Dysmenorrhea and depressive symptoms among female university students: a descriptive study from Saudi Arabia

Background

Dysmenorrhea has significantly increased in prevalence. There is also evidence of the coexistence of dysmenorrhea and psychological disorders. This study aims to explore the prevalence of dysmenorrhea and investigate its correlation with depressive symptoms among Princess Nourah bint Abdulrahman University (PNU) students. All participants (N = 487) in this cross-sectional study provided sociodemographic data, menstrual and medical history, and completed the Patient Health Questionnaire (PHQ-9) scale and (working ability, location, intensity, days of pain, dysmenorrhea [WaLIDD]) scale on a self-administered online questionnaire.

Results

The mean age of the females was 20.64 ± 2.38 years, and 40.7% were from health colleges. Severe dysmenorrhea requiring medical attention and pain killers or herbs was reported by 30.8% of the students. Significant predictors of severe dysmenorrhea were: younger age, earlier menarche, pain killers and herbs used for menstrual pain, a doctor visit for menstrual pain, and depression. In addition, significant protective factors of depression were: later menarche age, having a regular menstrual cycle, and longer duration.

Conclusions

Students with severe dysmenorrhea have a higher risk of depression than other students. The findings stress the importance of awareness, education, a multidisciplinary approach to women's health, and early detection to prevent future complications.

Immediate effect of pulsed high-intensity neodymium-doped yttrium aluminum garnet (Nd: YAG) laser on staphylococcus aureus and pseudomonas aeruginosa growth: an experimental study

[Purpose] The aim of this study was to evaluate the effect of pulsed high intensity neodymium-doped yttrium aluminum garnet (Nd: YAG) laser on staphylococcus aureus (S. aureus) and pseudomonas aeruginosa (P. aeruginosa) bacterial growth, which cause many health problems and establish which doses are effective in bacterial inhibition. [Materials and Methods] Five samples of S. aureus and five samples of P. aeruginosa were prepared in the microbiology lab, one used as control sample and the other 4 samples acted as experimental samples. The experimental samples received pulsed high intensity Nd: YAG laser with a total dose of 500, 600, 700 and 800 joules. The primary measures are colony count and the percentage decrease in colony count, the colony count was assessed at baseline and after 24 h of laser application. [Result] There was significant decrease in colony count and the percentage decrease in colony count after pulsed high intensity Nd: YAG laser application in all experimental samples of S. aureus and P. aeruginosa after 24 h of application for all doses (500, 600, 700 and 800 j) as compared with the control sample, with the most effect in higher doses of pulsed high intensity Nd: YAG laser than lower doses in both types of bacteria. [Conclusion] pulsed high intensity Nd: YAG laser was found to be an effective modality for inhibition of S. aureus and P. aeruginosa growth after a single application.

Burnout Among Respiratory Therapists in a Tertiary Hospital in Saudi Arabia

BACKGROUND

Respiratory therapists (RTs) provide many types of patient care in different clinical settings. Burnout can have an undesirable effect on RTs and their patients. Managing the COVID-19 pandemic, specifically in hospitals, could induce stress in RTs and increase the likelihood of burnout. Therefore, this study aimed to measure the level of burnout among RTs during the COVID-19 pandemic.

METHODS

A validated cross-sectional questionnaire was used to identify the prevalence and characteristics of burnout among RTs. The questionnaire was administered by the respiratory care department of a tertiary health care center in Riyadh, Saudi Arabia. The data analysis included descriptive, inferential, and correlational tests.

RESULTS

The survey was distributed among 100 RTs, with a response rate of 66%. Most respondents reported high burnout levels in the 3 domains of burnout: 77% reported emotional exhaustion; 98% reported depersonalization, and 73% reported low personal achievement. Univariate analysis revealed that emotional exhaustion was significantly higher among RTs who were male, married, or working in critical care settings. Female RTs and those working in general care settings reported feelings of reduced personal achievement. Furthermore, the analysis revealed a moderate positive correlation between the years of experience and emotional exhaustion (r = 0.6, P < .001).

CONCLUSIONS

A high prevalence of burnout was observed among RTs in one Saudi tertiary hospital. Burnout is associated with several factors, and interventions should target all domains of burnout. RT management and staff are responsible for addressing their needs and collaboratively working together to overcome burnout. Further investigations focusing on techniques and strategies to alleviate burnout are required.

