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Table of Contents
ABSTRACTS
Year : 2019  |  Volume : 2  |  Issue : 5  |  Page : 1-19

Abstracts


Date of Web Publication3-Jan-2019

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How to cite this article:
. Abstracts. J Nat Sci Med 2019;2, Suppl S1:1-19

How to cite this URL:
. Abstracts. J Nat Sci Med [serial online] 2019 [cited 2021 Apr 22];2, Suppl S1:1-19. Available from: https://www.jnsmonline.org/text.asp?2019/2/5/1/249396





The First Medical Student Research Forum was held on the March 30–31, 2018, in King Saud University College of Medicine and organized by King Saud University Medical Students Council. The aim of this forum was to expose students to the experience of submitting and presenting their work in medical conferences.

The forum's scientific program included eight talks, four oral presentation sessions, and three workshops that was accredited by the Saudi Commission for Health Specialties with 16 CME hours. Lectures and workshops were selected to fulfill the students' needs and inspire them to pursue a successful research career.

Through an on-line submission form, 238 abstracts were submitted from 13 different medical colleges from all over the country and the Gulf.

All abstracts were evaluated by the scientific committee and scored using a standard evaluation form. Each abstract was evaluated by one evaluator. Top 24 scored abstracts were presented during the forum as oral presentations. The average score was calculated, and all the above average abstracts were accepted as poster presentations. There are a total number of 99 posters.


  Profile and Spectrum of Congenital Heart Defect in Pediatric Patients with Down Syndrome Top


Najoud Alotaibi, Abdullah AlHuzaimi, Ghadah Alsuhaibani, Reem Alanazi, Sarah Alshihri, Shaik Shaffi Ahamed

King Saud University, Riyadh, Saudi Arabia

Background: Down syndrome (DS) is one of the most common chromosomal abnormalities worldwide. It occurs in 1 of every 800 live births. Almost one-half of patients with DS have congenital heart defect (CHD). Methods: A cross-sectional, retrospective study of the cardiac anomalies was conducted among 331 pediatric patients with DS in King Khalid University Hospital from August 2001 until October 2014. Demographic data, reason for referral, echocardiography data, presence of CHD, type and details of CHD, presence of pulmonary hypertension, history of cardiac surgeries or transcatheter interventions were gathered. Results: Among the 331 pediatric patients with DS, 230 (69.5%) patients have CHD. Patients with CHD were significantly younger (median age 3 months) with lower weight (P < 0.05) and height (P < 0.05) compared to patients with no CHD. The median age at the first assessment was 3 months. The most common type of CHDs among DS pediatric patients was atrial septal defect secundum (ASD II) accounting for 33.5% of all CHDs, followed by ventricular septal defect (VSD) accounting for 26.5%, atrioventricular septal defect (AVSD) 21.7%, and moderate-to-large patent ductus arteriosus (PDA) 21.7% and 11.7% had other types of CHDs. Pulmonary hypertension was present in 32% of patients with CHD versus 4% among patients with no CHD. There is a significant association between CHD and pulmonary hypertension with odds ratio of 11.3 (95% confidence interval: 3.99–31.83). Multivariate stepwise binary logistic regression showed that ASD, VSD, and hemodynamically PDA were independently statistically significantly associated with pulmonary hypertension. About 15% of patients underwent either cardiac surgery or transcatheter intervention. Conclusion: Almost two-thirds of DS patients have CHD with pulmonary hypertension affecting almost one-third of patients with CHD. The most common CHDs among DS patients were ASD, VSD, AVSD, and moderate–to-large PDA.


  Migraine Headache in the Pediatric Population of Saudi Arabia: Prevalence and Risk Factors Top


Ghada AlHindi, Nada Dammas, Fawaz AlHussain, Muath AlBalawi, Manar AlShamari, Fahad Al-Bashiri, Yousef Mohammad

King Saud University, Riyadh, Saudi Arabia

Background: Headache is one of the most common complaints by the pediatric age group. In addition, its negative impact on the child's life and school performance cannot be overestimated. Data on the prevalence and risk factors of this agonizing condition would help the community health workers to rationally and properly address its management. Unfortunately, very scarce data exist on the prevalence of headache and its associated risk factors in the pediatric population of the Kingdom of Saudi Arabia. Methods: This was a cross-sectional study that was conducted from October 2015 to August 2017. Children (aged 6–18 years) and their parents visiting major shopping malls in Riyadh, who agreed to participate in the study, were interviewed to complete a set of questions related to headache and its risk factors. We strictly adhered to the ICHD-3 beta criteria for the diagnosis of pediatric headache. The sample size was determined with the prior knowledge that the prevalence rate of migraine and headache in Saudi schoolchildren is somewhat similar to Western countries. Results: A total of 1455 individuals completed the questionnaire. The data revealed a headache prevalence of 36% (n = 528), and it was more prevalent in females (68%, n = 359) than in males (32%, n = 169). The mean age of the participants who suffered from headache was 14 years (6–18 years). Migraine constituted 16% (n = 232) of all headaches, of which 13% (n = 186) have associated aura. Stepwise multivariate logistic regression showed that female gender, use of electronic devices, bullying at school, Vitamin D deficiency, snoring, and depression are independent risk factors for the development of headache in this age group of population. Conclusion: Headache in the pediatric population of Saudi Arabia is quite prevalent and similar to that of other populations. Multiple modifiable risk factors have been identified. Hence, urgent measures must be implemented in addressing these factors.


  Assessment of the Influence of Family History of Type 2 Diabetes or Hypertension on the Physical Activity Pattern of Adolescents Aged 15–25 Years Top


Ibrahim Gosadi, Nouf Aloraini, Amirah Bin Zuair, Raghad AlAjlan, Njoud Alrasheed, Asmaa Alrusaias

King Saud University, Riyadh, Saudi Arabia

Background: This study is aiming to provide an evidence assessing the influence of family history of diabetes or hypertension on Saudi adolescents' physical activity levels. Methods: A cross-sectional study was conducted to obtain the study sample comprising boys and girls in the age group of 15–25 years. One university and four schools (two boys' and two girls' school) were chosen by multistage cluster random sampling technique between December 2016 and March 2017. The survey instrument used was a validated physical activity questionnaire developed for the Saudi population. Classification of the study sample was based on gender, study level, and family history of diabetes mellitus or hypertension. Results: The study included 497 individuals with a well-balanced male:female ratio (49%:51%). The proportion of individuals from high school and university was similar (48%:52%). The study population seems to be largely sedentary. Almost 40% of the students had a parental history of either diabetes or hypertension. Gender comparison showed females to have significantly higher sedentary behavior and lower levels of intense physical activity per week than the males (P = 0.002). University education seemed to have significant influence on reducing the physical activity levels in comparison with school students (P < 0.001). It was observed that levels of moderate and vigorous activities are higher in students where both parents were affected with diabetes in comparison to students who reported neither parents were affected (P = 0.025). Conclusion: These findings suggest an increased physical activity level among the offspring of parents affected with diabetes in addition to other important influence of gender and education level.


  Predictors and Prevalence of Social Jet Lag among King Saud Employees and Their Families Top


Reema Alnasser, Ahmad Hersi, Sarah Alhusaini, Jumana Fatani, Nouf AlJomah

King Saud University, Riyadh, Saudi Arabia

Background: Sleep is a crucial element in human beings' development and sustainment of a healthy lifestyle; any chronic misalignment between the sleep–wake cycles could be associated with numerous physical and mental disturbances. Social jet lag (SJL) is the discrepancy between the midpoint of sleep in workdays and free days. Up to date, there is a scarcity of studies conducted regarding this disorder in the Middle East. Hence, we aimed toward studying the prevalence and predictors of SJL. Methods: This was an observational cross-sectional study. The sample size was 328 participants who are King Saud University employees and their families. Saudi individuals aged 18 years and above were included in the study. Pregnant women were excluded from the study. Data were collected using an interview-administered questionnaire (Munich Chrono Type Questionnaire). SJL was calculated as the absolute difference between the midpoints of sleep on free days and workdays. The association between SJL and predictors was assessed using the Chi-square test. Results: A sample of 226 females and 62 males were analyzed. SJL was categorized into three groups, which are <1 h, 1–2 h, and >2 h. our results showed that SJL of >2 h represents approximately half of the participants (49.7%) and appeared to be more among the 18–33 years' age group (56.5%). Participants with >2 h were found to have a significant difference between sleep duration on work and free days (5.9 ± 1.8 vs. 8.67 ± 1.91 h, P < 0.001, respectively). Conclusion: Lower SJL hours is associated with factors such as increased age and similar sleep duration on work and free days, in addition to alarm use on free days. Whereas, younger age, inflexible work schedule, smoking, and soft drinks' consumption are linked with higher SJL hours. Our future aim is to increase the awareness of controlling the factors which lead to higher SJL hours and the importance of having a balanced sleep.


