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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 2 | Issue 4
Page Nos. 183-246

Online since Friday, October 4, 2019

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EDITORIAL  

Electronic vaping: Is it harmless or a snake in the grass? p. 183
Ahmed S Bahammam
DOI:10.4103/JNSM.JNSM_41_19  
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REVIEW ARTICLES Top

Publish ethically or perish p. 186
Arjumand S Warsy, Irfan Ahmad Warsy
DOI:10.4103/JNSM.JNSM_17_19  
The phrase “publish or perish” has been used in an academic context since the early 1970s to emphasize the importance of publishing the findings of research. It has also been widely used to describe the pressure in academic institutions to rapidly and continually publish academic work. The pressure to publish, the lack of knowledge about publication ethics, and other factors have led occasional authors to indulge in practices that are outside of the realm of the ethical principles. This article highlights the ethics of writing and publishing, outlines the various unethical practices (misconduct) that must be avoided, and highlights the severe consequences that may be inflicted on an author, whether a junior or a senior one, following detection of misconducts in publishing. The title of this article is a modified form of the maxim “publish or perish” because it is an important responsibility that every author publishes ethically.
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An overview of transcranial magnetic stimulation research with bibliometric Indicators p. 196
Shafiq Ahmad, Moath Alatefi, Ali Hamza, Shahid Bashir
DOI:10.4103/JNSM.JNSM_58_18  
Transcranial magnetic stimulation (TMS) is a noninvasive technique increasingly used in basic and clinical research practices around the world. Its established clinical applications include treatment of major depression and presurgical functional mapping of the motor and language cortexes. In experimental and clinical trials have aimed to test the therapeutic and diagnostic utility of TMS in a range of disease states, including obsessive–compulsive disorder, schizophrenia, autism, strokes, tinnitus, Alzheimer's and Parkinson's diseases, traumatic brain injury, multiple sclerosis, migraine, and dystonia. To quantitatively analyze the current worldwide progress in TMS research based on the Web of Science (WoS) database for the past 27 years. We conducted a quantitative analysis of articles regarding TMS that were published in English between 1988 and 2015 and that were indexed in the WoS database. In the past 27 years, there have been 14,077 studies on TMS indexed by the WoS database. The analysis results indicate that most of the research studies in the field were published by North American and European institutions. With respect to Asian countries, Japan also published a reasonable proportion of publications, but comparatively speaking, the number of publications is rare. From the perspective of research progress, we found that the number of published articles on TMS has increased significantly in the past 10 years.
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ORIGINAL ARTICLES Top