Shared Decision-Making: A Cross-Sectional Study Assessing Patients Awareness and Preferences in Saudi Arabia

BACKGROUND AND AIM

Shared decision-making (SDM) has become broadly accepted during the consultation, especially when there are many options of treatment. This study aims to assess patients' levels of awareness and preferences of SDM in Saudi Arabia.

METHODS

This is a cross-sectional study targeting patients in Saudi Arabia. Two validated questionnaires were used, the first validated questionnaire focuses on measuring knowledge, attitude and experiences of shared-decision making. The second questionnaire is the the Autonomy-Preference-Index focusing on patients' preferences for being involved in SDM. Relevant items to the study aim were chosen and translated into Arabic. Psychometric testing was conducted for Arabic and English versions and tested for content and face validity. The questionnaire administered online via social media channels, between February 2021 and May 2021. A total of 411 respondents completed the questionnaire.

RESULTS

The findings showed a positive association between awareness and preferences of SDM among patients in Saudi Arabia. In the awareness of the SDM domain, females reported higher scores than male participants (t = -4.504, P < 0.001). Saudis reported higher scores in their awareness of SDM than non-Saudis (t = 2.569, P = 0.011). Participants without health insurance reported higher scores in their awareness of SDM than those insured (t = -2.130, P = 0.034). Participants with degree have higher knowledge levels than participants with no degree (f = 10.034, P < 0.001). Females reported higher scores in their preferences of SDM than the male (t = -2.099, P = 0.036). Participants who visited private health-care settings in their last clinical encounter reported higher preferences of SDM than participants who received care in other settings (f = 2.653, P = 0.048).

CONCLUSION

The study concludes that the more aware a patient is, the more likely they prefer SDM practice. This finding can support health-care policymakers in developing SDM policies that enhance patient-centered care.

The use of Heated, Humidified, High-flow Nasal Cannulas, and Length of Hospital Stay Among Extremely Preterm Infants

Background

Extremely preterm infants (EPIs) often require advanced respiratory support to survive, and one such intervention is the heated, humidified, high-flow nasal cannula (HHHFNC). While the use of this cannula in EPIs has been studied, the relationship between its use and the length of hospital stay is an important yet unexplored research area that we aim to investigate in this study.

Methods

In a quantitative retrospective cohort study, data were extracted from an electronic database. The study included all EPIs younger than 28 weeks of gestational age admitted to the neonatal intensive care unit of a tertiary hospital from January 1, 2020, to December 31, 2022. The descriptive analysis was conducted to describe each infant's demographic, maternal, and neonatal characteristics. A chi-squared test was also conducted, and a p-value of < 0.05 was considered statistically significant.

Results

The findings suggest that infants who receive an HHHFNC have a longer hospital stay than those who do not. Specifically, infants who did not receive a cannula spent 42.5 days on average in the hospital, compared with 99 days among those who received it, with a significant p-value (p=0.0001).

Conclusion

Infants receiving a cannula stay in hospital on average for twice as long as those who do not. However, to reduce the possibility of bias and produce more reliable results, we advise conducting clinical trials or prospective studies in future research.

Gallic Acid: A Potent Metabolite Targeting Shikimate Kinase in Acinetobacter baumannii

Background/Objectives:Acinetobacter baumannii is a highly multidrug-resistant pathogen resistant to almost all classes of antibiotics; new therapeutic strategies against this infectious agent are urgently needed. Shikimate kinase is an enzyme belonging to the shikimate pathway and has become a potential target for drug development. This work describes the search for Food and Drug Administration (FDA)-approved drugs and natural compounds, including gallic acid, that could be repurposed as selective shikimate kinase inhibitors by integrated computational and experimental approaches. Methods: Approaches to drug design using structure-based and ligand-based methodology, in-silico screening, molecular docking, and molecular dynamics for the study of both binding affinity and stability. Experimental Validation Determination of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) on Acinetobacter baumannii and Enterococcus faecalis. Results/Conclusions: Among them, gallic acid, obtained from plants, proved to be the most promising compound that showed sufficient binding with shikimate kinase through computational studies. Gallic acid showed very good activity against Acinetobacter baumannii and Enterococcus faecalis in the MIC and MBC assay, respectively. Gallic acid exhibited better activity against Acinetobacter baumannii due to the overexpression of shikimate kinase. Gallic acid has emerged as a potential therapeutic candidate drug against A. baumannii infection and, therefore, as a strategy against the appearance of multidrug-resistant microorganisms. This study not only identifies a novel repurposing opportunity for gallic acid but also provides a comprehensive computational and experimental framework for accelerating antimicrobial drug discovery against multidrug-resistant pathogens.

