Diabetes-related lower limb wounds: Antibiotic susceptibility pattern and biofilm formation

The expeditious incidence of diabetes mellitus in Riyadh, Saudi Arabia, there is a significant increase in the total number of people with diabetic foot ulcers. For diabetic lower limb wound infections (DLWs) to be effectively treated, information on the prevalence of bacteria that cause in this region as well as their patterns of antibiotic resistance is significant. Growing evidence indicates that biofilm formers are present in chronic DFU and that these biofilm formers promote the emergence of multi-drug antibiotic resistant (MDR) strains and therapeutic rejection. The current study targeted to isolate bacteria from wounds caused by diabetes specifically at hospitals in Riyadh and assess the bacterium's resistance to antibiotics and propensity to develop biofilms. Totally 63 pathogenic microbes were identified from 70 patients suffering from DFU. Sixteen (25.4%) of the 63 bacterial strains were gram-positive, and 47 (74.6%) were gram-negative. Most of the gram-negative bacteria were resistant to tigecycline, nitrofurantoin, ampicillin, amoxicillin, cefalotin, and cefoxitin. Several gram-negative bacteria are susceptible to piperacillin, meropenem, amikacin, gentamicin, imipenem, ciprofloxacin, and trimethoprim. The most significant antibiotic that demonstrated 100% susceptibility to all pathogens was meropenem. Serratia marcescens and Staphylococcus aureus were shown to have significant biofilm formers. MDR bacterial strains comprised about 87.5% of the biofilm former strains. To the best of our knowledge, Riyadh, Saudi Arabia is the first region where Serratia marcescens was the most common bacteria from DFU infections. Our research findings would deliver information on evidence-based alternative strategies to develop effective treatment approaches for DFU treatment.

The epidemiological and clinicopathological features of breast cancer in Riyadh, Saudi Arabia

OBJECTIVES

To investigate the epidemiological and clinicopathological features of breast cancer (BC) in Saudi Arabia to improve decisions regarding resource allocation, disease control, and management.

METHODS

We retrieved the records of all patients who presented with histologically proven BC at King Fahad Medical City between 2019 and 2020. The data were analyzed quantitatively, and the results were expressed as percentages and frequencies.

RESULTS

This study comprised 419 patients. The mean age was 50.13 (± 10.96) years. The majority of the patients were obese (56.6%), and approximately a quarter had a history of oral contraceptive pill use, breast biopsy, or an affected family member. Most cases were from the central region (80.1%), followed by the southern provinces (12.7%). Breast lumps were the most common complaint (89%), whereas hypertension and diabetes mellitus were the most common comorbidities. Invasive ductal carcinoma was the most common pathologic type (89.7%). Most patients presented with TNM stages II and III (55.2%), and 27.7% had metastasis. The main therapeutic modalities included radical mastectomy (63.8%), neoadjuvant chemotherapy (60.4%), and adjuvant radiotherapy (82.9%).

CONCLUSION

In Saudi Arabia, a trend of BC incidence migration towards older patients may be ensuing. However, prediction of an advanced and aggressive presentation requires the enhancement of screening programs and standardized protocols for disease management.

Knowledge, Attitude, and Practice on Diabetic Retinopathy among Final-Year Medical Students in Riyadh

Introduction

This study aimed to evaluate the awareness, knowledge, and attitude on diabetic retinopathy of final-year medical students and the association of knowledge, attitude, and practice with the gender of medical students.

Methods

A descriptive cross-sectional study was conducted at the College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. The initial part of the questionnaire included demographic details, while the remaining parts of the questionnaire included six questions on knowledge, four on attitude, and three on practice. IBM SPSS Statistics 24 was used to retrieve and analyze data from an Excel file. A P value <0.05 was considered as statistically significant.

Results

Of 84 medical students, 51 (60.71%) and 33 (39.19%) were male and female medical students, respectively. The total knowledge score for male and female medical students was 4.28 (SD = 0.92). The majority of students correctly answered practice questions, indicating good significant practice toward diabetic retinopathy among diabetic patients with A score of 1.93 (SD = 0.83).

Conclusion

The majority of final-year medical students were good in knowledge and practice toward prevention and treatment of diabetic retinopathy, which helps them become better future care providers for patients with diabetes and diabetic retinopathy.

Prevalence of depression among Science students during the COVID-19 pandemic period in Riyadh, Saudi Arabia

Introduction

The present study aimed to examine the prevalence of depression among science students during the COVID-19 pandemic.

Methods

A survey-based study was conducted on 521 science students at Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia, using Beck's Depression Inventory (BDI), during the course of the semester.

Results

Showed that the Most students were female (62.19%). Sadness symptoms were observed among 59.69% of the students. We found a 77.74% overall prevalence of depression among students. Most individuals reported moderate BDI (25.34%), but extremely severe BDI was also reported in 7.29% of individuals. The BDI scores were highly significantly correlated with gender, education, and field of specialty (< 0.001) based on different statistical tests. BDI scores were significantly associated with number of the demographic and academic variables (p < 0.05).

Discussion

The study found significant symptoms of depression among students who displayed characteristics of depression during the COVID-19 pandemic. Therefore, students should undergo psychological counseling during difficult pandemic periods to prevent depression and mental stress.

Prevalence and Genetic Diversity of Cross-Assembly Phages in Wastewater Treatment Plants in Riyadh, Saudi Arabia

The most common DNA virus found in wastewaters globally is the cross-assembly phage (crAssphage). King Saud University wastewater treatment plant (KSU-WWTP); Manfoha wastewater treatment plant (MN-WWTP); and the Embassy wastewater treatment plant (EMB-WWTP) in Riyadh, Saudi Arabia were selected, and 36 untreated sewage water samples during the year 2022 were used in the current study. The meteorological impact on crAssphage prevalence was investigated. CrAssphage prevalence was recorded using PCR and Sanger sequencing. The molecular diversity of crAssphage sequences was studied for viral gene segments from the major capsid protein (MCP) and membrane protein containing the peptidoglycan-binding domain (MP-PBD). KSU-WWTP and EMB-WWTP showed a higher prevalence of crAssphage (83.3%) than MN-WWTP (75%). Phylogenetic analysis of MCP and MP-PBD segments depicted a close relationship to the Japanese isolates. The MCP gene from the current study's isolate WW/2M/SA/2022 depicted zero evolutionary divergence from 3057_98020, 2683_104905, and 4238_99953 isolates (d = 0.000) from Japan. A significant influence of temporal variations on the prevalence of crAssphage was detected in the three WWTPs. CrAssphage displayed the highest prevalence at high temperatures (33-44 °C), low relative humidity (6-14%), and moderate wind speed (16-21 Km/h). The findings provided pioneering insights into crAssphage prevalence and its genetic diversity in WWTPs in Riyadh, Saudi Arabia.

Impact of Vitamin D Deficiency on Mental Health in University Students: A Cross-Sectional Study

Students pursuing a university education are vulnerable to psychological burdens such as depression, anxiety, and stress. The frequency of vitamin D deficiency, on the other hand, is extensively recognized worldwide, and vitamin D regulates various neurological pathways in the brain that control psychological function. Therefore, the goal of this cross-sectional study was to determine the relationship between vitamin D deficiency and psychological burden among university students in Riyadh, Saudi Arabia. During March-May 2021 in Riyadh, a cross-sectional comparative study survey was delivered to university students. The DASS-21 scale was used to determine the severity of the psychological burden. Both univariate and binomial regression analyses were conducted to analyze the level of significance and influence of several factors on the development of psychological burden. The data were analyzed with SPSS-IBM, and a p value of <0.05 was considered significant. Of the 480 students recruited for the study, 287 (59.79%) had a vitamin D deficiency. Significantly (p = 0.048), a high proportion of the vitamin D-deficient students attained a low or moderate GPA compared to the control cohort. The prevalence of depression, anxiety, and stress among the vitamin D-deficient students was 60.35%, 6.31%, and 75.08%, respectively, which was significantly (p < 0.05) different from the control group. The odds of developing depression (OR = 4.96; CI 2.22-6.78; p < 0.001), anxiety (OR = 3.87; CI 2.55-6.59; p < 0.001), and stress (OR = 4.77; CI 3.21-9.33; p < 0.001) were significantly higher in the vitamin D-deficient group. The research shows a strong association between psychological stress and vitamin D deficiency. To promote the mental health and psychological wellbeing of university students, it is critical to create awareness about the adequate consumption of vitamin D. Additionally, university students should be made aware of the likelihood of a loss in academic achievement owing to vitamin D deficiency, as well as the cascade effect of psychological burden.

A retrospective review of Mohs micrographic surgery trends over more than 10 years in Saudi Arabia

OBJECTIVES

To review Mohs micrographic surgery (MMS) trends in Saudi Arabia.Mohs micrographic surgery is a precise surgical technique that has been proven to have the highest cure rate with maximum normal tissue preservation. It is the treatment of choice for non-melanoma skin cancer (NMSC), especially the aggressive histopathological forms, and tumors located in high-risk regions or where tissue preservation is a mandate.

