than 6%. In gastric mini-bypass surgery, there was a decrease in BMI of about 47% from the baseline BMI and a decrease in HbA1c of about 45% from the baseline less than 6%, during a 24-month monitoring. Both surgeries were fruitful and had efficient results on patients, but the gastric mini bypass was more efficient than sleeve gastrectomy in controlling and remission of DM type 2 without the need for medications. A long-term study should be performed to reveal their effect and benefits to the patients.

A theoretical study on the mass input and output and energy of the biomedical waste incinerator

Medical waste production has increased with many government and private hospitals and health centres due to the increase in the population, especially in the spread of Coronavirus Covid-19. This increase in medical waste is treating in medical incinerators. One of the advantages of incineration is the reduction of volume, weight and energy recovery. This paper examines the medical waste incinerator of one of the Medical City hospitals in Baghdad, as this incinerator internally divided into primary and secondary chambers. The medical waste for yellow bags placed in the primary chamber is burned with the help of air and a burner of 178-356 kW, resulting in waste burned. Then the combustion products pass through the secondary chamber, wherewith air and another burner of 178-356 kW, the combustion of gases and volatile materials from the waste completed. Air is then supplied to the flue gases to dilute the emission concentrations and reduce the flue gas temperature. This paper presents a study on the inputs and outputs of waste, air, fuel and the advantage of the heat quantity generated from the combustion of biomedical waste. As a result of this theoretical work, this incinerator provides an acceptable and durable solution to waste disposal problems and the risks of spreading viruses today.

Furosemide in Hypovolemic shock

Background: Shock is a common clinical state, we face chocked patients in causality, surgical and gynecological specialties like stab wounds, road traffic accidents, placenta preavia, placenta accrete, placenta pericreta, ectopic pregnancy, perforated viscus etc. All such patients undergo surgical exploration and majority of them are shifted to ICU to complete monitoring and support. High percent of them they develop acute kidney injury intra and postoperatively and carry high mortality rate because of not so good nursing care in ICU in Iraq.
 Objective: to clarify that Furosemide can protect kidney function during shock and reduce ICU admission and mortality rate.
 Method: 100 shocked patient were enrolled in this study which was done in medical city hospital, Al-Sadder General hospital and Alkindi teaching hospital in Iraq/Baghdad from January 2019 to June 2020. Patients were divided into 2 groups: group SN this include 50 patient who received 2 ml normal saline as placebo(control group)and second group SL which include 50 patient who received 2 ml (20 mg) furosemide (study group). This trial was double blind study, both the patient and the junior anesthesia doctor do not know about the study conducted. patients below age of 14 years were excluded from the study. 98 patients of those 100 patients were involved in multiple stab wound injury, multiple bullet injury and road traffic accident and only 2 patients were diagnosed as ectopic pregnancy.
 Result: ICU admission and mortality rate was less in patients receiving furosemide compared to patients received placebo (2% and 14% versus 1%and 7%respectively).
 Conclusion: furosemide reduces ICU admission and mortality rate in shocked patients.

Evaluation of Indoxyl Sulfate in Chronic Kidney Disease associated with Left Ventricular Hypertrophy

Chronic kidney disease CKD is widely prevalent globally and Left ventricular hypertrophy (LVH) is very common among CKD patients and contributes to CV mortality which can be monitored by measuring the levels of indoxyl sulfate (IS). Study the correlation of indoxyl sulphate and the degree of left Ventricular hypertrophy in CKD patients. A case control study was done on 90 patients with Chronic kidney disease CKD, 45 of them with who were recruited the Imamian Al-Khadhemian Medical City and Baghedad Hospital, Baghdad, Iraq between January, and September 2020. The levels of indoxyl sulfate and other parameters were measured in the serum of Left ventricular hypertrophy (LVH) and compared with those with a no evidence of LVH) who considered as BMI and sex matched control group. Indoxyl sulfate (IS) levels in patients with chronic kidney disease and an evidence of lift ventricular hypertrophy (LVH-CKD) group were significantly (p=0.001) higher than those of patients with chronic kidney disease without an evidence of lift ventricular hypertrophy (NLVH-CKD) and IS levels were associated significantly with the severity of LVH. The possibility to use IS as a marker for early diagnosis of LVH in patients suffered from CKD and it can be used to determine the severity of LVH in those patients.

Feasibility and safety in difficult laparoscopic cholecystectomies; a single surgeon experience.