  The Prevalence of Scalp Fungi among Asymptomatic Children in Primary Schools and Children Attending Primary Care Clinic at King Khalid University Hospital in Riyadh from February to March 2016 Top


Naif AlHifthi, Ziyad AlAjlan, Mohammed AlNafisah, Omar AlDhasee, Turki AlOtaibi

King Saud University, Riyadh, Saudi Arabia

Background: Tinea capitis (TC) is a fungal scalp infection that poses a universal concern due to its common spread among children, especially primary schoolchildren. The prevalence of TC is higher in developing countries than in developed ones due to many reasons such as the lifestyle and climate situation. Since TC is highly contagious, it is important to identify asymptomatic carriers in order to minimize its spread between siblings and schoolchildren and to avoid underestimation of TC prevalence. Therefore, the purpose of this study is to determine the prevalence of colonization with scalp fungi (dermatophytes) among asymptomatic children in primary schools and children attending primary care clinic at King Khalid University Hospital in Riyadh. Methods: A cross-sectional study was conducted with a total of 932 children aged between 2 and 15 years from February to March 2016. Questionnaires with a consent form were distributed among parents of the participants, and the samples were collected from the scalp using wet swabs and cultured in dermatophyte test medium. Cultures were incubated at 28°C for 2 weeks. Results: Following the exclusion of 60 participants due to incomplete surveys, the prevalence of dermatophyte carriers among the total sample size (n = 872) turned to be 0%. However, 35% (n = 305) of the sample size grew different fungal organisms other than dermatophytes. Significant associations between hair loss and itching scalp with the presence of immunological disease (P = 0.023 and 0.032, respectively) were observed. Our data revealed a higher prevalence of dandruff, hair loss, itching scalp, and lice among females more than males with an odds ratio of 1.5, 2.2, 1.3, and 1.5, respectively. Conclusion: The prevalence of 0% that was found in the present study is not unpredictable and we believe that this may be reassuring about the carrier state of the fungi in this region of the kingdom.


  Incidental Findings Associated with Unintentional Exposure during Conventional Chest Radiography in the Pediatric Intensive Care Unit Top


Saeed Nassar, Mohamad-Hani Temsah, Talal N. Alhoshan, Hatim A. Alebdi, Faisal M. Almojel, Moath A. Albattah

King Saud University, Riyadh, Saudi Arabia

Background: Physicians often order for additional chest X-rays (CXRs) in the pediatric intensive care units (ICUs) to monitor clinical progress and identify any complications. However, the utility of performing daily routine CXRs is unclear. However, anatomical overexposure could pose a major hurdle for the utility of CXRs. The current study was conducted to assess the percentage of overexposed organs, investigate the prevalence of incidental findings within the overexposed areas, and determine the factors leading to overexposure during conventional CXRs in the pediatric ICU. Methods: A total of 85 patients admitted to the pediatric ICU during the period from January 2015 to June 2016 were included in this study. The population was stratified by age, length of stay, and gender. Unintentional overexposure of the anatomical parameters and any incidental findings within the overexposed areas were evaluated according to the international standards for each CXR. Results: A total of 400 CXRs were evaluated in this study. Patients were approximately 43.9 months old with a mean weight of 14.3 kg and mean height of 87.2 ± 34.1 cm. The mean number of CXRs per patient was 4.7. Almost 99.75% of the chest radiographs were overexposed, with the most common unnecessarily exposed regions being upper abdomen (99.2%) followed by the upper limbs (97%) and neck (95.7%). Incidental findings were seen in 41.5% of the radiographs, of which the most common were gaseous abdominal structures (73.1%), low positioned nasogastric tube (24.6%), and constipation (10.5%). Conclusion: Anatomical overexposure in the chest remains a major concern for the critically ill children, and this needs to be addressed by quality improvement projects to reduce overexposures. However, incidental findings in the overexposed regions may be of diagnostic value for the health-care providers.


  Prevalence of Low Back Pain among Female Health Science Students Top


Zhour AlHedyan, Munir Saadeddin, Sarah AlJasser, Fahad AlShayhan

King Saud University, Riyadh, Saudi Arabia

Background/Aim: To identify the prevalence of low back pain (LBP) among female health sciences undergraduates and compare whose is at more risk among the specialties and to identify the risk factors of LBP among the study sample. Methods: A cross-sectional study was conducted among 747 female undergraduates from five health sciences colleges during the academic year 2016–2017. Self-administered questionnaire was conducted and included four sections: demographic characteristics, risk factors, Nordic Musculoskeletal Questionnaire, and Oswestry Disability questionnaire. The data were analyzed using SPSS. Results: The mean age was 20.3 ± 1.5 years. About 35.8% of students were physically active. Lifetime prevalence of LBP was 53.1%, 12 months 47.4%, and point prevalence 21.6%. Medical students reported highest lifetime prevalence of LBP (64.3%) with statistically significant P < 0.001. Physical activity was not associated with point prevalence of LBP. Body mass index of more than 25 was associated insignificantly with increased risk of LBP (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 0.74–1.73; P = 0.568). None of recreational sports (football, basketball, volleyball, and swimming) have been shown to be associated with LBP. Feeling discomfort on bed was significantly associated with LBP (OR: 2.49; 95% CI: 1.74–3.56; P = <0.001). Sitting on comfortable college furniture was associated significantly with decreased risk of LBP (OR: 0.56; 95% CI: 0.38–0.82; P = 0.003). Psychological factors such as being overwhelmed and feeling sad were associated with LBP. According to the Oswestry Disability Scale, majority of students who have LBP are having minimal disability due to LBP. Conclusion: This study has shown high prevalence of LBP among future health-care providers. Female medical students are at a higher risk to develop LBP compared to other health sciences students. These risk factors should be well established and identified to minimize the prevalence of LBP among future health sciences students.


  Awareness of Tuberculosis among General Populations in Riyadh Region and Its Surrounding Top


Faisal AlKulaib

Almaarefa University, Riyadh, Saudi Arabia

Background: In the past, and until the end of the 20th century, tuberculosis (TB) was one of the major causes of death. Nowadays, the world is still challenging with TB control, even though the percentage of TB has been decreased. In Saudi Arabia, the annual TB incidence rate is 12/100,000 population. Even though the incidence rate of TB has been decreased in Saudi Arabia, still TB cannot be fully controlled. Getting the world free from TB will not happen if general populations do not aware about TB. Methods: This was a cross-sectional study done by the selection of general populations in Riyadh region by random sample. The study was done by a self-administrated questionnaire that contains demographic data part and other parts that evaluate the awareness of TB. Comparison of results between many variables was done by Chi-square test, and P < 0.05 was considered statistically significant. Results: Of 519 participants in this study (response rate 94.36%) with a mean age of 33 years, only 3.3% have a history of TB and 21.1% have relatives with a history of TB. Only 19.4% of participants have good knowledge, only 18.0% have favorable attitude, and most (67.6%) of the participants have a good practice. People with higher degree of educational level have better knowledge than others. Non-Saudi people are better than Saudis in practice and people who have relatives with a history of TB are better in attitude than others. In practice, females are better than males, married people are also better than single, and people with a history of TB or their relatives with a history of TB are better than others. Conclusion: Populations in Riyadh and its surroundings have a very low level of knowledge toward TB. Most people have unfavorable attitude level. Even though there is a high level of good practice, still it needs to be increased. Education has an important role to increase the level of knowledge about TB.


  Prevalence of Attention-deficit Hyperactivity Disorder in a Pediatric Endocrine Clinic in Saudi Arabia Top


Sara Adnan Habis, Fatima Abdulrahman Alhaidar, Alaa Jassim Alharbi, Latifa Fahad Alanazi, Amir Babiker

King Saud University, Riyadh, Saudi Arabia

Background: Attention-deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder with a substantial lifelong impact on personal and social functioning, academic performance, and the health system in general. It is one of the most frequent childhood-onset psychiatric conditions, with an estimated worldwide-pooled prevalence exceeding 5% in school-age children and a prevalence of 1.3%–16% in Arab countries. It was previously hypothesized that ADHD may be associated with hormonal changes. We aimed to address this association and looking for any other possible related factors in the study group. Methods: This was a quantitative cross-sectional study to estimate the prevalence of ADHD among children with endocrine disorders who attended the Pediatric Endocrine Clinic at King Khalid University Hospital, Riyadh, Saudi Arabia (November 2015–March 2016). The data was collected by interview method. Three surveys were used, first one is a social demographic survey, the second one is the basic medical profile-including the endocrine illnesses, and the third one is a valid screening tool for ADHD (ADHD rating scale). Results: The study showed that ADHD occurred in males more than females. ADHD was associated with low socioeconomic status and other social demographic characteristics in our study group. Analysis revealed that the prevalence of ADHD in the study sample was 14.9% (n = 46/309 children). Of these, 67.39% (n = 31/309) were males. There was no statistical evidence to suggest association between ADHD and obesity, thyroid dysfunction, and growth deficit. However, there might be an association between ADHD and diabetes. There were no enough patients with cortisol abnormalities to include in our study in order to make a conclusion about a relationship with ADHD. Conclusion: Although ADHD, according to our findings, may not be associated with other endocrine disorders, diabetic children are probably less likely to develop ADHD. Further larger studies are required to confirm and possibly explore potential protective mechanisms of diabetes against ADHD.


