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Aim and Objective: To observe the features and frequency of complications among pilgrims with diabetes during Hajj. Materials and Methods: This retrospective observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE). People with diabetes who visited the outpatient department of BIDE after Hajj were invited to participate in the study between August and September 2018 and 2019, respectively. Those who were not willing to participate or perform Hajj have been excluded. The data collection was done by using a predesigned, close-ended questionnaire, including demographic and clinical parameters, practice compliance toward management, and the frequency of complications that occurred during Hajj. Results: In this study, a total of one hundred and forty-one people with diabetes participated with a mean age of 55.41±10.6 years. Out of these, 111 (78.7%) had visited their health care professionals for pre-Hajj consultation and education, 134 (95%) received their recommended vaccination, and 92 (65.2%) of the people had checked their HbA1c before going to perform Hajj. Diabetic foot problems were recorded in 27 (19.1%), and respiratory diseases were found in 18 (12.8%). A total of 38 (27%) of the study population have reported hypoglycemia, and 51 (36.4%) have reported hyperglycemia. Conclusion: In this study, a higher frequency of glycemic as well as foot complications was observed among pilgrims with diabetes. Pre-Hajj education is mandatory to prevent these avoidable problems. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) negatively affects the quality of life (QoL). However, few studies from Saudi Arabia have assessed the effect AD has on the QoL of pediatric patients. Objective: To determine the psychological impact of AD on pediatric Saudi patients using the Children's Dermatology Life Quality Index (CDLQI). Methods: This cross-sectional was conducted across five tertiary hospitals located across five cities of Saudi Arabia from December 2018 to December 2019. The study included all Saudi patients aged 5–16 years who were diagnosed with AD for at least 6 months prior to visiting the dermatology clinic of the included hospitals. The quality of life in children with AD was assessed using the Arabic version of the CDLQI. Results: A total of 476 patients were included, of which 67.4% were boys. AD had a very large and extremely large effect on the QoL in 17.4% and 11.3% of the patients, respectively; the QoL of only 5.7% of the patients was not impacted due to AD. The average CDLQI score was not significantly different between males and females (9.7 vs. 9.1, respectively; P = 0.4255). Domains related to symptoms and emotions were affected to a greater extent compared with the remaining domains, while the school domain was the least affected. The correlation between age and CDLQI (r = 0.04, P = 0.52) and between the duration of the disease and CDLQI (r = 0.062, P = 0.18) was not significant. Conclusions: This study found that AD affects the QoL of a significant proportion of the Saudi pediatric patients, thereby highlighting the need to consider QoL as a measure of treatment success. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the response of pilgrims at Almadinah Almunawwarah Airport toward knowledge of preventive measures on respiratory infectious diseases, and to study the factors affecting the response of pilgrims to prevent infectious diseases such as SARS. Materials and Methods: This study was conducted at Almadinah Almunawwarah airport in the Kingdom of Saudi Arabia. Pilgrims who arrived at the city airport of Almadinah Almunawwarah (during the pilgrimage season in 2019) were invited to participate in this study. The tool used to collect data was a paper-based questionnaire. Results: The respondents' mean age was 39.8 years with a range of 18 to >50 years and a median age of 35-50 years. The findings indicated that 82.8% of the study participants reported overcrowding could increase the risk of infections. In addition, 67.4% of them agreed that cardiovascular and heat-related illnesses are major causes of death in travelers to the Hajj. With regards to attitudes about 70% agreed that visiting a physician before travel is essential whereas 73.7% of them agreed that personal hygiene protects them from many diseases. Conclusion: The current study shows that knowledge, attitudes, and practices toward preventive measures against respiratory infectious diseases, such as SARS, among pilgrims, are generally less acceptable if contrasted with their ways toward preventive procedures. [ABSTRACT FROM AUTHOR]

