Dementia screening of geriatric patients by implementing an informant-based Alzheimer's disease eight-item tool in KSA.

OBJECTIVES: The screening of dementia among geriatrics is necessary to identify probable cases, confirm diagnosis, institute treatment, and plan for future family caregiving strategies. This study aimed to screen the incidence of dementia among geriatric patients using the informant-based Alzheimer's disease eight-item tool for dementia (AD8) in a KSA region. METHODS: A cross-sectional study was conducted among geriatric patients in the KSA region at selected hospitals from December 2019 to March 2020. The caregivers of 100 geriatric patients were interviewed using the AD8. RESULTS: Among the 100 patients, 43% were 65-75 years old, 52% were men, and 48% were women, mean age was (78) for both genders. Diabetes mellitus was the most reported chronic illness, found in 68% of the patients, followed by a history of cerebrovascular disease (52%). Loss of more than four but less than half of the teeth was reported in 41% of the patients, while 10% were reported to be undergoing polypharmacy. Dementia was diagnosed in 74% of patients and had a statistically significant association with a history of stroke (p < 0.001), number of teeth lost (p = 0.02), and number of drugs administered (p = 0.006). A binary logistic regression model fitted to predict dementia based on the effect of a stroke history, number of missing teeth, and number of drugs administered showed that patients with stroke were 1.43 (95% CI 1.4-4.2) times likely to develop dementia than those with no history of stroke. CONCLUSION: Cases of dementia are frequent among geriatric patients in the Qassim region of KSA. A dementia positive screening is correlated with a history of stroke, number of lost teeth, polypharmacy, and age. Stroke prevention and early treatment can potentially reduce the likelihood of dementia occurrence.

Scrotal Necrosis Following Heated Intra-peritoneal Chemotherapy: Case Report and Review of the Literature.

Scrotal necrosis is a rare occurrence that is scarcely reported among patients having undergone heated intra-peritoneal chemotherapy (HIPEC) procedures. Due to anatomic factors and the thermally enhanced cytotoxicity of chemotherapeutic agents, this complication can have debilitating post-operative effects. We herein highlight the presentation of scrotal necrosis in a patient who underwent HIPEC procedure for peritoneal metastasis secondary to colorectal carcinoma, and how it contrasts to previously documented cases of a similar nature. Furthermore, we describe a successful management strategy that consisted of conservative measures followed by surgical debridement and primary repair, and enabled the patient to experience significant functional and cosmetic improvement.

Phosphate binders usage, patients knowledge, and adherence. A cross-sectional study in 4 centers at Qassim, Saudi Arabia.

OBJECTIVES: To assess phosphate binders' usage, knowledge regarding their utilization, and adherence among hemodialysis patients in Qassim, Saudi Arabia. METHODS: A prospective cross-sectional study conducted at 4 dialysis centers in Qassim, Saudi Arabia with inclusion of 237 patients' undergoing hemodialysis between November 2018 to January 2019. The study involved interviewing the patients, reviewing their medical records for biomarkers used to assess kidney function, and assessing the patients' knowledge-based regarding dietary phosphate control, as well as adherence to phosphate binders' usage. Results: Out of 237 included patients, male to female ratio was 54:46. The prevalence of prescribing non- calcium phosphate binders was 82.7% whereas prescribing calcium phosphate binders was 73.8%. A total of 63% of patients showed a medium level of adherence to phosphate binders. Although adherence level was not poor, therapeutic eficacy was affected by other factors such as administration time adherence positively correlated with the serum phosphate level (p=0.00). CONCLUSION: Phosphate binders usage is frequent among hemodialysis patients in Qassim centers. Circulating phosphate level was affected by the extent of patients' knowledge of dietary control and adherence to the usage of phosphate binders. Thus, we recommend enhancing patient education in reference to high- and low- phosphate-rich diet to take wise dietary decisions, lower pill burden, and improve adherence toward the control of hyperphosphatemia.

Differential expression of T-helper cytokines in the peritoneal fluid of women with normal ovarian cycle compared with women with chronic anovulation.

BACKGROUND: Estrogen and progesterone immunoregulate the genital environment by expression of cytokines and growth factors. OBJECTIVE: To investigate the pattern of expression of T-helper cytokines during the ovarian cycle compared with women with chronic anovulation resistant to clomiphene citrate. HYPOTHESIS: Expression of T-helper cytokines in women with chronic anovulation may be different from the pattern in women with a normal ovarian cycle. METHODS: We evaluated 31 infertile women having laparoscopy for evaluation of tubal patency and evidence of ovulation in two groups during (a) the luteal phase (17 women) and (b) the follicular phase (14 women). A third group was composed of 14 women with polycystic ovarian syndrome, but they were resistant to clomiphene citrate for induction of ovulation and had laparoscopic ovarian cautery. Peritoneal fluid was collected during laparoscopy. Estimation of T-helper cytokine interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, IL-4 and IL-6 in serum, peritoneal fluid and culture of the peritoneal mononuclear cells was performed by ELISA. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, estradiol and progesterone were evaluated by the Vidas Parametric System. RESULTS: The LH : FSH ratio was significantly higher in the women with polycystic ovaries than in the ovulatory groups. IL-2 and IFN-gamma were more highly expressed in the follicular phase but the T-helper 2 cytokines IL-4 and IL-6 predominated in the luteal phase, serum, peritoneal fluid and culture of the peritoneal mononuclear cells. From the follicular to the mid-luteal phase, IL-6 increased three to fivefold in the serum and peritoneal fluid, but there was low expression with anovulation. CONCLUSIONS: The peritoneal fluid levels of IL-4 and IL-6 are higher in the luteal phase. Low IL-6 levels in chronic anovulation may be a marker of resistance to clomiphene citrate.