Background: laparoscopic cholecystectomy is commonly used for the treatment of gallstones. Objective: To determine the feasibility and safety of difficult laparoscopic cholecystectomies. Methodology: This cross sectional study was based on retrospective collection of data from patient records, including 323 patients with difficult laparoscopic cholecystectomies was conducted in Department of Surgery, Sharif Medical City Hospital, and Rasheed Hospital, Lahore from June 2010 to December 2019. Difficult cholecystectomy was defined on intraoperative findings based on Nassar intraoperative scoring system. Feasibility was defined as successful accomplishment of procedure without complication and safety was defined as having no intraoperative or postoperative complications. Results: There were 75 (23.21%) male and mean age was 48±8 years. Class I difficulty was observed in 185 (57.3%) patients, class II difficulty in 83 (25.7%) patients, class III difficulty in 44 (13.6%) patients and class IV difficulty in 11 (3.4%) patients. Mean duration of surgery and mean hospital stay were 98.87±11.76 minutes and 1.91±1 days, respectively. Conversion to open cholecystectomy was done in 10 (3.1%). The procedure was feasible in 313 (96.9%) patients. Overall complications were seen in 19 (5.9%) patients. The complications included Common Bile Duct injury in 1 (0.31%) patient, intraoperative bleeding in 1 (0.3%) patients, bile leakage in 2 (0.62%) patients, postoperative jaundice in 3 (0.93%) patients, superficial infections in 10 (3.1%) patients and deep infections in 2 (0.62%) patients. Safety of laparoscopic surgery was seen in 304 (94.1%) patients. Conclusion: Laparoscopic cholecystectomy in difficult situations was found to be feasible and safe in majority of patients. However, it was associated with a longer operative time.

The Role of MDCT and 3D computed tomography in the assessment of maxillofacial fractures and their types: a tertiary care hospital experience

Background: Maxillofacial region is a complex anatomical region that is commonly injured due to trauma and Multidetector Computed Tomography and Three-Dimensional Computed Tomography are used for accurate assessment of fractures and associated soft tissue injuries for correct clinical management. The objective of this study was to determine the frequency, various types of maxillofacial fractures and associated injuries using MDCT and 3D computed tomography (3D CT) at Sharif Medical City Hospital, Lahore.
 Patients and methods: This was a cross-sectional study, carried out in the Department of Diagnostic Radiology, Sharif Medical City hospital, Lahore from December 2018 to November 2019. 3D reconstructed CT images were obtained in 70 patients with maxillofacial injuries referred to the Radiology Department of Sharif Medical City Hospital, using 16 slices Toshiba® Aquillion Multidetector Computed Tomography scanner. CT images were evaluated by consultant radiologists and data was collected.
 Results: The maxillofacial fractures were significantly higher in the male population 61 (87%) than the female population 9 (13%). Road traffic accidents were the most common cause of injury and the mean age was 30±12 years with the most common age group were 21-30 years (32.8%). Maxilla and maxillary sinus wall fracture were commonest fracture 23 (33%) followed by orbital 20 (28%) bone fractures. Hemosinus 22 (31.4%) was the commonest associated injury.
 Conclusion: The complex anatomy of the facial bones requires MDCT and 3D CT which offers excellent spatial resolution, and helpful in the accurate diagnosis of the maxillofacial fractures their exact site, number, and associated injuries, and surgical planning.

Clinical Descriptive Study of Masturbatory Behavior Among Infants and Preschool Children: A Recent Observation From Iraq.

Background: Pleasurable feelings are normal human behaviors experienced not only by adults but even in infancy and childhood. These feelings might become habitual behavior in form of masturbation.Objective: To evaluate the clinical criteria of infants and preschool children with masturbation habits who were described by parents as having unremitted genital pruritus.Patients and methods: This is a case-series study describing cases of children with masturbation referred to the Department of Dermatology at Baghdad Medical City and Basra Teaching Hospital, central and southern Iraq, for four years (2014-2018). Children and their parents were carefully interrogated including detailed information about the problem. Local and general examinations were performed. Children with obvious genital lesions and those who proved to have urinary or gastrointestinal problems were not included.Results: Forty-four children with masturbation were enrolled in the study (22 females and 22 males). The only reason for referral was unremitted genital pruritus. The mean age was 3.6 years. The frequency of masturbation events was variable; the mean length of events was 5 minutes. In 80% of children, masturbation happened at any time. Behavior during the event was prone or supine posturing with rubbing of the genital area with either hands or furniture followed by facial congestion, sweating, and sleep. The majority of children (68%) belonged to low social class families.Conclusion: Masturbatory behavior is not uncommon in infants and preschool children and may mimic episodes of ongoing genital pruritus.

