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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 3 | Issue 2
Page Nos. 79-141

Online since Thursday, April 2, 2020

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EDITORIAL  

Coronavirus disease-19 (severe acute respiratory syndrome-coronavirus-2) is not just simple influenza: What have we learned so far? Highly accessed article p. 79
Ali M Somily, Ahmed S BaHammam
DOI:10.4103/JNSM.JNSM_22_20  
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REVIEW ARTICLES Top

Biodynamic activities of ellagic acid: A dietary polyphenol p. 83
Bikash Debnath, Waikhom Somraj Singh, Manik Das, Sanchari Goswami, Kuntal Manna
DOI:10.4103/JNSM.JNSM_32_19  
Plant polyphenols are fast-growing food products for the health beneficial properties. Ellagic acid (EA) is a fused four-ring polyphenol. It is present in the form of ellagitannin in plants. A significant quantity of EA was found in raspberry, blackberry, strawberry, cloudberry, and pomegranate. The present article provides ample information on the biological sources from fruits, its biotransformation, bioavailability, and metabolism along with biofunctions on human health.
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Allergic bronchopulmonary aspergillosis: A systematic review of its management with a call to action in Saudi Arabia p. 91
Saad Mohammed AlShareef
DOI:10.4103/JNSM.JNSM_52_19  
Allergic bronchopulmonary aspergillosis (ABPA) is a relatively common, but underdiagnosed allergic complication of asthma and cystic fibrosis, occurring in about 13% and 9% of cases, respectively. Significant progress has been made over the last decade in establishing diagnostic criteria and a pragmatic clinical approach to its management with steroids, antifungals, and newer agents, including anti-immunoglobulin E (IgE) monoclonal antibodies. In spite of this, there is very little literature on ABPA in Saudi Arabia, and the few papers that do exist suggest that ABPA may be associated with Aspergillus species other than Aspergillus fumigatus. This is of particular concern since the recommended current diagnostic screening is based on A. fumigatus-specific IgE levels, and other Aspergillus species may have different clinical profiles. This article provides an overview of ABPA for the practicing physician, provides an up-to-date review of randomized controlled trials in ABPA, and highlights urgent research priorities for ABPA in Saudi Arabia.
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ORIGINAL ARTICLES Top