  Knowledge and Attitude of First Aid among Students at Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia Top


Lubna Halawani, Manal Alwazae, Shahad Alghamdy

Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia

Background: First aid is the most essential care that can save life and decrease morbidity to an individual in health-threatening circumstances. A certified person will have the necessary knowledge to keep a harmed individual alive until medical emergency services arrive. The aim of this study is to assess the knowledge and attitude of students attending Princess Nora Bint Abdul Rahman University in providing first aid care. Methods: A cross-sectional study was conducted at Princess Nora Bint Abdul Rahman University in Riyadh, from October 2017 to December 2017. A total of 1000 female students from 15 different colleges answered a self-administered questionnaire. Knowledge was assessed using questions covering different emergency situations such as choking, fractures, epistaxis, burns, and snake bites. Results: Half of the participants had previous first aid training. Good knowledge was observed only in 34.7% of the participants, moderate knowledge in 57.5%, and poor knowledge in 7.8%. Analysis of knowledge in specific emergency situations showed that the students were more knowledgeable in cases of epistaxis, ingestion of toxins, burns, hypoglycemia, and loss of consciousness. However, in handling situations of seizures, choking, and snake bites, students were found to be less knowledgeable. Nearly 20.2% of the students encountered a situation where CPR was required and 65.3% of these students did not provide first aid due to lack of knowledge (35.2%), nervousness (20.1%), and other reasons (10%). Previous first aid training was strongly associated with having good knowledge level. In addition, being a health college student was also significantly associated with better knowledge. Conclusion: Overall, the students had a positive attitude toward first aid. Despite the fact that half of the students had previous first aid training, they still did not possess the knowledge necessary to be able to act in emergency situations. There is a need for increased public health awareness on first aid courses for all colleges in the university.


  Prevalence of Allergic, Rhinoconjunctivitis, and Bronchial Asthma among High School Students in Sakaka, Al-Jouf Region, Saudi Arabia Top


Abdualelah Alrashidi, Ahmed Al-Wasim, Tariq Altymani, Mostafa Ragheb

Jouf University, Sakakah, Saudi Arabia

Background: Allergic rhinitis and asthma are common disorders that often go undetected in the primary care setting. As no local study was available for northern regions, we carried out this study to determine the prevalence of different types of allergy including asthma and the possible associated risk factors. Methods: This cross-sectional study was conducted among 450 male students from three high schools in Sakaka, Al-Jouf, KSA. Of all, only 380 (84.4%) responded to a self-administered Arabic questionnaire. Data inquired were age, academic year, exposure to animals, smoking status, present and family history of allergy, and manifestations of allergy of skin, eye, nasopharynx, and chest. Allergic rhinitis was diagnosed if two or more manifestations were present. Asthma was diagnosed if wheezes or cough occurred at night or with physical activity and may be precipitated by infection and exposure to dust or pollens or smoke. Results: The mean age of participants was 16.9 years, 8 (2.1%) were married. First- and second-hand smoking were recalled by 13.2% and 46.3% of students respectively. Manifestations of bronchial asthma Of all, 25.3% had animals near their homes, 26.1% claimed they had allergic disease, and 35.0% had family history of allergy. Dermatitis, conjunctivitis, and allergic rhinitis were described by 8.9%, 21.6%, and 33.2% of participants respectively. manifestations of allergy (eye, skin, nose, and pharynx) were significantly more frequent in students with asthma. Similarly, active and passive smoking, the number of cigarettes & duration of smoking, and family history of allergy were significantly associated with asthma. Although exposure to animals showed more frequency in asthma-like compared to possible asthma and no asthma, the differences were not statistically significant. Conclusion: The prevalence of allergic rhinitis and asthma is high among high school students in Al-Jouf region. The high frequency of association of both types of allergy in this study emphasizes the importance of early screening, counseling, and intervention to lessen morbidity.


  Medical Specialties Visits and Diagnoses Received by Saudi Narcolepsy Patients before a Diagnosis by a Sleep Specialist Top


Sara Aljebrin, Musab Alageel, Reem Labani, Hussain Alkaff, Omar Rahbeeni

King Saud University, Riyadh, Saudi Arabia

Background: Narcolepsy is a rare sleep disorder characterized by a tetrad of symptoms that include irresistible attacks of sleep, hypnagogic hallucinations, cataplexy, and sleep paralysis. Studies have revealed that symptoms of narcolepsy were more commonly attributed to mental, neurological, and other disorders. The true obstacle in diagnosing narcolepsy emerges when the patient presents with one symptom, rather than all four combined. Objectives: To assess medical specialties visits and diagnoses received by Saudi narcolepsy patients before their diagnosis by a sleep specialist and the overlap between symptoms of narcolepsy and other diseases. Methods: This was a quantitative, observational, and cross-sectional study. This study was conducted in the sleep disorder center at King Saud University. A paper questionnaire was distributed to all the follow-up patients with narcolepsy. It is composed of 53 questions, which are classified into four sections: sociodemographic, psychiatric, neurological, and narcoleptic symptoms. Results: A total of 55 responses were recorded. Males comprised 83.6% of the sample. The mean body mass index was 29. Before visiting the sleep center, 34.5% of the patients visited neurologists and 33.3% visited psychiatrists. Psychiatric disorders were diagnosed in 20% of the patients and neurological disorders in 10.9%. Surprisingly, 40% of the patients were told that their symptoms were solely caused by the evil eye. Conclusion: The most common departments visited by patients with narcolepsy before receiving the correct diagnosis were neurology followed by psychiatry. The underrecognition of narcolepsy is reflected by the fact that patients' symptoms were more commonly attributed to psychiatric disorders or neurological disorders and occasionally the evil eye. Extra efforts are needed to increase the awareness about narcolepsy.


  Hypoglycemic Knowledge among Diabetics, the Unknown Truth Top


Afrah Al-Juhani, Ruba Al-Zuhairi, Nuha Al-Ghamdi, Manal Al-Wazea, Hana Al-Rashid, Amel Fayed

Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia

Background: Of all the complications of diabetes, hypoglycemia is among the most recurring and serious complications; patients' limited knowledge about hypoglycemia can result in dire consequences. The purpose of this study is to determine the level of knowledge of diabetic patients about hypoglycemia and investigate their reactions in hypoglycemic occurrence. Methods: A cross-sectional study of 157 diabetics was conducted, using validated questionnaire assessing knowledge about hypoglycemia in terms of symptoms, precipitating factors, and measures for treatment and prevention. Patients who correctly answered at least 60% were considered as having acceptable knowledge. In addition, sociodemographic, history of diabetes, and hemoglobin A1c (HbA1c) were assessed. Results: The average age of the participants was 44.5 ± 16.0 years, 65% were female, 58% had type II diabetes, and 55% had diabetes for more than 7 years. Nearly 48% of participants had acceptable knowledge level; the majority correctly recognized most of the hypoglycemic symptoms such as fatigue, hunger, tremors, and dizziness. However, 45% of participants were wrongly associated with polyuria (45%) and thirsty (53%) with hypoglycemia. Patients recognized fasting (75%), high doses of medication (66%), and forgetting to eat (65%) as precipitating factors. However, 12% of participants believed that forgetting to take medicines causes hypoglycemia. About 45% of participants considered eating sweets (45%), drinking juice (43%), or eating any food (66%) will treat hypoglycemia. Unfortunately, 2% of participants believed that taking medicines treat hypoglycemia. To avoid hypoglycemia, 55% of participants chose to measure their glucose regularly, and disappointingly, 35% chose to adjust the doses themselves. In addition, younger and female patients were more knowledgeable about hypoglycemia when compared to elderly and male patients. Increasing knowledge level was weakly correlated with HbA1c level (P = 0.69). Conclusion: Despite being one of the most frequent complications, hypoglycemia is not clearly understood among diabetics. Dangerous misconceptions about hypoglycemia – such as taking medication to treat it – require high attention. Furthermore, educating the patients about hypoglycemia is an urgent matter and needs immediate action.