METHODS

A multicentric retrospective study was performed on patients who underwent MMS between January 2010 and September 2022. The information was extracted from the database of King Saud University Medical City and Prince Sultan Military Medical City in Saudi Arabia.

RESULTS

A total of 70 participants were enrolled in this study. Two-thirds (67%) of the tumors that were treated using MMS were basal-cell carcinomas (BCC), 18.6% were squamous cell carcinomas (SCC), 5.7% were sebaceous carcinoma, 4.3% were dermatofibrosarcoma protuberans (DFSP), and 1.4% were rare tumors such as primary mucinous carcinoma. The most common type of reconstruction used to repair post-MMS defect was primary closure in more than half of the patients followed by secondary intention healing (20%). There were no side effects apart from a hematoma in one patient and wound infection in two patients.

CONCLUSION

Although MMS is still generally underutilized in Saudi Arabia, its use has increased in the last decade.

Characteristics of out-of-hospital cardiac arrest patients in Riyadh province, Saudi Arabia: a cross-sectional study

Introduction

Little work has been done on out-of-hospital cardiac arrest (OHCA) in Saudi Arabia. Our goal is to report the characteristics of OHCA patients and predictors of bystander cardiopulmonary resuscitation (CPR).

Materials and methods

This cross-sectional study utilized data from the Saudi Red Crescent Authority (SRCA), a governmental emergency medical service (EMS). A standardized data collection form based on the "Utstein-style" guidelines was developed. Data were retrieved from the electronic patient care reports that SRCA providers fill out for every case. OHCA cases that were attended by SRCA in Riyadh province between June 1st, 2020 and May 31st, 2021 were included. Multivariate regression analysis was performed to assess independent predictors of bystander CPR.

Results

A total of 1,023 OHCA cases were included. The mean age was 57.2 (±22.6). 95.7% (979/1,023) of cases were adults and 65.2% (667/1,023) were males. Home was the most common location of OHCA [784/1,011 (77.5%)]. The initial recorded rhythm was shockable in 131/742 (17.7%). The EMS mean response time was 15.9 min (±11.1). Bystander CPR was performed in 130/1,023 (12.7%) and was more commonly performed in children as compared to adults [12/44 (27.3%) vs. 118/979 (12.1%), p = 0.003]. Independent predictors of bystander CPR were being a child (OR = 3.26, 95% CI [1.21-8.82], p = 0.02) and having OHCA in a healthcare institution (OR = 6.35, 95% CI [2.15-18.72], p = 0.001).

Conclusion

Our study reported the characteristics of OHCA cases in Saudi Arabia using EMS data. We observed young age at presentation, low rates of bystander CPR, and long response time. These characteristics are distinctly different from other countries and call for urgent attention to OHCA care in Saudi Arabia. Lastly, being a child and having OHCA in a healthcare institution were found to be independent predictors of bystander CPR.

Scrotal pain as a novel symptom of multisystem inflammatory syndrome in children (MIS-C): Report from Riyadh, Saudi Arabia

A previously healthy child, presented with severe abdominal and scrotal pain with scrotal swelling for five days. There was associated fever, vomiting, and diarrhea. There was history of COVID-19 infection in the previous month. The patient was febrile (39°C), and in pain. His other vitals were unremarkable. Testicular torsion and appendicitis were ruled out by ultrasound. Abdominal CT scan showed signs indicating terminal ileitis. His MIS-C panel revealed elevated inflammatory markers and cardiac enzymes and positive SARS-CoV-2 IgG levels. All cultures and RT-PCR COVID-19 were negative. Echocardiogram showed only minor mitral and tricuspid regurgitation. The patient was diagnosed as a case of MIS-C. and recovered completely on management. Our patient showed an inexplicable previously unreported complaint of scrotal pain and swelling as a symptom of MIS-c. Further research tackling MIS-C's different presentations and comparing the efficacy of the different treatment methods will help us better manage this disease.

Prevalence of sleep problems and habits among children in Saudi Arabia: A cross-sectional study

OBJECTIVES

To investigate children's sleep problems, habits, and lifestyle changes.

METHODS

A cross-sectional study was carried out in Riyadh, Saudi Arabia, over a period of 2 months, from August through September 2022, with parents of children aged 2-14 years after reviewing the literature and formulating a validated Google questionnaire containing 30 questions related to sleep habits, problems, and disorders.

RESULTS

In total, 585 questionnaires were included in the analysis. The sample comprised 345 (59%) males and 240 (41%) females. The mean age of patients was 7 (range: 2-14) years. Bed-time resistance was the most prevalent sleep problem (70.3%), followed by sleep-onset delay (58.1%), difficulty waking up in the morning on weekdays (41.3%), weekends (38%), and interrupted sleep (31%). An alarmingly high prevalence of hyperactivity (41.8%) and aggressive behaviour (42.2%) was noted. Co-sleeping with parents was reported in 41% of children. Night terror was reported in 20.6% and 26.5% in nightmares. Statistically significant associations were noted between screen time, snoring, and witnessed apnoea with sleep problems.

CONCLUSION

Sleep problems are common among children in Saudi Arabia. The study sheds some light on sleep habits and practices in this age group in Saudi Arabia, such as the high prevalence of bed-time resistance and sleep-onset delay, hyperactivity, and sleep-affecting culprits such as screen time, snoring, and witnessed apnoea.

Effect of Varicocelectomy on Serum Follicle-Stimulating Hormone and Testosterone; The Interrelationship Between Hormonal Variables

Purpose

The present study was conducted to analyze the effect of varicocelectomy on serum follicle-stimulating hormone (FSH) and testosterone. The interrelationship between seminal and hormonal variables is also investigated.

Patients and Methods

A prospective cohort study was conducted on patients of the urology clinic from 2012 to 2017. The study was conducted in the Security Forces Hospital, in Riyadh, Saudi Arabia. Infertile patients who had already undergone the FSH examination and testosterone twice were included in the study. Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the data.

Results

A total of 186 patients were studied which reveals that the age group of 21-30 years was higher than other age groups 80 (43%), micro varicocelectomy was performed in 138 (74%) of patients and 79 (47%) patients had one-year infertility. The study assessed the effect of varicocelectomy on sperm count and motility serum FSH, testosterone, luteinizing hormone (LH), and prolactin, and it was found that none of the variables showed significant association after varicocelectomy, except for luteinizing hormone (P-value = 0.014). Testosterone levels in patients who had FSH ≤10 were also evaluated and it was found that the level of testosterone was increased with a decreased level of FSH (P-value = 0.005).

Conclusion

It was concluded from our results that after varicocelectomy, those patients who had FSH levels ≤10 were found to have increased testosterone levels. LH was also found to be significant; however, other hormones were not found to be significant. This may occur due to the reason that we have the majority of the participants in the age group 21-30. Further prospective studies are needed to evaluate the association with ample sample size.

Work-related musculoskeletal disorders among information technology professionals in Riyadh, Saudi Arabia

BACKGROUND

This study was done to see the prevalence of work-related musculoskeletal disorders among information technology (IT) professionals in Saudi Arabia, the risk factors associated with them, their consequences, and to propose some preventive measures.

MATERIAL AND METHODS

A self-administered online questionnaire that included questions on the demographic data, job nature, medical history, work-related pain after joining information technology profession and distribution and severity of pain was sent to 250 information technology professionals working in Saudi Arabia.

RESULTS

Out of 250, 202 (81%) IT professionals participated in the study. At least 62 (32%) reported that they have developed some type of musculoskeletal pain after joining their profession and 38 (61%) respondents further reported that it was so severe that they had to seek some sort of treatment for their pain. On the Visual Analog Scale ranging 0-10, 14 (23%) respondents reported that their worst ever pain was >7. Despite lower representation 67% of the females reported to develop work-related pain.

CONCLUSIONS

Development of work-related musculoskeletal pain among information technology professionals has been shown to affect their activities of daily living. It may even force them to change their work setting or reduce working hours. Information technology sector has rapidly grown in Saudi Arabia in the recent times and there is no data on the incidence or prevalence of such disorders among them. Role of ergonomics and counseling should be emphasized during their training that help them work effectively and efficiently. A similar large-scale study should be conducted to see the effect of lifestyle related to COVID-19 on the lives of working population especially IT professionals. Med Pr. 2022;73(5):397-406.