Clinical Characteristics and Outcomes of Pediatric Patients With Immune Thrombocytopenic Purpura in King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital: A 10-Year Study.

BackgroundImmune thrombocytopenic purpura (ITP) can be defined as “an immune-mediated acquired disease characterized by a transient or persistent decrease in the platelet count”. Medical treatment is usually not needed but, in some cases, intravenous immunoglobulin G (IVIG), corticosteroids, and anti-D immunoglobulins are used. Splenectomy can be an option for chronic cases with no response to pharmacological treatments. The aim of this study was to describe the clinical characteristics and outcomes of pediatric patients with ITP in King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children’s Hospital (KASCH) in a 10-year period.MethodsThe study was conducted at KAMC and KASCH. The number of recorded cases was 95, which included all ITP patients aged 1 to 14 from both genders who presented to KAMC previously and KASCH currently from January 1, 2007, to December 31, 2017. The data analysis and entry were performed using the Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY).ResultsAmong 95 pediatric patients with ITP, 51 (53.7%) were males and 44 (46.3%) were females, with a median age of 4.00 ± 3.977. Among them, 84 (92.7%) had purpura, 38 (46.3%) had epistaxis, 43 (39%) had petechia, 17 (24.3%) had fever, and 20 (19.5%) had gum bleeding. Out of 95 patients, 91 (95.8%) were given treatment. Out of those 91 patients who were given treatment, IVIG was used in 84 (92.3%), steroids were used in 44 (48.4%), 14 patients received platelet transfusion (15.4%), rituximab was used in 7 (7.7%), and splenectomy was done in 5 (5.5%); 32 (33.7%) cases were considered chronic (more than one year), and 63 (66.3%) were considered acute. Among chronic patients, only one death was recorded, while in acute, no deaths were recorded.ConclusionIn conclusion, ITP is an autoimmune disease that decreases platelet count. The results showed a significant difference in treatment compared to the literature but similar results in other aspects.

Congenital Diaphragmatic Hernia: A Single Center Experience Over Seven Years

Objective: To define the effectiveness of nutrition education pregnant women during pregnancy.Method: A cross-sectional a study behave in medical city hospital. The sample was selected by (nonprobability convenient sampling) and sample size was (150).Results: The result detected that the middle age of the subjects was 27.40 ± 6.78 years and the 52.7% werehousewife, A Prevalent source of information for pregnant women about nutrition during conception 48%.After nutrition education involvement the ratio of pregnant women with learning on adequate nutritionduring pregnancy increased from (39.78 to 74.33), while the pregnancy nutrition practice of the pregnantwomen increased from (50.17 to 76.89).Conclusions: A nourishment education intervention will have a plus effect on nutritional knowledge andpractice of pregnant women.

The Incidence and Risk Factors of Cholelithiasis Development After Bariatric Surgery in Saudi Arabia: A Two-Center Retrospective Cohort Study.

Background: Rapid weight loss after bariatric surgery is a known risk factor for cholelithiasis development. This study aimed to estimate the incidence of cholelithiasis following bariatric surgery among morbidly obese patients who underwent bariatric surgery.Methods: This is a retrospective cohort study of all morbidly obese patients who underwent bariatric surgery in King Abdulaziz Medical City (Riyadh, Saudi Arabia) or King Abdulaziz Hospital (Al Ahsa, Saudi Arabia) between January 2015 and December 2018. Patients with a history of cholecystectomy or previous bariatric surgery were excluded. We estimated the incidence rate of cholelithiasis among the cohort. We also examined the associated risk factors of cholelithiasis development.Results: The study cohort contained 490 patients (38.7% males; 61.43% females) with a mean age of 36.87 ± 11.44 years. Most patients (58.54%) were followed up for 12 months. The incidence of cholelithiasis post-operation was 6.53% (n = 32). The average period of cholelithiasis formation was 12–24 months. The percentage of total weight loss (TWL%) was significantly associated with the development of cholelithiasis post-operatively.Conclusion: A significant association was found between weight loss following bariatric surgery and the incidence of cholelithiasis. Gender, age, and comorbidities were not associated with the formation of cholelithiasis. We recommend regular follow-up appointments with thorough patient education about gradual weight loss to reduce the risk of developing cholelithiasis.