Publishing determinants and barriers among family physicians during and after training in Saudi Arabia p. 208
Sulaiman Abdullah Alshammari, Abdullah Sulaiman Alshammari
DOI:10.4103/2589-627X.260447  
Objective: This study aims to examine the topics covered and the type, scope, and methodology used in family physicians' research projects. In addition, this study explores the determinants and barriers to publishing that affect family physicians' publication behavior. Methods: This study reviewed the end of training research projects of family medicine residents in Saudi Arabia in 2012 and 2013 to determine their topics, scope, and methodologies. Participants were followed for 5 years. Residents' attitudes toward publishing, percentage of work published in peer-reviewed journals, whether participants continued to publish afterward, and obstacles to research and publication were assessed. Results: Residents (n = 157, 66.7% of men) completed an electronic self-administered questionnaire comprising information about training, sex, and publication history. Seventy-six (48.4%) successfully managed to publish in peer-reviewed journals. Most employed questionnaires in their projects (93%) and used descriptive statistical analysis (94.3%). A smaller number of family physicians (n = 15, 9.6%) continued to publish after completing training and resuming family medicine service. Most published projects (95.8%) employed a cross-sectional design. Some (n = 60, 38.2%) expressed interest in publishing if they received an expert's assistance. Reported obstacles to publishing included lack of time (19.1%), unavailability of technical support (14.0%), and lack of incentives (3.1%). Conclusion: Overall, participants' attitudes toward research and publication were positive; however, their publication rate after completing a training program was low. Publication should be promoted through continued education about research and writing methodology and through incentivization of professional mentors and financial support.
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Glycemic control in intensive care unit: Experience of a tertiary care center p. 215
Hadil A Alotair, Shereen Ahmed Aldasoqi, Juren P Baldove, Mohammed Ahmed Abdou
DOI:10.4103/JNSM.JNSM_20_19  
Background: Hyperglycemia complicates the course of illness of many critically ill patients and contributes to the increased morbidity and mortality in adult intensive care units (ICUs). Objective: The objective of this study is to compare the effectiveness of a modified nurse-implemented insulin infusion protocol (NIIP) against the original protocol used in the adult ICUs, in terms of controlling hyperglycemia while averting significant hypoglycemia. Methodology: Blood glucose (BG) readings that were collected over 3 months in medical and surgical ICUs (SICUs) while on the original insulin infusion protocol were retrospectively reviewed. A modified insulin infusion protocol was prepared by a dedicated adult ICU quality focus group composed of physicians, nurses, clinical pharmacists, and quality representative. The rate of insulin infusion was increased by 10%–20% for the BG ranges above 13.1 mmol/L, allowing early transition from a mild-to-moderate scale. The new protocol was implemented for 2 months, and BG readings were compared to the results of the original insulin infusion protocol. Results: A total of 3490 BG readings in the medical ICU and 3006 in SICU were analyzed. Hyperglycemia was found in 1743 readings (26.83%) while on the original insulin protocol. When the modified insulin infusion protocol was applied, hyperglycemia was significantly less (19.83%, P < 0.0001) and significantly more readings were in the range of 7.8–10 mmol/L (52.57% vs. 46.54%, P= 0.0001). The reduction in hyperglycemia was more significant in SICU patients (19.20% vs. 31.27%, P < 0.0001). Meanwhile, severe hypoglycemia remained within the benchmark. Conclusions: The modified NIIP achieved fewer episodes of hyperglycemia in critically ill patients while avoiding the deleterious effects of hypoglycemia. This affirms the value of periodic monitoring and adjustment of ongoing protocols in ICUs.
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Knowledge, attitudes, and practices pertaining to cotton-bud usages and the complications related to their mi suse among outpatients in an ear, nose, and throat clinic p. 220
Maha Saleh Alrajhi, Bader Mohammed Alim, Sara Dokhayel Aldokhayel, Leena Mohammad Zeitouni, Layan Khalid Al Tawil, Farid A Alzahrani
DOI:10.4103/JNSM.JNSM_10_19  
Introduction: Cotton buds are small plastic rods with cotton-covered tips. They have been widely misused since their development. Objectives: This study aims to determine the prevalence of cotton bud usage and examine patients' attitudes toward their utilization. It also aims to investigate the complications associated with their misuse. Methodology: This cross-sectional observational study was conducted in King Abdulaziz University Hospital, on patients attending the ear, nose, and throat outpatient clinics between January and March 2018. Data were collected using paper-based questionnaires and analyzed using SPSS. Results: A total of 378 patients completed the survey. Most respondents (69.6%) confirmed that they had used cotton buds previously. However, only 18% of the respondents suffered ear canal complications associated with cotton bud use. Respondents reported ear wax impaction as the most common complication (41.2%), followed by ear pain (39.7%). The majority (63.2%) of the respondents stated that they had received at least one educational session warning them against improper cotton bud use. Almost half of the patients were unsure whether cotton buds could cause complications or not. The mean overall rating of the attitude of the patients toward using cotton buds resulted in a score of 12 out of 20, thereby denoting that these patients were slightly inclined toward using cotton buds. Furthermore, patients who reported having used cotton buds had significantly greater attitudes toward cotton bud usefulness (mean, 13.4; standard deviation, 2.8; P < 0.001). Conclusion: Overall, patients seem to have relatively insufficient knowledge and lax attitudes toward cotton bud usage and the complications related to their use. Further studies on a broader scale are warranted to evaluate the extent of cotton bud use.
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Prevalence and factors associated with methicillin-resistant Staphylococcus aureus colonization among clinical medical students p. 226
Nora Naser Albusayes, Khalifa Binkhamis, Ruba Mohammed Alselaimy, Monirah Misfer Alsalouli, Raghad Abdulaziz Alnafisah, Lina Abdullah Albawardi, Ali M Somily, Abiola Senok
DOI:10.4103/JNSM.JNSM_3_19  
Background: This study was carried out to assess the prevalence and determinants of methicillin-resistant Staphylococcus aureus(MRSA) colonization among clinical clerkship medical students in Saudi Arabia. Methods: A cross-sectional study was performed at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Nasal samples were obtained from 360 clinical clerkship medical students (3rd–5th years). Questionnaires were filled. MRSA identification was done using the standard laboratory procedures. Data were analyzed using SPSS Pc + 21.0 software. Results: Of 360 samples, 100 (27.7%) were positive for S. aureus and 12 (3.3%) were MRSA positive. The following variables and the outcome (MRSA+/MRSA−) showed statistically significant association; previous hospital admissions, immunocompromised status, chronic disease, and female gender. We found that our MRSA colonization prevalence rate of 3.3% predominately in female gender. Third-year medical students have the highest MRSA colonization of 4.8%, then 4th year 2.8%, and 5th year 1.2%. 17.6% of students with history of hospital admission where found to be MRSA positive, 10% of bronchial asthma sufferers, and 37.5% of immunocompromised students either due to medication or cancer were MRSA positive. Conclusion: MRSA nasal carriage among clinical medical students in KSUMC was found to be 3.3%. We recommend teaching standard practices of infection control protocols and additional precautions.
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Knowledge, attitudes, and self-reported practices of pediatric emergency physicians toward the pediatric emergency care applied research network criteria in Al-Qassim region p. 231
Mohammad Abdulaziz Alhasoon, Reema Altowayan, Amal Alqufly, Renad Aloqayli, Anfal Alfeneekh, Ghaid Alkharaz, Moath Saleh Aljohani
DOI:10.4103/JNSM.JNSM_77_18  
Objective: The study was conducted to assess the knowledge, attitudes, and self-reported practices of pediatric emergency physicians toward Pediatric Emergency Care Applied Research Network (PECARN) criteria among physicians who are covering the emergency room at Ministry of Health Hospitals in the Al-Qassim Region. Methodology: A cross-sectional study was conducted. A questionnaire that included various sociodemographic variables and items on knowledge, attitude, and self-reported practices was administered. To explore significant differences across different sociodemographic variables, the Mann–Whitney U-test and Kruskal–Wallis test were implemented as appropriate. Results: A total of 117 pediatric emergency physicians were surveyed. The data show a mean knowledge score of 8.17 (standard deviation [SD] 3.14). There were no significance differences in age group, gender, nationality, experience, or doctor category (P > 0.05). However, significant differences were observed in level of education (P = 0.014). The mean score for attitude was 6.81 (SD 2.3). Among sociodemographic variables, only those in educational level (P = 0.004) and experience in years (P = 0.001) were significant. Practice average score was 5.79 (SD 1.8). As in the case of attitude, the data showed significant differences in level of education (P = 0.002), as well as years of experience (P = 0.004). Conclusions: This demonstrates that the application of PECARN in Al-Qassim Province, Saudi Arabia, will minimize the risk of exposure to radiation in the pediatric population with head trauma. Positive knowledge, attitudes, and practices regarding PECARN identified pediatric patients at low risk of clinically significant traumatic brain injuries.
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The prevalence rate and associations of depressive symptoms and smoking among applied medical science students in a large university in Saudi Arabia: A cross-sectional study p. 237
Eiad AlFaris, Farhana Irfan, Hussein Saad Amin, Riaz Qureshi, Nasr AlMaflehi, Mohammed Ali Batais, Abdullah M A. Ahmed, Gominda Ponnamperuma, Saira AlQahtani, Abrar T AlTurki, Amro K Bin Abdulrahman, Cees van der Vleuten, Heba AlFaris
DOI:10.4103/JNSM.JNSM_68_18  
Background: Depression among health professional students is a topic of concern. Often, it is associated with other unhealthy habits such as smoking. This study aimed to find the prevalence rate of depressive symptoms and smoking among applied medical science (AMS) students and their associations with each other. Methodology: In this descriptive-analytic, cross-sectional study, a stratified proportionate sampling strategy was used to select the study sample from the AMS school students, Saudi Arabia, during the academic year 2012–2013. The students were screened for depressive symptoms and smoking status using Beck Depression Inventory (BDI II) and a sociodemographic form, which included the smoking status. Results: The instruments were administered to 461 AMS students, representing 27.6% of the total school students (1672). Overall, 46% of the total sample (43% of males and 48% of females) had depressive symptoms. The rate of smoking currently was 11.5%, and it was much lower among female students (2.2%) as compared to their male counterparts (20.3%). There was a higher mean BDI score among current smokers compared to nonsmokers (P = 0.049). This association was statistically significant among the female students (P = 0.029) but not among the male students (P = 0.072). Conclusion: The rate of depressive symptoms in this study is alarmingly high. The association between the presence of depressive symptoms and smoking is in line with the literature on this topic. A qualitative study in this population is recommended to explore students' perception of the factors associated with smoking, depression, and stress and their coping strategies.
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CLINICO-PATHOLOGICAL PEARLS Top

Apophyseal ring fracture, posterior longitudinal ligament lift, case report p. 244
Waleed Mohammad Awwad, Muhannad Saleh Alwabel, Khalid Abdulrazzak Alsalih
DOI:10.4103/JNSM.JNSM_12_19  
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