  Factors Affecting Adherence to Treatment among Diabetics in Riyadh Top


Manal Mohsen Alwazae, Ruba Mohammed Alzuhairib, Afrah Eid Aljuhani, Hana Rashid Alrashid, Nuha Ramadan Alghamdi, Amal Fayed

Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia

Background: Adherence to medications is strongly associated with diabetes and its outcome. Recently, nonadherence has been strongly linked with poor glycemic control. This undesirable influence may be due to sociodemographic variability and diabetic type and course. To date, no studies investigate the hidden factors that affect the patient's compliance among Saudis. Methods: A cross-sectional study of consented 157 diabetics was conducted. The self-reported adherence to treatment (SRAT) was estimated using the Morisky 8-item Scale which demonstrated good internal consistency (α = 0.70). Glycemic control was assessed using the most recent hemoglobin A1c (HbA1c) results. Sociodemographic and study-related confounders as diabetes type, complication, and treatment were assessed. Descriptive and bivariate analyses were examined for demographic- and study-related variables. Stepwise multiple linear regression was used for adjustment of confounders and bootstrap was used to test the mediating effects. Results: The average age of the participants was 44.5 ± 16.0 years, 65% were female, 79% were type II diabetes, nearly 55% had diabetes for more than 7 years, and the average HbA1c level was 8.9% ± 2.2%. Moreover, clinically significant of 46% of participants were defined as having satisfactory SRAT that was significantly more evident by older participants. Only advanced age was independently associated with better SRAT (R2 = 0.21, P < 0.05). However, other covariates were not statistically associated with SRAT. In addition, improvement of SRAT significantly enhanced the glycemic control as reflected from lower HbA1C (r = −0.32, P < 0.01). Conclusion: SRAT is commonly reported among diabetic patients, but to date, this is the first report to determine that SRAT is mediating negative impact on glycemic control in the Saudi population.


  Prescription Writing Variations among Health-care Centers in Al-Qassim Region in Saudi Arabia Top


Souhib Ali, Abdulnassir Barmo, Fayez Al Hamoy, Mohammed Saddik, Asghar Mehdi, Nazmus Saquib

Sulaiman Al Rajhi Colleges, Al Bukayriyah, Saudi Arabia

Background: A prescription has definitive parts; omission of information in any of these parts may result in patient confusion, treatment failure, or harm to patients. There was no study in the gulf region that assessed physicians' prescriptions according to the World Health Organization (WHO) or the US Food and Drug Administration (FDA) guidelines. Objectives: To determine the variations in a sample of hand-written prescriptions by physicians working in the Al-Qassim region of Saudi Arabia. Methods: We collected 556 prescriptions from the pharmacies and health centers, selected conveniently from four major towns in the Al-Qassim province with the following inclusion criteria: hand-written and dated 2016. Two research assistants independently extracted data from these prescriptions as per the items specified by the WHO (n = 14) and FDA (n = 13). We reported frequencies for the presence of each item. Results: Information was present for six items common to both guidelines as follows: prescriber's telephone (34%) and signature (92%), patient's name (100%) and address (0%), name of the drug (100%), and date (99%). Frequencies for six items unique to FDA were department name (32%), prescriber's address (34%) and stamp (77%), pharmacy stamp (33.6%), total drug quantity (73%), and the presence of methods to avoid refilling (34%). Frequencies for seven items unique to the WHO were patient's age (79%), prescriber's name (34.0%), drug amount (67.6%), strength (76.1%) and dosage (86.9%), instructions on drug administration (32.2%), and warning about drug (0%). Conclusion: A wide variation existed among the hand-written prescriptions and most were written not in accordance to the WHO or FDA guidelines.


  Is There a Need for Premarital Screening for Thalassemia in Riyadh, Saudi Arabia? Top


Ghada Alouda, Ahmed Hersi, Hadeel AlKofide, Atheel Saleh AlDbassi, Dania Abdulrahman Raslan, Haneen Mohammed AlKhanbashi, Malak Ahmad AlZahrani, Sara Mohammad AlSubki

King Saud University, Riyadh, Saudi Arabia

Background/Objectives: To measure the prevalence of thalassemia, sickle cell anemia, HIV, and hepatitis infections in patients who underwent premarital screening and to determine the cost of screening for thalassemia in the premarital screenings and the cost of its treatment in KSUMC, Riyadh, Saudi Arabia, from 2015 to 2016. Methods: A retrospective, quantitative, cross-sectional study was conducted using secondary data from the medical records that included all individuals applying for premarital screening at KSUMC from 2015 to 2016; the data were entered into Excel Sheets and the values were analyzed. Results: Of a total of 694 patients, 7 were positive for beta thalassemia trait. Three (0.6%) of which were from Riyadh and 4 (1.9%) were from unknown regions. The cost of screening for an individual is 240 SAR, making a total of 166,560 SAR for all patients. Furthermore, the annual routine treatment for one affected individual with beta thalassemia was found to cost 150,018 SAR. Conclusion: Riyadh is considered a low-prevalent region for β-thalassemia as established by the 1% of patients testing positive for β-thalassemia trait only. Screening such a low-prevalent area could be a financial burden. In the case of β-thalassemia, the annual routine treatment of one patient costs nearly the same as screening around 694 patients/year. Further studies using advanced cost-related study designs can address the idea of customizing the β-thalassemia screening test according to the different variables associated with its regional variations around the kingdom.


  Influence of Weak Transcranial Direct-Current Stimulation on Cognition, Safety, and Tolerability in Healthy Saudi Adults Compared to Sham Stimulation Top


Azzam Bamugaddam, Muath Alasheikh, Tariq Alhassan, Saud Alhaidar, Abdulelah Almutairy, Mohammed Alfaleh

King Saud University, Riyadh, Saudi Arabia

Background: The principal aim of this investigation is to study the influence of weak transcranial direct-current stimulation (tDCS) on cognition, safety, and tolerability in healthy Saudi adults compared to sham stimulation. Methods: We conducted a double-blinded, deliberate (quota) sampling, sham-controlled Phase II clinical trial in 30 right-handed males with no neurological disorders or magnetic resonance imaging incompatible implants, at King Khalid University Hospital. The control and sham groups underwent a tDCS session, control group received 2 mA for 20 min of tDCS while sham stimulation group received 2 mA for 30 s of tDCS. The neuropsychological state was assessed through stop-signal task (SST) go trials and pattern recognition memory (PRM) tests using the Cambridge Neuropsychological Test Automated Battery (CANTAB) which was used for measure, followed by a questionnaire to study the effect of tDCS. Results: There is a statistical significance for cognitive function in terms of PRM (P = 0.008 and P < 0.05), SST go trial (P = 0.019), and SST correct response time on go trials (P = 0.04) after active stimulation, but no significance in the sham group. For the side effects, there was a statistical significance for headache (P = 0.002 and P < 0.05), pain in the scalp (P = 0.022), laziness and somnolence (P = 0.025 and P < 0.05), and itching (P = 0.043 and P < 0.05) after active stimulation, but there was no significance in the sham group. Conclusion: The results indicated that tDCS-induced cortical plasticity compared to sham assessed by the CANTAB showed four significant side effects (headache, pain in the scalp, laziness and somnolence, and itching).


  Knowledge, Attitude, and Practice of Physical Exercise among Women during Pregnancy in Qassim, Saudi Arabia Top


Abeer A. Alaglan, Rania F. Almousa, Arwa A. Alomirini, Elaf S. Alabdularazaq, Renad S. Alkheder, Khawlah A. Alzaben, Ghaida A. Alonayzan, Juliann Saquib

Qassim University, Buraydah, Saudi Arabia

Background: Despite many benefits of physical exercise to women during pregnancy, majority of Saudi women do not engage in an adequate amount of activity. The purpose of this study was to evaluate the knowledge, attitude, and practice of physical exercise during pregnancy among Saudi women. Methods: This was a cross-sectional study in Qassim region as it is one of the largest provinces in KSA with a population of 1.4 million. It included 267 women who in the past 2 years had given birth, from nine primary health cares and a maternity and children hospital in Buraidah. The inclusion criteria included being a Qassim resident and having a child aged between 1 month and 2 years. However, those who were restricted to do exercise due to any physical disability were excluded. Data were attained on sociodemographic, and a prior validated questionnaire was used. Data were analyzed using Chi-square and Hosmer–Lemeshow, at P < 0.05 alpha level. Results: The sample included 274 women, who had a mean age of 31.9 years. Majority of women thought that physical exercise during pregnancy was necessary and had sufficient knowledge (mean score = 77%) about types and amount of physical activity. The prevalence for physical exercise in the recent pregnancy was 75%; however, only a portion (42%) were engaged in an adequate amount of physical exercise (i.e., ≥150 min/week), and walking was the most recorded (26%). Among women who were adequately active, 93.0% reported that exercise during pregnancy was necessary compared with 80.9% of inactive women. Among women who were adequately active, 55.2% reported excellent self-health, compared with 39.9%, among inactive women. Conclusion: Majority of women had sufficient awareness and knowledge about physical exercise during pregnancy, but less than half of the women were either walking or exercising adequately.


