Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey.

OBJECTIVE: To identify factors related to women's delay in presenting with breast cancer symptoms to improve diagnosis in the occupied Palestinian territory (oPt). DESIGN: Cross-sectional. SETTING: Two government cancer hospitals. PARTICIPANTS: A consecutive sample of 130 Palestinian women living in Gaza with newly diagnosed breast cancer were approached in the waiting rooms of cancer hospitals in Gaza between 1 January 2017 and 31 December 2017. 120 women took part and returned the completed questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinical information about breast cancer was collected from hospital cancer records. An interval of 3 months or more between women's self-discovery of symptoms and their first presentation to a medical provider was considered as a delay. RESULTS: 94% (122/130) of women attending cancer hospitals in Gaza agreed to take part in the study. Their mean age was 51 years (range: 23-72), 33.6% (31/122) had a family history of breast cancer and 74.5% (41/55) of those whose cancer stage was known had been diagnosed at stage III or IV. Around one-half (62/122) said they had not recognised the seriousness of their breast changes but only 20% (24/122) of women delayed seeking healthcare by 3 months and more. The two only factors associated to late presentation were that the woman considered their symptoms not serious (p<0.001) and lack of pain (p=0.012). Lower socioeconomic status, older age, lower education and negative family history of breast cancer were not statistically associated with women's delay. CONCLUSIONS: Women's awareness about the seriousness of breast changes and the critical importance of seeking prompt diagnosis needs to be improved using context-relevant and evidence-based awareness campaigns. This should be accompanied with training of female nurses on promoting early detection and improvement in diagnostic facilities to ensure timely diagnosis of cancer in the oPt.

Diagnostic accuracy of CT enterography correlated to histopathology in the diagnosis of small bowel Crohn's disease.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory process affecting the gastrointestinal tract, mainly the terminal ileum of small bowel. Although ileocolonoscopy provides good mucosal visualization, it does not allow evaluation of extraluminal abnormalities. Computed tomographic enterography (CTE) is an emerging imaging modality for assessment of small bowel disorders. The study aimed to explore the diagnostic accuracy of CTE in the diagnosis of patients with CD benchmarked against a histopathological reference. METHODS: A cross-sectional study entailed 126 consecutive patients with known or suspected CD who underwent CTE and biopsy by ileocolonoscopy via retrograde terminal ileum intubation. Spearman's rank was used to test the correlation and Kappa coefficient agreement between CTE and histopathology. Area under the curve (AUC) of receiver operating characteristic (ROC) was used to measure CTE diagnostic accuracy. RESULTS: The overall sensitivity and specificity of CTE were 93.88% and 85.71%, respectively. The PPV was 95.83%, and the NPV was 80%. The accuracy of CTE indicated an overall probability of correct patient classification of 92.06%. The AUC of the ROC of CTE was 0.898 (P < 0.001). Thus, CTE has a high sensitivity for assessment of small bowel CD. The CTE and histopathological gradings were strongly correlated (Spearman's coefficient = 0.962, P < 0.001). CTE exhibited perfect agreement with histopathology (Kappa coefficient (κ) = 0.847, P < 0.001). CONCLUSION: CTE is a reliable technique that has high diagnostic accuracy in the assessment of CD. Hence, it may be useful for follow up and for preoperative guidance in treatment planning.

Knowledge and Practices of Female Nurses at Primary Health Care Clinics in Gaza Strip-Palestine Regarding Early Detection of Breast Cancer.