Molecular Profiling of Class I Integron Gene in MDR Salmonella typhi Isolates

Typhoid fever is a paramount reason for horribleness that more mortal sin “around the sum ages aggregations clinched alongside iraq it initiated by salmonella typhi. Salmonella typhi is diagnosed serologically by the Widal test and confirmed by vitek and using polymerase chain reaction (PCR) based amplification of DNA from the bacterial samples of typhoid fever patients. The present study was designed to detect class I integron gene encoding antimicrobial of S. typhi using appropriate primers by PCR. These isolates of this study were collected from postgraduate laboratories (Prepared samples in vitro prepared diagnostics), they were a previous collected from carried out in Al Najaf provenance, throughout those period from July 2018 on March 2019 including 231 cases from blood, stool samples collected from patients suffering from typhoid fever were attended to Al-Sader Medical City and Al-Hakim General Hospital in Al-Najaf province. Biochemically tests and monovalent antisera gave 117 (50.64%) positive result S. typhi isolates and confirmed by Vitek system and PCR which showed positive result 59 (50.42%). Fifty nine isolates of S. typhi, were collected from patients with typhoid fever that distributed to 40/59 (34 %) from blood , 19/59 (15.1%) stool. Molecular detection revealed that most isolates of S. typhi were positive results to (intI) gene 43/59 isolate (the specific primer (intI) gene for S. typhi bacteria was designed in this study by using bioinformatics programs with NCBI website). According to the different diagnostic above, Vitek and PCR method were more sensitivity technique for S. typhi detection among typhoid patients. The results of virulence factors of S.typhi isolates were negative results for gelatinase, hemolysin, protease and capsulated. Multidrug resistance (MDR) of S. typhi isolates were represented by 18 antibiotics resistance to class and sub class of antibiotic. All S. typhi isolates appeared high resistance 100% to Aztreonam (AZM15), Nitrofurantion (F), Amoxicillin/clavulanicacid (AMC30), (PY25), Clarithromycin (CLR), Cefoxitin (FOX30), Penecillin(P10), Cefotaxime (CTX30), ampicillin (AMP), Meropenem (MEM), Tetracycline(TE30). Also resistance of isolates that revealed 91% to Impinem (IP ), 88% Ampicillin (AM10), 85%Amoxillin (AX), 81% Gentamicin (CN10), 80% Chloramphenicol (C30), 74% Cefpirome (CPR) and 68% Carbenicillin (CB).

Pattern of Pro-Angiogenic Serum Placental Growth Factor in Gestational Hypertensive Women

Objective: The aim of this study was to investigate maternal serum levels of an angiogenic factor called Placental Growth Factor (PLGF) at different ages of pregnancy in gestational hypertensive women residing in Raiwind Lahore, Pakistan. Methods: The analytical cross-sectional study was conducted at the Department of Obstetrics and Gynecology Sharif Medical City Hospital, Lahore from January 2015 - April 2015. Serum levels of PLGF were measured and compared between 22 control normotensive subjects (Group A) and 18 gestational hypertensive (Group B). Moreover, comparison was also made among different gestational weeks groups (I, II and III). Results: Serum PLGF levels were raised in gestational hypertensive (Group B) compare to normotensive (Group A) [366 (185-695) vs. 156 (132-319) ng/L], (P= 0.024). Serum PLGF levels were 156 (132-319) in gestational hypertensive individuals and 366 (185-695) ng/L in normotensive individuals. Serum levels PLGF of 18 -28 (I), 29-35 gestational weeks (II) were raised [425 (197-452) vs. 163 (91-332)], [546 (309-1519) vs. 137 (86-147)]. While in last 36- 40 weeks group (III) levels were decreased [216 (136-881) vs. 315 (185-612)] in comparison of normotensive subjects. Conclusion: It is concluded from this research that placental–derived angiogenic biomarker PLGF plays a significant role in gestational hypertension. The pattern of the PLGF marker in various intervals of pregnancy may provide information for the management of hypertension in pregnancy.

