Adult Attention Deficit Hyperactivity Disorder (ADHD) among residents of Saudi Arabia: a cross-sectional study

 OBJECTIVE: In this study, we aim to estimate the prevalence of adult ADHD among Saudi adults, determine its demographic correlates, the impact of the disorder on school/work, social life, and productivity, and describe its association with other psychiatric disorders such as depression and anxiety.

SUBJECTS AND METHODS

A cross-sectional study involving 993 adult participants was carried out utilizing a validated online questionnaire that was given to the Saudi population between January 2022 and March 2022. Socio-demographic information, the adult ADHD Self-Report Scale, the Sheehan Disability Scale (SDS), and the Hospital Anxiety and Depression Scale (HADS) are among the data gathered from the questionnaire.

RESULTS

Participants' median age group was 21-30 years (48.4%), with 77.8% being females. The prevalence of participants who were positive for ADHD symptoms was 46.6%. In univariate analysis, age group, marital status, depression, anxiety, Sheehan scale domains, day lost, and unproductive days were all significant risk factors for ADHD. In a multivariate regression analysis, anxiety, depression, symptoms that disrupted work/school work, family life/home responsibilities, and days unproductive remained statistically significant and determined as the significant independent predictors of positive ADHD.

CONCLUSIONS

Morbidity of adult ADHD symptoms appreciably existed among younger adults of Saudi Arabia, mostly students with no favorable genders. Adult ADHD symptoms were found to affect the quality of social life and work/schoolwork performance as they decreased the productivity rate and increased the absenteeism rate. Moreover, symptoms of depression and anxiety were in a profound correlation with Adult ADHD symptoms.

Effect of total fasting hours on the overall quality of recovery after surgery: An observational study

Context

Preoperative fasting is one of the pre-requisite for patients undergoing a surgery. Despite clear instructions, patients frequently fast for extended periods before elective surgeries. Longer periods of fasting may cause discomfort, thirst, hunger, and other physiological problems.

Aims

To assess the quality of postoperative recovery among adult patients having different preoperative fasting hours by using the postoperative Quality of Recovery40 (QoR40) score.

Settings and Design

This was an observational study that was conducted for adult patients undergoing elective surgery during four weeks between 19th September and 13th October 2022 at Security Forces Hospital Riyadh, Kingdom of Saudi Arabia.

Methods and Material

We excluded pediatric patients, patients undergoing spine or neurosurgery, emergency cases, or local anesthesia cases. Non-probability convenient sampling technique was used in this study. The postoperative quality of recovery-40 (QoR-40) questionnaire was distributed among 200 patients.

Statistical Analysis Used

All analyses were performed with Statistical Package for the Social Sciences software (SPSS) v25. Descriptive statistics (frequency, percentage, median, and IQR) were used for the questionnaire's variables. The difference between the variables was analyzed using Kruskal-Wallis, and a P value <0.05 was considered statistically significant.

Results

Out of 200 patients, 172 patients responded but 16 responses were excluded. A total of 156 adult patients' responses were included in this study. The majority were female (53%), 31% were older than 45 years. More than 50% of patients reported fasting for more than 6 hours for drinking and more than 8 hours for eating. On the positive scale, the comfort score was significantly affected by the fasting hours for drinking (P value = 0.045). On the negative scale of the questionnaire, the emotions were significantly affected by fasting hours for both drinking (P value = 0.027) and eating (P value = 0.043).

Conclusions

The study results showed better comfort for patients with lesser fasting hours for drinking. Moreover, the results strongly suggest the need of following the fasting guidelines without prolonging the fasting duration. However, further studies with larger sample sizes are recommended.

Comparing the Effectiveness of Role-Play Simulation versus Real Patient Transferal Skills Training in Occupational Therapy Students in Saudi-Arabia- A Quasi-Experimental Study

Purpose

To compare the effectiveness of using role-play simulation as a possible alternative to real-patient training to teach transferal skills to occupational therapy students.

Patients and Methods

Seventy-one occupational therapy students (including those in their second, third and fourth years) participated in a quasi-experimental study. The students were randomly divided into two groups. One group received role-play simulation at the university. The other received training on real patients with mild to moderate stroke and spinal cord injury (one session/week for six weeks) in clinical (inpatient) settings in Jeddah to learn patient transferring skills. Student performance was taken as a measure of teaching method effectiveness, and was evaluated by using a validated OSCE-type assessment tool developed at the end of training. The tool showed good reliability (Cronbach's α was > 0.7) and inter-reliability (Kappa < 0.001).