  Impact of Self-directed Learning Readiness on Academic Achievement among Third-year Medical Students at King Saud University College of Medicine 2015–2016 Top


Razan AlDhahri, Hamza Abdulghani, Afnan Almotawa, Nuha Almandeel, Maha Alzeheary

King Saud University, Riyadh, Saudi Arabia

Background: Self-directed learning (SDL) is a very crucial aspect of learning process since almost all health-care professionals require to obtain knowledge, skills, and attitude. Objectives: this study aims to measure the readiness of third-year medical students for SDL and its relation with academic achievement and to identify factors that affect SDL among students. Methods: This is a cross-sectional quantitative observational study involving convenient sample of third-year medical students at King Saud University. The level of SDL readiness was determined by a validated Fisher's SDL readiness scale (SDLRS). Data were analyzed using SPSS to find if there is a relation between SDL scores and students grade point average (GPA). Results: There were 205 students participated in the study. The overall mean score on Fisher's readiness scale was 156.73 ± 15.85. The mean score on self-control was 61.2 ± 6.4, and the mean score on self-management skills was 47.1 ± 6.6, but 40% (forty percent) of students agreed on having difficulties in managing their time. However, the mean score on desire for learning was 48.4 ± 5.6. More than 98% scored 150 and above, which is an acceptable level of readiness for SDL on a scale ranging from 40 to 200. No significant difference observed between male and female students. Moreover, high SDL scores were found to have a positive relationship with students' academic achievement, in which students with high SDLRS were found to have a high GPA and vice versa. Conclusion: The study findings showed that high SDLRS is directly proportional to students' academic achievement. Students were highly self-directed learners, but they have a slight problem in time management. Therefore, greater effort is needed to improve time management among students and spread awareness about it.


  The Association between Smartphone Addiction and Dry Eye Disease: A Cross-sectional Study Top


Ayman Baabdullah, Abdulmalik Abumohssin, Yara Alqahtani, Ismail Nemri, Dania Sabbahi, Nizar Alhibshi

King Abdulaziz University, Jeddah, Saudi Arabia

Background: The use of smartphones has increased exponentially. Excessive usage of smartphones has been shown to have a negative impact on ocular health. The aim of this study was to evaluate the relationship between smartphone addiction and dry eye disease (DED) and determine the risk factors of DED in participants associated with smartphone addiction. Methods: This cross-sectional study was conducted in May 2017. Participants were selected from the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia. Stratified random sampling technique was used to recruit participants according to their academic year with equal allocation of males and females. Only participants owning smartphones were included in the study. DED was assessed using the Ocular Surface Disease Index questionnaire, and the smartphone addiction scale short version was used to assess smartphone addiction among the participants. Data were analyzed using Pearson's Chi-square test and binary logistic regression. Results: A total of 443 completed questionnaires were received, providing a response rate of 94%. Almost half of the participants were found to have DED (49.4%). There was no significant association between smartphone addiction and DED (P = 0.102). However, significant associations were observed between the DED and contact lens use, eye drops use, eye disease, and Vitamin A therapy (P < 0.05). Conclusion: The usage of contact lenses, eye drops, and Vitamin A therapy was found to be associated with DED. Furthermore, there was a statistically significant association between DED and preexisting eye disease. Despite the prevalence of DED, there was no statistically significant association between smartphone addiction and DED in our study.


  Diagnostic Procedures among Patients Undergoing Appendectomy: Findings from a Tertiary Hospital in Saudi Arabia Top


Omar AlDhasee, Yazeed Alharthi, Mohammed Alqahtani, Abdulrahman Alqahtani, Suliman Alghnam

King Saud University, Riyadh, Saudi Arabia

Background: Acute appendicitis is one of the most common reasons for abdominal surgery. Medical history, clinical examination, and supportive imaging “computed tomography (CT)” are used in the diagnosis of appendicitis. However, the definite diagnosis of acute appendicitis is only possible postoperatively by the report from the histopathology laboratory. The prevalence of negative appendectomy is stated in a previous literature fluctuating from 20% to 40%. To reduce the percentages of negative appendectomy, several clinical scoring systems have been established. One of which is Alvarado scoring system. Because of the high cost and limitations of CT in diagnosing acute appendicitis. Hence, the purpose of this study was to evaluate the reliability and accuracy of Alvarado scoring system for diagnosis of acute appendicitis. Methods: This was a retrospective, cross-sectional study of 369 patients, who underwent appendectomies. All were patients of King Abdulaziz Medical City-Riyadh who attended the emergency department between January 2016 and July 2017. Patients' information including demographical data, Alvarado clinical score assessment, and radiological and pathological results were collected from their medical records for further analysis. Results: Two hundred and forty-two (65.6%) patients diagnosed using CT scan compared with 127 (34.4%) patients were diagnosed only by Alvarado score. In CT group, 18 (7.4%) patients had a normal appendix according to the histopathology report. Perforation rate was 18.2% among this group. Of Alvarado score group, the negative appendectomy rate was in 22 (17.32%) patients, while perforation rate was found to be 7.9%. Specificity and sensitivity scores of Alvarado score were 62.5% and 64.7%, respectively. Conclusion: The results of this study suggest that Alvarado score was neither accurate nor reliable diagnostic tool. Although the ideal use of CT scan in diagnosing acute appendicitis carries some disadvantages, it remains the most specific and sensitive diagnostic tool. Therefore, it could not be replaced by Alvarado score.


  Child Maltreatment between Knowledge, Attitude, and Beliefs among Saudi Pediatricians and Medical Students Top


Sara AlSiddiqi, Yossef Alnasser, Amani Albijadi, Waad Abdullah, Dana Aldabeeb, Alanoud Alomair, Yara Alsalloum

King Saud University, Riyadh, Saudi Arabia

Background: Child maltreatment is not included in Saudi medical schools and pediatric residency curriculums, which might limit knowledge and spread misconceptions. In addition, physicians might have different attitudes regarding reporting child abuse and neglect. In this study, we hypothesize that medical students and pediatric trainees have limited knowledge, oblivious attitude, and misbeliefs regarding child maltreatment in comparison to experienced pediatricians. However, medical students and trainees might hold higher motives and willingness to learn about child maltreatment and their consequences. Methods: A self-reported questionnaire was distributed after a pilot study to include pediatricians, pediatrics trainees, and medical students in all main areas of pediatrics services: pediatric wards, pediatric outpatient clinics, critical care, and pediatric emergency. Results: In disregard to their level of training, medical students and physicians believed that child maltreatment occurs within the kingdom and is common. They were familiar with the child maltreatment definition, although only one-third thought it is subjected to culture sensitivity. However, experienced physicians were more knowledgeable, especially about neglect. Moreover, female participants were more likely to report despite being more skeptical of readiness of Saudi law system to deal with cases of maltreatment. In general, knowledge about reporting was clearly deficit at all levels. Fortunately, all participants requested and were enthusiastic to receive further training. Conclusion: Saudi medical students, pediatric trainees, and pediatricians have good basic knowledge, positive attitude, and willingness to learn more to provide a safe environment for children in Saudi Arabia.


  Autism among Down Syndrome Patients Top


Abdulelah Alalqeel, Mohammad Alharbi, Wael Almoger, Fahad Algasham

King Saud University, Riyadh, Saudi Arabia

Background: An increasing number of children with Down syndrome are also diagnosed with autism. Research is exploring the prevalence of autism in those with Down syndrome to inform more reliable diagnoses. This study of autism in Down syndrome patients was conducted to increase the awareness of the prevalence of autism in society. To the best of our knowledge, this is the first time such research has been conducted in Saudi Arabia. Methods: This community-based study was observational with a cross-sectional design. The goal of this research was to determine the prevalence of autism among subjects with Down syndrome aged 5 to 29 years. This study was conducted at both public and private Down syndrome centers in Riyadh, Saudi Arabia, between 2015 and 2016. Simple random sampling methods were used for data collection. The data were collected using questionnaires. The data were then extracted from hard copies of the questionnaires into an SPSS form produced specifically for this study. Results: A majority of the subjects in this study, 95%, did not have seizure disorders. Only approximately 22% of the participants had mental retardation, while 48% had no level of mental retardation. Approximately 60% of the study subjects had a history of other medical illnesses. According to their psychiatric history, approximately 43% of the study participants had attention deficit hyperactivity disorder. A majority of the participants, 51%, had Down syndrome, and approximately 4% of these subjects also had autism. According to their Social Communication Questionnaire scores, only 24% of the participants were at high risk for autism disorders. Conclusion: There is strong and significant correlation between seizures and autism and between history of psychiatric diseases and autism in Down syndrome patients. At 3.6%, the prevalence of autism among Down syndrome patients is much lower in Saudi Arabia than in other countries. In this study, only two female and one male Down syndrome patients had autism.