ON-1 and BA-IX Are the Dominant Sub-Genotypes of Human Orthopneumovirus A&B in Riyadh, Saudi Arabia

Human orthopneumovirus (HOPV) is the major viral pathogen responsible for lower respiratory tract infections (LRTIs) in infants and young children in Riyadh, Saudi Arabia. Yet, predominant HOPV subtypes circulating in this region and their molecular and epidemiological characteristics are not fully ascertained. A total of 300 clinical samples involving nasopharyngeal aspirates (NPAs), throat swabs, and sputum were collected during winter seasons of 2019/2020 and 2021/2022 for HOPV subtyping and genotyping. Of the 300 samples, HOPV was identified in 55 samples (18.3%) with a distinct predominance of type A viruses (81.8%) compared to type B viruses (18.2%). Importantly, the ON1 strain of HOPV-A and BA-IX strain of HOPV-B groups were found to be responsible for all the infections. Sequence analysis revealed a duplication region within 2nd HVR of G protein gene of ON1 and BA-IX strains. This nucleotide duplication exerted a profound effect on protein length and affinity towards cell receptors. Further, these modifications may aid the HOPV in immune evasion and recurrent infections. Data from this study showed that ON-1 genotype of HOPV-A and BA-IX genotype of HOPV-B were dominant in Riyadh, Saudi Arabia. Further, a duplication of sequence within 2nd HVR of G protein gene was found.

Awareness of Pet Owners in Riyadh Regarding Pet-Related Health Risks and Their Associated Preventative Measures

Objectives: This study aims to determine the sociodemographic characteristics of pet owners and their sources of information regarding pet-related health risks. It also assesses pet owners' perception of pet-related health risks and evaluates their attitudes and practices regarding preventative measures toward pet-related health risks. Methods: A cross-sectional study was conducted in Riyadh, Saudi Arabia from September 2020 to February 2021. The target population was pet owners visiting pet stores. The city was divided into five equal sectors and data were collected from each sector using a questionnaire. Results: A total of 508 participants were engaged in the study. Of these, 402 participants fit the inclusion criteria. The mean age of the participants was 25.5 years. Gender was almost equally distributed, and the majority of participants were single, however most of the participants lived with four or more family members. Around 49.5% of participants had household members at a higher risk for pet-related diseases. The most common pet types were cats (77.4%), followed by birds (24.6%) and dogs (9.7%). Most participants were satisfied with their understanding of pet-related health risks and were not concerned about getting sick because of contact with pets. Physical harm was the most common pet-related health risk that the participants were satisfied with their level of understanding about, on the other hand their satisfaction with their understanding about gastrointestinal infections from pet contact was the lowest. Most participants had good pet husbandry and hygiene practices. Social media and veterinarians were the most common sources of information regarding pet-related health risks. Conclusion: Although most pet owners reported having good pet husbandry practices, further education is needed to raise awareness about pet-related health risks. Since most pet owners receive their information about this topic from social media and veterinarians, further education through these platforms might be beneficial.

Fatigue, Depression, and Anxiety Among Ambulating Multiple Sclerosis Patients

Background

Multiple sclerosis (MS) is an inflammatory disease associated with adverse effects: including depression, anxiety, fatigue, which may affect physical activity and the quality of life (QoL) among patients with MS (pwMS).

Objective

This study aims to assess the prevalence of depression, anxiety, and fatigue among pwMS who have no physical disability in Saudi Arabia, and demonstrate any correlation between these factors and physical activity as well as the QoL.

Methods

A cross-sectional study was conducted in the Neuroimmunology outpatient clinics in King Fahad Medical City (KFMC) and King Saud University Medical City (KSUMC) in Riyadh City, KSA. The Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels. The HADS scores were then categorized into three levels according to the total points: normal (0–7 points), borderline (7–10 points), and anxiety/depression (11 – 21 points). The Arabic version of the Fatigue Severity Scale (FSS) was used to measure fatigue (cut-off point ≥5). The physical activity was measured by the Arabic version of the short form of the International Physical Activity Questionnaire (IPAQ), which measure time spent walking, moderate- and vigorous-intensity physical activity of at least 10 minutes duration. The QoL was also measured by the Arabic version of the EuroQOL five-dimensional (EQ-5D-3L) instrument (i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression).

Results

A total of 323 pwMS participated in this study, 83 had scores that indicated anxiety (25.7%) and 44 had depression (13.6%). The majority of patients had scores with the normal range of depression and anxiety (70% and 57% respectively). The mean of EuroQol Group visual analogue scale (EQ-VAS) score was 80.43 (SD=19.8). 156 (48.3%) out of 323 pwMS reported fatigue while the remainder had no fatigue (n=167, 51.7%). The results indicate that only 143 patients (44.3%) had participated in vigorous physical activity during the last 70 days, with a median of 3 days per week (IQR= 5–3) and a median of 60 minutes per day 0 (Interquartile range: IQR = 60–30). Only 149 patients (49.2%) had patricpated in moderate physical activities during the previous week with a median of 3 days per week (IQR = 5–3) and a median of 40 minutes per day (IQR = 60–30). 194 patients had participated in walking activities (60.0%) with a median of 5 days per week (IQR = 7–3) and a median of 45 minutes per day (IQR = 60–30). The results revealed that fatigue was positively correlated with depression (r = 0.407, p-value < 0.001) and anxiety (r = 0.289, p-value < 0.001).

Conclusion

The current study shows depression, anxiety, and fatigue tend to be correlated and clustered together among pwMS in our cohort. However, fatigue is not associated with the intensity of physical activity undertaken. The results of this study are important for the improvement of the clinical management of MS patients.

Vitamin D and iron deficiencies among Saudi children and adolescents: A persistent problem in the 21st century

BACKGROUND

Although several studies have reported on the prevalence of micronutrients in Saudi Arabia, most frequently vitamin D and iron, they are either old or hospital- or primary health care center-based. The objectives of our study were to provide more updated data on the prevalence rate of micronutrients deficiency among the Saudi general pediatric population and to determine if there is an association between micronutrients deficiency and undernutrition.

METHODS

The present study is part of a cross-sectional mass screening study, "Exploring the Iceberg of Celiacs in Saudi Arabia" conducted among school-aged children (6-16 years) in 2014-2015. A sample of 7,931 children aged 6-16 years was randomly selected. We identified thin children [body mass index (BMI) z-score <-2 SD, for age and gender], using the WHO reference 2007. A case-control study was performed, where the sera of 182 thin children (cases) and 393 normal BMI children (controls) were tested for levels of iron, ferritin, vitamin D, zinc, selenium, and copper.

RESULTS

The prevalence of thinness was 3.5%. The two most common micronutrients deficient among Saudi children with normal BMI were iron (20%) and vitamin D (78%). Vitamin D levels were significantly higher among boys as compared to girls (39.6 nmol/L vs. 31.15 nmol/L; P < 0.001). Deficiency of copper, zinc, and selenium occurred in 0.25%, 1%, and 7.4% of the children with normal BMI. Comparisons between the cases and controls did not show statistically significant differences.

CONCLUSION

Vitamin D and iron deficiencies are still common forms of malnutrition in the Saudi community, that have remained unchanged over the past 20-30 years, while the intake of trace elements (zinc, copper, and selenium) is adequate as evident by normal serum levels in the vast majority of the investigated children. We could not observe a correlation between undernutrition and micronutrient deficiencies.

Emergency Medicine Personnel's Preparation, Performance and Perception of Their Night Shifts: A Cross-Sectional Study from Saudi Arabia

PURPOSE

This study aimed to investigate the perceptions and habits of different emergency department (ED) workers (nurses, residents, and attending physicians) and their pre- or post-shift routines. The study also examined the effect of night shifts on personal life, social life, and health.

PATIENTS AND METHODS

An anonymous, online, cross-sectional, multiple-choice, self-rating (5-point Likert scale) survey was administered to the participants. All analyses were performed using the SPSS version 22.0. Ethical approval was obtained from the Institutional Review Board (IRB) of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia.

RESULTS

Thirty-three nurses, 51 residents, and 39 attending physicians participated in the survey (response rates of 21%, 100%, and 100%, respectively). A significant difference was noted in the need to use physical sleeping aids between the three groups (P < 0.003), with more nurses using humidifiers as a sleeping aid (21.2%) than residents or attending physicians. However, there was no difference in the use of pharmacological aids between the three groups. All groups utilized coffee as the preferred stimulant, especially residents (76.5%, P <0.032). Nurses and attending physicians wake up 2 hours before their shift, while residents prefer 3 hours (P <0.001). Attending physicians reported the highest accident rates post-night shifts of 17.9% (P < 0.001). Residents reported satisfaction while working night shifts and were least in agreement with night shifts reducing life span. Attending physicians were more in agreement with the increasing risk of drug/alcohol misuse and the incidence of depression in relation to night shifts.

CONCLUSION

Participants shared many commonalities, yet residents were less likely to use sleeping aids and enjoy night shifts more than the other groups. All groups consumed coffee for stimulation. Attending physicians reported the highest accident rates post night shifts.