Results

A total number of 71 students participated in the study. The majority of the students were female (66.2%, N=47) and 33.8% (N=24) were male. About 33.8% (N=24) of students were in the second year, 29.6% (N=21) were in the third year and 36.6% (N=26) were in the fourth year. There were 36 (49.3%) students in the simulation group The mean age of the students was 20.70 (SD=1.2). There was no significant difference in the students' performance in both groups with a P-value of 0.139.

Conclusion

Role-play simulation can effectively be used for students' training as there was no difference in the outcome of the students' performance in patient transferring skills in both groups. This finding can help in designing and implementing training through simulation, especially in situations where training on severely ill patients may be a safety risk.

An Evidence Theory Based Embedding Model for the Management of Smart Water Environments

Having access to safe water and using it properly is crucial for human well-being, sustainable development, and environmental conservation. Nonetheless, the increasing disparity between human demands and natural freshwater resources is causing water scarcity, negatively impacting agricultural and industrial efficiency, and giving rise to numerous social and economic issues. Understanding and managing the causes of water scarcity and water quality degradation are essential steps toward more sustainable water management and use. In this context, continuous Internet of Things (IoT)-based water measurements are becoming increasingly crucial in environmental monitoring. However, these measurements are plagued by uncertainty issues that, if not handled correctly, can introduce bias and inaccuracy into our analysis, decision-making processes, and results. To cope with uncertainty issues related to sensed water data, we propose combining network representation learning with uncertainty handling methods to ensure rigorous and efficient modeling management of water resources. The proposed approach involves accounting for uncertainties in the water information system by leveraging probabilistic techniques and network representation learning. It creates a probabilistic embedding of the network, enabling the classification of uncertain representations of water information entities, and applies evidence theory to enable decision making that is aware of uncertainties, ultimately choosing appropriate management strategies for affected water areas.

The Mechanical Properties of Blended Fibrinogen:Polycaprolactone (PCL) Nanofibers

Electrospinning is a process to produce versatile nanoscale fibers. In this process, synthetic and natural polymers can be combined to produce novel, blended materials with a range of physical, chemical, and biological properties. We electrospun biocompatible, blended fibrinogen:polycaprolactone (PCL) nanofibers with diameters ranging from 40 nm to 600 nm, at 25:75 and 75:25 blend ratios and determined their mechanical properties using a combined atomic force/optical microscopy technique. Fiber extensibility (breaking strain), elastic limit, and stress relaxation times depended on blend ratios but not fiber diameter. As the fibrinogen:PCL ratio increased from 25:75 to 75:25, extensibility decreased from 120% to 63% and elastic limit decreased from a range between 18% and 40% to a range between 12% and 27%. Stiffness-related properties, including the Young's modulus, rupture stress, and the total and relaxed, elastic moduli (Kelvin model), strongly depended on fiber diameter. For diameters less than 150 nm, these stiffness-related quantities varied approximately as D^-2; above 300 nm the diameter dependence leveled off. 50 nm fibers were five-ten times stiffer than 300 nm fibers. These findings indicate that fiber diameter, in addition to fiber material, critically affects nanofiber properties. Drawing on previously published data, a summary of the mechanical properties for fibrinogen:PCL nanofibers with ratios of 100:0, 75:25, 50:50, 25:75 and 0:100 is provided.

Enhancing Graph Routing Algorithm of Industrial Wireless Sensor Networks Using the Covariance-Matrix Adaptation Evolution Strategy

The emergence of the Industrial Internet of Things (IIoT) has accelerated the adoption of Industrial Wireless Sensor Networks (IWSNs) for numerous applications. Effective communication in such applications requires reduced end-to-end transmission time, balanced energy consumption and increased communication reliability. Graph routing, the main routing method in IWSNs, has a significant impact on achieving effective communication in terms of satisfying these requirements. Graph routing algorithms involve applying the first-path available approach and using path redundancy to transmit data packets from a source sensor node to the gateway. However, this approach can affect end-to-end transmission time by creating conflicts among transmissions involving a common sensor node and promoting imbalanced energy consumption due to centralised management. The characteristics and requirements of these networks encounter further complications due to the need to find the best path on the basis of the requirements of IWSNs to overcome these challenges rather than using the available first-path. Such a requirement affects the network performance and prolongs the network lifetime. To address this problem, we adopt a Covariance-Matrix Adaptation Evolution Strategy (CMA-ES) to create and select the graph paths. Firstly, this article proposes three best single-objective graph routing paths according to the IWSN requirements that this research focused on. The sensor nodes select best paths based on three objective functions of CMA-ES: the best Path based on Distance (PODis), the best Path based on residual Energy (POEng) and the best Path based on End-to-End transmission time (POE2E). Secondly, to enhance energy consumption balance and achieve a balance among IWSN requirements, we adapt the CMA-ES to select the best path with multiple-objectives, otherwise known as the Best Path of Graph Routing with a CMA-ES (BPGR-ES). A simulation using MATALB with different configurations and parameters is applied to evaluate the enhanced graph routing algorithms. Furthermore, the performance of PODis, POEng, POE2E and BPGR-ES is compared with existing state-of-the-art graph routing algorithms. The simulation results reveal that the BPGR-ES algorithm achieved 87.53% more balanced energy consumption among sensor nodes in the network compared to other algorithms, and the delivery of data packets of BPGR-ES reached 99.86%, indicating more reliable communication.