Background: Granular cell tumor (GCT) or Abrikossoff's tumor is an uncommon neuro-derived tumor in which Schwann cells are found and express S-100 protein. Often, it is a benign lesion. Histopathologically, there are granular cell infiltrations through the entire dermis without necrosis which are periodic acid Schiff (PAS) stain positive and reactive with S-100. The aim of this study is the clinicopathological evaluation of GCT. Material and Methods: In this paper, we described the experience of 6 patients with a GCT in different locations (4 cases in the skin and 2 cases in the mucosa), for example, a case with a tumor in the abdomen and a keloidal-like presentation with a highly sclerotic pattern (an uncommon pathological feature). Another case developed a lesion secondary to physical trauma. Result: In one case, the presence of a lesion in the lower lip associated with actinic damage secondary to chronic sun exposure resulted in misdiagnosis with actinic cheilitis and squamous cell carcinoma. Conclusion: Histopathologically, there were granular cell infiltrations through the entire dermis without necrosis which are PAS-positive and reactive with S-100. [ABSTRACT FROM AUTHOR]

Background: Periorbital hyperpigmentation (POH) is a common skin condition that presents as infraorbital darkening. POH has a multifactorial etiology. Studies evaluating POH treatment are several with varying satisfaction results. Objectives: To compare carboxytherapy and microneedling (MN) combined with topical glutathione for POH treatment. Materials and Methods: A split-face pilot clinical trial was conducted on 31 female patients with POH. Carboxytherapy injection was done at the right periorbital area, and MN with topical glutathione (Left periorbital area), for 6 biweekly sessions. Visual analogue scale (VAS), dermoscopic evaluation, patient satisfaction, and patient dermatology life quality index questionnaire (DLQI), safety evaluation were done with 3 months follow up. The trial registry number is NCT04389788. Results: Carboxytherapy showed a higher significant improvement as regards VAS evaluation compared to MN with glutathione during the active treatment phase (P = 0.001) and during the follow-up phase (P = 0.006). Also, the dermoscopic evaluation showed a statistically significant improvement in the Carboxytherapy group. DLQI showed a statistically significant improvement (P <.001). As regards patient satisfaction, carboxytherapy showed in comparison to MN with glutathione (80.6% vs 25.8% in moderate satisfaction) and (3.2% vs 0% in marked satisfaction respectively) (P =.05). As regards the patients' safety, there was no significant difference between both eyes (P =.23). Conclusions: Carboxytherapy showed higher efficacy than MN with glutathione in POH patients. Carboxytherapy improved clinical, dermoscopic, patient satisfaction, and patient DLQI; with a good safety profile. [ABSTRACT FROM AUTHOR]

Background: Alopecia is a common health condition that can be associated with social and psychological consequences. Aims: This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region. Methods: This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition. Results: A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition. Limitations: The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis. Conclusion: A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a common inflammatory disease with significant comorbidities, and regardless of its extent, it affects the patients' quality of life. The various modalities of treating psoriasis comprise topical or systemic medications, phototherapy, and an array of biologic agents. There is a lack of Indian recommendations on the management of psoriasis with these different modalities and challenges faced by the clinicians in day-to-day practice. Aim: To develop India-specific consensus for systemic management of patients with moderate-to-severe psoriasis. Method and Results: A panel of dermatology experts, based on the evidence and international recommendations, coupled with their own clinical experience, developed recommendations for systemic management of patients with moderate-to-severe psoriasis. Conclusion: These recommendations are meant to provide guidance in terms of choice of systemic therapies, dosing, effectiveness, and safety. It also addresses clinical challenges that may be experienced during psoriasis management. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a depigmenting disorder which can be psychologically devastating. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aims and Objectives: The aim was to study the clinico-epidemiological and hematologic investigation profiles of childhood vitiligo. Materials and Methods: First 200 pediatric patients younger than 18 years, with vitiligo who attended the dermatology outpatient department of a tertiary center in Northeast India, between September 2015 and August 2017 were included in the study. A detailed history and examination along with autoimmune diseases and laboratory parameters were recorded. Results: Among the 200 patients, 62% were girls. The mean age was 10.3 ± 4.9 years. The mean age at onset was 9.1 ± 4.9 years (ranging 2 months–17 years), with duration of disease varying from 1 month to 8 years with mean duration of 1.39 ± 1.63 years. Most common pattern of vitiligo was vulgaris (39.5%) followed by focal (25%), segmental (15.5%) genital (10%), acral and lateral lip (8%), and acrofacial (4%). Family history of vitiligo was seen in 12% of patients. In 96% patients, only <5% of body surface area was affected. Nearly 8.5% had Koebnerization while 9% showed leukotrichia. Thyroid-stimulating hormone and antithyroid peroxidase abnormalities were seen in 4.5% and 1% patients, respectively. Low Vitamin D level was seen in 21.5%. Conclusion: Any depigmented lesion in children should be evaluated and followed up properly to rule out vitiligo. Dermatologists and pediatricians should understand the characteristics of childhood vitiligo properly since it behave differently from adult-onset disease. [ABSTRACT FROM AUTHOR]