Arabic validation of problematic use of mobile phone scale among university students in Saudi Arabia p. 101
Hatem Alshahwan, Fahad Dakheel Alosaimi, Haifa Alyahya, Nawal Al Mahyijari, Shaffi Ahamed Shaik
DOI:10.4103/JNSM.JNSM_9_19  
Objectives: Smart phone addiction is rampant worldwide, especially among young adults; hence, its quantification using a reliable and valid instrument is essential. The problematic use of mobile phones (PUMP) scale, designed with 20 items, is a validated tool to assess smart phone addiction based on DSM-5 criteria. This study aims to test the reliability and construct validity of the Arabic version of the PUMP scale among a sample of university students in Saudi Arabia. Methods: This study was conducted among 2367 students of King Saud University, Riyadh, Saudi Arabia. An Arabic version of the PUMP scale was developed; then, its reliability and validity were assessed. The internal consistency of the PUMP scale was assessed using Cronbach's alpha, and its construct validity was assessed by factor analysis. Results: The internal consistency values of the 20 items ranged between 0.904 and 0.912, which are highly statistically significant. The average value of the internal consistency is 0.911 (95% CI: 0.905 to 0.916). The factor analysis provides the 3 factors that can be labelled as Factor1: “use of cell phone longer than intended and activities reduced“, Factor2: “dependence and craving” and Factor3: “use despite failure of obligations, social and physical problems“. Conclusions: The study concludes that the PUMP scale used to quantify smart phone addiction was proven to be reliable and valid in the Arabic language in Saudi population. Future studies are recommended in other parts of Arabic speaking societies to confirm the reliability and construct validity of the Arabic PUMP scale.
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Community awareness of noise-induced hearing loss from portable listening devices and possible preventive measures p. 107
Farid Alzhrani, Saad Al-Saleh, Shayma Asrar, Ahmed Al-Dhafeeri, Bashaer Al-Baqami, Mona Al-Harbi, Amani Al-Harbi, Mai Al-Masoud, Tahera Islam
DOI:10.4103/JNSM.JNSM_29_19  
Introduction: Although there is some degree of awareness among adults concerning noise-induced hearing loss (NIHL), they may not perceive themselves to be at risk and may, therefore, find it unnecessary to change their listening habits. The current study investigated the beliefs, attitudes, and practices regarding NIHL in the community. Materials and Methods: A cross-sectional, community-based survey was conducted on 739 respondents from different regions (north, south, west, east, and central) of Saudi Arabia. An electronic Arabic questionnaire (Survey Monkey Arabic questionnaire) was distributed through social media (Facebook, WhatsApp group, and Twitter) for 3 months starting from May 2017. A total of forty questions were designed in order to investigate the participants' beliefs and knowledge about NIHL within the community. Results: Approximately 25% of the study participants reported mild-to-severe hearing problems, especially among male participants. A significantly higher prevalence of hearing problems was noted in listeners who were accustomed to using a volume level of more than 80%. The risk factors for NIHL included the number of sessions per day that the participant was exposed to a noise source and the degree to which the volume of the TV or the radio was increased along with the duration of exposure per session. Approximately 75% of the study participants preferred to decrease the volume of their personal audio devices as a means of protection against NIHL. Conclusion: This study identified that there is a significant prevalence of hearing impairment in the Saudi community. In general, majority of the respondents are aware of the risk factors concerning NIHL. In spite of that, the practice of population showed unhealthy listening habits. The positive attitude of the participants toward changing their lifestyle indicates that there is a need for NIHL awareness campaigns to further educate the community.
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Outcome of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma p. 115
Hadeel A Helmi, Falwah F Alharthi, Ahmad A Madkhali, Faisal A Alsaif, Albatoul Y Alshanifi, Weam S Hussein, Shargan M BinKhamis, Abdulsalam Alsharabi, Mazen M Hassanain
DOI:10.4103/JNSM.JNSM_30_19  
Background and study Aims: Liver cancer, most commonly known as hepatocellular carcinoma (HCC), was ranked as the sixth most common cancer in Saudi Arabia in 2014. Management of unresectable HCC is multidisciplinary and could include radiofrequency ablation, systemic-targeted therapy, and transarterial chemoembolization (TACE). This study aimed to assess the survival outcome of patients with unresectable HCC undergoing TACE in Saudi Arabia. Patients and Methods: We retrospectively studied patients with unresectable HCC who were treated with TACE between 2004 and 2016. Patient's demographics, etiology of liver disease, Child–Turcotte–Pugh stage, computed tomography scan findings, laboratory results, details of treatment sessions, and follow-up visit data were obtained from the National Liver Disease Research Database. Results: Thirty-nine patients diagnosed with HCC underwent 103 TACE sessions at our hospital. Median overall survival time was 20 months (range 0–98). Median progression-free survival was 9 months (range 1–98). Follow-up imaging revealed progressive disease in 20 patients (54.05%), while 17 had no disease progression, and none had complete resolution. Conclusion: Our results are similar to those of previous studies that reported the benefit of TACE on survival rates of HCC patients. The correlation found between median overall survival and international normalized ratio and bilirubin level could reflect the importance of liver function deterioration effects on outcomes.
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Diagnostic accuracy of fine-needle aspiration cytology with histopathology of thyroid swellings in king Abdulaziz Medical City p. 121
Sameer Al-Bahkaly, Abdullah Alshamrani, Leen Omar Hijazi, Maysan Mohammed Almegbel, Majed M Pharaon
DOI:10.4103/JNSM.JNSM_46_19  
Introduction: Thyroid nodules are a common clinical problem. Currently, many diagnostic tests are used to diagnose thyroid swellings with fine-needle aspiration cytology (FNAC) being the gold standard test. However, FNAC has limitations, and a histopathology report is needed for the final diagnosis. The purpose of this study is to correlate the FNAC findings with the histopathology of the excised specimens. Materials and Methods: This is a retrospective review of 98 patients undergoing thyroidectomy in the Department of ENT, Head and Neck Surgery at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Period of study was from May 2011 to June 2014. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNAC for the diagnosis of solitary thyroid nodules were 55.56%, 88.73%, 65.22%, 84%, and 79.59%, respectively. Conclusion: FNA is a simple, safe, and cost-effective diagnostic modality for thyroid carcinoma. It is recommended as the first-line investigation for the diagnosis of solitary thyroid nodule.
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Public perception in the management and prevention of common ear, nose, and throat diseases in Saudi Arabia p. 126
Feras Alkholaiwi, Muteb Mousa Alharbi, Abdulrahman Yousef Aldayel, Asem Mustafa Shadid, Faisal Eid Almutairi, Abdulmajeed Bin Dahmash
DOI:10.4103/JNSM.JNSM_50_19  
Objective: The objective was to evaluate the awareness and knowledge of and attitudes toward common ear, nose, and throat (ENT)-related diseases among Saudi Arabian adults in Riyadh, Saudi Arabia. Methods: A cross-sectional quantitative study was conducted in Riyadh in April 2018 through 2500 self-administered, convenient sampling technique online questionnaires. Sociodemographic data, as well as knowledge regarding common ENT-related conditions, were collected and evaluated. Results: Of the 2500 distributed questionnaires, 1611 responses were received (response rate = 64.4%). The majority of participants (79.4%) had poor knowledge of ENT-related diseases (<50% score). In terms of general knowledge, 69.6% of the participants correctly answered the questions related to the safety of cotton buds for the ears and 17.75% and 19.9% correctly answered the questions related to the role of Vitamin C in the treatment of the common cold and the difference between dizziness and vertigo, respectively. Most participants had acceptable knowledge when questioned on hearing loss (score ≥50%), whereas only 18.37% scored correctly regarding the use of hearing aids in infants. The question related to the initial step in controlling nasal allergies was the highest scoring question (95.65%). The most common information resources were community, social media, and Internet websites. Conclusion: Lack of awareness of ENT-related issues is common among people in Riyadh. In addition, our findings imply that there is a need to educate and increase public awareness, especially through community-based public health campaigns and awareness programs, as community was the major information source among participants in this study.
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CLINICOPATHOLOGICAL PEARLS Top