Perspectives of the Key Stakeholders of the Alignment and Integration of the SaudiMEDs Framework into the Saudi Medical Licensure Examination: A Qualitative Study

PURPOSE

The purpose of the Saudi Medical Education Directives Framework (SaudiMEDs) is to assure the essential level of competencies for medical graduates, which should be reflected in the Saudi Medical Licensure Examination (SMLE). This study explored the opinions of key stakeholders of the alignment and integration of the SMLE's blueprint and contents with the SaudiMEDs competency framework's themes and domains.

PARTICIPANTS AND METHODS

This was a qualitative case study, using a purposive sampling technique. Ten participants participated in the study representing the main stakeholders. The participants were four deans, an assistant dean, two residents, and three interns of various colleges of medicine (COM). In-depth interviews were conducted through a semi-structured format, either online or in-person. The interviews were recorded, transcribed verbatim and analyzed according to the general guidelines of qualitative content analysis.

RESULTS

Four major themes emerged from the data, including the current alignment practices of the COM, competencies enhanced through preparing according to the SMLE, the SaudiMEDs representation in the SMLE, and finally a roadmap to achieve optimum alignment between the SaudiMEDs and the SMLE.

CONCLUSION

The participants were knowledgeable about the SaudiMEDs and perceived the SMLE blueprint and contents to be partially aligned with the themes and domains of the SaudiMEDs competency framework. The responses suggested that additional effort is required to improve the current alignment to assess the competencies of COM graduates appropriately.

Primary Ectopic Breast Carcinoma in Man Mimicking Keloid

Background:

Case report:

Conclusion:

Knowledge, attitude and management of hearing screening in children among family physicians in the Kingdom of Saudi Arabia

BACKGROUND

Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide.

OBJECTIVES

This study aimed to assess family physicians' knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss.

METHODS

A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children.

RESULTS

The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%).

CONCLUSION

This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.

Translation into Arabic and validation of the Patient Assessment of Care for Chronic Conditions questionnaire for diabetes

Background

The Patient Assessment of Care for Chronic Conditions (PACIC-5As) is a questionnaire developed in English and designed to evaluate the health care experiences of people living with chronic conditions such as diabetes.

Aims

This study aimed to translate, culturally adapt and validate the PACIC-5As instrument for the Arab context in a sample of Saudi Arabian people with diabetes.

Methods

The PACIC-5As was translated into Arabic using a forward and backward translation process. The Arabic version was then validated with a sample of 557 Saudi Arabians with diabetes who were recruited from tertiary level diabetes centres in Riyadh between January and March 2018. In order to evaluate the psychometric properties of the Arabic version, Cronbach alphas and item correlations were determined and exploratory factor analysis was performed.

Results

The translated PACIC-5As had good psychometric quality. Cronbach alpha was > 0.9 and the inter-item correlation ranged between 0.36 and 0.56. Exploratory factor analysis showed a single-factor structure.

Conclusion

An Arabic version of the PACIC-5As questionnaire is now available to assess the experience of patients with diabetes. The results of this study can be used to improve the quality of the delivery of health care in Arabic-speaking countries.

Does build angle have an influence on surface roughness of anterior 3D-printed restorations? An in-vitro study

PURPOSE

To evaluate the effect of build direction on the surface roughness (Ra) of stereolithography (SLA) printed full-coverage anterior dental restorations before and after surface polishing.

MATERIALS AND METHODS

A total of 45 full-coverage dental restorations were 3D printed using the SLA additive manufacturing technique. Five groups were defined based on the build angles: 90, 120, 135, 150, and 180 degrees. The Ra was measured with the contact profilometer to evaluate the arithmetic average of the absolute Ra value on the labial surface before and after polishing procedures. Data were analyzed using two-way ANOVA, and statistical significance was set at α = .05.

