Knowledge and Practice of Primary Health Care Providers in the Management of Asymptomatic Hyperuricemia and Gout in the Qassim Region of Saudi Arabia.

Introduction & Aim The most prevalent type of inflammatory arthritis is gout. It develops because of hyperuricemia, which makes monosodium urate (MSU) crystals accumulate in the joints. However, hyperuricemia does not always cause gout. Methodology The following is a cross-sectional study conducted in the Qassim region of Saudi Arabia. 133 PHPs in this region were given a self-administered questionnaire through an online survey. The questionnaire included four sections: Demographic data (i.e., age, gender, years of experience) Knowledge of asymptomatic hyperuricemia; Management practices of asymptomatic hyperuricemia; Knowledge and practice of gout management Results One hundred thirty-three primary healthcare providers took part (males 63.9%; females 36.1%). The proportion of PHPs who attended continuing medical education (CME) on AH or gout was 32.3%. Moreover, 67.7% already knew the guidelines for managing AH or gout. PHPs' level of knowledge regarding the management of AH and gout was good (45.9%), but their level of practice was poor (23.3%). Greater experience and CME attendance on AH and gout contributed to better understanding and higher practice scores. Conclusion Although PHPs' knowledge of managing AH and gout was adequate, this did not reflect in their practice. Physicians with more years of experience who attended CME on AH and gout demonstrated better knowledge and practice than the rest of the PHPs. It is necessary to address the gaps in the practice of our PHPs, which could be done through in-depth training about AH and gout. Our study could guide other researchers to assess the gaps in other clinical practices that PHPs face.

Hand Grip Strength as an Index of Health Does Not Associate With Insomnia: A Cross-Sectional Study.

Introduction Insomnia is one of the most prevalent diseases globally, with many adults around the world suffering from at least one of its symptoms. It has a significant effect on the body's normal physiology and may lead to the development of chronic diseases that impair the main functional domains of health and cognition if left untreated. Handgrip strength (HGS) has previously been linked to several diseases that occur in tandem with insomnia. Thus, this study aimed to investigate the association between HGS and insomnia. Materials and methods This is a cross-sectional study in which the involved participants were approached in different locations. The participants were surveyed using the Insomnia Severity Index (ISI) to evaluate the presence of insomnia. A hydraulic hand dynamometer was used to measure the HGS of the participants' right and left hands. Results A total of 494 questionnaires were collected, including 365 (74%) males and 129 females (26%). About 16% of females had insomnia, compared to 15% of males. There was no significant association between gender and insomnia (P=0.873). The difference between the mean HGS for the right and left hands among males and females was not statistically significant (P>0.05). The correlation coefficients of the right and left HGS scores with insomnia were r=0.019 and r=0.018, respectively, which showed no statistically significant association (P>0.05). Conclusions The study found no significant association between HGS and insomnia. The study recommends conducting further large-scale studies focusing on specific groups in the population to understand the relationship between HGS and chronic sleep disturbance.

Prostate Laser Photovaporization in Older People With and Without Bladder Catheter.

OBJECTIVES: To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. DESIGN: Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. SETTINGS AND PARTICIPANTS: A total of 305 patients (three groups: younger than 70, 70-80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. RESULTS: A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality-of-life (QoL) score was worse for patients older than 80 years (P = .04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. CONCLUSION: PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888-1894, 2019.

Intraoperative ultrasound control of surgical margins during partial nephrectomy.

AIMS: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. SUBJECTS AND METHODS: This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. RESULTS: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. CONCLUSIONS: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.