BACKGROUND: Breast cancer (BC) is the leading cause of cancer deaths among females in Palestine. Female nurses play a vital role in increasing women's awareness of BC early detection. OBJECTIVE: This study aimed to assess the knowledge and practices of female nurses at Primary Health Care Clinics (PHCCs) in the Gaza Strip regarding early detection of BC. MATERIALS AND METHODS: This is an analytical, cross-sectional study with a census sample that includes all target female nurses (152) currently working at PHCCs. The study was conducted during the period February 2019 - March 2020.  A structured self-administered questionnaire was used to collect data among female nurses. Descriptive and inferential analyses were used to examine the relationship between the variables. Ethical approval was obtained from a Helsinki Committee Gaza Strip-Palestine. RESULTS: The nurses demonstrated a good knowledge of signs and risk factors of BC,  with scores of 85.3% and 77.9%, respectively. The majority of the participants correctly defined breast self-examination (BSE) and claimed that clinical breast examination (CBE) is a useful tool to detect BC (94.1% and 97.4%, respectively). Nurses who had previous training in CBE had better knowledge than those who had not (t = 3.5; P-value <0.001). Nurses who previously performed mammography had a knowledge score (mean ± SD = 78.1±12.8) higher than those who did not (mean ± SD = 72.5±14). Nurses having previous training had a knowledge score of 8.9 times higher than those without relevant training (t = 4.2, P-value < 0.001). Nurses' knowledge of BC risk factors  increased the practicing score by a factor of 0.22 (t = 3.0, P-value = 0.003). CONCLUSION: Nurses demonstrate good knowledge and practices of early BC detection. Previous education sessions affect the knowledge of early detection methods positively.

Determination of risk factors associated with inflammation in hypertensive patients with type-2 diabetes mellitus in a Palestinian Diabetes Study.

OBJECTIVE: To determine the risk factors associated with inflammation in hypertensive patients with type-2 diabetes mellitus. METHODS: A total of 164 hypertensive patients with type 2 diabetes patients aged 38-60 years were selected from 7 primary healthcare centers in Gaza city, Palestine. Interview questionnaire were employed to collect data related to age, gender, smoking habits, and physical activity pattern. Laboratory biochemical tests included fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), interleukin 6 (IL-6), high sensitive C reactive protein (hs-CRP), and adiponectin were estimated in all patients. RESULTS: The study involved 118 (72%) women and 46 (28%) men; the mean of age was 53.7 ± 0.46 years. A tertile of inflammation feature with hs-CRP was developed. The highest tertile of hs-CRP was significantly associated with women, higher obesity indices, metabolic dysregulation involving lipid profile markers, FBG and blood pressure, IL-6, and lower adiponectin. After adjusting for age, gender, smoking habits, and physical activity; the risk factor of high level of hs-CRP were the increased body mass index [OR: 1.17, p = .018], IL-6 [OR: 2.22, p = .025] and FBG [OR: 1.01, p = .007], as well as reduced adiponectin [OR: 0.81, p = .002]. CONCLUSION: The inflammation state was affected by obesity and had been related to altered adipokines levels of IL-6 and adiponectin, as well as affected by the glycemic control, as evidenced by higher serum level of FBG.

Coronary computed tomography angiography versus invasive coronary angiography: medical staff perceptions and diagnostic interest in Gaza-Palestine.

BACKGROUND: Invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) are used in the diagnosis of coronary artery disease (CAD). The medical benefits, as well as the ethical and logistical implications, should be explored, particularly in the scarcity of medical resources. We explore the perception of medical staff toward the interest of CCTA and ICA in diagnosis CAD to maximize the utility of both procedures. METHODS: A triangulated observational, analytical prospective cohort study carried out among patients suspected with CAD who underwent CCTA and ICA. The quantitative part included 381 patients (250 underwent ICA and 131 underwent CCTA). The qualitative part included a purposive sample of two radiologists, three cardiologists, and two medical imaging specialists. RESULTS: Low diagnostic yield of the ICA through 31.3% and 39.7% diagnosed without CAD and non-significant CAD, respectively. Risk factors such as the family history of heart disease, obesity, high cholesterol, and diabetes were with high frequency in the patients with significant CAD. The sensitivity, specificity, PPV, and NPV of CCTA technique was 94.74%, 94.23%, 92.31%, and 96.08% respectively. Cardiologist's perceptions focused on radiation concerns and difficulties for convincing patients to perform the CCTA procedure. Radiologists and medical imaging specialists focused on complete cooperation from the cardiologist to better preparation of patients to perform optimal CCTA procedures. CONCLUSION: Efficient diagnostic benefits of CCTA and overuse of ICA for stable CAD are documented. Clear diagnostic strategy with medical, ethical, and logistical issues should be considered when selecting the CCTA or ICA for diagnosis CAD.