Introduction: Diabetes mellitus (DM) is defined as a chronic metabolic disorder characterized by persistent high blood glucose. Proper insulin injection is indispensable to achieve adequate control of DM and prevent complications. Therefore, this study aims to assess the knowledge of DM patients about their insulin injection techniques. Materials and Methods: A questionnaire-based and cross-sectional study was carried out from January to March 2020 at three locations in Makkah, Saudi Arabia. The inclusion criteria of research subjects included patients diagnosed with type-1 or type-2 DM and using insulin pen injection. The questionnaire included demographic data including age, gender, nationality, educational level, and chronic disease as well as specific questions about insulin injection technique. Results: Four hundred and thirty-seven DM patients participated in the study. The most prevalent age group was between 20 and 60 years old (69.1%). The vast majority of patients were females (64.1%), Saudi nationals (92.9%), and residents of Makkah city (70%). There were roughly equal numbers of patients with type-1 and type-2 DM (47% and 53%, respectively). With regard to complications of DM, 19.5% of patients had previous acidosis, and 16.5% of patients were admitted to hospital for various complications. Injection-related complications were reported by almost half of the patients (49.9). The knowledge of insulin injection practices was examined among DM patients according to different variables. Only the frequency of administration exhibited a significant difference in the practices toward proper insulin injection technique (p = 0.049); patients who administered insulin injection three times daily had the best practices toward insulin injection when compared to other patients. Conclusions: Our study showed that the practices toward insulin use among the surveyed DM patients in Makkah region were not satisfactory. Poor insulin injection technique is an important modifiable risk factor for uncontrolled blood glucose levels. More awareness campaigns and better counseling initiatives are crucial to guarantee steady insulin levels among DM patients.

Iatrogenic injury to an internal organ such as the stomach, colon, small bowel, or liver after percutaneous endoscopic gastrostomy (PEG) tube insertion is a rare complication. We present a case of rectal bleeding due to colon injury during PEG tube placement. This required urgent exploratory laparoscopic surgery with segmental resection of the transverse colon and replacement of the PEG tube. Postoperatively, the patient significantly improved with time and tolerated PEG tube feeding.

Xanthogranulomatous pyelonephritis (XGP) is one of the rare diseases characterized by chronic inflammation and destruction of the renal parenchyma, and it is usually associated with renal infection, and nephrolithiasis. Infliximab is an anti-tumor necrosis factor-alpha (anti-TNF-α) monoclonal antibody, which is widely used for treating inflammatory bowel disease, and it is known to increase the risk of rare and opportunistic infections. In this study, we report a case of XGP presenting after the initiation of infliximab treatment. We highlight one of the possible complications associated with immunosuppression due to infliximab. Furthermore, the importance of increasing the awareness among physicians for early recognition of this rare complication.

Introduction: Inflammatory bowel disease (IBD) is common worldwide, including the gulf region. Early diagnosis of IBD can improve patients' outcomes. However, early diagnosis is dependent on patients' awareness of the disease to seek medical advice. This study aims to survey the awareness of IBD in the the general population of the western region of Saudi Arabia. Methods: A questionnaire about Crohn's disease (CD) and Ulcerative colitis (UC) was distributed to the general public. A score of 1 was given for the right response and 0 for an incorrect response giving a maximum of 3 and a miminum of 0 for the three questions in the questionnaire. Results: 1304 participants responded. 29% had not heard or read about CD, while 19% had not heard or read about UC. The mean awareness level score was 1.72±1.19. Females showed a significantly higher score compared to males (p < 0.001). Age group 31 to 40 had the highest score (p =0.002). Moreover, responders, who had a Ph.D., showed significantly higher scores than other educational degrees (p <0.001). Responders who dealt with CD or UC patients, showed significantly higher scores than their peers (p < 0.001) for both. Conclusion: The general population in Saudi Arabia has an unacceptable level of awareness of IBD. Females, young adults (age group 31-40 years), educated individuals (with a PhD) and those who had dealt with IBD patients previously had better awareness compared to the rest of the population. National acts are essential to improve public awareness towards the disease.

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