Health-Related Quality of Life and Psychological Distress Status in Survivors of Nasopharyngeal Carcinoma: A Retrospective Study

Introduction Nasopharyngeal carcinoma (NPC) is an uncommon cancer globally, with a low incidence in Western countries. However, this rate increases significantly in some endemic regions, including the Middle East. Although studies have evaluated the physical health outcomes, treatment efficacy, and short-term effects, long-term effects - especially quality of life (QoL) - have been neglected. Therefore, we aimed to assess the QoL and psychological distress status of survivors of NPC and investigate the demographic, clinical, temporal, and therapeutic factors that impact the well-being of such patients. Methodology This cross-sectional analysis was performed in 2023 at the King Abdulaziz University Hospital (KAUH), a major tertiary care facility located in Jeddah, Kingdom of Saudi Arabia. We retrospectively reviewed all reported cases of NPC at KAUH from 2010 to 2023 and identified 34 patients who met our inclusion criteria. Data on the QoL and psychological distress status were collected using telephone interviews, during which three questionnaires were administered: the "European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Version 3.0" (EORTC QLQ-C30), the "European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck Module 43" (EORTC QLQ-HN43), an additional questionnaire designed to be utilized alongside the EORTC QLQ-C30, and the "Hospital Anxiety and Depression Scale." Demographic and clinical information were also obtained. Results The patients had a mean age of 49.88 ± 2.27 years (range: 18-70 years). The mean survival duration was 5.88 years (range: 1-14 years). From the pooled data, abnormal borderline depression, borderline anxiety, and anxiety were identified in five patients (14.7%), four patients (11.76%), and two patients (5.88%), respectively. Patient age showed a significant positive correlation with both "fatigue" (r = 0.367, p = 0.033) and "social contact" (r = 0.423, p = 0.013), where higher scores on both symptom scales indicate worse symptoms (i.e., greater fatigue and more difficulties with social interactions). The mean "global health status/QoL" was significantly lower in patients with comorbidities (p = 0.039) and "oral dryness" (p = 0.027) compared to those without. The tumor stage showed a significant negative correlation with the "global health status/QoL" (r = -0.664, p = 0.001). Conclusion A significant number of survivors of NPC experienced borderline depression and anxiety. "Global health status/QoL" was low in advanced tumor stages. The mean "global health status/QoL" was low in the presence of certain factors, including coexisting comorbidities and treatment-related side effects. Our findings suggest that patients diagnosed with NPC should undergo assessments for anxiety and depression before, during, and after treatment. Moreover, symptomatic treatment of therapeutic side effects, especially "oral dryness," should be undertaken. "Oral dryness," experienced by most of the patients, was significantly correlated with a low mean "global health status/QoL."

Repurposing FDA-Approved Agents to Develop a Prototype Helicobacter pylori Shikimate Kinase (HPSK) Inhibitor: A Computational Approach Using Virtual Screening, MM-GBSA Calculations, MD Simulations, and DFT Analysis

