The Effects of Smoking on the Severity of Atopic Dermatitis in Saudi Arabia

Background Atopic dermatitis (AD) is a well-known inflammatory skin disease that is associated with a family history of other atopic diseases. Tobacco smoking has been found to affect AD as well as several other inflammatory skin diseases. In this study, we aimed to investigate this association and to elucidate the link between dose-dependent tobacco exposure and symptom severity. Methods This cross-sectional study was conducted on individuals from the general population of Riyadh, Saudi Arabia. Data were collected using an online questionnaire. All statistical analyses were performed using RStudio, version 1.1.363 (RStudio, PBC, Boston, Massachusetts, United States). Questions about the participants' age, sex, and occupational status were included. The participants were asked to report their daily handwashing habits and history of atopic diseases. Data on the smoking duration, number of cigarettes smoked per day, and passive exposure were collected. Results A total of 510 participants (41.3 %) reported having AD. Smoking was significantly associated with an increased prevalence of AD. The odds of having AD were 1.78 and 2.27 times higher in occasional smokers (odds ratio (OR) = 1.78, p < 0.05) and daily smokers (OR = 2.27, p < 0.001) than in non-smokers. Neither smoking frequency (p = 0.19) nor duration (p = 0.73) was significantly associated with AD prevalence. Conclusion Smoking is significantly associated with an increased prevalence of AD. Adults should be discouraged from smoking in order to prevent adult-onset AD. The level of nicotine exposure should be measured objectively in future studies.

Depression, stress, anxiety and burnout among undergraduate and postgraduate medical trainees in Saudi Arabia over two decades: A systematic review

BACKGROUND

Evidence suggests physicians have higher rates of mental distress than other professionals. Although multiple studies have been conducted among Saudi medical trainees to address this issue, no reviews assessed multiple psychological problems simultaneously. We aimed to examine the prevalence and trends of depression, anxiety, burnout and stress among Saudi medical trainees.

METHODS

A systematic review was conducted searching PubMed/Medline, OVID, Scopus, PsychInfo, EBSCOhost and the Directory of Open Access Journals (DOAJ) for studies addressing depression, burnout, stress and anxiety among Saudi medical trainees, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Joanna Briggs Critical Appraisal Checklist was used to evaluate quality. The main findings were summarised in tables.

RESULTS

We identified 57 records from 2001 to 2020. Overall (mild, moderate or severe) depression ranged from 28% to 70.6%, while stress ranged from 30.5% to 90.7%. Burnout was primarily assessed among residents with an overall prevalence reaching 85.5%. Overall anxiety ranged from 52.7% to 67%, and was only assessed among undergraduates. Higher levels of all four mental conditions were reported among females.

CONCLUSION

This review suggests high prevalence of depression, stress, burnout and anxiety among medical trainees, with higher estimates for females compared to males.

Bioinformatics Analysis of the Rothia dentocariosa Proteome and Assessment of the Proinflammatory Potential of Biofilm and Planktonic Cells

Background

Rothia dentocariosa is an opportunistic pathogen found in the oral cavity and is found to be involved in many oral infections as it has the ability to attach to tooth and mucosal surfaces, produce substantial amounts of acids and integrate into dental plaque biofilms.

Aim

To analyze the proteome of R. dentocariosa by using bioinformatics tools and to investigate the proinflammatory potential of R. dentocariosa.

Material and Methods

Protein sequences of R. dentocariosa were downloaded from NCBI and various in silico analyses were performed using bioinformatics tools. R. dentocariosa CCUG 35437 was grown on blood agar in 5%CO2 in air at 37 C for 2 days. Biofilms were cultured for 2 days and quantified by crystal violet staining. Human whole blood was stimulated with biofilms, biofilm-supernatants, planktonic cells, and whole cells. Proteome Profiler and ELISA based quantification of cytokines was performed for the samples.

Results

In silico analysis of the whole genome and proteome of R. dentocariosa revealed a number of proteins predicted to be potentially secreted but also possess virulence properties. R. dentocariosa was able to form only moderate biofilms. The ability of R. dentocariosa to induce different cytokines varied depending on the stimulant being used. Biofilms and planktonic cultures induced specific cytokines that were not induced by whole cells or biofilm-supernatants. While IL-8 was induced at near-similar levels from biofilm and planktonic cells, IL-10 was induced at significantly higher levels (P<0.05) only by the planktonic cultures. The biofilm-supernatant and the whole cell stimulants induced lower levels of cytokines than biofilm and planktonic cultures.

Conclusion

Identification of potential virulence factors predicted to be secreted extracellularly may suggest a key role for R. dentocariosa in oral and non-oral infections. Different stimulants from R. dentocariosa showed varying potential to induce cytokines from human whole blood. This may suggest differences in the composition/concentration of the bacterial components in the stimulants, with varying abilities to induce cytokine production, may be the reason for the observed differences.