Air Quality of Work, Residential, and Traffic Areas during the COVID-19 Lockdown with Insights to Improve Air Quality

This study investigated the concentrations of air pollutants (NO, NO₂, NO_x, SO₂, CO, O₃, PM₁₀, and PM_2.5) at three sites with different traffic loads (work, residential, and traffic sites) before, during, and after the COVID-19 lockdown. The main objective of this study was to evaluate the effects and associated potential pollution control implications of the lockdown on the quality of ambient air at three selected sites in the urban area of Riyadh City. The average concentrations of NO, NO₂, NO_x, and CO decreased during the lockdown period by 73%, 44%, 53%, and 32% at the work site; 222%, 85%, 100%, and 60% at the residential site; and 133%, 60%, 101%, and 103% at the traffic site relative to the pre-lockdown period, respectively. The average concentration of O₃ increased by 6% at the work site, whereas the concentration of SO₂ increased by 27% at the residential site and decreased by 6.5% at the work site. The changes in PM₁₀ and PM_2.5 varied and did not exhibit a clear pattern. The air quality index (AQI) results indicated that the contribution to "undesired" air quality by O₃ was 35.29% of the lockdown period at the work site while contributions to undesired air quality by PM₁₀ and PM_2.5 were 75.6% and 100% at the work site, 94.5% and 100% at the residential site, and 96.7% and 100% at the traffic site, respectively. The findings of this study are useful for devising effective urban pollution abatement policies. Applying control measures comparable to the lockdown measures over one week will result in a decrease of approximately 19% and 15% in CO mean concentration and 25% and 18% in NO₂ mean concentration at residential and traffic sites, respectively.

Prevalence and socioeconomic correlates of growth impairment among Saudi children and adolescents

BACKGROUND

Saudi Arabia has witnessed economic prosperity leading to changes in diet and lifestyle. Concurrent with these changes, the prevalence rates of overweight and obesity are rising. No recent data exist on the trends and pattern of growth impairment among Saudi children. We aimed to provide the most recent estimate of the prevalence of thinness and short stature among healthy school-aged children in Riyadh, Saudi Arabia, and to investigate the effect of parental socioeconomic status (SES) on growth impairment.

METHODS

A cross-sectional study was conducted in 2015 among schoolchildren in Riyadh. A sample of 7931 children (67% girls) aged 6-16 years was randomly selected. Body mass index (BMI) z-score <-2 SD and height z-score <-2 SD, for age and sex, using the WHO reference 2007, defined thinness and short stature, respectively. To assess the impact of SES on growth, we categorized SES into 4 levels by incorporating 4 main indicators: parents' educational level, family income, type of residence, and parents' jobs.

RESULTS

The prevalence of short stature was 15%, and the prevalence of thinness was 3.5%. Stratification of the thinness prevalence rate according to gender indicated that boys were significantly thinner than girls (4.7% versus 2.8%, P = 0.048). Short stature was significantly higher among children in the lower SES classes than among their counterparts in the higher SES classes. Parents of thin children were more likely to be less educated, have less income, live in apartments, and have a lower SES than parents of overweight and obese children.

CONCLUSIONS

The rate of thinness among Saudi children is low, similar to that in developed countries, and is significantly correlated with SES.

Vaccine hesitancy towards childhood immunizations as a predictor of mothers' intention to vaccinate their children against COVID-19 in Saudi Arabia

Background

Despite the success of childhood immunization in reducing vaccine-preventable diseases, vaccine hesitancy is now a global health threat to this achievement. The current COVID-19 pandemic may change the picture of vaccine hesitancy toward childhood immunizations, which could influence the mothers’ intention to vaccinate their children against COVID-19.

Aim

To measure the prevalence and related factors of vaccine hesitancy towards childhood immunization during the era of COVID-19 along with the prevalence of mothers’ intention to vaccinate their children the future COVID-19 and its association with childhood vaccine hesitancy.

Methods

Cross sectional study was conducted among 270 Saudi mothers attending outpatient clinics at King Abdullah University Hospital (KAAUH) in Riyadh by purposive sampling technique. Data were collected from January to February 2021 using SAGE Group standardized questionnaire.

Results

Although most mothers strongly agree on the importance of the vaccine (79%), almost one-fourth of mothers were hesitant towards childhood immunization (24.31%). Similar percentage of mothers’ intended to vaccinate their children against COVID-19 in the next 6 months was reported (24%). Vaccine hesitancy was found to be a significant predictor of mothers’ intention. Mothers’ education level was significantly associated with being hesitant towards childhood immunization as well as the intention to accept the future COVID-19 vaccine (p < 0.05). Main reason that was highly significantly associated with being hesitant is the concerns about the side effect (50%).

Conclusion

The present study reported a considerable percentage of mothers who are hesitant towards childhood immunization which predicts their intension to vaccinate towards COVID19 and is associated with the level of education.

Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia

This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required.

Translation, cultural adaptation, and evaluation of the psychometric properties of an Arabic diabetes distress scale: A cross sectional study from Saudi Arabia

Objectives:

To translate, validate, and adapt the diabetes distress scale (DDS)-17 to a Saudi Arabian (SA) DDS (SADDS-17). Also, to evaluate the psychometric properties of the newly adapted SADDS-17.

Methods:

This was a cross-sectional study evaluating the psychometric properties of the DDS. The DDS was translated using the forward-backward translation from English to Arabic at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in January 2016. Statistical analyses included exploratory factor analysis, internal consistency, testretest reliability, and construct validity. Moreover, contingent validity was evaluated using hospital anxiety and depression scale, visual analogue scale, and the World Health Organization quality of life assessment instrument.

Results:

A total of 109 participants were included in this study. The exploratory factor analysis of our Arabic scale supported the original DDS with 4 sub-scales. Correlations ranged from 0.376 to 0.718 for items in regimen-related distress, 0.327 to 0.533 for items in emotional burden, 0.413 to 0.722 for items in physician-related distress, and 0.492 to 0.556 for items in interpersonal distress. The Cronbach’s alpha value of the SADDS was 0.848 for the total scale. The test-retest reliability value was 0.78.

Conclusion:

Our SADDS is a valid and reliable instrument for detecting diabetes distress among Saudi Arabian patients with type 2 diabetes.

First evidence of microplastics occurrence in mixed surface and treated wastewater from two major Saudi Arabian cities and assessment of their ecological risk

In this study, water of the channels and ponds that conduct residual water in two most important cities of Saudi Arabia were assessed to ascertain the influence of the population on the occurrence and pollution characteristics of microplastics (MPs) (> 20 µm in size). Riyadh has 7.6 million inhabitants and is an urban city even though also have industry while Al-Jubail has only 0.78 and is the biggest industrial city. MPs showed an average of 3.2 items/L in Riyadh and 0.2 items/L in Al-Jubail showing a statistically significant difference between both cities. Sampling with a Turton Tow Net of 20 µm mesh, fibers were dominant in all sites (60%). MPs size was mainly distributed between 80 and 250 µm (60%), and their major colors were white (40%), red (25%) and blue (20%). Infrared spectral analysis revealed that most of the selected particles were identified as MPs of polypropylene and polyethylene (48.3%). The risk assessment was carried out using both the hazard index (HI) and the pollution load index (PLI). The results showed that, in this case, the decisive index is the PLI since the main difference in the MPs characteristics between the two cities is their concentration.

Antimicrobial resistance patterns among different Escherichia coli isolates in the Kingdom of Saudi Arabia

Antimicrobial resistance patterns among different Escherichia coli isolates in the Kingdom of Saudi Arabia. This study aimed to investigate the patterns of antimicrobial resistance in E. coli isolated from different samples, and to identify potential pathogenic isolates in Riyadh, Kingdom of Saudi Arabia (KSA). In total, 51 bacterial isolates were recovered from 113 samples of human urine, food (raw meat, raw chicken, raw egg surface, and fresh vegetables), water, and air. Twenty-four E. coli isolates were tested for susceptibility to 26 antibiotics. The air sample isolates were most resistant to amoxicillin, ampicillin, amoxicillin/clavulanic acid, amoxicillin/sulbactam, piperacillin/tazobactam, cefalotin, cefuroxime, cefoxitin, cefixime, nitrofurantoin, and trimethoprim/sulfamethoxazol. The isolates from vegetable samples were resistant to amoxicillin, ampicillin, amoxicillin/clavulanic acid, amoxicillin/sulbactam, cefalotin, cefuroxime, cefoxitin, and cefixime. By contrast, the isolates from the water samples were resistant only to amoxicillin and ampicillin. The isolates from the human urine samples were most frequently resistant to norfloxacin (80%) followed by amoxicillin and ampicillin (70%), trimethoprim/sulfamethoxazole (55%), ciprofloxacin and ofloxacin (50%), cefalotin (30%), cefuroxime, cefixime and cefotaxime (25%), ceftazidime, ceftriaxone, cefepime and aztreonam (20%), amoxicillin/clavulanic acid, piperacillin/tazobactam and gentamicin (10%), and amoxicillin/sulbactam and cefoxitin (5%). Almost all (23/25, 95.8%) (n = 23) of the isolates were multi-drug resistant (MDR) (i.e., resistant to 3 or more classes of antibiotics), and 16.7% (n = 4) of those were positive for extended spectrum β-lactamase (ESBL). Of the 4 ESBL-producers, 3 were positive for blaCTX-M-15 and blaCTX-M1group, 2 were positive for blaCMY-2, and 1 each was positive for blaCTX-M-2 group, blaSHV, and blaOXA-47. The quinolone resistance gene qnrS was detected in 25% (n = 6) of the E. coli strains isolated from urine (N = 5) and air (N = 1) samples. The considerable number of antimicrobial resistance genes detected among E. coli isolates tested here is alarming and should raise public health concern.