Background/Objectives:Helicobacter pylori infects approximately half of the global population, causing chronic gastritis, peptic ulcers, and gastric cancer, a leading cause of cancer mortality. While current therapies face challenges from rising antibiotic resistance, particularly to clarithromycin, alongside treatment complexity and costs, the World Health Organization has prioritized the development of new antibiotics to combat this high-risk pathogen. In this study, we employed computer-aided drug design (CADD) methodologies, including molecular docking, Molecular Mechanics-Generalized Born Surface Area (MM-GBSA) analysis, molecular dynamics (MD) simulations, and Density Functional Theory (DFT) calculations, to explore the potential repurposing of FDA-approved agents as inhibitors of Helicobacter pylori shikimate kinase (HpSK). Methods: Using the Glide module, the HTVS method was initially applied to screen 1615 FDA-approved agents followed by extra-precision (XP) docking for the obtained 111 hits. The obtained XP scores were used to confine the results to those hits with a score above the reference ligand, shikimate, score. This yielded 31 final hits with an XP score above -5.867. MM-GBSA calculations were performed on these top candidates and the reference ligand to refine the analysis and compounds' prioritization. Results: The 31 compounds displayed binding free energy (ΔGbind) values ranging from 3.61 to -55.92 kcal/mol, with shikimate exhibiting a ΔGbind of -34.24 kcal/mol and 10 hits having a lower ΔGbind value. Out of these ten, three drugs-Dolutegravir, Cangrelor, and Isavuconazonium-were selected for further analysis based on their drug-like properties. Robust and stable binding profiles for both Isavuconazonium and Cangrelor were verified via molecular dynamics simulation. Additionally, Density Functional Theory (DFT) analysis was conducted, and the Highest Occupied Molecular Orbitals (HOMOs), Lowest Unoccupied Molecular Orbitals (LUMOs), and the energy gap (HLG) between them were calculated. All three drug candidates displayed lower HLG values than shikimate, suggesting higher reactivity and more efficient electronic transitions than the reference ligand. Conclusions: These findings suggest that the identified drugs, although not optimal for direct repurposing, would serve as promising leads against Helicobacter pylori shikimate kinase. These drugs could be valuable leads for experimental assessment and further optimization, particularly with no prototype yet identified. In terms of potential for clinical repurposing, the results point to diflunisal as a promising candidate for further testing.

EFFECT OF ENLARGED ADENOIDS AND TONSILS ON BLOOD OXYGEN SATURATION IN AL BAHA, SAUDI ARABIA

INTRODUCTION

The adenoids and palatine tonsils, part of the lymphoid tissue, act as a first line of defense protecting the lower airways and gastrointestinal tract. Adenotonsillar hypertrophy in children may lead to airway obstruction. This study aims to demonstrate the association between adenotonsillar hypertrophy and decreased blood oxygen saturation.

METHODS

A retrospective cohort study was conducted among children aged 7-12 years with adenotonsillar hypertrophy and obstructive symptoms, admitted to King Fahad Hospital and Prince Mishari Hospital, Saudi Arabia, for tonsillectomy between July 2023 and January 2024. Exclusion criteria included respiratory diseases, cardiac disease, nasal polyps, nasal septum deviation, chest wall abnormality, and lower airway diseases. The control group included 56 healthy children. An otolaryngologist determined the severity of airway obstruction using the tonsil size. Oxygen saturation was measured using pulse oximetry. The determinants of oxygen saturation were assessed using multiple linear regression, with significance set at p<0.05.

RESULTS

The study included 357 participants, with an even age distribution between 7-9 years (49.6%) and 10-12 years (50.4%), and 52% males. Diagnoses included adenoid hypertrophy (30%), tonsil hypertrophy (35%), both conditions (19%), and the control group (16%). Tonsil sizes ranged from Grade 1 (48%) to Grade 4 (8.4%), with 17% normal. The median oxygen saturation was 96.0% for the adenotonsillar hypertrophy group and 99.0% for the control. Oxygen saturation levels differed significantly across groups (p<0.0001), with lower median saturation in hypertrophy groups than controls. Males had a lower oxygen than females (estimate: -0.338, 95% CI [--0.640, -0.036], p=0.028). Adenoid hypertrophy (estimate: -3.863, 95% CI [-5.241, -2.484], p<0.001), tonsil hypertrophy (estimate: -3.631, 95% CI [-5.053, -2.208], p<0.001) and having both conditions (estimate: -3.777, 95% CI [-5.3.7, -2.247], p<0.001) was associated with lower oxygen saturation. Grade 1 tonsil size was associated with an increase in oxygen saturation (estimate = 2.905, 95% CI [1.616, 4.194], p<0.001). In contrast, Grade 4 tonsil size was linked to lower oxygen saturation (estimate=-4.848, 95% CI [-6.367, -3.329], p<0.001). Grades 2 and 3 were not significantly associated with changes in oxygen saturation.

CONCLUSION

Adenotonsillar hypertrophy is significantly associated with decreased blood oxygen saturation and related cardiopulmonary complications in children. Early adenotonsillectomy may be of benefit in preventing these complications and improving oxygen saturation levels.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons

OBJECTIVES

To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low.

METHODS

This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties.

RESULTS

For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management.

CONCLUSION

Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.

AWARENESS AND KNOWLEDGE OF OBSTRUCTIVE SLEEP APNEA AMONG THE POPULATION OF THE AL-BAHA REGION OF SAUDI ARABIA: A CROSS-SECTIONAL STUDY

Obstructive sleep apnea (OSA) is a known sleep-disordered breathing, with known morbidity and mortality, that affects a lot of people worldwide. In Saudi Arabia, the prevalence of OSA is estimated to be around 8.8% among adult males and 5.1% among adult females. The research is a cross-sectional study design conducted in the Al-Baha region; Saudi Arabia in 385 participants. To evaluate the knowledge and awareness of OSA, the study utilized a validated and reliable adapted Arabic version of the OSA questionnaire. The degree of consciousness and understanding regarding OSA demonstrated a noteworthy connection with varying levels of education and a favorable family history of OSAS (p<0.05). The regression analyses unveiled that people with a familial OSA background had a 2.565-fold increased likelihood of identifying daytime fatigue as a symptom of OSA (p<0.05). The study reported an insufficient level of awareness and knowledge of OSA among the Saudi Arabian population. Various factors, including gender, education, and family history of OSA, may affect the awareness and knowledge of this condition.

Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience

BACKGROUND

With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.

METHOD

This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.

RESULTS

Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01-1.06], P < 0.01) after adjusting for confounding variables.

CONCLUSION

The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.

Assessment of the Current Knowledge and Practice of General Practitioners Towards Laryngopharyngeal Reflux in Saudi Arabia

Background General practitioners (GPs) have a significant role in the diagnosis of patients with laryngopharyngeal reflux (LPR). Some published data revealed a lack of knowledge among GPs about the disease, consequently, this lack of knowledge impacted their performance. This survey aims to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia. Methodology This survey study was conducted to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia using an online questionnaire. The questionnaire was distributed and collected from the five regions in Saudi Arabia, which are The Central Region (Riyadh, Qassim), Eastern Region (Dammam, Al-Kharj, Al-Ahasa), Western Region (Makkah, Madinah, Jeddah), Southern Region (Asir, Najran, Jizan), and Northern Region (Tabuk, Jouf, Hail). Results In the current study, we collected data from 387 general practitioners, 61.8% of whom were aged between 21-30 years old, and 57.4% of the participants were males. Moreover, 40.6% of the participants thought that both LPR and gastroesophageal reflux disease (GERD) share pathophysiology, however, they are two different diseases considering their clinical presentation. Moreover, it was found that heartburn was the most known symptom of LPR among the participants (Mean score 2.14 (SD=1.31), where a lower score indicated more relation). Considering the treatment of LPR, 40.6% and 40.3% of the participants reported using proton pump inhibitors once or twice daily respectively. In contrast, antihistamine/H2 blockers, alginate, and magaldrate were used to a lesser extent as reported by 27.1%, 21.7%, and 12.1%. Conclusion The current study showed limited knowledge among general practitioners considering LPR with a higher rate of referring patients to other departments depending on symptoms which may increase the pressure on other departments of mild cases.

Unraveling the stigma: a qualitative descriptive exploration of the relationship between culture, religion, and mental disorders in Saudi Arabia

BACKGROUND

A lack of understanding about the needs of people in Middle Eastern and Islamic contexts living with mental health disorders, and their experiences of diagnosis-related social and personal stigma inhibits high-quality care.

METHODS

This qualitative descriptive study, based in Saudi Arabia, used the Stigma Mitigating Conceptual Model to explore mental disorder-related stigma from the perspective of challenges and strategies connected to knowledge, attitudes and behaviours. Thirteen adults with mental health disorders completed semi-structured interviews, analysed using reflexive thematic analysis.

RESULTS

Four major themes and nine subthemes pertaining to the impact of stigma on public and self/personal knowledge, attitudes, and behaviors were identified: (1) effects of the mental disorder on everyday life, (2) challenges, (3) overcoming the challenges, and (4) types of stigma experienced. Greater knowledge of mental health disorders promoted Islamic principles of compassion and support, while the absence of knowledge exacerbated public stigma and fears the individual is under the influence of the 'Evil Eye', or lacks prayers and devotion. Participant strategies to mitigate stigma include education, and more opportunities for those living with mental health disorders to share their stories.

CONCLUSIONS

Study findings provide nuance into the role of stigma in the context of cultural and religious factors in Saudi. These insights can be used to help tailor care and interventions to people from Middle Eastern contexts, as Western perspectives have predominantly driven mental health care.