A nationwide survey to assess COVID-19's impact on health and lifestyle in Saudi Arabia

OBJECTIVE

Since COVID-19 outbreak, there is a lack of extensive literature on the impact of the COVID-19 pandemic on health and lifestyle. The aim of the study was (1) to assess the COVID-19 related knowledge and its socio-demographic correlates in individuals from different parts of Saudi Arabia, (2) to evaluate the health-related impact and lifestyle changes in the Saudi population because of the COVID-19 pandemic, and (3) to determine the perceived importance of future preparedness among residents.

MATERIALS AND METHODS

A cross-sectional study was conducted in different regions of Saudi Arabia from  December 2020 to February 2022. Individuals aged 18 years and above were surveyed from different parts of the county. The questionnaires were made available online, and the participants filled them in. The questionnaires included COVID-19 related knowledge, the assessment of the health impact of COVID-19, perceived importance of future preparation for the pandemic, lifestyles, and demographics. Likert plot, univariate and multivariate logistic regression analyses were done.

RESULTS

A total of 616 respondents were included in the study. The majority of the repondents were female (58.6%).  36% of the respondents considered their knowledge level on the novel coronavirus as very good. 43.5% said their knowledge level on preventing the spread of the novel coronavirus is excellent. Retired people were 84% (aOR 0.16, 95% CI 0.03-0.78) less likely of higher physical activity as compared to working (≥40 hrs/week) professionals. Separated/divorced/widowed and singles were 3.65 times (aOR 3.65, 95% CI 1.34-9.94) and 2.23 times (aOR 2.23, 95% CI 1.28-3.89) more likely of higher screen time as compared to those who were married/cohabitation/common-law.

CONCLUSIONS

Lifestyle in Saudi Arabia has changed significantly due to the COVID-19 pandemic. Healthy habits such as eating at home and cooking at home have increased, while unhealthy habits such as reduced physical activity, screen time have increased.

community pharmacists’ experiences and beliefs towards providing pharmacy services to deaf and hard of hearing patients: a mixed-method study in Riyadh, Saudi Arabia

Introduction

Provision of pharmacy services to patients requires the pharmacist to well communicate with the patients. Research has shown that healthcare providers, including community pharmacists, face many challenges while providing services to deaf and hard-of-hearing patients (DHOH).

Aim

To investigate community pharmacists’ experiences and beliefs about providing pharmacy services to DHOH in Riyadh, Saudi Arabia.

Methods

This was a sequential explanatory mixed-method study involving a survey and semi-structured interviews. At first, a web-based, self-administered survey was disseminated to community pharmacists in Riyadh, Saudi Arabia during the period October to November 2020. The survey was disseminated through the official twitter account of Saudi Pharmaceutical Society. Two reminders were sent. It was made clear that the survey targeted community pharmacists working in Riyadh city. To calculate an appropriate sample size, according to Hair et al, the general rule to have a minimum sample size would be five observations per variable (5:1), and an acceptable sample size would be ten observations per variable (10:1). In this survey, there are 16 items, and hence the acceptable sample size was 160 participants. The semi-structured telephone-based interviews were conducted with a purposive sample of survey respondents to gather in-depth information on experiences, beliefs, and barriers about providing pharmacy services to DHOH. The interviews were conducted until saturation occurred. Survey data was analysed using Statistical Package for Social Sciences (SPSS version 24), and the semi-structured interviews were analysed by Framework analysis.

Results

A total of 175 community pharmacists completed the survey. The majority were: male (84.6%), aged between 25 to 35 years (74.9%). Of the respondents, 32.2% and 29.1% had experience in community pharmacy of 1-5 and 6-10 years, respectively. The number of DHOH patients the pharmacists met during the past 6 months were as follows: 68 (38.9%) pharmacists met 1-2 patients, 71 (40.6%) %) pharmacists met 3-4 patients, and 19 (11%) %) pharmacists met ≥ 5 patients. The provided services included: prescription medications (by 82.9%), counselling on prescription medications (by 56.6%), OTC medication dispensing (by 4.3%), and counselling on OTC medications (by 52.6%). Forty participants (22.8%) reported their awareness of the basics of Saudi sign language (SSL). Of the participants, 101 (57.7%) believed that they have handled communication barriers appropriately, while 61(35%) acknowledged unmanageable communication barriers. Among the main barriers identified were the lack of knowledge of the basics of SSL. (70.9%) and the inability to recognize disability (52.6%). The semi-structured interviews further explored pharmacists’ experiences and views on providing such a service. Of the main themes emerged were: (1) Experience; interviewees preferred written communication with DHOH patients regardless of their literacy level, while spontaneous hand gesturing was the least preferred method of communication, and they also acknowledged that their roles in providing services, to the DHOH, need to be improved (2) Beliefs; interviewees believed that awareness of the basics of SSL is important to ensure safe medication use. The barriers emerged from the interview were classified as pharmacist-related, system-related, and patient-related.

