Elderly Attending General Practice Clinics in Poor Urban Areas: A Cross-Sectional Study in Jordan

This study aimed at analyzing the level of awareness and satisfaction among elder patients attending general practice clinics in poor urban areas in Jordan. The researchers adopted the descriptive methodology by using a questionnaire as a study tool, consisting of two dimensions and ten paragraphs, and was applied to a sample of 726 elderly patients. The study reached a number of results, the most important of which was the high level of awareness among the elderly about the importance of the role of general practice clinics in poor urban areas in Jordan. The researchers recommended to educate elder patients about the importance of general practice clinics, as they provide health services and health care in poor areas of Jordan, and to encourage them to exploit the medical services provided by the general practice clinics in poor areas of Jordan in the correct manner. Keywords: Elder patients, general practice clinics, poor urban areas, Jorda

Impact of tumor necrosis factor antagonist combination and anti-integrin therapies on body mass index in inflammatory bowel disease: A cross-sectional study

BackgroundThe impact of biologic therapies on body mass index (BMI) in patients with inflammatory bowel disease (IBD) is unclear. This study investigates any associations between BMI, type of IBD, and the type of medications taken among patients with IBD with varying weight categories.MethodsA cross sectional study was performed in an IBD tertiary care center. Data was obtained from patients with IBD attending outpatient clinics from January 1st, 2021 until November 1st, 2021. Adult patients, older than 18 years, with a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) were recruited. The primary outcome was the association between BMI and medication used in IBD. The secondary outcome was the association between BMI and disease type and location in patients with IBD.ResultsThe study included a total of 528 patients of which, 66.5% have CD. Patients with normal weight comprises 55.9% of the participants, while those who are underweight, overweight or obese are 3.4, 28.2, and 12.5%, respectively. None of the underweight patients had UC. Among the normal weight, overweight and obese BMI categories, 34.6% vs. 36.2% vs. 31.8% had UC, respectively. Patients who are on tumor necrosis factor inhibitors (anti-TNF) with an immunomodulator (anti-TNF combination), are more likely to be overweight or obese than patients who are not on anti-TNF combination (OR 2.86, 95% CI 1.739–4.711, p < 0.001). Patients on vedolizumab are twice as likely to be overweight or obese than patients not on vedolizumab (OR 2.23, 95% CI 1.086–4.584, p < 0.05). Patients with ileocolonic CD are more likely to be overweight or obese compared to other subtypes of CD (OR 1.78, 95% CI 1.14–2.77, p = 0.01).ConclusionMany patients with IBD are either obese or overweight. Patients with IBD who are on anti-TNF combination therapy or vedolizumab monotherapy are more likely to be obese and overweight. In addition, patients will ileocolonic CD are more likely to be obese or overweight

Prevalence And Risk Factors of Eye Allergies Among Adults In Ksa: A Cross-Sectional Study

Objective: To determine the prevalence of eye allergies and associated risk factors among adults in KSA. Methods: This research employs a cross-sectional study design to assess the prevalence and risk factors of eye allergies among adults in the Kingdom of Saudi Arabia (KSA). A cross-sectional approach allows for the collection of data at a single point in time, providing a snapshot of the condition's status within the study population. Results: The study included 640 participants. The most frequent age among them was 18-28 years (n= 331, 51.7%), followed by 40-50 years (n= 139, 21.7%). The most frequent gender among study participants was female (n= 389, 60.8%) followed by male (n= 251, 39.2 The most frequent nationality among study participants was Saudi (n= 613, 95.8%) followed by non-Saudi (n= 27, 4.2%). The educational level among study participants with most of them being the university (n= 553, 86.4%) followed by the school (n= 85, 13.3%). The work nature among study participants with most of was inside the building. Participants were asked if they had an eye problem that affected their daily life. The most frequent answer was moderately (n= 309, 48.3%) followed by never (n= 271, 42.3%), and the least was a lot (n=60, 9.4%).  Conclusion: The results of the study showed that most of the study participants are Saudis and most of them work inside the building. The majority have university education, and the largest percentage of participants are women. Most of the participants are non-smokers. Most study participants had good social communication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of a home-based programme on physical activity among undergraduate female students in Iraq