Background: We studied clinico-epidemiological features of 945 patients with vitiligo with an objective to delineate epidemiological and clinical aspects of vitiligo from this part of the country. Materials and Methods: The medical records of patients with vitiligo attending outpatient clinic over a 5-year period from January 2013 to December 2017 were analyzed retrospectively for this descriptive, observational study. Results: There were 449 men and 496 women (m:f 1:1.1) aged between 2 and 83 years (mean 24.4 years) and having vitiligo for 1 week to 64 years (mean 5.1 years). The majority, 478 (50.6%) patients were aged ≤20 years and 248 (26.2%) were children aged ≤12 years. The age at the onset was between 6 months and 82 years (mean 20.5 years), and the majority 674 (71.3%) patients had it before 25 years of age. The consultation time was within 5 years in 692 (73.2%) patients. A family history of vitiligo was present in 150 (15.9%) patients. The majority 871 (92.2%) patients had involvement of up to 10% body surface area and vitiligo vulgaris in 562 (59.5%) and focal vitiligo in 117 (18.7%) patients were the most common clinical types. An association with other systemic disorders was in 124 (13.1%) patients and predominately included thyroid abnormalities and diabetes mellitus. Conclusions: Our observations are essentially consistent with the literature. There was no difference in clinico-epidemiological features of vitiligo. Patients with an affected first-degree family member had early onset, but difference was not statistically significant. Screening for concurrent thyroid disorders appears important. However, our inferences remain limited by single center, retrospective, observational, and cross-sectional nature of the study. [ABSTRACT FROM AUTHOR]

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this is to find out the hand hygiene (HH) knowledge among primary health care workers (PHCWs) in Abha health district, southwestern Saudi Arabia. Methods: Data were collected through an anonymous self-administered questionnaire. The questionnaire was based on a WHO "Knowledge Questionnaire for Health Care Workers." Results: The study included 478 PHCWs (239 males and 239 females). The sample included 186 physicians, 212 nurses, and 80 technicians. The highest proportion receiving formal training was nurses (82.1%). Females (77.4%) received significantly more training than males (70.3%). Only 59.2% (283) of the HCWs properly identified unclean hands of HCWs as the main route of the cross. Only 26.4% (126) of the HCWs properly identified germs already present on or within the patient as the most frequent source of pathogens in a health-care facility. Only 54.8% (262) of HCWs properly identified 20 s as the minimal time needed for alcohol-based hand rub to kill most germs on hands. Conclusion: The study revealed gaps in the knowledge regarding HH. To promote HH at primary health care setting, WHO bundle of multimodal strategies should be adopted including system change; training/education; evaluation and feedback; reminders in the workplace; and institutional safety climate. [ABSTRACT FROM AUTHOR]

Background: The spectrum of pyoderma changes constantly, and so does the antibiotic susceptibility pattern. Aims: This study was done to assess the magnitude and clinical patterns of pyodermas, their causative micro-organisms, and the antibiotic susceptibility patterns. Materials and Methods: Five hundred consecutive, clinically diagnosed and untreated cases of pyoderma, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from October 2010 to September 2011 were the subjects of this study. A detailed clinical examination, and relevant investigations including bacterial culture and sensitivity, were carried out and recorded. Statistical Analysis: For statistical analysis of data, the software 'EPI-INFO Version 6' was used, and Chi-square (χ²) test was applied. Results: Of 19576 cases attending skin OPD during the study period, pyoderma was seen in 500 patients; the incidence being 2.55%. Males outnumbered females. The highest number of cases (109; 21.8%) was observed in 1st decade. Lower extremities were the commonest site of predilection. Primary pyodermas outnumbered secondary pyodermas. Furuncle (136; 27.2%) and infectious eczematoid dermatitis (62; 12.4%) were the commonest entities among primary and secondary pyoderma respectively. Staphylococcus aureus was the commonest causative agent in both primary and secondary pyoderma. It showed high susceptibility to amoxycillin + sulbactam, aminoglycosides and cefoperazone, moderate susceptibility to linezolid, while low susceptibility to fluoroquinolones and cephalexin. Conclusion: Such studies help to assess the changing trend of bacterial infections, their causative organisms and antibiotic susceptibility pattern. [ABSTRACT FROM AUTHOR]

