Experiences of Dermatologists and Patients Regarding Psoriasis and Its Connection to Psoriatic Arthritis in Saudi Arabia.

Purpose: Psoriasis is a chronic, inflammatory, immune-mediated skin disease that has significant impact on a patient's quality of life, yet it remains challenging for dermatologists to successfully identify and manage. Without effective screening, diagnosis and treatments, psoriasis can potentially progress to psoriatic arthritis. A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and patients with psoriasis was conducted to explore dermatologist and patient perspectives of psoriasis, including diagnosis, management, disease course and unmet needs. Patients and Methods: This study involved a quantitative questionnaire administered to 31 dermatologists and 90 patients with psoriasis at eight medical centers and was analyzed using descriptive statistics. Results: Dermatologists and patients perceived that psoriasis treatment was initiated promptly and that follow-up visits were sufficient. Their perspectives differed in the time to diagnosis and patient reaction, symptom severity, input into treatment goals and educational needs. The dermatologists' concerns about underdiagnosed psoriasis (13%) were primarily related to patient awareness (87%), physician awareness (58%), and the absence of a regular screening program (52%). Only 31% of patients with psoriasis were highly satisfied with their psoriasis treatment, with 78% experiencing unpleasant symptoms of pain or swelling in joints indicative of psoriatic arthritis. However, only 56% of these patients reported these symptoms to their physicians. When dermatologists were made aware of this difference, referrals to a rheumatologist increased. Conclusion: The study highlights the importance of strengthening psoriasis management by enhancing dermatologist referral and screening practices, adopting a multidisciplinary approach to care, and improving education and resources for physicians and patients. These results can help to inform the improvement of psoriasis screening, diagnosis and treatment strategies and ensure that expectations meet treatment outcomes. Further research exploring the dermatologist and patient perspectives of the disease pathway from psoriasis to psoriatic arthritis and tailor-made treatment approaches is recommended.

National Saudi Consensus Statement on the Management of Atopic Dermatitis (2021).

Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regionally and globally. It is characterized by intense itching and recurrent eczematous lesions. With the increase in the availability of treatment options for healthcare practitioner and patients, new challenges arise for treatment selection and approach. The current consensus statement has been developed to provide up-to-date evidence and evidence-based recommendations to guide dermatologists and healthcare professionals managing patients with AD in Saudi Arabia. By an initiative from the Ministry of Health (MOH), a multidisciplinary work group of 11 experts was convened to review and discuss aspects of AD management. Four consensus meetings were held on January 14, February 4, February 25, and March 18 of 2021. All consensus content was voted on by the work group, including diagnostic criteria, AD severity assessment, comorbidities, and therapeutic options for AD. Special consideration for the pediatric population, as well as women during pregnancy and lactation, was also discussed. The present consensus document will be updated as needed to incorporate new data or therapeutic agents.

Treatment of periorbital dark circles: Comparative study of carboxy therapy vs chemical peeling vs mesotherapy.

OBJECTIVE: Evaluation and comparison of the efficacy and safety of 3 different modalities of treatment for dark circles that function via different modes of action. METHODS: In total, 45 female patients with periorbital hyperpigmentation were randomly selected to participate from those attending the outpatient dermatology clinic of Al-Zahraa University Hospital within a 6-month period. Patients were divided into 3 groups, and the groups were subjected to different types of therapy: group A, carboxy therapy; group B, chemical peel; and group C, vitamin C mesotherapy. RESULTS: No statistically significant differences were detected in improvements in pigmentation or the degree of patient satisfaction between any of the groups. However, the mesotherapy group reported more of a burning sensation following treatment than the other 2 groups but also showed a significant improvement in pigmentation and patient satisfaction compared with the carboxy group. CONCLUSION: All 3 treatment modalities were effective in the reduction in periorbital pigmentation. However, mesotherapy showed a significant improvement in pigmentation and a higher level of patient satisfaction compared with the other types of treatment.

Successful Treatment of Inflammatory Linear Verrucous Epidermal Nevus with Concomitant Psoriasis Using Etanercept.

Linear psoriasis is a rare form of the disease characterized by the linear distribution of lesions involving dermatome or along Blaschko's lines. Clinically, it may resemble inflammatory linear verrucous epidermal nevus; a combination of history, skin examination, and histopathology are required to ensure correct diagnosis and appropriate therapy. This paper describes a case of a 23-year-old male presenting with unilateral erythematous scaly plaques arranged in a linear path on the left leg. Etanercept was initiated after poor response to adalimumab. Improvement of his psoriasis was noted, with PASI 75 reduction after 24 weeks of treatment. Clinical studies have shown excellent efficacy of etanercept, and our patient well tolerated treatment with etanercept for 52 weeks without any adverse effects.

Saudi practical guidelines on biologic treatment of psoriasis.

The current treatment of psoriasis patients with biologic agents in the Kingdom of Saudi Arabia (KSA) is mainly based on clinical experience. Although there are published international guidelines for treatment with biologics, such as the European S3 guidelines (a joint project of the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the International Psoriasis Council), many nations have found it beneficial to develop country-based guidelines that incorporate specific regional aspects of therapy (legal and practical). With the expanded role of biologic agents in the treatment of psoriasis in Saudi Arabia, a need for local Saudi guidelines has become evident. Here we present a practical approach to the evidence-based clinical administration of biologics for professionals who treat patients with psoriasis.

Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit.

OBJECTIVE: To reduce ventilator associated pneumonia (VAP) incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate. METHODS: This study was a prospective longitudinal study conducted on adult intensive care unit (ICU) patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied: head-of-bed elevation; daily sedation-vacation along with a readiness-to-wean assessment; peptic ulcer disease (PUD) prophylaxis; and deep venous thrombosis (DVT) prophylaxis. RESULTS: Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance (p=0.001). Most frequent pathogens found were Pseudomonas aeruginosa (30.8% of all isolates) followed by Acinetobacter baumannii (27.7%), and methicillin-resistant Staphylococcus aureus (15.4%). CONCLUSION: Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care.

Hand hygiene compliance rate among healthcare professionals.

OBJECTIVE: To motivate healthcare professionals, with a focus on improving hand hygiene compliance. METHODS: An observational, prospective, longitudinal study was conducted on the evaluation of hand hygiene compliance at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from May 2009 to May 2010. Four components to improve hand hygiene compliance were implied; daily audit, monthly staff education; quarterly workshops of hand hygiene, and education material distribution. The compliance rate was calculated by its adherence with number of opportunities. RESULTS: Of total 163 healthcare professionals were surveyed for hand hygiene compliance; 57 (35%) were doctors, 92 (56.4%) nurses, and 14 (8.6%) patient care technicians. The overall compliance rate was 50.3%, and its distribution among staff was as follows; doctors 49.1%, nurses 52.2%, and technicians 42.8%. The highest compliance rate among doctors and nurses was found in surgical units. A low compliance in high intensity patient care area was observed such as in the emergency room and out patient department. The patient care technicians showed highly variable results, as their compliance rate was 100% in medical units while 0% in various other clinical areas. CONCLUSION: The overall hand hygiene compliance rate of healthcare professionals reached 50% after a long education campaign, and was highest among the nurses. Further study is needed to explore the reasons for non-compliance.

Multi-drug resistant Ewingella americana.

We report a case of pneumonia due to multi-drug resistant Ewingella americana in a young patient admitted in the Intensive Care Unit of Hera General Hospital, Makkah, Saudi Arabia with severe head injury in a road traffic accident. He was an Indonesian pilgrim who had traveled to the Kingdom of Saudi Arabia to perform Hajj in December 2007. Ewingella americana was identified to be the pathogen of pneumonia with clinical signs and symptoms along with positive radiological findings.

Causes and outcome of medication errors in hospitalized patients.

OBJECTIVE: To develop better understanding of Medication Errors (MEs) in the health care sector, and to improve the error prevention services in the hospital. METHODS: We conducted a retrospective study at the Hera General Hospital, Makkah, Saudi Arabia. The medical records were reviewed for adult hospitalized patients from June 1, 2000 to June 30, 2002. Patients demographic data, types, and causes of MEs, were recorded. The contributing factors, frequency and patient's outcome were also analyzed. RESULTS: A total of 2627 patient files were analyzed, 3963 errors were studied as follows: 1559 files contain one error, 800 files with 2 errors, and 268 with >3 errors. The most common type of error found was wrong strength (concentration) in 914 patients (34.79%), 807 patients (30.7%) had wrong route of administration, and 788 (30%) had wrong dosage form. On the other hand, the most common cause identified for MEs, was human factor, which accounted in 1223 patients (46.49%). Miscommunication was the most common second cause in 920 patients (35.02%), and the third common cause was name confusion [484, (18.43%)]. Medication Errors were classified from a regulatory prospective into actual in 735 patient files (28%), potential in 1866 (71%) and serious in 26 (0.98%). CONCLUSION: The study showed that wrong strength was the most common ME found and human factors were the most common cause contributing MEs. Therefore, focusing on these factors will definitely minimize MEs in hospitalized patients.

Prevalence of Helicobacter pylori infection in patients with peptic ulcer diseases.

OBJECTIVE: To determine the prevalence of Helicobacter pylori (H. pylori) infection among patients presenting with peptic ulcer disease (PUD) and to establish the relationship between H. pylori infection and its diverse pathology. Secondly, we aimed to examine the effect of age, gender, and geographical distribution on the prevalence of the disease. METHODS: The study included patients with PUD who underwent upper gastrointestinal endoscopy at Hera General Hospital, Makkah, Kingdom of Saudi Arabia between January 2003 and February 2004. We tested the biopsies for the detection of H. pylori by Campylobacter like organism (CLOTM) test, histopathology, immunoglobulin G (IgG) antibodies, culture, and antimicrobial susceptibility testing. RESULTS: The overall prevalence rate of H. pylori infection among 132 patients with PUD was 63%, while it was high among females (70%) as compared with males (58%). The H. pylori were mainly found in chronic active gastritis (89%) and severe active gastritis (96%). Helicobacter pylori were documented by CLOTM test in 73 (55.3%) cases, histopathology in 69 (52.3%) cases, microbiological culture in 59 (44.7%) cases, and IgG antibodies in 61 (46.2%) cases. The highest resistance (31%) was found in metronidazole, while lowest the (3%) in tetracycline and erythromycin. CONCLUSION: The highest prevalence of H. pylori was found in the younger age group with female preponderance. The leading causes of multifocal pathology were chronic and severe active gastritis secondary to H. pylori infection.