A reconnaissance study of pharmaceuticals, pesticides, perfluoroalkyl substances and organophosphorus flame retardants in the aquatic environment, wild plants and vegetables of two Saudi Arabia urban areas: Environmental and human health risk assessment

In this study, the occurrence of 12 organophosphorus flame retardants (OPFRs), 64 pesticides, 21 perfluoroalkyl substances (PFASs) and 34 pharmaceuticals and personal care products (PPCPs) in surface water, sediments and vegetation collected from seven locations along the South Riyadh and six locations along the Al-Jubail industrial city (Saudi Arabia) were reported. The median of the concentrations of ƩOPFRs, ƩPesticides, ƩPFASs and ƩPPCPs in water was 297, 231, 29.7 and 3794 ng L^-1, respectively, in sediments 56.2, 40.4, 5.66 and 419 ng g^-1 d.w., in crops for human consumption of 45.6, 42.0, 0.46 and 42.0 ng g^-1, in farm crops of 13.4, 57.5, 3.2 and 637 ng g^-1, and in natural vegetation of 51.7, 10.3, 1.88 and 1580 ng g^-1. Predominant compounds in all matrices were tris-(1,3-dichloro-2-propyl)phosphate (TClPP), acetamiprid, imidacloprid, caffeine, bisphenol A (BPA), diclofenac and ibuprofen. Tris(2-butoxyethyl) phosphate (TBEP), tris-(2-ethylhexyl)phosphate (TPhP), perfluoroctanoic acid (PFOA), perfluoroalkyl sulfonate (PFOS) and paracetamol were also in many samples but at low concentrations. The contaminants' levels showed similar values in both cities. However, pesticide levels were significantly higher in surface water (p < 0.05) and lower in natural vegetation (p < 0.05) of Riyadh than those of Al-Jubail. The risk assessment for the aquatic biota showed that abamectin, diazinon (pesticides), bisphenol A and caffeine (PPCPs) had the highest risk levels. The cumulative risk assessment showed that the contaminant mixture in all water samples is of concern. As far as the risk to human health is concerned, individual contaminants did not show a significant hazard for the population. However, OPFRs and pesticide requires a closed monitoring since % of admissible daily intakes (ADIs) or reference doses (RfD) are high. This is one of the most comprehensive study covering environmental and human risk assessment of emerging contaminants carried out in Saudi Arabia.

Metabolic syndrome awareness and attitudes among family medicine residents in Riyadh 2019-2020

CONTEXT

Metabolic syndrome (MS) is a group of metabolism diseases which includes over increase of the body weight, high insulin levels, elevated blood pressure, and abnormal level of cholesterol; these disorders may increase the risk of evolving coronary heart diseases. Primary health care physicians are responsible for caring for general patients and thus must have sufficient knowledge about MS, positive attitudes, and good medical practices.

AIMS

To evaluate the knowledge, attitudes, and practices of family medicine residents in Riyadh regarding the diagnosis, management, and preventive measures of MS.

METHODS AND MATERIAL

This study is a cross-sectional; it was conducted on family medicine residents in Riyadh using a survey to investigate the demographics, knowledge, attitudes, and practices of the residents regarding MS.

RESULTS

This study included 224 physicians, of whom 35.3% had a high level of knowledge, 63.8% had positive attitudes, and 50% had good practices. No factors were associated with knowledge level; conversely, male gender and training at the KFMC were significantly associated with attitude (P = 0.009 and 0.004, respectively), and training level R1 and R2 were significantly related to the level of practice (P = 0.013 and 0.015, respectively).

CONCLUSIONS

The family medicine residents reported a low knowledge level; however, more than half of them had positive attitudes and half had good practices.

Assessment of knowledge, attitude, and practice regarding Deep Margin Elevation (DME) among dental practitioners in Riyadh, Saudi Arabia

Objectives:

To evaluate Knowledge, Attitude, and Practice (KAP) regarding deep margin elevation (DME) among dental practitioners in Riyadh city.

Materials and Methodology:

A cross-sectional study that comprised a total number of 535 dental practitioners: 255 (47.7%) were males and 280 (52.3%) females. A self-constructed 21 close-ended self-administered questionnaire was utilized in the study. The data were entered and analyzed by Chi-square test and descriptive analysis using Statistical Package for the Social Sciences (SPSS) software.

Results:

Although the majority of the respondents have heard about DME, only 30.4% have utilized this technique in their clinical practice by having general practitioners and specialists utilize this technique more often than consultants. Among the participants, 65.4% of them have agreed that adhesion by bonding to deep cervical dentin is predictable and related to the success of the final restoration.

Conclusion:

The knowledge level of DME among the study participants was adequate. The findings of this study revealed that the total number of dentists who utilize the technique in restoring large subgingival defects of posterior teeth with proximal caries is very minimal. Thus, it is recommended that dental practitioners have this technique introduced in their dental clinics as an alternative to surgical crown lengthening. Although years of experience and dentist rank may influence the clinical decision, in-depth factorial analysis with a greater sample size is necessary.

Knowledge, attitude and practices of healthcare professionals of Riyadh, Saudi Arabia towards covid-19: A cross-sectional study

Background & objectives

COVID-19 is an emerging pandemic that necessitates the implementation of effective infection prevention and control steps. The knowledge, attitudes, and practices (KAP) of healthcare professionals toward COVID-19 affect their compliance to prevention and control initiatives. During the evolving pandemic, we examined the KAP among healthcare professionals against COVID-19 in this research.

Materials and methods

This was a cross-sectional study conducted among Riyadh region health care professionals from the beginning of December 2020 to the end of February 2021 using a validated self-administered questionnaire. The knowledge questionnaire contained questions about COVID-19 clinical characteristics, prevention, and management. The evaluation of attitudes and practices included questions regarding actions and adjustments in COVID-19 response activities. Knowledge scores were measured and compared using demographic characteristics, as well as attitudes and practices toward COVID-19. Using SPSS-IBM 25, bivariate statistics were done to analyze the data.

Results

146 healthcare professionals completed the survey. Physicians were the most prominent party in the survey, accounting for 74 (51 percent), followed by nurses 44 (30 percent) and pharmacists 28 (19 percent). The participants' average age was 39.69 ± 8.48 years. The participant's mean knowledge, attitude, and practice scores were 11.43 ± 1.34, 3.89 ± 0.93, and 3.85 ± 0.81, respectively. With a positive attitude, the mean knowledge score was 11.52, and with proper practice, it was 11.32. With an improvement in knowledge, the attitude score increased significantly (r = 0.172, P = 0.001). Besides, there was a greater association between attitudes and practices (r = 0.170, P = 0.029). A significant enhancement in the practice score of the professionals was noted with an increase in knowledge score (r = 0.095, P = 0.010), an indicator for a positive correlation between practice and knowledge scores.

Interpretation & conclusion

Healthcare practitioners have a good understanding of COVID-19. Improved knowledge and a positive attitude toward COVID-19 infection are linked to appropriate practice. There is a need for more manpower, better COVID-19 management training, and strategies to reduce anxiety among healthcare professionals.

Decomposition process for buried rat (Rattus norvegicus, Berkenhout 1769) carcasses in Riyadh city, Saudi Arabia: A preliminary study

The present report outlines the initial observations from an ongoing study examining the decomposition rate of buried rat (Rattus norvegicus, Berkenhout 1769) carcasses in Riyadh city, Saudi Arabia. Eight rat carcasses were buried in separate holes at depths of 20 and 40 cm (four holes per depth) to allow natural decomposition and examined at 10-day intervals up to 40 days. During the study period, environmental factors such as humidity, soil temperature, and air temperature were monitored at each depth on a daily basis. At the end of each burial period, one carcass from each depth was exhumed and the degree of decay and presence of insect activity were examined. The results showed that burial depth and temperature were major factors affecting the decomposition rate, whereas no insect activity was observed. The findings of this study can be used to more accurately estimate the time since burial of carcasses.