RESULTS

The highest Ra was recorded in specimens printed with the 90-degree build angle, whereas the lowest values were recorded in specimens printed with the 180-degree build angle (P = .000). In all groups, the Ra values measured after polishing were significantly lower than prepolished values (P = .000), with no difference among the different build angles.

CONCLUSION

Build angle significantly influenced the Ra of the SLA-printed full-coverage restorations. Polishing minimized the effect of build angle on the Ra. The 180-degree build angle is recommended when SLA printing an anterior restoration, as it provides the lowest Ra values and also requires a minimal support area and minimal number of support structures.

Mode of bond failure between 3D-printed denture teeth and printed resin base material: effect of fabrication technique and dynamic loading. An in-vitro study

PURPOSE

To evaluate the failure load of 3D-printed denture resin material and teeth before and after dynamic loading.

MATERIALS AND METHODS

A total of 40 specimens were fabricated following ISO/TS 19736 and were divided into two equal groups. In the test group, the cylindrical base and denture teeth were 3D printed separately and then luted together. In the control group, the specimens were fabricated from conventional heat-cured polymethyl methacrylate (PMMA) and commercially available denture teeth using the compression-molding technique. Ten specimens from each group were subjected to dynamic load of 50 N for 250,000 cycles in a chewing simulator. All specimens were subjected to static load of 50 N using Instron machine with a crosshead speed of 1 mm/minute until fracture. The fractured surfaces were analyzed using field emission scanning electron microscopy. The failure loads were calculated and compared using analysis of variance (P < .05).

RESULTS

All specimens survived the loading, undergoing 250,000 cycles without fracture. The mean failure load was influenced by fabrication technique and was significantly higher for the 3D-printed test group (P = .028). 3D-printed teeth showed a mixed mode of fracture, whereas in the control group, the specimens showed cohesive fracture within the teeth.

CONCLUSION

The fabrication technique has an influence on the mode of failure between acrylic teeth and resin base material. Cohesive failure in teeth was predominant in the conventional group, suggesting possibly higher bond strength between the teeth and resin base in this group. The observed failure modes reveal that both fabrication techniques exhibited satisfactory bond strength. Chewing simulation did not significantly influence the bond strength of any of the tested groups.

A study of quality of life among hemodialysis patients and its associated factors using kidney disease quality of life instrument-SF36 in Riyadh, Saudi Arabia

We aimed in this study to assess the quality of life for kidney-ill patients using Kidney Disease Quality of Life Instrument-SF36 (KDQOL-SF36) and the impact of other demographic, clinical, and social factors on patients' QOL. The quality of life was assessed using an Arabic version of KDQOL-36. The KDQOL-36 subscales Physical Component Summary (PCS), Mental Component Summary (MCS), Burden of Kidney Disease, and Effects of Kidney Disease were calculated. The effect of sex, diabetic status, diabetes mellitus, marital and status employment status, etc. on these subscales was evaluated. Reliability was determined by calculating Cronbach's alpha. A total of 254 patients were enrolled. The mean age was 58.2 (standard deviation 18.2) years; 61% were male, 56.7% diabetic and 20.1% were employed. The mean domain scores on the PCS, MCS, burden of kidney disease, and effects of kidney disease subscales were 49.4, 38.7, 52.6, and 37.2, respectively. Afternoon shift patients score highest among all shifts in MCS and PCS (P = 0.0001). The MCS score (38.7 ± 28.7) was significantly lower than PCS (49.4 ± 16.5) (P = 0.0001). The "effect of kidney disease" subscale was higher in males (P = 0.02), employed patients (P = 0.02), in the afternoon dialysis shift (0.0001). For PCS higher scores were seen in males (P = 0.0001), in non-diabetics (compared to diabetics) (P = 0,006), in the employed patients (P = 0.02). The highest score was seen in the "burden of kidney disease" subscale and the lowest in the "effects of kidney disease" subscale. Higher scores were seen in males, in nondiabetics, in the employed patients.

How Does the Remaining Single Kidney Cope After Contralateral Nephrectomy of the Kidney Donor? A Single-Center Cohort Study

Introduction

Immediately after kidney donation, the remaining kidney will undergo hyperfiltration and work at a higher level to compensate for the other kidney's loss. It is estimated that 70% of the baseline renal function before the donation is recovered post-donation. However, factors that determine the post-donation renal compensation are not well understood.

Methods

We conducted a retrospective study of 190 consecutive kidney donors who completed a one-year follow-up in order to predict the factors affecting the function of the remaining kidney post-contralateral nephrectomy.