Conclusion

To our knowledge, this is the first study of its kind to be conducted in Saudi Arabia. The study highlighted that when providing pharmacy services to DHOH patients, community pharmacists encountered multiple barriers. These barriers need to be addressed for better support and provision of pharmacy services to DHOH. Further studies with large sample size, are warranted to better understand the situation.

References

(1) Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Harlow: Pearson Education Limited; 2014

(2) Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009 Mar 22;40(1):4-11.

(3) Ferguson MC, Shan L. Survey evaluation of pharmacy practice involving deaf patients. Journal of pharmacy practice. 2016 Oct;29(5):461-6.

The Association Between Dry Eye and Sleep Quality Among the Adult Population of Saudi Arabia

Background and objective

Dry eye disease (DED) is one of the most prevalent ocular diseases worldwide. DED symptoms can result from disturbances to the homeostasis of the middle tear film layer (aqueous layer), including inflammation, pain, and eye discomfort, which can have a negative impact on individuals’ quality of life and daily activities. Sleep disorders are highly prevalent among patients with DED, and the incidence of sleep disturbances in DED patients has been reported to be as high as 40%. Decreased sleep quality can aggravate dry eye symptoms by increasing tear osmolarity and decreasing tear production. In this study, we aimed to investigate the association between DED and sleep quality in the adult population of Saudi Arabia.

Methods

This cross-sectional study was conducted among adult patients aged 18 years and above in Saudi Arabia in August 2021. A validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and the Ocular Surface Disease Index (OSDI) questionnaire was employed to diagnose DED. Data collection and analysis were performed using the SPSS Statistics software (IBM, Armonk, NY).

Results

A total of 234 subjects were analyzed, and 59.8% of the participants were women. Our tool suggested that 71.4% of the included participants had severe DED, 15% had moderate DED, and 13.7% had mild DED. However, 40.6% of the participants reported that they had not been diagnosed with DED previously and 34.6% had no previous DED symptoms. The mean total PSQI score was 8.63 ±2.23, with the highest score recorded for component 2: sleep latency (1.73) and the lowest score recorded for component 4: habitual sleep efficiency (0.20). Poor sleep quality as assessed by PSQI showed a significant positive correlation with the severity of DED as assessed by OSDI.

Conclusion

The significant positive correlation between poor sleep quality and DED indicated that patients with DED had a higher risk of poor sleep quality compared to healthy patients. Patients with DED should be educated about the steps and techniques to improve their sleep patterns.

Anatomical Evaluation of Root and Root Canal Configuration of Permanent Maxillary Dentition in the Population of the Kingdom of Saudi Arabia

AIM

This study is aimed at combining the sample sizes of all studies on permanent maxillary teeth conducted in different regions of the Kingdom of Saudi Arabia (KSA) to obtain a large sample size that represents the population of the KSA. The outcome of these combined studies is compared with international studies in terms of the number of roots, number of canals, and canal configurations on the basis of Vertucci's classification. Methodology. The studies were systematically reviewed using the Preferred Reporting Items for Systematic Review and Meta-analysis chart. Studies were included in the analysis if they were conducted in the KSA, involved permanent human maxillary teeth, and had a sample of more than 10 teeth (power). By contrast, studies were excluded if they involved deciduous teeth in the sample size, investigated nonhuman teeth, were not conducted in the KSA, and were case reports, case series, review studies, and anomalies. Relevant literature was searched from PubMed, Scopus, Web of Science, Embase, Cochrane, and Direct Science by two calibrated teams, starting in August 2020, without time limits or language restrictions.

RESULTS

The database searches and cross-referencing identified a total of 19 relevant studies. All maxillary canines (N = 1,018) had one root, whereas 98.4% had one canal and 98.3% had Vertucci type I. Moreover, 63.2% of the maxillary first premolars had two roots, and 91.4% had two canals. The most common Vertucci root canal configuration was type IV (64.6%). The maxillary second premolars mostly had one root (84.4%) and one canal (50.4%). The most common canal configuration was Vertucci type I (47.1%). The majority of maxillary first molars had three roots (98.9%), 48.7% of which had three canals, and 46.4% had four canals. The most prevalent feature of the canal morphology of mesiobuccal roots was Vertucci type II (35.3%). The investigated maxillary second molars had three roots, 88.0% of which had three canals.

CONCLUSION

This systematic review represents the Saudi population since samples were combined from different studies from different regions of the country. Variations in findings were observed in the same group of teeth from different regions and the same region, while the overall combined samples results fell within the range of other international studies.