Postpartum prophylaxis of venous thromboembolism with anticoagulation: A case report

Although there is a remarkably high risk of venous thromboembolism (VTE) during pregnancy and postpartum, a cautious approach is needed while initiating therapeutic and prophylactic anticoagulant therapy. The merits of heparin for thromboprophylaxis in postpartum patients are exaggerated, and its risk is generally overlooked. This study aimed to report the inappropriate use of anticoagulants in postpartum patients. The patient in this report was a 31-year-old healthy woman who had had a normal spontaneous vaginal delivery and visited the hospital a 3-day history of small itchy blisters at the enoxaparin injection sites. An examination revealed class II obesity. The Naranjo Scale assessment showed the possibility of an enoxaparin-induced hypersensitivity reaction. The clinical care team decided to discontinue the heparin. A follow-up examination did not show any signs of VTE. Although many pregnant and postnatal women might need VTE prophylaxis, routine anticoagulation for such a population is not essential. Clinicians should weigh the risks versus benefits to avoid any adverse drug reactions that may occur with this class of medication.

Knowledge, awareness, and vaccination compliance of hepatitis B among medical students in Riyadh's governmental universities

Background:

Hepatitis B is a blood-borne infectious liver disease caused by the Hepatitis B Virus (HBV) and it is best prevented by immunization. Due to occupational exposure, medical students have an increased risk of contracting HBV. Therefore, it is essential for all medical students to have good knowledge about HBV and to complete their HBV vaccinations.

Aims:

The aim of this study was to assess and compare HBV knowledge, awareness, and vaccination compliance among pre-clinical medical students in four universities.

Settings and Design:

A cross-sectional study was conducted in September 2018 at the College of Medicine of four governmental universities: King Saud Bin Abdulaziz University for Health Sciences, King Saud University, Princess Noura university, and Imam Mohammed bin Saud Islamic University, in Riyadh, Saudi Arabia.

Methods and Materials:

Two-hundred-sixty-three pre-clinical medical students completed a questionnaire with sections about demographics, HBV awareness, knowledge, and vaccination compliance.

Statistical analysis used:

The data was transferred to Excel and SPSS version 22 was used for statistical analysis. A significance level of P < 0.05 was considered statistically significant.

Results:

The overall knowledge about HBV and vaccination compliance were poor. KSU students had the highest vaccination compliance (n = 52, 54.2%) and KSAU-HS the lowest (n = 19, 23,8%). The most-cited reasons for noncompliance were “forgetting about the vaccine” and “busy schedule“.

Conclusion:

Overall, most of the participants had poor HBV knowledge and vaccine compliance. Therefore, we recommend the implementation of pre-clinical vaccine checking and the addition of an infectious disease awareness and prevention program.

Level of awareness regarding stroke among Riyadh population

BACKGROUND

Stroke is known to be the second leading cause of death and persistent disability worldwide, with 5.5 million deaths each year. Public knowledge regarding risk factors, signs and symptoms and the prevention of stroke is an important factor in reducing the incidence of stroke.

OBJECTIVE

This study aimed to determine the level of awareness regarding stroke in Riyadh, Saudi Arabia.

METHODS

This study recruited 150 participants from primary health care (PHC) centres, based on the methodology of a similar cross-sectional study conducted in Riyadh. The study group included adult male and female PHC visitors and excluded visitors with mental illness and medical personnel. Systematic random sampling was used to select participants. Data were collected using a self-administered questionnaire and analysed using SPSS. Microsoft Excel was used to generate tables and charts. Consent was obtained before data collection, with emphasis on each participant's right to withdraw from the study at any time.

RESULT

A total of 150 respondents were included in this study. We found that the majority of the participants had a high level of awareness regarding the risk factors of stroke (n = 115, 76.66%). More than half of the participants (n = 95, 63.3%) had a moderate level of awareness of the signs and symptoms of stroke. The study also revealed that there was no statistically significant relationship between education level and level of awareness regarding risk factors of stroke (p = 0.334).

CONCLUSION

This study found that the majority of participants had a high level of awareness regarding stroke. Regarding the education level of the participants, we found that the majority of participants with primary school-level education had a high level of awareness regarding stroke risk factors. Furthermore, we found that the level of awareness about prevention of stroke was moderate among participants. Thus, further studies should explore how to improve levels of awareness regarding the prevention of stroke.

Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh

Background & objectives

Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh.

Materials and methods

This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25.

Results

Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior.

Interpretation & conclusion

In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

Knowledge and awareness of folic acid usage in Saudi pregnant women in Riyadh city from 2019-2020

BACKGROUND

Folic acid (FA) supplementation is an important intervention to avoid nutritional deficiencies during pregnancy and later on will have an effect on mother and fetus. Inadequate dietary intake will lead to nutritional deficiency which further requires to depend on supplementation. FA is one of the vital nutrients which is mandatory for improving pregnancy outcomes. Previous studies have documented the pregnant women who know about supplementation of FA but not consuming during pregnancy will lead to complications in their neonates. This study aimed to inspect the knowledge and awareness about supplementation of FA in Saudi pregnant women and to compare present study results with other prior studies carried out in the Saudi population.

METHODS

In this study, we have opted 406 Saudi pregnant women with the age range of 18-65 years of age through questionnaire-based research, was further assessed for FA supplementation usage during the pregnancy. Involved pregnant women have filled questionnaire and signed the consent form.

RESULTS

The results of this study showed 38% of women were pregnant during 31-40 years of the age range. Almost 96% of pregnant women have awareness about FA supplementation during pregnancies, and 5.9% of women had histories for not using FA supplementation and had abnormal offspring. The current study questionnaire survey confirms 55.7% of pregnant women have information about FA supplementations. Nearly 89% of women have used FA in their previous pregnancies.

CONCLUSION

Saudi pregnant women has good knowledge and awareness about the usage of FA supplementation during pregnancy. Limited efforts should be implemented national wide in all the hospitals and clinics to improve the awareness about maternal nutrition during pregnancy. Nutritional counselling should be conducted in remote areas to get a perception in Saudi Arabia.

Cefdinir associated bloody stool in Riyadh infant: A case report

Cefdinir is one of the broad spectrum cephalosporin used as a replacement to amoxicillin in allergic pediatric population. There are reports of forming red stool in patients receiving cefdinir along with iron or iron containing preparations. This is a benign interaction and wane upon completion/discontinuation of cefdinir therapy. This case report describes a 6-month-old boy whose parents were distressed when they found reddening of their ward's diaper while taking cefdinir in presence of iron supplements.

Relative Insect Frequency and Species Richness on Sun-Exposed and Shaded Rabbit Carrions

On rabbit carcasses (Oryctolagus cuniculus L.) exposed in open and shaded habitats, the relative abundance of insects and species richness were observed. The decomposition process was classified into four stages: fresh, bloated, decayed, and dry. Except for the decayed stage, the elapsed time for each stage of decomposition was similar between open and shaded habitats, with all carcasses reaching dryness in 13 and 14 d, respectively. In total, 2009 insects were collected during the decomposition process with 1,863 flies belonging to seven families and 15 species, and 146 beetles belonging to six species and three families. Insect abundances rose between the fresh and decay stages. The dominant families of insects included Calliphoridae and Muscidae (80.9% of the collected insects) and accounting for 38.07% of the species richness, whereas Histeridae accounted for 4.3% of the collected insects and 14.29% of the species richness. The open habitat attracted 1,233 insects belonging to 18 families, including 1,142 flies and 91 beetles, whereas the shaded habitat attracted 776 insects belonging to 18 families, including 721 flies and 55 beetles. Diversity level and ratios of exclusive species are also reported for each habitat (open 61.4%; shaded 38.6%). Between habitats, there were substantially separate insect communities, however. In addition, there was a substantial difference in the insect number and species between decomposition stages. This study demonstrates that the exposure status needs to be evaluated and examined when estimating the time since death.

Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh

Background:

Diabetic ketoacidosis (DKA) is considered to be a serious acute life-menacing complication of diabetes type (1) and type (2). The study aims to assess the level of awareness regarding DKA among diabetic patients in the Riyadh population.

Methodology:

The study is an institution-based cross-sectional study with a sample size of 150 participants. The participants are chosen through systemic random sampling, who have type (1) or type (2) diabetes mellitus patients and are 18–35 years of age. The medical personnel were excluded from the study. A self-administered, precoded, and pretested questionnaire was developed especially for this study after consulting literature and epidemiologists containing data about the risk factor, management, and complication. Data were analyzed using (SPSS). A P value of less than 0.05 was considered significant.

Results:

38.67% (58) participants have poor awareness regarding complications, 67.34% (101) have poor knowledge regarding management, and 6% (9) participants have a good knowledge, 38% (57) participants have poor knowledge regarding risk factors and 30% (45) of the participants have good awareness. The relation between having a first degree relative with diabetes and awareness regarding management is significant with a P value of 0.022; 73% (110) of the participants had no relatives with diabetes mellitus and 71% (79) had a poor level of awareness regarding the management of DKA. However, 55% (22) of respondents who had relatives with diabetes mellitus also had a poor level of awareness regarding treatment.