Results

We enrolled 190 living kidney donors who had completed at least one year of follow-up after nephrectomy. Among the participants, 149 (78.4%) were males and 41 (21.6%) were females. The mean age of the participants was 31.33 ±7.9 years and the mean body mass index (BMI) was 25.6 ±3.9 kg/m². Before kidney donation, the mean estimated glomerular filtration rate (eGFR) and serum creatinine were 114.31 ±15.94 ml/min/1.73 m² and 71.60 ±10.62 mmol/min, respectively. At the one-year follow-up, the mean eGFR was 77.97 ±14.44 ml/min/1.73 m² and serum creatinine was 100.84 ±20.15 mmol/min. The female gender [odds ratio (OR): 20.6, 95% CI: 3.9-107.7, p: <0.001] and having a higher baseline eGFR (OR: 8.8, 95% CI: 1.6-45.8, p = 0.01) were found to be significant predictors of having a better eGFR at one year post-nephrectomy.

Conclusions

Female gender and pre-donation low serum creatinine and high eGFR were the significant predictors of better kidney function at one year post-contralateral nephrectomy. However, further studies with longer follow-up durations are needed to better assess the factors that could predict renal compensation and the renal compensation rate's suitability as a prognostic measure for long-term renal outcomes.

A Secure and Robust Image Hashing Scheme Using Gaussian Pyramids

Image hash is an alternative to cryptographic hash functions for checking integrity of digital images. Compared to cryptographic hash functions, an image hash or a Perceptual Hash Function (PHF) is resilient to content preserving distortions and sensitive to malicious tampering. In this paper, a robust and secure image hashing technique using a Gaussian pyramid is proposed. A Gaussian pyramid decomposes an image into different resolution levels which can be utilized to obtain robust and compact hash features. These stable features have been utilized in the proposed work to construct a secure and robust image hash. The proposed scheme uses Laplacian of Gaussian (LOG) and disk filters to filter the low-resolution Gaussian decomposed image. The filtered images are then subtracted and their difference is used as a hash. To make the hash secure, a key is introduced before feature extraction, thus making the entire feature space random. The proposed hashing scheme has been evaluated through a number of experiments involving cases of non-malicious distortions and malicious tampering. Experimental results reveal that the proposed hashing scheme is robust against non-malicious distortions and is sensitive to detect minute malicious tampering. Moreover, False Positive Probability (FPP) and False Negative Probability (FNP) results demonstrate the effectiveness of the proposed scheme when compared to state-of-the-art image hashing algorithms proposed in the literature.

Imaging photonic crystals using hemispherical digital condensers and phase-recovery techniques

We describe experiments where Fourier ptychographic microscopy (FPM) and dual-space microscopy (DSM) are implemented for imaging photonic crystals using a hemispherical digital condenser (HDC). Phase-recovery imaging simulations show that both techniques should be able to image photonic crystals with a period below the Rayleigh resolution limit. However, after processing the experimental images using both phase-recovery algorithms, we found that DSM can, but FPM cannot, image periodic structures with a period below the diffraction limit. We studied the origin of this apparent contradiction between simulations and experiments, and we concluded that the occurrence of unwanted reflections in the HDC is the source of the apparent failure of FPM. We thereafter solved the problem of reflections by using a single-directional illumination source and showed that FPM can image photonic crystals with a period below the Rayleigh resolution limit.

Challenges associated with treating children with diabetes in Saudi Arabia

BACKGROUND

Type 1 Diabetes Mellitus (T1DM) patients among the children have been increasing rapidly in the recent years in Saudi Arabia, as a result there is a need for extensive research in this area. Various suggestions were kept forward including m-health technologies, telemedicine etc. However, very little research has been conducted in understanding the T1DM among the children, measures being taken to control, and the feasible policies and procedures that could be adopted for managing T1DM among child population.

OBJECTIVE

The primary aim of this study is to investigate and identify the challenges being faced in T1DM among the children in Saudi Arabia.

METHODS

A questionnaire based survey is conducted with the child participants including the parents of the children with T1DM. The questionnaire has a multiple choice answers which need to be selected according to the participants views.

RESULTS

Lack of initiatives taken by the health ministry in creating awareness about T1DM and its complications, and also in providing the effective infrastructure in healthcare centres; the role of schools in providing additional care for the children with T1DM is limited; the children are completely unaware of the T1DM self-management techniques, and feel nervous and embarrassed about the disease management process; and they are completely dependent on their parents for managing the disease.

CONCLUSION

Though there are few aspects where the care is delivered through parents, the need for self-management techniques is necessary and highlighted as the children spend most of their time in schools away from the parents.