Giant posterior mediastinal goitergiant posterior mediastinal goiter p. 136
Muhammad H Mujammami, Aishah A Elkhzaimy, Abdulaziz A Alodhayani, Sarah M Aljasser, Abdulaziz A Alsaif
DOI:10.4103/JNSM.JNSM_35_19  
Vast majority of mediastinal goiters are situated in the anterior mediastinal compartment and rarely located in the posterior mediastinum. Posterior mediastinal goiters should be differentiated from other mediastinal masses through appropriate work-up by the computed tomography which is the most valuable technique. We reported a case of symptomatic mediastinal goiter extending from the neck to the posterior mediastinum compressing the trachea and airway. The surgical intervention is considered the treatment of choice in such cases. The surgical approach was done through a classical transverse cervical incision, lateral right thoracotomy, and median sternotomy. The histopathological report was consistent with a multinodular goiter. The patient's recovery was uneventful with an excellent postoperative symptomatic relief.
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DISHphagia and DISHphonia DISHguised as a stroke p. 139
Abdulrahman Khalid Alfadhel, Abdullah K Almanea, Rajkumar Rajendram, Abdulaziz G Alsaad
DOI:10.4103/JNSM.JNSM_47_19  
Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory condition that usually affects the elderly patients with several metabolic derangements. It is characterized by symptoms that mimic more sinister conditions such as stroke or malignancy. Indeed, this diagnosis can easily be “DISHmissed” if not considered in the differential diagnosis. Dysphagia is the most common symptom reported by patients with DISH. Always due to cervical osteophytes, dysphagia due to DISH has been described as DISHphagia. Extrapolation of this terminology to DISHphonia, DISHpnea, DISHpepsia, and DISHesthesia may increase awareness of the plethora of symptoms that may be caused by DISHplacement of anatomy. This is clinically significant because the prevalence of DISH is likely to increase, and DISH can be managed with conservative, medical, and surgical therapies.
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