Conclusion:

The majority of the participants had a poor level of awareness. There is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA.

Comprehensive study for BRCA1 and BRCA2 entire coding regions in breast cancer

BACKGROUND

About 5-10% of incidences of breast cancers have been reported as a result of germline mutations of BRCA genes. However, the mutational spectrum of BRCA1 and BRCA2 genes among breast cancer Saudi women patients is inadequate at present. Therefore, the present study aimed to report the specific germinal mutation of BRCA1 and BRCA2 in the entire coding regions, to investigate the prevalence rate of BRCA1 & BRCA2 mutations among Saudi women and the effect of these mutations, both benign and malignant tumors.

METHODOLOGY

A total of 270 tissue samples of benign and malignant breast tumors were collected from Saudi women patients, Riyadh, Saudi Arabia. Examination of BRCA1 and BRCA2 germline mutations was performed using heteroduplex DNA analysis (HDA) or single-stranded conformation analysis (SSCA). 177 breast cancer women with malignant tumors and 93 with benign tumors were enrolled in the study. A total of 62 out of 177 breast cancer patients carried a BRCA1 or BRCA2 mutation (54 BRCA1 and 8 BRCA2). The analysis was done using the Sanger sequence assay.

RESULTS

Point and frameshift mutations through the entire coding area of the two genes indicated that all the mutations were germline alterations and of early-onset breast cancers. The mean ages of diagnosed breast cancer women for BRCA1 and BRCA2 mutation carriers were 36.3 (± 3.5) and 37.9 (± 3.7) years, whereas that of benign control was 35(± 2.5) years.

CONCLUSION

Point and frameshift mutations across the entire coding region of BRCA1 and BRCA2 are responsible for many breast cancers cases.

Food Selection Under Stress Among Undergraduate Students in Riyadh, Saudi Arabia

Background

University students might experience numerous sources of stress in their daily lives. Previous research has found that stress affects food selection patterns, but the effect might vary by country and sex. No previous study conducted in Saudi Arabia has assessed the association between stress and dietary habits among university students. Thus, this study aimed to examine the association between perceived stress and food selection patterns among undergraduate students by sex at King Saud University (KSU).

Methods

A cross-sectional study of 400 students attending the College of Applied Medical Sciences in Riyadh, Saudi Arabia, was conducted. The self-administered questionnaire that was used consisted of three sections: sociodemographic, food frequency questionnaire, and Cohen's Perceived Stress Scale.

Results

Approximately (59.0%) of the participants reported suffering from some level of stress, with more females (64.5%) experiencing stress than males (54.0%). The univariate analysis showed that under stress, more females (68.0%) reported eating more than usual than males (49.0%), while the percentage of respondents that reported eating less than usual was higher for females (23.0%) than that for males (31.0%). The McNemar test indicated that under stress, there was an increased preference for salty flavors, which was not associated with sex. Significantly more females (82.0%) than males (64.5%) reported preferring sweets under stress. More males reported preferring bitter and savory flavors than females. Under stress, females preferred homemade food, while males preferred takeout foods. More females (68.0%) reported losing control and overeating than males (49.0%). A logistic regression showed that for female students, perceived stress was associated with frequent consumption of sweets, cake/cookies, snacks and beverages and less frequent consumption of fruits and vegetables. For males, the consumption of fast food and meat was significantly positively associated with perceived stress.

Conclusion

Perceived stress led to unhealthy changes in eating patterns in both sexes, as evidenced by reports of an increased preference for sweets, snacks and cake/cookies among females and an increased preference for fast food and meat among males. These results may be potentially important targets for interventions for stress-related food consumption.

Parental levels of stress managing a child diagnosed with type 1 diabetes in Riyadh: a cross sectional study

BACKGROUND

Caring for a child with Type 1 Diabetes (T1D) pose a significant burden on parents especially when they struggle with their child's T1D management. The experience of not coping or struggling to cope increases the level of stress in parents, which may adversely affect their child's diabetic control (Al Dubayee et al, Horm Res Paediatr 88:2019). In this study, we assessed the level of stress parents experience in caring for a child diagnosed with T1D in four different domains.

METHODS

This was a cross-sectional study conducted in two specialized diabetic centers in Riyadh, Saudi Arabia, from February to May 2015 (Al Dubayee et al, Horm Res Paediatr 88:2019). We used an Arabic translation of the validated Pediatric Inventory for Parents (PIP) questionnaire. The frequency and perceived difficulty of stressful events were rated by interviewing parents caring for children with T1D using two 5-point Likert scales.

RESULTS

The sample realized as 390 parents. The level of stress increased in separated and unemployed parents. The frequency (mean 64.9/210, SD 7.529) and difficulty (mean 65.3/210, SD 9.448) indices of the parental level of stress were compared with variables possibly associated with stress. Both of the frequency difficulty indices correlated with the marital status, the father's level of education and occupation as well as HbA1c level (P-value < 0.05). In addition, the frequency index correlated with the frequency of hypoglycemia and the difficulty index correlated with the number of children in the family (P-value < 0.05).

CONCLUSION

Parents of children with T1D in Riyadh experience a significant level of stress that may affect the child's glycemic control (Al Dubayee et al, Horm Res Paediatr 88:2019). Assessing the level of stress and providing support for these families has the potential to improve the clinical outcome.

Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015

To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015-January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%-32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

Where are we today with Helicobacter pylori infection among healthy children in Saudi Arabia?

BACKGROUND/AIMS

The available studies on Helicobacter pylori (H. pylori) prevalence among healthy asymptomatic population across Saudi Arabia suffers from significant limitations. We conducted this large population-based study to estimate the H. pylori seropositivity rate among apparently healthy children in Saudi Arabia, using anti-H. pylori immunoglobulin A (IgA) and IgG serology tests, and to study the influence of H. pylori infection on growth.

MATERIALS AND METHODS

We conducted a cross-sectional study to screen apparently healthy school aged Saudi children (aged 6-15 years), attending primary and intermediate schools in Riyadh between 2014 and 2016, for H. pylori seropositivity by checking for the presence of anti-H. pylori IgG and IgA antibodies in serum specimens.

RESULTS

Out of 3551 serum specimens, 1413 cases tested seropositive for H. pylori organism (40%): 430 (12.2%) were both IgG and IgA positive, 212 (6%) and 771 (21.7%) cases showed isolated positivity for IgG or IgA, respectively. Male gender, older age, lower levels of socioeconomic status (SES), and family members >10 were significantly associated with H. pylori seropositivity. The proportion of participants with short stature was significantly more in the H. pylori seropositive group than the seronegative group (OR1.249, confidence interval [1.020-1.531], P= 0.033). There was no significant association between H. pylori seropositivity and gastrointestinal symptoms.

CONCLUSION

The prevalence of H. pylori seropositivity among apparently healthy Saudi children (40%) is intermediate compared with that in developed and developing countries. The Saudi pediatric population shows a predominant IgA-type immunological response to H. pylori infection.

Barrier to Access and Dental Care Utilization Behavior with Related Independent Variables in the Elderly Population of Saudi Arabia

Objectives:

The study aimed to evaluate barriers associated with access and utilization of dental services among the elderly population of Saudi Arabia.

Materials and Methods:

A systematic random sample of 350 elderly people recruited from various gathering places of the elderly including all nursing home residents (n = 73) was included in this study. The data were collected through face-to-face structured interviews related to access and utilization of dental services, and sociodemographic, behavioral, medical, and financial barriers to dental services. Statistical analysis included frequency distributions, chi-squared tests, and regression analysis using the Statistical Package for the Social Sciences (SPSS) program.

Results:

Approximately 37% of the elderly had proper access to and utilization of dental services. Independent variables that affect access and utilization of dental services were low income (odds ratio [OR] = 2.23, confidence interval [CI] = 1.34–3.72), unmarried participants (OR = 3.25, CI = 1.75–6.05), community residents (OR = 5.15, CI = 2.52–10.53), smokers (OR = 1.93, CI = 1.02–3.68), irregular users of toothbrushing (OR = 3.53, CI = 2.09–5.95), no dental insurance (OR = 1.88, CI = 1.06–3.37), and unaffordable price (OR = 2.55, CI = 1.38–4.69) in the bivariate analysis. In logistic regression analysis, the significant variables that were associated with proper access and utilization of dental services were having dental insurance (OR = 2.24, CI = 1.15–3.82), affordable prices (OR = 2.19, CI = 1.21–3.70), brushing regularly (OR = 3.58, CI = 2.01–6.37), higher education (OR = 1.87, CI = 1.10–3.20), and being married (OR = 1.68. CI = 0.97–2.91).