Background: The main professional goal of nurses is to provide and improve human health. Medication errors are among the most common health threatening mistakes that affect patient care. Such mistakes are considered as a global problem which increases mortality rates, length of hospital stay, and related costs. This study was conducted to evaluate the types and causes of nursing medication errors. Materials and Methods: This cross-sectional study was conducted in 2009. A total number of 237 nurses were randomly selected from nurses working in Imam Khomeini Hospital (Tehran, Iran). They filled out a questionnaire including 10 items on demographic characteristics and 7 items about medication errors. Data were analyzed using descriptive and inferential statistics in SPSS for Windows 16.0. Results: Medication errors had been made by 64.55% of the nurses. In addition, 31.37% of the participants reported medication errors on the verge of occurrence. The most common types of reported errors were wrong dosage and infusion rate. The most common causes were using abbreviations instead of full names of drugs and similar names of drugs. Therefore, the most important cause of medication errors was lack of pharmacological knowledge. There were no statistically significant relationships between medication errors and years of working experience, age, and working shifts. However, a significant relationship was found between errors in intravenous injections and gender. Likewise, errors in oral administration were significantly related with number of patients. Conclusion: Medication errors are a major problem in nursing. Since most cases of medication errors are not reported by nurses, nursing managers must demonstrate positive responses to nurses who report medication errors in order to improve patient safety. [ABSTRACT FROM AUTHOR]

Background/Aim: Earlier reports from Saudi Arabia have shown high prevalence of Helicobacter pylori infection. However, recent studies have documented a reduction in the infection prevalence. No prior study has assessed the prevalence in morbidly obese Saudi patients. We aimed to study the prevalence of H. pylori infection in a group morbidly obese Saudi patients referred for endoscopy prior to bariatric surgery. Materials and Methods: We retrospectively reviewed the medical records of all patients who were referred for upper endoscopy prior to bariatric surgery from June 2006 to September 2008. All data were recorded including patient's demographics, comorbid conditions, endoscopic and histological findings. Results: There were 62 patients included, 20 males and 42 females. The mean age was 34 years (range 18 - 51) with a mean BMI of 55 Kg/m2 (range 35 -92). H. pylori were present in 53 patients (85.5%) with chronic active gastritis. All patients with positive H. pylori had chronic gastritis of variable severity. Intestinal metaplasia was present in 5%. The prevalence of H. pylori infection was similar in patients with and without co-morbid conditions. Main endoscopic findings were gastritis in 67.7%, hiatus hernia in 13%, and gastric erosions in 13%. No patient had duodenal or gastric ulcer. Conclusions: There is a high prevalence of H. pylori infection in morbidly obese Saudi patients undergoing bariatric surgery being referred for upper GI endoscopy. Further prospective studies are needed to evaluate the clinical implication and benefit of eradication treatment of infection in these patients. [ABSTRACT FROM AUTHOR]

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus (LE profundus), characterized by inflammation of the subcutaneous fat. LE profundus occurring as initial manifestation of LE is rare. We report a case where the patient presented with lupus mastitis and years later, she developed disseminated discoid LE (DLE) and polyarteritis nodosa (PAN). PAN and DLE are connective tissue diseases with different etiologies, clinical, immunological, and histopathological features. One connective tissue disease evolving into another is rare, and the reasons remain unexplained. This woman had histopathologically proven DLE and lupus mastitis with a negative antinuclear antibody profile. She satisfied the American College of Rheumatology criteria for PAN. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Use of A Ballpoint Pen in the Diagnosis of Physical Urticaria."

A letter to the editor is presented in response to the article "Pattern of Psoriasis In A Tertiary Care Teaching Hospital In South India."