  Prevalence of Migraine Headaches in King Saud University Medical Students Top


Faris M. Al Ghulaiga, Abdulrahman Barri, Moath Aleisa, Abdulrahman Alharbi, Mohammed Alkharraz, Laiche Djouhri

King Saud University, Riyadh, Saudi Arabia

Background: Migraine is an episodic disorder, with headache being the most prominent manifestation. Medical students are at increased risk of migraine due to exposure to established triggers. The aim of this study is to determine the prevalence of migraine in medical students with regard to gender and year. Methods: An observational, cross-sectional study was conducted in the College of Medicine, King Saud University (KSU) during 2016–2017. Subjects: This study included KSU medical students. Inclusion: Medical students from year 1 to year 5 were included in the study. Exclusion: Staff or students from other colleges were excluded from the study. Data: A survey was distributed to students containing demographic information (gender, age, and academic year) and the ID Migraine questionnaire. ID Migraine asks about three variables which have strong association with migraine: nausea, photophobia, and headache-related disability. If two are answered with yes, migraine is considered positive. Analysis: SPSS version 21 was used. Results: Three hundred and ninety-one students completed the questionnaire, 231 males and 160 females. The response rate varied by college year, with second year being highest at 27.1%. The mean age of the participants was 21. One hundred and twenty-five participants were identified with migraine, resulting in a prevalence of 32%. There is a significant difference between the prevalence of migraine among females (40.6%) compared to males (26%) (P < 0.002). The most common symptom reported was headache-related disability (95.2%), with least being nausea/vomiting (59.2%). There was no significant difference in the prevalence between college years (P < 0.066). The highest prevalence was in the 4th year students (40.3%) and the lowest in the 5th year students (24.3%). Conclusion: The prevalence of migraine among medical students of KSU is high, with percentage being 32%. Migraine was 1.5 times more prevalent in females than males, supporting multiple studies. There were peaks in the 1st, 3rd, and 4th years. We recommend in-depth studies be conducted studying associated factors of migraine, including a larger sample size and other health-care specialties. We recommend medical schools make more effort educating students about migraines and their triggers and encourage reducing stress and seeking treatment.


  Second-to-Fourth Digit Ratio, Body Mass Index, and Physical Activity: Their Relationships in Saudi Male and Female King Saud University Medical Students Top


Sara AlKharashi, Mohammad M. Al-Qattan, Abdullah Kattan, Noha M. Al-Qattan, Ghada AlHindi, Nada Dammas

King Saud University, Riyadh, Saudi Arabia

Background: The “second-to-fourth digit ratio” (2D:4D) has not been studied in the Saudi population. The aim of this study is to correlate the 2D:4D to physical activity and body mass index (BMI) in Saudi males and females at King Saud University (KSU), Riyadh, Saudi Arabia. Methods: This cross-sectional comparative study was conducted at KSU, Riyadh, Saudi Arabia. The study included 150 Saudi KSU medical students (70 males and 80 females) between the ages of 20 and 30 years. We measured the length of the index and ring fingers in both hands using a caliper. We also measured the height and weight of each individual using a scale. The level of physical activity of each individual was obtained using a predesigned questionnaire. The physical activity index was electronically calculated after the questionnaire was completed. Results: There was no significant difference between Saudi male and female 2D:4D digital ratios. There was a significant association between 2D:4D and physical activity in females; more physically active females had lower 2D:4D than less physically active females in both hands. Furthermore, there was a significant association between 2D:4D and BMI in males; males with lower BMI had lower 2D:4D than males with higher BMI in the right hand. Conclusion: Unlike previous studies done in other populations, the 2D:4D digital ratio was not affected by gender in our Saudi population. A significant association was found when 2D:4D was correlated to BMI and physical activity.


  The Prevalence of Social Anxiety and Its Effect on the Communication Skills of Medical Students in King Saud University Top


Maha Alrabiah, Shaikh Shaffi Ahamed, Hanan Mohamed Abdulmonem, Sarah Nasser Aljasser, Moneera Osama Aldraihem

King Saud University, Riyadh, Saudi Arabia

Background: Social anxiety disorder (SAD) is a common underdiagnosed mental disorder that limits a person's ability to socialize and communicate with others. SAD could affect the physician's ability to build a healthy doctor–patient relationship as a result of poor communication skills. The aims of this study are to estimate the prevalence of social phobia among medical students at the College of Medicine in King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia, and to compare the social phobia between male and female medical students and preclinical and clinical students. Finally, we aim to identify the correlation between social phobia and general and interpersonal communication skills. Methodology: This study adopted a cross-sectional study design done on the male and female medical students of grades 1 to 5 in KSU using Social Phobia Inventory Assessment. A total of 434 medical students at KSU participated in this study during the academic year 2016–2017. Results: The prevalence of social phobia among KSU medical students was 34% and was significantly more common in females. There was no statistical difference in social phobia between preclinical and clinical students. Moreover, there was a negative correlation between social phobia and communication skills (r = −0.396, P < 0.01). Conclusion: Implementing a teaching course of communication skills should be a fundamental part of any medical school's curriculum with continuous assessment and feedback. Furthermore, more student awareness of social phobia and more encouragement to consult therapists are needed in order to decrease possible negative outcomes in the long run.


  Tumors of the Lateral and Third Ventricle in Pediatric Patients: Surgical Management and Outcome Analysis Top


Ghaida Alawaji, Wajda Alhothali, Abdulrahman Albakr, Abdulrazag Ajlan, Amro Alhabib, Sherif Elwatidy

King Saud University, Riyadh, Saudi Arabia

Background: Tumors of the lateral and third ventricles present a unique challenge to the neurosurgeon due to their deep location and relationship with vital neural and vascular structures. The current study aims to examine the clinical presentation, pathological diagnosis, and surgical outcome for a series of pediatric patients treated for lateral and third ventricular tumors. Methods: This is a retrospective series study conducted between January 2006 and January 2018. The study includes 26 pediatric patients (mean age: 12 years; range: 2 months–18 years) with lateral and third ventricle tumors surgically treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, radiological, surgical, histopathological, and follow-up data were reviewed and analyzed. Results: Most frequently encountered presentation was headache (66.7%). Other symptoms include nausea/vomiting (40.7%), visual disturbance (33%), seizures (14%), and gait disturbance (11%). Lesions were located in the lateral ventricle in 12 patients, third ventricle in 9 patients, and involving both the lateral and third ventricles in 5 patients. The most common tumor types were pineal region tumors (n = 5), pilocytic astrocytoma (n = 5), and atypical teratoid rhabdoid tumor (n = 3). Moreover, the postoperative complication rate was 34.6%, with diabetes insipidus (14%) being the most common, wound site infection (7%), and hydrocephalus (7%). Surgical mortality occurred only in one patient, resulting from postoperative brain abscess and ventriculitis. Conclusion: The choice of the surgical approach depends mostly on the surgeon's preference and experience. We recommend selecting the surgical approach to be based on the anatomical considerations that provide the safest access to the lesion with minimal retraction and risk to neural tissue.


  Defining the Response to Chemoradiation Therapy in Unresectable Glioblastoma Multiforme Patients based on MGMT Promoter Methylation Status Top


Maryam Tawfik, A. Almubarak, A. Allam, H. Alhindi, F. Al-Otaibi, A. Al-Hebshi, E. Khalil, N. Al-Moghrabi

Alfaisal University, Riyadh, Saudi Arabia

Background: The optimal therapy for glioblastoma multiforme (GBM) constitutes maximal safe resection followed by adjunctive concurrent radiation and chemotherapy with temozolomide (TMZ). However, in certain cases, safe maximal resection is not practically amenable. The methylation of the MGMT promoter is being used as a prognostic and predictive factor for the GBM response to TMZ therapy. In the present study, we aimed to measure the outcome of GBM Saudi patients who underwent tumor biopsy followed by radiation therapy with or without chemotherapy based on the MGMT promoter methylation status. Methods: The methylation-specific PCR assay was used to study the methylation status of the MGMT promoter in 77 formalin-fixed, paraffin-embedded tissues of high-grade glioblastoma. Results: MGMT promoter methylation was detected in 48 (62%) samples. Interestingly, significant difference (P = 0.0073) was found in overall survival between patients treated with surgery, radiotherapy, and TMZ and those treated with surgery and radiotherapy only, irrespective of MGMT promoter status. The survival rate for patients with MGMT-methylated tumor was significantly different favoring the plus TMZ group (P = 0.0107). However, for the patients with MGMT unmethylated tumor, there was no significant difference (P = 0.1453) between the two groups. Using the Cox proportional-hazards model, the methylation status of the MGMT promoter emerged as a statistically significant (P = 0.0234), clinically relevant predictor of benefit from TMZ. Conclusion: Here, we have demonstrated that MGMT methylation has significantly improved the survival rate in Saudi patients with unresectable GBM who received concomitant radiation therapy and TMZ. However, MGMT methylation status did not impact the response to radiation therapy.