Conclusion:

Lack of perceived need, no dental insurance, unaffordable price, transportation, and fear from dental treatment were the most common significant barriers to dental services.

Influence of Clothing on Decomposition and Presence of Insects on Rabbit Carcasses

The decomposition rate and insects attraction to carcasses are affected by a number of factors such as temperature, body mass, the presence of poisons, humidity, and insect activity. The present study was planned to investigate the influence of clothing on both the decomposition process and the presence of insects on rabbit carcasses. The study was performed in May 2016 and involved the use of 18 live mature rabbits (Oryctolagus cuniculus L.), which were euthanized by chloroform. Rabbit carcasses were divided into three replicates with six rabbits in each replicate. Rabbits in each replicate were further subdivided, so that three rabbits were wrapped with cloth, whereas the remaining three were left unclothed. Both clothed and unclothed carcasses reached the dry stage within 6 d. The results of this study showed that clothes neither affect the decomposition process nor the presence of insects (flies and beetles). The pattern of flies and beetles, however, did vary significantly in the different decomposition stages. In total, 2,849 insects, including 2,459 flies and 390 beetles, were collected and sorted during the decomposition process. Among the dominant species, flies were assigned to the families Calliphoridae and Muscidae, whereas beetles were assigned to the families Dermestidae and Histeridae. Lucilia sericata Meigen, Musca domestica L., Dermestes maculatus DeGeer, and Saprinus moyses Marseul were the most abundant species occurring on both the clothed and unclothed carcasses. In conclusion, this study emphasized that, the clothes have no effect when dealing with decay process and insect attraction to the carrions.

Attitudes towards depression among non-psychiatric physicians in four tertiary centres in Riyadh

Depression is a common mental illness that has a profound impact on an estimated number of 300 million people worldwide. Depression is stigmatised in communities and even physicians, especially, non-psychiatric physicians, which affects depressed patients’ care. This study aims to investigate non-psychiatric physicians’ attitudes towards depression in Riyadh, Saudi Arabia. The study surveyed 380 participants using Revised Depression Attitude Questionnaire. Non-psychiatric physicians in Riyadh are optimistic and have a positive perspective towards depression. Yet, the majority preferred dealing with physical rather than mental illness. Understanding the attitudes of medical practitioners is important to shape service delivery and assess training needs.

Wheelchair accessibility of mosques in Riyadh

BACKGROUND

Engagement in religious and spiritual activities and expression are important to many people. Praying in a mosque is a major component of basic worship for Muslims. Riyadh has a population of more than six million people and more than 17 thousand mosques.

OBJECTIVE

The purpose of this study was to explore wheelchair accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers.

METHODS

A survey was conducted to explore the opinions of wheelchair users and their caregivers regarding wheelchair accessibility of frequently used mosques.

RESULTS

Forty-eight wheelchair users and 12 caregivers participated in the study. The main reason for being confined to a wheelchair was a motor vehicle accident (77%). The majority of the participants (84%) indicated that they needed assistance to propel their wheelchairs. Overall, 86% of wheelchair users and 84% of caregivers expressed dissatisfaction with the mosques' accessibility for wheelchair users.

CONCLUSION

Mosques were found not to be accessible for wheelchair users. The current situation forces wheelchair users to pray in isolation in their houses, preventing them from participating in an important part of their faith. Though acts mandating the accessibility of public places for wheelchair users have been promulgated in the Kingdom of Saudi Arabia (KSA), the acts are not implemented in ways which can contribute to a meaningful, tolerable and independent life for wheelchair users.

Prevalence of primary headache among medical students at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Background

Headache is among the commonest complaints in medical students; it could be due to many physical or psychological stressors. It has two main types: primary (including tension-type, migraine, and cluster) and secondary. The aim of this study is to assess the prevalence of headache among male and female medical students.

Materials and Methods

This study was conducted at KSAU-HS, COM, in January 2018. Third- and fourth-year medical students from both genders who have experienced headache throughout their life or are experiencing it for the past 3 months were included in this study. All medical students completed filling the questionnaire, which consisted of demographical data, headache characteristics and triggers, and associated symptoms.

Results

A total of 264 [150 (56.81%) males and 114 (43.19%) females] students were evaluated. The prevalence of headache was 53.78%, and the prevalence of tension-type headache was 41.66%. The prevalence of migraine headache was 7.1%. Only one case of cluster headache was detected. Those who did not fit the criteria for the primary types were categorized as unspecified headache. The prevalence of unspecified headache was 3.78%.

Conclusion

We can conclude from the study that tension-type headache is commonly reported in medical students. It is imperative to provide a stress-free study environment where students can perform more effectively, and sessions on how to reduce stress and alleviate fatigue are highly recommended.

Prevalence of constipation among central region population, Riyadh and Qassim provinces, Saudi Arabia, 2018-2019

Background

Due to the lack of data and studies concerning the prevalence of constipation in Saudi Arabia, this study aimed at determining the level of prevalence among central region population in Saudi Arabia, specifically in Riyadh and Qassim provinces.

Aims

To determine the prevalence of constipation, to estimate the overall prevalence of constipation among the society, and to identify risk factors of constipation.

Materials and Methods

In this cross-sectional study, 543 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover eight different aspects concerning constipation. SPSS package was used to analyze the data collected from the sample.

Results

The results of the scoring system showed that the prevalence of constipation among the sampled individuals is only 4.4%, whereas those whose result indicates no suffering from constipation represented 95.6%. Constipation is more prevalent among females (79.2%) rather than males (20.8%). Moreover, constipation is more sever among those who are between 20- and 35-year old, while it reaches 0% among old people (over 51 years). Riyadh residents are more likely to suffer from constipation rather than Qassim residents. In Riyadh, 83.3% suffered from constipation, whereas the percentage in Qassim was 16.7%. The results show also that constipation is more prevalent among those who eat fiber-rich food once in a week, who are getting stressed all the time, nonsmokers, and who get dehydrated and do not carry a bottle of water. There is a significant relationship between suffering from constipation and only two variables, which are regularity of being stressed and regularity of getting dehydrated. The test value for these two variables were (0.0) in the two cases.

Conclusion

The prevalence of constipation is relatively very low among population of central region in Saudi Arabia.

Prevalence of Malocclusion among Male School Children in Riyadh City

BACKGROUND:

Malocclusion is defined as irregularity of the teeth or a molar relationship between the dental arches beyond the range of what is accepted as normal.

AIM:

To determine the prevalence of malocclusion among male school children aged 12-15 years old in Riyadh, Saudi Arabia.

MATERIALS AND METHODS:

Five hundred (500) school children in Riyadh city, Saudi Arabia with an age of 12-15 years participated in this study. The prevalence of malocclusion among the students was determined using a clinical examination form specially prepared for this study. The required information was collected from each subject, and descriptive statistics were performed.

RESULTS:

The Molar Class I relation involved the highest percentage of the sample (71.2%) while Class II relation involved only 23% which was four times of Class III (5.8%). The maxillary arch crowding was present in 23.2% of the sample which was double than that of spacing. Whereas, the mandibular arch crowding was present in 28% of the sample which was three times more than spacing (8.8%). The open bite was present in 4% of the sample while deep bite was present in 9.6%.

CONCLUSION:

The prevalence of malocclusion involved the highest percentage in Class I in comparison with other malocclusions.

The visual status of adolescents in Riyadh, Saudi Arabia: a population study

Purpose

The visual status of adolescents in Saudi Arabia (SA) has not been well reported. To date, the prevalence and types of refractive errors (REs), amblyopia, strabismus, and correctable visual impairments have not been quantified. The aim of the study was to investigate the visual status in adolescents in Riyadh, SA.

Methods

This study was based on a population cross-sectional and random cluster design. After design and the sample calculations, 1,007 participants, 12–20 years of age, were screened during the study. Nine participants were excluded due to ocular disorders. The participants were assessed for REs, distance visual acuity logarithm of the minimum angle of resolution, contrast sensitivity, stereoacuity, pinhole test findings, and cover–uncover test findings.

Results

The results showed that 55.5% of the participants had some form of REs, while correctable visual impairment was found in one-fifth of the screened participants. Myopia was the dominant type (53.3%, ranged from −0.50 DS to −14.00 DS), whereas hyperopia was found in 2.2% (+2.00 DS to +5.50 DS) and astigmatism was present in 15% (−0.75 DC to −5.25 DC). Only 43% of the participants had corrected REs; however, the noncompliance for spectacle use was 20.25%.

Conclusion

This study was the first attempt to investigate the visual status in adolescents in SA. It provided estimations of the REs, amblyopia, and strabismus. The high prevalence of REs emphasizes the need to identify the best proactive strategies to detect and manage REs to reduce the incidence of visual impairment in SA. Increasing awareness about eye health and employing efficient screening programs could help to address the need for REs corrections.