People Giving Hope in the Time of COVID-19: They Also Serve Who Care and Share

People Giving Hope in the Time of COVID-19: They Also Serve Who Care and Share

Comparing the use of Arabic decision aid to usual care. A multicenter randomized controlled trial for Arabic speaking metastatic colorectal cancer patients in Saudi Arabia.

Objectives:To evaluate the effect of decision aids (DAs) for metastatic colorectal cancer (mCRC) patients in the Arabic language.Methods:A multi-centered randomized control trial was used to evaluate the effect of Arabic DA use with usual care for mCRC patients compared to usual care alone. Patients were recruited from 4 main oncology centers in Saudi Arabia King Fahad Medical City, Riyadh; King Khalid University Hospital, Riyadh; King Saud Medical City, Riyadh; and King Fahd Specialist Hospital, Dammam, Saudi Arabia, between March 2016 and October 2018. The final follow up was in April 2019. The study measured patient understanding of prognosis, treatment options, and the level of the patient’s anxiety.Results:Ninety-two patients were included in the analysis; 51 in the intervention group. A small proportion of both (DA with usual care and usual care) understood that mCRC was incurable (8% and 5%) of the 2 groups, respectively. There was no significant difference between groups in anxiety level; however, a time effect both initially and after one month was significantly higher than at 6 month.Conclusion:The study shows that a higher level of patient’s baseline understanding lowered anxiety levels over time. Decision aids group presented low levels of anxiety over time than those provided the usual care. We recommend using Arabic DA in the oncology centers dealing with mCRC patients, aiming to empower patients in decision making.

The prevalence of lipohypertrophy and its associated factors among Saudi patients with type 2 diabetes mellitus.

ObjectivesWe conducted this study to establish the prevalence and associated risk factors of lipohypertrophy (LH) in patients with type 2 diabetes mellitus (T2DM) who are on insulin therapy in the Kingdom of Saudi Arabia (KSA).MethodsThis multicenter, cross-sectional study was executed at primary care clinics in King Saud University Medical City and Prince Mohammed Bin Abdulaziz Hospital in Riyadh KSA from May 2017 to October 2017. All adult patients over 18 years old with T2DM who had been treated with insulin via either a syringe or pen for at least two years were physically examined for LH.ResultsA 39.7% prevalence of LH was found in our study cohort of which as many as 57.5% patients were found to be in LH grade 1, 33.75% grade 2, and 8.75% grade 3. LH was detected in 68.8% patients who used different sites for every injection and in 63.7% (p = 0.182) of patients who had injected more than 60 units per day (p < 0.,0001). Overall logistic regression analysis showed that the patients who used alcohol swabs were 2.6 times more likely to develop LH. Interestingly, the patients who used more than 60 units of insulin per day were 0.362 times more likely to develop LH.ConclusionsLipohypertrophy is a complication common among patients with T2DM in KSA. It is incumbent upon healthcare providers to raise awareness about LH and to provide extensive education about correct insulin administration among patients with T2DM on insulin therapy.

Incidence of Toxoplasmosis in Psoriasis Patients and Possible Correlation with Tumor Necrosis Factor-α

Toxoplasma gondii is an opportunistic parasite in immune-compromised persons. The prevalence of toxoplasmosis in psoriasis patients is investigated. In addition, the treatment effect on psoriasis patients infected with toxoplasmosis through evaluating Tumor Necrosis Factor-α (TNF-α) cytokine levels is studied. Blood samples were collected from 130 individuals who involved 60 control samples and 70 samples with psoriasis. They attended Medical City Hospital in Baghdad province from October 2017 - February 2018. Then, the anti- T. gondii antibodies (IgM and IgG) and TNF- α in the sera were determined via the enzyme linked immune-sorbent assay. The highest rate of anti-Toxoplasma IgG was in psoriasis patients before treatment, it was 45 (64.29%) compared with the control which was 33 (55.00%), while the highest sero-positive rate of T. gondii IgM in the control group was 14 (23.33%) compared with patients with psoriasis 10 (14.29%). The highest rate of toxoplasmosis was in the age group (21-30) years in psoriasis patients which was 14 (31.82%). In addition, the TNF- α levels in psoriatic patients before treatment were 180.2±2.2 µg/ml, and after treatment were 223.3±41.1 µg/ml compared with the healthy control group 90.5±1.9 µg/ml. These findings suggest that incidental rate of toxoplasmosis is higher in psoriasis patients. Thus, the incidental rate of toxoplasmosis could be considered as an indication to the high risk of psoriasis.