  Seizure Outcome after Functional Hemispherectomy for Refractory Epilepsy in Children and Adolescents: A Retrospective Review of 64 Patients Top


Dalal Bawazeer, M. Alkhateeb, I. Althubaiti, F. Alotaibi, S. Albaz, T. Abalkhail, S. Khan

Alfaisal University, Riyadh, Saudi Arabia

Background: The term hemispherectomy refers to the complete removal or functional disconnection of a cerebral hemisphere. It produces remarkable results in terms of seizure outcomes and quality of life for medically intractable hemispheric epilepsy mostly in children and adolescents. Here, we report a retrospective analysis of seizure outcome postfunctional hemispherectomy procedure. Methods: This was a retrospective review of all patients who had undergone functional hemispherectomy in our institution between 1995 and 2014. We collected clinical, electroencephalography, imaging, and surgical data and evaluated seizure outcomes at 1-, 3-, and 5-year follow-ups (minimum follow-up 1 year after surgery). We summarized the data using proportions for the categorical data and means for continuous variables and calculated them using SPSS 18. Results: Our cohort consisted of 64 patients, 26 male and 38 female children, and adolescents. The majority of seizure onset had occurred during the neonatal period, and the earliest age at surgery was 4 months old. Hemispherectomy was performed early in most cases. With proper patient selection, outcomes are generally excellent with regard to seizure burden and serious complications result in seizure-free rates of 70%–80% and most patients are seizure free after 1 and 3 years. Some patients who gain seizure freedom successfully discontinue anti-epileptic drugs, while those who do not achieve seizure freedom enjoy some improvement in their seizure burden. Conclusion: This study shows positive long-term improvements in seizure control and quality of life after hemispherectomy.


  Public Perception of Plastic Surgery in Saudi Arabia Top


Abdulrahman Alsalim, Abdulaziz Khalid Alotaibi, Faisal Abdullah Alhabradi, Salah Aldekhayel

King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Background: Plastic and reconstructive surgery covers broad spectrum of conditions. This diversity created confusion for general public seeking appropriate medical care. In addition, media has a great impact in perceiving plastic surgeons as cosmetic surgeons. Objective: To explore the public perception of plastic surgery in Saudi Arabia. Methods: An online survey was shared with the Saudi public through social media. They were asked to match 12 medical and surgical procedures with the specialist whom they thought was the most qualified to perform. Results: A total of 4842 participants responded to the survey. Their gender and age demographics showed that the majority (74.54%) were female participants and the age distribution was as follows: 20.15% aged <21 years, 36.04% aged 21–24 years, 39.95% aged 25–40 years, 3.47% aged 41–54 years, and 0.39% aged >55 years. The majority (57.13%) of participants had a college degree. The percentage of respondents who chose plastic surgeons as experts in the following procedures included rhinoplasty (39.18%), mandible fracture (5.29%), blepharoplasty (77.61%), cleft lip surgery (60.78%), thumb replantation (28.53%), hand/finger fracture (6.23%), rhytidectomy (83.19%), breast reconstruction (88.88%), breast augmentation (96.58%), open leg wound (23.99%), open wound on the face (53.87%), and Botox (60.97%). Plastic surgeons were the most commonly selected experts in only 7 of these 12 domains (58.33%). These included blepharoplasty, cleft lip and palate surgery, rhytidectomy, breast reconstruction, breast augmentation, treatment of open wound of the face, and Botox injections. Conclusions: Although most of the procedures were matched to plastic surgeons, the Saudi public was not fully aware of many conditions that were fundamentally within the roles of plastic surgeons.


  Deep Brain Stimulation in Young Children: Technical Challenges and Long-term Assessment of Lead Location Top


Sarah Aleshaiwy, A. Mokeem, M. Almuhaizea, F. Alotaibi

Alfaisal University, Riyadh, Saudi Arabia

Background: Deep brain stimulation (DBS) is a well-established treatment method for certain movement disorders. The popularity of DBS use in children is increasing globally. However, the current literature exploring DBS lead location over long-term follow-up is minimal. Methods: A retrospective analysis of a group who underwent DBS for various movement disorders was carried out between January 2011 and June 2016. Implantation occurred under general anesthesia utilizing standardized surgical techniques and intraoperative neurophysiological monitoring. The outcome was assessed using the Burke–Fahn–Marsden Dystonia Rating Scale movement subscore (BFMDRS-M). Follow-up assessments of the lead location were done using computed tomography brain and electrode stimulation. Results: A total of 16 children (6 females and 8 males) underwent DBS implantation; 10 for secondary dystonia, 1 for primary dystonia, 1 for chorea, 3 for choreoathetosis, and 1 patient for Woodhouse–Sakati Syndrome. The age ranged between 5 and 13 years (mean, 8.2 years). The follow-up period ranged between 7 and 38 months. Postoperative improvement was assessed using BFMDRS-M: 30%–60% in secondary dystonia, 80% in primary dystonia, 40%–70% in choreoathetosis and chorea, and 50% in Woodhouse–Sakati syndrome. DBS was implanted in different targets (GPI, zona incerta, and thalamus). One patient developed infection, which was treated with unilateral partial system removal and antibiotics. Another patient developed twiddler's syndrome that required distal system revision. No lead upward migration from the targets was seen over 3, 4, and 5 years of follow-up. Conclusions: DBS improves functional state of various movement disorders in children under 14 years of age. The best response occurred in primary dystonia and chorea. No lead migration was identified with long-term follow-up.


  Idiopathic Intracranial Hypertension with Chronic Disc Edema in a Tertiary Care Center Top


Lama AlFakhri, Qais Dirar, Israa Bamogaddam, Ala'a AlSahli, Abdulaziz AlZoba, Selwa ALhazzaa, Jeylan El-Mansoury

Alfaisal University, Riyadh, Saudi Arabia

Background: Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology. It predominantly affects obese women of childbearing age. The chronic elevation of intracranial pressure leads to significant neurologic manifestation which can progress to papilledema, optic atrophy, and eventually blindness, which is a major morbidity. The symptoms of increased intracranial pressure are headaches, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia and papilledema that are commonly associated with loss of sensory visual function. Methods: Herein, we describe the neuro-ophthalmological features of 11 individuals (3 males and 8 females; aged at final examination 4–55 years) from unrelated consanguineous families with IIH. These patients were diagnosed with IIH and followed up regularly at the ophthalmology department in King Faisal Specialist Hospital and Research Center, a tertiary care center in Riyadh, Saudi Arabia. Results: Eight of the 11 patients were reportedly obese with a high body mass index. Visual acuity was decreased in seven patients. All patients had equally reactive pupils with negative RAPD and normal color vision. Esotropia was reported only in one case. On fundus examination, nine of the patients had chronic optic disk edema without optic nerve atrophy. Two of the patients showed abnormalities on visual field examination. Intraocular pressure was normal in all the patients. Conclusion: Early diagnosis of the disease is essential to prevent further complications. Further studies are needed to establish clear guidelines on the symptoms and management of patients with IIH.


  Assessment of Antioxidant Vitamins and Trace Elements in Patients Suffering from Sickle Cell Disease during Vaso-occlusive Crisis and Stable State Top


Sarah Aljasser, Rana M. W. Hasanato, Rana Ahmed Aljunidel, Amal Saad Aseeri, Daad, Abdulrahman Alotaibi, Nourah Mohammed Almofarej

King Saud University, Riyadh, Saudi Arabia

Background: Sickle cell disease (SCD) is associated with oxidative stress and altered antioxidant blood levels. Low oxygen tension is considered a predisposition for stable SCD patients to suffer from vaso-occlusive crisis (VOC). This study was performed to assess the blood levels of antioxidant trace elements (zinc, copper, and selenium) and Vitamins (A, C, and E) among stable SCD patients and SCD patient during VOC. Methods: This case–control study was performed at King Khalid University Hospital, Riyadh, during December–February 2016–2017. Using consecutive sampling technique, blood samples were collected from 71 consenting patients with SCD. There were 27 patients with VOC (mean age, 19.93 ± 10.8 years) and 44 stable patients with SCD (mean age, 25.64 ± 10.8 years). Vitamins A, C, and E were assessed by high-performance liquid chromatography whereas zinc, copper, and selenium levels were determined by atomic absorption spectrophotometry. Results: There was no difference in mean zinc levels between the stable SCD patients (0.67 + 0.08 μg/ml) and those in crisis (0.64 + 0.06 μg/ml) whereas the crisis group had significantly lower copper (0.83 + 0.10 μg/ml) levels compared to the stable patients (1.34 + 0.14 μg/ml; P < 0.0001). Similarly, patients during crisis had lower blood levels of selenium (66.21 + 8.74 μg/ml) than the stable patients (74.75 + 11.44 μg/ml; P < 0.001). Similarly, the mean blood levels of Vitamin A in the crisis group (49.63 + 7.58 μg/dl; P < 0.0001) were higher than the stable group (34.26 + 8.5 μg/dl). There were no differences in Vitamins C and E levels between the groups. Conclusion: Selenium and cupper deficiency may predispose SCD patients to VOC.