The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

Background: Severe coronavirus disease 2019 (COVID-19) can boost the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. In COVID-19 patients, the use of inhaled corticosteroids (ICS) is surrounded by controversy regarding their impacts on viral infections. This study aims to evaluate the safety and efficacy of ICS in critically ill patients with COVID-19 and its clinical outcomes. Method: A multicenter, noninterventional, cohort study for critically ill patients with COVID-19 who received ICS. All patients aged ≥ 18 years old with confirmed COVID-19 and admitted to intensive care units (ICUs) between March 1, 2020 and March 31, 2021 were screened. Eligible patients were classified into two groups based on the use of ICS ± long-acting beta-agonists (LABA) during ICU stay. Propensity score (PS)-matched was used based on patient's Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, systemic corticosteroids use, and acute kidney injury (AKI) within 24 h of ICU admission. We considered a P-value of < 0.05 statistically significant. Results: A total of 954 patients were eligible; 130 patients were included after PS matching (1:1 ratio). The 30-day mortality (hazard ratio [HR] [95% confidence interval [CI]]: 0.53 [0.31, 0.93], P-value = 0.03) was statistically significant lower in patients who received ICS. Conversely, the in-hospital mortality, ventilator-free days (VFDs), ICU length of stay (LOS), and hospital LOS were not statistically significant between the two groups. Conclusion: The use of ICS ± LABA in COVID-19 patients may have survival benefits at 30 days. However, it was not associated with in-hospital mortality benefits nor VFDs.

Internship preparedness among students in healthcare-related fields in the COVID-19 era: Exploring the attitude and knowledge in Saudi Arabia

Background: In the COVID-19 era, efforts are being made to increase awareness among students and enhance best practices to mitigate the outbreak. To that end, the overarching aims of this study were to understand students’ attitude toward and knowledge of COVID-19 and examine the predictors of their attitude toward hand hygiene.

Design and Methods: This cross-sectional survey study, conducted in Saudi Arabia, enrolled interns from diverse healthcarerelated fields. The questionnaire was divided into three sections: sociodemographic data, knowledge of COVID-19, and attitude toward hand hygiene. The data was expressed as median and interquartile range (IQR).

Results: In all, 371 responses were analyzed. The median knowledge score was 20, which was considered good. There were no statistically significant differences across age, hospital setting, or gender. Of the 254 respondents who had attended an educational session, 167 (65%) had a good knowledge score and 83 (33%) had a moderate score, compared with only four (2%) who had a poor score. The cumulative median score of the respondents’ attitudes was 6 (IQR [2]), which reflects a suboptimal attitude - only 38 (22%) reported a good attitude. The predicted effect of knowledge on attitude (good/suboptimal) was statistically significant (p=0.02) using univariate logistic regression.

Conclusions: The results suggest a strong need to encourage the current training program that targets hand hygiene practices among students in healthcare-related fields, especially prior to the internship year.

Competency differences in ECG interpretations between medical students, interns, and family residents

Background

The 12-lead electrocardiogram (ECG) is an indispensable screening and diagnostic tool used to identify cardiovascular abnormalities as well as fatal cardiac emergencies. Our aim was to identify whether a competency difference in interpreting ECG strips between medical students, interns, and family residents exists.

Methods

A cross-sectional, single-center study conducted at tertiary health care facility and its academic institution. Participants were given a self-administered questionnaire which consisted of a demographic sheet and 10-ECGs each with 9 multiple choice questions about the basic ECG parameters. Correct answer was given a 1-point score, with the minimum and maximum scores being 0 and 90, respectively.

Results

The total participants were 93; 54 (58.1%) medical students, 27 (29.0%) interns, and 12 (12.9%) family Medicine residents. Medical students had a statistically significant higher mean score 84.7±9.5 when compared to the medical interns 73.4±12.9 (p&lt;0.001) and family medicine residents 58.2±18.0 (p&lt;0.001). There were no differences in the mean scores between male and female medical students and interns. However, female family medicine residents had a higher mean score when compared to their male colleagues (p-value=0.04). Medical students performed better in detection of more than 65% of all ECG parameters when compared to the interns and residents. Fifty-seven (61.3%) reported that ECGs exposure during their medical program was not sufficient. Lectures were reported as the most effective modality of ECG teaching among 38 medical students (70.4%) and 9 residents (75.0%). However, 9 medical interns reported self-teaching (33.3%) as effective as standard lectures (33.3%) in teaching ECG.

Conclusion

Among our study cohort, medical students had higher ECGs-related skills, interpretation skill and more reading competency than medical interns and family residents. Most used method of learning ECG in all levels was lectures. Although Study generalizability is limited, refining ECG reading skills is required.

Funding Acknowledgement

Type of funding source: None