The study aimed to evaluate the effect of home-based programme to improve physical activity among undergraduate female students in Iraq. The participants were Iraqi sedentary undergraduate female students (N=44) who were assigned to two groups consisted of experimental group (N=22) and control group (N=22) respectively. The experimental group received a 12-week home based intervention programme which focuses on PA, while the control group were maintaining their usual life. Measurements for all the variables were taken prior to the intervention (pre-test), at week 6 (post-test1), and after 12 weeks (post-test2). The results of Mixed between-within subjects analysis of variance shows a statistically significant between the mean test scores in the pre-test, post-test1, and post-test2 measurements of PA in the experimental group. This study provided evidence that home-based intervention programme which focused on physical activity had a significant effect on improving physical activity

Are patients aware of potential risks of weight reduction surgery? An internet based survey

Background/Aim: Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reportedly overweight. Morbid obesity has been associated with an increased risk of many comorbidities and mortality. Bariatric surgery is currently considered the most effective treatment option for morbid obesity. However, there are many concerns regarding the short and long-term complications of weight reduction surgery. It is unclear whether the general population is adequately aware of these risks. Therefore, we aimed to assess awareness of the general population of bariatric surgery complications. Although effective, bariatric surgery has been associated with many acute complications, reported in a range of 0.3% to 8% of operations. Patients and Methods: We performed a cross-sectional study between July and August of 2017 in Jeddah, Saudi Arabia. We used a 26-item, Arabic, electronically distributed questionnaire, to examine public awareness of the acute complications of bariatric surgery. Hypothesis testing was used to examine associations. Results: In total, 624 questionnaires were completed electronically. Mean age of participants was 25 (±13.2) and 66% were females. Of the surveyed population, 64% reported being aware of acute complications of bariatric surgery. Participants who had previously undergone a bariatric operation had a higher degree of awareness when compared to those who had not undergone a bariatric operation before (80.4% vs. 61.3%, P < 0.001). Females had higher awareness compared to males (70.8% vs. 52.1%, P < 0.001). Awareness of complications was not statistically different when stratified by level of education (P = 0.131) but occupation predicted awareness (P = 0.007). Conclusion: Two-thirds of the general population appears to be aware of the potential acute complications associated with bariatric surgery. Furthermore, awareness seems to be higher in females, individuals who had previously undergone weight reduction surgery, and health care workers

A comprehensive assessment of phytochemicals from Phyla nodiflora (L.) Greene as a potential enzyme inhibitor, and their biological potential: An in-silico, in-vivo, and in-vitro approach

This work explored Phyla nodiflora (L.) Greene as a potential source of the bioactive medicinal agent. In this aspect, methanol (PN-M) and dichloromethane (PN-D) extracts were prepared from the whole plant and evaluated for phytochemical composition (total bioactive contents, UHPLC-MS analysis, and HPLC-PDA polyphenolic quantification), biological (antioxidant and enzyme inhibition) potential and in-vivo toxicity. The PN-M was found to contain higher phenolic (26.08 mg GAE/g extract) and flavonoid (50.25 mg QE/g extract) contents which might correlate to the higher radical scavenging (DPPH: 52.94 mg TE/g extract; ABTS: 72.11 mg TE/g extract) and reducing power (FRAP: 71.96 mg TE/g extract; CUPRAC: 142.65 mg TE/g extract) antioxidant potential, as well as AChE (4.33 mg GALAE/g extract), tyrosinase (125.36 mg KAE/g extract), and amylase (1.86 mmol ACAE/g extract) inhibition activity of this extract. In contrast, the PN-D extract was found to be most active for phosphomolybdenum (1.30 mg TE/ g extract) and metal chelation (54.84 mg EDTAE/g extract) assays in addition to BChE (4.70 mg GALAE/g extract) and glucosidase (0.62 mmol ACAE/g extract) enzyme inhibition activity. The PN-M extract on UHPLC-MS analysis revealed the tentative identification of 24 different secondary metabolites, most of which belonged to the flavonoid, glycoside, and terpenoid classes of phytochemicals. The polyphenolic composition of the extracts was appraised by HPLC-PDA. Seven phenolic compounds were identified in the extracts. PN-M was found to be rich in catechin (0.25 µg/extract) and 3-OH benzoic acid (0.64 µg/extract), while PN-D contained epicatechin (0.30 µg/extract), 3-OH-4-MeO benzaldehyde (0.21 µg/extract), and 2,3-Di-Meo benzoic acid (0.97 µg/extract) in higher amounts. The methanol extract was found to be non-toxic even at higher doses. Furthermore, the relationship between the phytochemicals and the tested enzymes was highlighted by molecular docking studies. In sum, this research showed that the studied extracts were effective as enzyme inhibitors and antioxidants, suggesting it would be worth investigating in more depth for further advanced studies to explore its pharmacological properties

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit