Sibship Composition and BMI Z-Score Among Saudi Preschoolers: A Cross-Sectional Study

Background and objective The association between sibship composition and child body mass index (BMI) has not been investigated in any Arab/Middle Eastern populations. In light of this, this study aimed to examine the association of the number of siblings, number of older siblings, and number of younger siblings with child BMI z-score (BMIz) among preschoolers in the Kingdom of Saudi Arabia (KSA). Methods A total of 209 mothers and their children were recruited from preschools in Jeddah, KSA. Mothers reported their responses to the study questionnaire via telephone. Child anthropometry was objectively measured; BMIz was calculated based on age- and sex-specific World Health Organization (WHO) growth standards and reference data. We used hierarchical multiple linear regression to examine the association between sibship composition variables and child BMIz, independent of the effect of potential confounders, and to evaluate changes in model fit. Results The number of siblings was negatively associated with child BMIz [b = -0.18, 95% confidence interval (CI) = -0.35, -0.06, p<0.01, adjusted R2 = 0.16]. There was a negative association between the number of older siblings and child BMIz (b = -0.23, 95% CI = -0.38, -0.11, p<0.01, adjusted R2 = 0.21) as well as between the number of older sisters and child BMIz (b = -0.18, 95% CI = -0.52, -0.09, p<0.01, adjusted R2 = 0.19). However, there were no significant associations between the number of older brothers or the number of younger siblings and child BMIz. Conclusions Based on our findings, sibship composition was found to be associated with BMIz among a sample of preschoolers in KSA. More research is needed to further establish this association and to understand the underlying mechanism of the association of the greater number of older siblings and older sisters with lower BMIz.

Acute Rheumatic Fever in Children: The Known and the Unknown Among Saudi Mothers in the Jazan Region

Background Acute rheumatic fever (ARF) is a significant public health problem that causes morbidity and mortality in low and middle-income countries. Therefore, this study aims to assess mothers' knowledge of acute rheumatic fever and their attitudes in the Jazan region. Methods A cross-sectional study was conducted between the mothers using an online survey. The knowledge level was ranked as poor, fair, and good. In contrast, the attitudes were ranked as positive or negative. Association with sociodemographic variables was assessed, and statistical significance was set at p < 0.05. Results Four hundred thirty-six (436) mothers were included; 39.9% of them were aged 21-30 years, 68.8% were married, 57.3% were non-workers, and 72.2% were university-educated. Most of the mothers had a poor level of knowledge (53%); however, positive attitudes toward the disease were reported in 79.1% of mothers. The poor knowledge levels were related to age, marital status, occupation, and monthly income. Conclusion Despite having positive attitudes toward diagnosing and managing ARF, most of the mothers showed poor knowledge of acute rheumatic fever. This study highlights the situation in the Jazan region, which could be an essential basis for constructing an educational program to raise awareness and knowledge of acute rheumatic fever in the community.

A Case Report of Yamaguchi Syndrome in a Saudi Male

Apical hypertrophic cardiomyopathy, also called Yamaguchi syndrome, is a rare variant of hypertrophic cardiomyopathy. Yamaguchi syndrome is characterized by hypertrophy almost confined to the apical region of the left ventricle rather than the left ventricular septum. A case of 65-year-old Saudi man presented to the ER with angina, and the ECG, echocardiogram, and nuclear study confirmed the diagnosis with Yamaguchi. Reporting this case serves to help physicians broaden their vision in approaching patients with symptoms mimicking acute coronary syndrome.

Prevalence of Depression Among Older Adults Visiting the Primary Healthcare Centers in Jizan City, Saudi Arabia: An Analytical Cross-Sectional Study

Background and objective Older adults are susceptible to various disorders, including depression. Depression manifests as a disorder characterized by a persistent depressed mood, feelings of sadness and loneliness, sleep disturbances, and loss of interest lasting for two weeks or more. This condition can significantly affect the quality of life for older adults, resulting in adverse outcomes that have a negative impact on their overall well-being. In this study, our objective was to assess the prevalence of depression and identify associated risk factors among individuals aged 60 years and above who attended Primary Healthcare Centers (PHCCs) in Jizan City. Methodology We conducted an analytical cross-sectional study among older people attending PHCCs in Jizan City between May and December 2022. In this study, we interviewed 300 participants using the Patient Health Questionnaire-9 (PHQ-9) to assess depression. IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY) was used for data entry and analysis. We used the chi-square test and binary logistic regression model to detect the associations and predictors of depression among older adults. Results One-third of the study participants experienced depression, with 49 (16%) exhibiting mild depression, 33 (11%) reporting moderate depression, and 17 (6%) individuals indicating moderately severe depression. Depression was more common among females (158, 52.7%) than males (142, 47.3%). The predictors of depression among the study participants were the dependency to perform daily tasks and abnormal sleep duration. Conclusions Depression is a prevalent health problem among older people in Jizan City, particularly among females, those who are divorced or widowed, individuals dependent on others for daily tasks, and those with abnormal sleep duration. We conclude that we need more research on older adults to assess their mental problems and fill in the literature gap.

Moyamoya Syndrome in Children With Sickle Cell Disease in Saudi Arabia: A Single-Center Experience

Background Sickle cell disease (SCD) is relatively common in Saudi Arabia. Its neurologic complications such as stroke and Moyamoya syndrome (MMS) can be severe and devastating. Such complications can be minimized by modern investigative tools such as transcranial Doppler (TCD) ultrasound, which is unavailable in many high-risk places. Our aim is to investigate the prevalence and characteristics of these complications in children with SCD in our center where TCD is not available. Methods We conducted a retrospective record review of children with SCD admitted to the pediatric ward and visited the pediatric hematology outpatient clinic of King Fahad Military Medical Complex, Dhahran, Saudi Arabia, from January 2010 to December 2021. The target population was children aged six months to 14 years with SCD and a history of stroke or transient ischemic attacks (TIAs). Their magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) of the brain radiographic features were reviewed. A descriptive analysis was used to summarize the demographic characteristics and clinical features of patients with and without MMS. Results Twenty-six children (out of 385 with sickle cell anemia, originating mainly from the southwestern and eastern provinces of Saudi Arabia) experienced an overt stroke with an overall prevalence of 6.7%. All patients with stroke were originally from the Southwestern province. Their genotype was SS, and the median age at the onset of the first stroke was six years (IQR: 5.5). The main presenting symptoms were seizures (57.7%), motor weakness (42.3%), headache (15.3%), cranial nerve palsies (11.5%), cognitive deficit (7.6%), and dysphasia (3.8%). The majority of strokes were ischemic (92.3%). MMS was detected in 61.5% and was seen at the onset of the first stroke in all patients with this MRA abnormality. Seven children with moyamoya (43.8%) had recurrent strokes. Conclusion In this study, the prevalence of overt stroke is 9% in children with SCD originating from the southwestern region of Saudi Arabia (26/286), and 61.5% of them (16/26) had MMS. It is absent in the children of Eastern origin (99 children). In places lacking TCD facilities, further studies are required to determine if MRA brain screenings of children with SCD may detect MMS before the onset of stroke and help start protective therapy.

Prevalence and Pattern of Injuries Across the Weight-Training Sports

Background The prevalence and pattern of injury among weightlifters are insufficiently documented despite these research works. Understanding the injury pattern is crucial for minimizing side effects and maximizing the advantages of weight training. Therefore, the purpose of this study is to determine the frequency and pattern of musculoskeletal injury among weightlifters and to investigate the associations between the prevalence of injury and sociodemographic and training characteristics variables. Methods A descriptive cross-sectional, questionnaire-based study was conducted. An online questionnaire was designed by Google Forms to collect the data by using a self-administered questionnaire. From all health clubs in Taif city, Saudi Arabia, one club was chosen by simple random sampling methodology, where all attendant weightlifters during the study period were contacted to participate in the study. Data was entered on the computer using Microsoft Office Excel 2016 for Windows. Qualitative data was expressed as numbers and percentages, and the Chi-squared test (χ2) was used to assess the relationship between variables. A p-value < 0.05 was considered statistically significant. Results The study included 393 participants, and most respondents fall within the age range of 18-29, accounting for 60.1% of the total. About 27% of participants had a weightlift injury during the last six months. The body parts most injured during weightlifting include the shoulder (7.4%), knee (4.6%), and wrist (3.6%). In terms of the type of injuries sustained, inflammation and pain in the bending of the body (5.9%), torsion (3.6%), ligament tear/muscle tear (3.8%), and stripped-off injuries (2.3%) were reported. Conclusion Musculoskeletal injuries are prevalent among weightlifters due to the nature of the sport and the demands it places on the body. There was no significant association between the injury occurrence with gender, age, or body mass index. However, there was a significant association between the occurrence of injury and weight carried while lifting weights.

Osteoporosis as Perceived by Saudi Physicians: A Cross-Sectional Study of Quality of Practice and Current Barriers in Management

Background Osteoporosis (OP) is a state of abnormal bone quality and architecture that leads to fragility fractures, with lifetime costs reaching 16.27 billion Saudi Arabian Riyal (SAR). Methods An electronic survey was distributed to physicians from July 2020 to May 2021 to assess the quality of the practice of physicians toward OP and barriers in OP management in Saudi Arabia. Specialties included were endocrinology, general medicine, family medicine, primary care, orthopedic surgery, rheumatology, obstetrics and gynecology, and geriatrics. Results A total of 177 surveys were eligible (55.9% female and 44.1% male). The majority were family consultants (42.9%). In terms of knowledge, 18.1% of our sample recognized all risk factors, and 24.9% recognized all indications to assess bone density. A central dual-energy X-ray absorptiometry (DEXA) was accessible to only 49.4% of the sample. Over 80% of the sample performed comprehensive laboratory workup. Although 68.4% of participants were aware of fracture risk assessment (FRAX), 53.7% used it in their practice. The most cited barrier was a lack of physicians' awareness (80.2%), followed by a lack of patients' awareness (63.6%). The specialty was significantly associated with the awareness of the densitometry certificate (P-value < 0.0001) and the use of FRAX (P-value = 0.0001). Conclusion Our results revealed a below-satisfactory quality of practice among Saudi physicians toward OP. Additionally, our results identified many gaps in knowledge and many barriers to optimal care.

Emotions, Perceived Stressors, and Coping Strategies Among Nursing Staff in Saudi Arabia During the COVID-19 Pandemic

Objective The COVID-19 pandemic resulted in heightened stress for nurses and other healthcare workers, particularly during the initial phase of the crisis. Despite the adoption of various coping strategies, psychological distress persisted, affecting nurses' well-being and jeopardizing the overall resilience of the healthcare system. This study assessed the emotional response, perceived stressors, and coping strategies among nurses' staff who worked during the first wave of COVID-19 pandemic. Method A cross-sectional study was carried out among nurses who worked during the initial phase of the COVID-19 crisis (June - August 2020), at a tertiary care center in Western Saudi Arabia. The questionnaire explored five main sections. The first section (15 items) assessed emotions experienced during the initial wave of COVID-19, capturing both positive and negative sentiments, such as "joy" or "fear." The second section (20 items) examined the presence of stressors, like "lack of protective equipment" or "fear of infection." The third section (14 items) evaluated the perceived effectiveness of certain stress-reducing factors, including "peer support" or "training." In the fourth section (13 items), participants rated their usage frequency of various coping strategies, such as "meditation" or "seeking advice." Lastly, the fifth section assessed the hypothetical impact of 10 incentives, like "financial bonuses" or "additional training," in motivating nurses' involvement in future epidemic responses. The questionnaire was completed with demographic and professional data. A convenience sampling method was employed, and 315 nurses participated in the study. Descriptive statistics were carried out using SPSS version 24 for Windows (IBM Corp., Armonk, NY). Result The most commonly experienced emotion was a feeling of responsibility and ethical duty, reported by 97.5% of the participants, followed by nervousness and fear (83.8%), anger (73.3%), and stigma (70.2%). On the other hand, 86.7% were expecting a financial compensation. The most common stressors were related to the nurses' own safety, or the safety of their families and colleagues, reported by 92.4-95.2% of the participants. The perceived uncontrollability of COVID-19 was also a significant stressor. The improvement of the health status of infected colleagues (98.1%) or patients (97.5%) were the most common factors associated with the reduction in nurses' stress. Among the coping strategies, five were almost systematically deployed by the nurses (>95%), all consisting of cognitive and behavioral mechanisms to enhance own knowledge and safety and avoid being infected. The most crucial determinants for commitment in future pandemics are the availability of a cure or vaccine (93.3%), family support (91.4%), adequate personal protective equipment from the hospital (90.8%), and exemption from overtime (90.2%). Conclusion The first wave of COVID-19 exerted a tremendous psychological stress on nurses, due to concerns about safety, disease uncertainties, and social isolation. Analyzing these impacts offers insights for enhancing institutional and national crisis strategies, emphasizing staff safety and psychological well-being, especially for first responders like nurses. Policy implications include prioritizing mental health support and preparedness in future crisis plans. Additionally, ensuring continuous training and strategic workload management is crucial for maintaining frontline commitment.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with a mean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% had glaucoma and 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

Complementary and Alternative Medicine Use Among Patients With Diabetes Mellitus in Saudi Arabia: A Community-Based Cross-Sectional Study

BACKGROUND

Global studies have observed a disparity in the use of complementary and alternative medicine (CAM) among diabetic patients.

OBJECTIVES

To estimate the prevalence, types, and correlates of CAM use among patients with diabetes mellitus (DM) in Saudi Arabia.

METHODOLOGY

A cross-sectional study was conducted among 1290 Saudis with type 2 DM aged ≥18 years. An electronic questionnaire was distributed through social media to collect data about patient demographics and DM-related characteristics, including age at DM diagnosis, DM duration, family history of DM, DM complications, DM medicine, and chronic diseases. The use of CAM and its type, cost, and duration; sources of CAM-related information; reason for using CAM; usefulness and side effects; CAM use in the future; and doctor consultation before CAM use were also evaluated. Among CAM non-users, the reason for not using CAM and future considerations of CAM were assessed.

RESULTS

A total of 1290 patients were included (27.4%) aged 18-29 years; 726 (56.3%) were women; 554 (42.9%) had a bachelor's degree in education; and 457 (35.4%) were unemployed. The prevalence of CAM use was 528 (40.9%). The most commonly used types were bitter apple 503 (95.3%), cinnamon 341 (64.6%), and ginger 290 (55.1%). The most frequent sources of CAM-related information were friends, families, and neighbors 259 (49.2%), while the most frequent justifications for use were the need for another DM treatment and faith in its advantages. Only 106 (20.1%) of the patients who used CAM disclosed adverse effects; 373 (51.8%) said they would use it again, and 66.1% said they would recommend it to other patients. Only 145 (27.5%) consulted a doctor before using CAM. CAM was more commonly used by patients who were older, women, married, and taking hypoglycemic drugs; whose most recent HbA1c level was 7-10%; and who had dyslipidemia, chronic disease, and a family history of DM.

CONCLUSION

The prevalence of CAM use is high among the Saudi population. Analyzing CAM use is essential in clinical interactions with Saudis with DM. The managing healthcare professionals must educate patients with DM on how to use CAM more effectively and safely.

The Efficacy of Educational Interventions in Improving School Teachers' Knowledge of Attention Deficit Hyperactivity Disorder

BACKGROUND

Well-trained primary school teachers should be competent in recognizing attention deficit hyperactivity disorder (ADHD) in students and be able to assist in providing care and support.

OBJECTIVES

This study intends to assess primary school teachers' knowledge of ADHD and evaluate the effectiveness of a short-term educational intervention.  Methods: A quasi-experimental quantitative study was conducted among primary school teachers in Jazan, Saudi Arabia. A two-hour educational intervention was designed and run in six schools using a specific knowledge rating scale before and after the application of the intervention.  Results: A total of 150 primary school teachers were included in this study, of which 64% were males, 51.3% were in the age group of 40-49 years, and 28% had teaching experience of more than 20 years. Regarding ADHD knowledge, the pre-intervention knowledge of the general criteria, symptoms and diagnosis, and treatment was considered adequate in 3.3%, 16.7%, and 2.7% of the participants, respectively, which improved post-intervention to 22%, 54.7%, and 19.3%, respectively. There was a significant association between the pre-intervention knowledge of the general criteria and the gender and between the knowledge of symptoms and diagnosis and the attendance of ADHD workshop by the participants. Also, there was a significant association between the participants' age, residence experience, attendance of ADHD workshops, and the general criteria and treatment domains.

CONCLUSIONS

 Most primary school teachers in Jazan have insufficient knowledge of ADHD. Using a knowledge improvement intervention can substantially improve the teachers' knowledge. Therefore, it is necessary to incorporate thoughtful knowledge improvement programs into the educational curricula for teachers.

Prevalence of Irritable Bowel Syndrome in Saudi Arabia: A Systematic Review and Meta-Analysis

Irritable bowel syndrome (IBS) is a commonly found global functional pathology with no detectable structural changes. It affects the quality of life and often coexists with psychiatric and somatic issues. We reviewed all articles published between 1990 and April 2023. The databases used for the data search were Google Scholar, Web of Science, Cochrane Library, and PubMed/MEDLINE. Ovid search engine was also used to broaden the search strategy. Predefined keywords, including "Irritable bowel syndrome" (MeSH) OR "IBS" (all fields), along with "Saudi Arabia" and "Middle East," were used to avoid data loss and ambiguity. Any cross-sectional study that reported the prevalence of IBS in any gender, age, and group of the Saudi population was included. Data extraction was independently performed in duplicate to mitigate bias and data loss. Statistical analysis of proportion was conducted by using Miller (Freeman-Tukey double arcsine - exact inverse). Out of 350 records identified, only 38 studies were included in the quantitative synthesis. The total number of study participants was 26,567, on the basis of the predefined inclusion criteria of the study. StatsDirect software was used for the statistical analysis of the study parameters. Based on all 38 identified studies, the calculated pooled prevalence was 20.7% (95% confidence interval (CI) = 17.8% to 23.7% by applying random effects (DerSimonian-Laird method). IBS was identified in 21% (95% CI = 16.7% to 25.7%) of the general population, 22% (95% CI = 17.6% to 26.7%) of students, and 18.3% (95% CI = 13.3% to 23.9%) of healthcare workers. The pooled prevalence of IBS among the Saudi population was 20.7%. The pathophysiology of IBS is complexed and significantly affected by genetics, diet, cultural characteristics, age, anxiety, depression, stress, and sleep disorders. This study fills a gap in understanding IBS prevalence in Saudi Arabia, contributing valuable data to this region.

Knowledge and Awareness of Syncope Among General Populations of Makkah Region in Saudi Arabia: A Cross-Sectional Study

Background Syncope is a transient loss of consciousness and postural tone due to global cerebral hypoperfusion which is followed by spontaneous recovery. It is relatively common and increases the risk of subsequent falls and injury. There is scant literature and targeted research on the population's knowledge of syncope. Hence, this study aimed to assess awareness and evaluate the knowledge of syncope among the population of the Makkah region. Methodology An online cross-sectional study was done on 563 participants. A questionnaire was used to collect data about participants' demographics, experiencing syncope in relatives, and knowledge about syncope using case scenarios. Results Females represented 72.6% of the participants and about one third of participants admitted that they had experienced syncope throughout their life. About one-third of participants admitted that they had experienced syncope throughout their life. Most of the study participants (68.9%) showed a good level of knowledge about syncope while 31.1% of them had poor knowledge; the average awareness score was 5.3±1.64. Cardiogenic syncope was the most commonly recognized type of syncope. Furthermore, participants aged between 18 and 35 years and widowed participants demonstrated a good amount of knowledge about syncopal attacks (p<0.001). Conclusions General population of the Makkah region in Saudi Arabia had a sufficient level of knowledge about syncope. Additional studies along with educational programs are needed.

Restorative and Endodontic Management of a Mandibular Canine With Two Roots and Two Canals: A Case Report

The existence of a permanent mandibular canine with two roots and two canals is rare. This case report presents restorative and endodontic management of a mandibular canine with two roots and two canals of a 32-year-old Saudi woman with multiple periradicular lesions of mandibular anterior teeth. Cone beam computed tomography (CBCT) was used for accurate diagnosis of the root canal morphology. CBCT helped to accomplish the restorative and endodontic treatment in a conservative approach.

Sick Leave Patterns in Common Rheumatological Diseases

Objectives The study aims to analyze the patterns and determinants of sick leaves (SL) associated with the most common rheumatological diseases and estimate the associated productivity loss cost (PLC). Method A retrospective study reviewed all SLs that were issued from a rheumatology outpatient clinic between 2016 and 2019 for the following diagnoses: low back pain (LBP), knee osteoarthritis (OA), rheumatoid arthritis (RA), and disc disorders. The duration of each sick leave was captured and analyzed by patients' age category, gender, and diagnosis. The human capital method was used to estimate the PLC. Result One thousand and two SLs have been issued during the study period, for a cumulative 4,649 days. The majority of the patients were female (86.3%), and the mean (SD) age was 42.01 (10.71) years. SL durations ranged from 2 to 14 days. The most frequent diagnosis was RA (34.3%), followed by LBP (30.1%). Disc disorder, knee OA, and RA were independently associated with 2.01 (p=0.014), 9.07 (p<0.001), and 7.75 (p<0.001) odd ratios for long SL (≥7 days), by reference to LBP. The average PLC was estimated at $235.29 per day of sick leave, for a total cumulative cost of $235,755.30. Conclusion Rheumatological diseases are responsible for approximately 4.5 days of SL prescribing per day in our clinic, with an average yearly cost of $58,938.83. Monitoring the pattern of sick leave and identifying the interplay between their cofactors are essential to developing a comprehensive approach to enable evidence-based clinical practices along with advancements in work-based protective measures and policies.

Effect of Premarital Education on the Quality of Life of Female Partners: A Cross-Sectional Study

Background A happy and satisfied marriage is the result of two happy spouses. Getting premarital education is one of the most significant reasons for marital and sexual satisfaction. This study aimed to assess the effect of premarital education on the quality of life of Saudi women. Methodology A cross-sectional study was conducted on 596 Saudi women married for ≤15 years selected from the general population. Data on participants' demographics were collected, and the quality of life was assessed using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Results Only 37.2% of the participants had premarital counseling and education, even though 86.4% thought it was crucial before marriage. When this study was conducted, most participants with shorter mean marriage durations had received premarital education or counseling. The mean WHOQOL-BREF score, which measures the quality of life, was considerably higher for participants who indicated that premarital education significantly impacted the quality of their marriage and those who received premarital counseling or attended any form of premarital education. Conclusions Even though premarital education was viewed favorably, only 37.2% of couples obtained it. There is a need to increase public awareness of premarital education's significance and incorporate it into the education curriculum due to the positive associations between receiving it and a higher quality of life.

Construct Validity and Reliability of the Arabic Version of Hypertension Knowledge-Level Scale Among Saudi Population

Background Knowledgeable people are more likely to follow their treatment plan and reduce hypertension morbidity and mortality. This study aimed to construct the validity and reliability of the Arabic version of the Hypertension Knowledge-Level Scale (HK-LS) among Saudis. Methods This cross-sectional questionnaire research targets hypertensives and non-hypertensives. Cronbach's alpha and Spearman's correlation matrix analysis measured the questionnaire's construct validity. Wilcoxon rank sum tests examined HK-LS tools' discriminant validity. A p<0.05 was considered significant. Results A total of 1424 responses were received. However, the 1419 individuals were evaluated after applying exclusion criteria. About 60% of the participants were female, with the most common age groups being 18-29 years (38.5%) and 40-49 years (24.0%). A personal history of hypertension was reported by 26.1%, and a family history of hypertension by 73.3% of the subjects. Cronbach's alpha for the whole HK-LS was 0.883, suggesting that the tool was reliable. All the items of the HK-LS questionnaire were significantly correlated with each other, except for a non-significant correlation between statements two and seven (r=0.05, p=0.091). The strongest correlations were apparent between items 19 and 20 (r=0.70, p<0.0001), items one and two (r=0.64, p<0.0001), and items 18 and 19 (r=0.56, p<0.0001). However, the weakest associations were reported among items two and six (r=0.06, p<0.05), items two and nine (r=0.07, p<0.05), and items one and 19 (r=0.07, p<0.05). The discriminant validity showed that a personal history of hypertension was associated with significantly higher scores of two HK-LS subscales, including definitions and complications. In addition, the overall knowledge score was significantly higher among participants with a positive history of hypertension among family and/or friends.  Conclusions The Arabic version of the HK-LS was found to be a reliable and valid tool for measuring knowledge about hypertension among the Saudi population. This reliable instrument can assist medical professionals in establishing education programs.

Gender Differences in Coronary Artery Disease, Clinical Characteristics, and Angiographic Features in the Jazan Region, Saudi Arabia

BACKGROUND

Cardiovascular disease is a major cause of death worldwide. In Saudi Arabia and the gulf area, coronary artery disease (CAD) is considered a serious problem with high mortality. Previous studies identified multiple risk factors, that include hypertension, diabetes, dyslipidemia, obesity, smoking, and low physical activity, which might be related to lifestyle changes over the last few decades. Limited data about gender differences in clinical and angiographic characteristics among CAD patients in the Jazan region are available. The aim of this study is to assess potential gender differences in CAD and its clinical characteristics and angiographic features in the Jazan region.

METHODS

This retrospective chart review collected data between January 2020 and March 2021 from the follow-ups of 498 patients (100 females and 398 males) aged over 18 years at the Prince Mohammed bin Nasser Hospital in the Jazan region of Saudi Arabia. The data were collected after all patients admitted to the hospital were reviewed, and cardiac catheterization was performed.

RESULTS

Of the 498 patients with CAD, 100 (20.1%) were female and 398 (79.9%) were male. The mean age of female patients (59.44 years) was significantly higher than that of male patients (55.1 years; P=0.0002). In addition, risk factors differed significantly between genders (P=0.0210). Moreover, vessels differed significantly between genders (P=0.0002). Coronary angiogram findings showed significant correlations between gender and percutaneous coronary intervention (PCI; P=0.0001) and MEDICAL (P=0.0010). Diagnosis findings showed significant gender differences in STEMI (P<0.0010) and unstable angina (P<0.0010).

CONCLUSIONS

CAD severity did not differ by gender, but coronary angiogram findings showed significant relationships between gender, PCI, and MEDICAL treatment with CAD.

The Impact of Diabetes Distress on the Glycemic Control Among Adolescents and Youth With Type 1 Diabetes in Two Tertiary Centers, Jeddah, Saudi Arabia

Introduction

Adolescents with type 1 diabetes (T1D) experience multiple symptoms of diabetes distress including fear of acute complications such as severe hypoglycemia which may lead to permanent brain damage or death. They also experience fear of acute hyperglycemia that can lead to diabetic ketoacidosis as well as chronic complication including diabetic nephropathy and retinopathy. No previous research was conducted in Saudi Arabia to assess diabetes distress among adolescents and youth with T1D. This study aimed to assess diabetes distress in adolescents and youth with T1D and its relation to clinical characteristics, glycemic control and diabetes co-morbidities.

Methodology

A cross-sectional study was conducted on 158 patients at King Abdulaziz University Hospital and Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. Data about participants’ characters, episodes of DKA, last HbA1c level, diabetes co-morbidities were collected. Diabetes distress (DD) was assessed by the Problem Areas in Diabetes (PAID) and Diabetes Distress Scale (DDS) scores.

Results

The prevalence of diabetes distress among our population of adolescents with T1D was 24.1%. The mean scores of PAID and DDS were 43.56 ± 13.84 and 2.22 ± 1.05, respectively. Patients with suboptimal HbA1c had significantly higher mean PAID and DDS scores. There is also a significant positive correlation between HbA1c level and number of ketoacidosis episodes. A highly significant positive correlation was found between PAID and DDS scores.

Conclusion

This study found that participants with uncontrolled HbA1c had significantly higher mean PAID and DDS scores with a significant positive correlation between the last HbA1c measured level and number of ketoacidosis attacks and PAID and DDS scores. Future studies on larger samples are needed to implement interventions to minimize the burden of diabetes distress among adolescents with T1D.

Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial

OBJECTIVE

Vitamin D deficiency has been associated with an increased risk of COVID-19 severity. This multi-center randomized clinical trial aims to determine the effects of 5000 IU versus 1000 IU daily oral vitamin D3 supplementation in the recovery of symptoms and other clinical parameters among mild to moderate COVID-19 patients with sub-optimal vitamin D status.

STUDY DESIGN AND SETTING

A total of 69 reverse transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 positive adults who were hospitalized for mild to moderate COVID-19 disease were allocated to receive once daily for 2 weeks either 5000 IU oral vitamin D3 (n = 36, 21 males; 15 females) or 1000 IU oral vitamin D3 (standard control) (n = 33, 13 males; 20 females). Anthropometrics were measured and blood samples were taken pre- and post-supplementation. Fasting blood glucose, lipids, serum 25(OH)D, and inflammatory markers were measured. COVID-19 symptoms were noted on admission and monitored until full recovery.

RESULTS

Vitamin D supplementation for 2 weeks caused a significant increase in serum 25(OH)D levels in the 5000 IU group only (adjusted p = 0.003). Within-group comparisons also showed a significant decrease in BMI and IL-6 levels overtime in both groups (p-values < 0.05) but was not clinically significant in between-group comparisons. Kaplan-Meier survival analysis revealed that the 5000 IU group had a significantly shorter time to recovery (days) than the 1000 IU group in resolving cough, even after adjusting for age, sex, baseline BMI, and D-dimer (6.2 ± 0.8 versus 9.1 ± 0.8; p = 0.039), and ageusia (loss of taste) (11.4 ± 1.0 versus 16.9 ± 1.7; p = 0.035).

CONCLUSION

A 5000 IU daily oral vitamin D3 supplementation for 2 weeks reduces the time to recovery for cough and gustatory sensory loss among patients with sub-optimal vitamin D status and mild to moderate COVID-19 symptoms. The use of 5000 IU vitamin D3 as an adjuvant therapy for COVID-19 patients with suboptimal vitamin D status, even for a short duration, is recommended.

Stature estimation for Saudi men based on different combinations of upper limb part dimensions

Estimating stature based on body/limb parts can help define the characteristics of unidentified bodies. The most studied upper limb part is the hand, although few studies have examined whether stature can be estimated using fingers plus other hand dimensions. Moreover, there is paucity in anthropometric studies that determined whether bilateral whole limb parts (e.g., arms, forearms, and hands) are related to stature among the living subjects.This prospective cross-sectional study aimed to evaluate the relationship between different upper limb measurements and the stature of Saudi men. Furthermore, I assessed whether upper limb asymmetry was present, and developed regression models to estimate stature based on different available measurements. Stature and 13 upper limb parameters were measured for 100 right-handed Saudi men who were 18 to 24 years old.All measurements were positively correlated with stature (P < .001), and the best single predictor was the bilateral ulnar length. Asymmetry was more pronounced in the hand measurements. A multiparameter model provided reasonable predictive accuracy (±3.77-5.68 cm) and was more accurate than single-parameter models. Inclusion of the right-side fingers improved the model's accuracy.This study developed potential models for estimating stature during the identification of bodies of Saudi men.

Non-diabetic end-stage renal disease in Saudis associated with polymorphism of MYH9 gene but not UMOD gene

The prevalence of risk factors of chronic kidney disease in Saudi Arabia has augmented an already serious public health problem, therefore, determination of genetic variants associated with the risk of the disease presents potential screening tools that help reducing the incidence rates and promote effective disease management.The aim of the present study is to determine the association of UMOD and MYH9 genetic variants with the risk of non-diabetic end-stage renal disease (ESRD) in the Saudi population.Two single nucleotide polymorphisms (SNP), rs12917707 in gene UMOD and rs4821480 in gene MYH9 were genotyped in 154 non-diabetic ESRD Saudi patients and 123 age-matched healthy controls using Primers and Polymerase chain reaction conditions (PCR), Sanger sequencing, and TaqMan Pre-designed SNP Genotyping Assay. The association of these genetic variants with the risk of the disease and other renal function determinants was assessed using statistical tools such as logistic regression and One-way Analysis of Variance tests.The genotypic frequency of the two SNPs showed no deviation from Hardy-Weinberg equilibrium, the minor allele frequency of UMOD SNP was 0.13 and MYH9 SNP was 0.08. rs4821480 in MYH9 was significantly associated with the risk of non-diabetic ESRD (OR = 3.86; 95%CI: 1.38-10.82, P value .010), while, rs12917707 showed lack of significant association with the disease, P value .380. and neither of the 2 SNPs showed any association with the renal function determinants, serum albumin, and alkaline phosphatase enzyme.

An Investigation of the Needs of Saudi Parents of Preterm Infants in the Neonatal Intensive Care Unit

Objective This study aimed to identify the needs of Saudi parents who had an infant in a neonatal intensive care unit (NICU) in one of five hospitals in Riyadh City, Saudi Arabia. Materials and methods Data were collected using a questionnaire that comprised questions about demographic characteristics and a modified version of the NICU Family Needs Inventory. A convenience sample of 36 Muslim Saudi mothers and fathers completed a self-reported questionnaire. Parents were asked to rate 52 statements in the NICU Family Needs Inventory as not important, somewhat important, important or very important. Results Saudi parents ranked the needs for assurance, proximity, and information as the most important needs. The comfort and support needs were ranked as the least important. Moreover, the highest top-ranked items were related to assurance of pain infant being treated for (86%), infant expected outcome (83%), and infant being handled gently (83%). Conclusion Nurses should create a relationship with parents and provide them with comprehensible and honest assurance and information. Likewise, it is imperative to provide a high-quality holistic care for parents that relies on their needs assessment.

Sotos syndrome: A case report of 1st genetically proven case from Saudi Arabia with a novel mutation in NSD1 gene

RATIONALE

Sotos syndrome is a rare genetic disorder characterized by rapid growth during infancy and childhood; ≥2 SD for height and head circumference; distinctive facial appearance and developmental delay.Ten clinically diagnosed cases have been reported from Saudi Arabia; none of them was genetically confirmed.

PATIENT CONCERNS

A male Saudi patient, who had a birth length and head circumference above 97th centile, presented with abnormal rapid growth, delayed motor and mental milestones, aggressive behavior, obsession to close doors, nail biting, defective attention, and hyperactivity.

DIAGNOSES

Sotos syndrome was suspected INTERVENTIONS:: Molecular genetic analysis for NSD1 gene was carried for the patient.

OUTCOMES

A novel heterozygous deletion of all exons 1 to 23 of the NSD1 gene was detected. Genetic counseling was carried for the family with extended genetic testing for the parents and his siblings with normal results.

LESSONS

Despite its worldwide distribution, Sotos syndrome may be under-reported. Besides its characteristic clinical picture, molecular genetic testing is also extremely recommended.

Lethal neonatal mitochondrial phenotype caused by a novel polymerase subunit gamma mutation: A case report

RATIONALE

Polymerase subunit gamma (POLG) is a gene that codes for the catalytic subunit of the mitochondrial DNA polymerase, which is involved in the replication of mitochondrial DNA. Mutations in these genes are associated with a range of clinical syndromes characterized by secondary mtDNA defect including mtDNA mutation and mtDNA depletion which may culminate in complete failure of energy production (respiratory changes complex 1 defect) as in this case.

PATIENT CONCERNS

We herein report a full term Saudi female neonate born to consanguineous parents, who was noticed immediately after birth to have severe hypotonia, poor respiratory effort, and dysmorphic features. She had 3 siblings who died with same clinical scenario in neonatal period.

DIAGNOSES

Molecular genetic testing revealed a novel compound heterozygous mutation of POLG gene c.680G>A (p.Arg227Gin) and c.3098C>T (p.Ala1033Val).

INTERVENTIONS

The patient remained in neonatal intensive care unit with multidisciplinary team management and was ventilator dependent until she passed away.

OUTCOMES

The detected mutation had led to complete failure of energy production (respiratory changes complex 1 defect) until she died at the age of 5 months.

LESSONS

Mitochondrial respiratory chain defect should be considered in patients with severe neonatal hypotonia,encephalopathy, and respiratory failure especially in highly consanguineous population.

Alström syndrome: A novel mutation in Saudi girl with insulin-resistant diabetes

RATIONALE

Alström syndrome is an autosomal recessive disorder characterized by hearing loss, blindness, obesity, non-insulin dependent diabetes, and others.

PATIENT CONCERN

A 10 years old Saudi girl, who presented with diabetic ketoacidosis and found to have hearing loss and blindness.

DIAGNOSIS

Alström syndrome.

INTERVENTIONS

Multidisciplinary team approach, with echocardiography, hearing test, eye exam and genetic test for Alström syndrome.

OUTCOMES

The patient has retinitis pigmentosa, bilateral hearing loss, double diabetes with weakly positive anti-insulin antibodies and DNA analysis showed novel mutation for Alström syndrome.

LESSONS

the combination of obesity, diabetes, hearing loss and blindness should alert the physician to test for Alström syndrome.

Variation in inflammatory bowel disease care among saudi pediatric gastroenterologists

BACKGROUND/AIM

Although international guidelines in inflammatory bowel disease (IBD) management are currently available, variations in IBD care still exist. The aim of this study was to determine the extent of the variation in IBD care among Saudi pediatric gastroenterologists.

MATERIALS AND METHODS

A cross-sectional survey was conducted among all pediatric gastroenterologists who were members of the Saudi Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SASPGHAN) from August 2015 to December 2015. The questionnaire included items on demographic characteristics and utilization of different diagnostic and therapeutic interventions in IBD care.

RESULTS

Of the 45 registered pediatric gastroenterologists surveyed, 37 (82%) returned the survey from 20 centers across the country; 75.7% were practicing in tertiary care centers. There was a considerable variation in the use of different diagnostic tests during the initial evaluation of the disease. Utilization of calprotectin assays, magnetic resonance imaging enterography, and bone densitometry seemed to vary the most between physicians practicing at tertiary and secondary care centers. There were statistically significant differences in the prescription of biological therapy between the two groups.

CONCLUSIONS

We found a considerable variation in the use of different diagnostic and therapeutic interventions in the management of pediatric IBD patients. Such variations could lead to unintended differences in patient outcomes. Implementation of the available evidence-based guidelines may limit such variations and ultimately could improve the quality of IBD care provided.

Dairy products consumption and serum 25-hydroxyvitamin D level in Saudi children and adults

Vitamin D deficiency is implicated in several calcium deficiency-related disease conditions. We aimed to investigate vitamin D status and its association with consumption frequencies of various dairy products in Saudi population. Subjects consisted of 820 children (327 boys; mean age 14.9 yrs and 493 girls; 14.8 yrs) and 565 adults (249 men, 27.9 yrs and 316 women 32.2 yrs). We estimated the consumption frequencies of various dairy food products (fresh milk, powdered milk, laban, yoghurt and cheese) using a qualitative food frequency questionnaire and serum level of 25-hydroxyvitamin D (25 (OH) D). Associations between variables of interest were assessed by Pearson correlation analysis. Among the study subjects, 80% boys, 90% girls, 64% men and 50% women had deficient/insufficient levels of vitamin D. Modest associations were found between mean serum 25 (OH) D concentration and fresh milk consumption in children (r=0.11) (especially in girls (r=0.12)), and overall dairy products consumption in women (r=0.12).

CONCLUSION

Results indicated widespread vitamin D deficiency in Saudi Arabian children and adults. High level of vitamin D deficiency and a lack of strong correlation between dairy product consumption and serum level of vitamin D imply a need for adequate fortification of milk and other dairy products with vitamin D.

Differences and associations of metabolic and vitamin D status among patients with and without sub-clinical hypothyroid dysfunction

BACKGROUND

Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile.

METHODS

A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium.

RESULTS

Cases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01).

CONCLUSIONS

Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.

Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease

BACKGROUND/AIMS

Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors.

SETTINGS AND DESIGN

We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008.

PATIENTS AND METHODS

Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines.

STATISTICAL ANALYSIS USED

Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses.

RESULTS

Ninety-five patients were included; 46% had Crohn's disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD.

CONCLUSIONS

Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.

Evaluation of blood units with isolated anti HBC for the presence of HBV DNA

We screened blood donors in one center in Saudi Arabia for a safety transfusion. We found that among 5043 blood donors negative for HCV and HIV, the incidence of HBsAg positivity was 2.97%. When antiHBc antibody was measured (HBcIg) in HBsAg negative donors, we observed that 21.47% were positive indicating previous exposure to hepatitis B virus. The HBcIg positive blood was further screened for HBsAb and the specimens were found to be reactive in 81.54%. Based on these data blood transfusion was permissible from donors who showed HBsAg negativity, HBcIg positive and HBsAb reactive blood. In order to ensure safety transfusion an aliquot of specimens (n = 80) was further analyzed for HBV DNA by PCR. We found only one specimen positive with incidence of 1.25%. So we recommended restricting transfusion from the previously mentioned donors to emergencies.