  Awareness of Risk Factors of Diabetic Ketoacidosis among Diabetic Adults in KSA Top


Ahmed Alanazi, Abeer Jalawi Alotaibi, Hussein Ali Albakheit, Sarah Naif Aldewish, Maram Khalf Ayad Alenzi, Alhanouf Abed Salim

Almaarefa College, Riyadh, Saudi Arabia

Background: Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus (DM) that lingers to have high rates of morbidity and mortality, regardless of advances in the management of DM. The main cause of DKA is DM 1 with insulin deficiency, however, a subgroup of type 2 diabetes patients might as well have ketosis-prone diabetes. Objective: To assess the level of awareness of the risk factors of DKA as well as the adherence of DM patients with drugs. Methods: This was a questionnaire-based, cross-sectional study enrolling a total of 100 randomly selected diabetic Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using the Statistical Package for the Social Sciences 23. Awareness levels for DKA were calculated as absolute frequencies and were reported as overall percentages. Results: Of a total of 100 randomly selected diabetic Saudi adults (81 females and 19 males), 56% were diagnosed with DM-1 while 44% had DM-2 and only 11% were active sport practitioners. Moreover, only 62% of participants reported a robust adherence to DM medications. The majority of the respondents scored low knowledge on DKA (54%). Regarding the awareness of predisposing risk factors, 9% and 29% of the participants have related DKA to infection and febrile illness, respectively. However, 50% of the participants suggested an association between physical stress and DKA. Conclusion: Our results revealed a compelling need to bridge the disparity in awareness of DKA among Saudi adults with both types. The current knowledge gap does not only incur a significant cost burden on the patients and their sponsors because of the high cost treatment and rehabilitation but also and more severely incur the complications that can be life-threatening if not spotted and treated quickly. Accordingly, we recommend the launch of education and awareness programs for the public at large, in the hope that this will lead to improved quality of life, particularity for DM patients and their caregivers as well as establishing nutrition and sports programs at schools and universities that can teach children and young adults the preventive measures and appropriate management of DKA early on in life. Other public awareness raising campaign through TV and radio spots, culture and art activities, and informational events would add a great value.


  Knowledge, Attitudes, and Practices of Self-ear Cleaning among Medical Students, Majmaah University, Saudi Arabia Top


Saad Abbas Aldawsari, Abdulrahman Abbas Aldawsari, Atheer Abdulaziz Aljthalin, Faisal Mohammed AlDossari, Meshary Abdullah Alhammad, Meshary Saud Al Shatri, Raseel Abdulaziz Aljthalin, Raneem Abdulaziz Aljthalin, Saleh Asaad Alsaadoon, Salman Hathal Alotaibi

Majmaah University, Al Majmaah, Saudi Arabia

Background: Wax is the normal and healthy substance that has several functions, and the quantity of production differs between individuals. Furthermore, its components vary according to race. Most of the individuals of the population are unaware of the disorders that occur as a result of the unhygienic maintenance of ears. Using cotton buds to clean ears is very common, and the insertion of these buds is unnecessary as it causes several complications such as trauma, retention of cotton buds, and impacted ear wax. Objective: To assess the knowledge, attitude, and practice of medical students regarding self-ear cleaning. Methods: This is an institutional–based, cross-sectional study which was conducted at Majmaah University in Majmaah city. The study included students from 2nd to 6th year of the College of Medicine. A questionnaire was used to investigate the demographics of participants, knowledge, attitude, and practice regarding self-ear cleaning. Results: The present study included 258 students, 71.7% of them were male, and 28.3% were female. About 44.6% of students had good knowledge, while 55.4% had poor knowledge. Regarding attitude, 65.5% of students were cotton bud users; the most common reason for self-ear cleaning was hygiene 40.7%. Regarding practice, 88.2% of students had low-risk practice. Conclusion: There was poor knowledge about self-ear cleaning among students, while there were a positive attitude and excellent practice. Awareness programs are required to be applied.


  12 years experience of Saudi Pediatric Nutritional Surveillance: Cross-sectional study Top


Msab Aldakheel, Naif Alruwaished

Dar Al Uloom University, Riyadh, Saudi Arabia

Background: Nutritional surveillance program helps understand the nutritional health status of the individuals, for appropriate policies processes selection to control and prevent malnutrition. The Saudi Nutritional Surveillance started in 2000 with children <5 years, and in 2010, it also included pregnant women and chronic diseases. Methods: This study was carried out in the selected primary health-care centers from health regions in Saudi Arabia. The subjects were infants and children aged from birth to 5 years old. Structured interview technique by the use of a questionnaire was employed to collect data from the mothers of the infant and children. Results: A sample size of 5446 was involved in this study. Fifty-three percent (2419) of them were male. The low birth weight prevalence (<2500 g) was 10.1% among newborn females and was 8.1% among newborn males. 5.2% of the subjects were underweight and 9.9% had growth limitations. Conclusion: The Saudi pediatric surveillance illustrated that the Saudi children growth was within the acceptable or low prevalence of stunting, underweight, and wasting. Using bottle-feeding is so common among Saudis.


  Fast-Food Effect on Cognitive and Metabolic Functions and Quality of Life Top


Mohammad Alqahtani, Mohammad Alsabieh, Abdulaziz Altmimi, Abdullah Albasha, Alwaleed Alsulaiman, Abdullah Alkhamashi, Shahid Bashir

King Saud University, Riyadh, Saudi Arabia

Background: Fast-food consumption is one of the habits that have been increased significantly worldwide, which is associated with high risk of morbidities, and in this research, we investigate the relationship between fast-food consumption and cognitive and metabolic functions of Saudi adults aged 18–25 years in Riyadh, KSA. Methods: Our study was a cross-sectional study that was done at the Department of Physiology, College Medicine, King Khalid University Hospital, Riyadh, KSA. The subjects were recruited conventionally and they were required to complete the designed pro forma that included demographic data, quality of life (wellness, stress, sleepiness, and physical activity), mini–mental state examination, and fast-food frequency. To investigate the metabolic function, blood was taken for high-density lipoprotein, low-density lipoprotein, cholesterol, and triglyceride. Cognitive function was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Subjects were divided into two groups based on the fast-food consumption: Group 1 who eat <3 times/week and Group 2 who eat >3 times/week. Results: The number of subjects in Group 1 was 35 with the mean age of 21 years and in Group 2 was 25 with the mean age of years. In CANTAB test, there was a difference but not statistically significant in mean response time among all cognitive function task including attention switching task and delayed matched sample task among two group tests which were used (AST, DMS, IED). It is found that an increase in the level of HDL is significantly associated with a decrease in the AST correct median latency and the AST correct median latency congruent (P = 0.02, P = 0.01, respectively). Conclusion: Fast-food consumption has an effect on metabolic functions, but has no direct effect on cognition and quality of life.


  Spontaneous Sphenoid Wing Meningoencephaloceles Treated with Minimally Invasive Endoscopic Transpterygoid Approach: Case Report and Technical Note Top


Wajda Alhothali, Abdulrazag Ajlan, Khalid AlTuhaini, Waleed AlQurashi

King Saud University, Riyadh, Saudi Arabia

Background: Spontaneous meningoencephalocele of the sphenoid wing is a rare form of basal encephaloceles. The most common presentation is cerebrospinal fluid (CSF) rhinorrhea. Others include seizure disorder and recurrent meningitis. Diagnosis is usually made on further investigations with endoscopic evaluation, neuroradiologic studies, and biochemical analysis of nasal fluids. Surgical repair is usually required especially in the case of CSF leak and meningoencephaloceles to decrease the risk of developing ascending intracranial complications, e.g., meningitis and brain abscess. A review of the literature demonstrates much debate in the management of meningoencephaloceles of the sphenoid sinus. Previously, transcranial approaches (pterional route or frontosphenotemporal) have been used and are associated with significant morbidity. On the other hand, endonasal transpterygoid endoscopic routes are much less invasive and have been efficiently used in the treatment of CSF leaks and meningoencephaloceles of the lateral recess of the sphenoid sinus. Clinical Presentation: We present the case of a 45-year-old female with seizure disorder for 15 years. She presented with a 3-year history of intermittent CSF rhinorrhea from both nostrils exacerbated by dependent head positioning, i.e., “reservoir sign,” intermittent left ear otorrhea, and decreased hearing. Moreover, for the last 3 months, she noticed that the frequency of her seizures has increased and the characteristic has changed, and she also complained of upper vision cloudiness. Neuroimaging investigations revealed a sphenoid wing meningoencephaloceles with lateral sphenoid sinus extension with prominent CSF spaces (empty sella and large Meckel's cave). Minimally invasive endoscopic transpterygoid approach was performed for resection of the encephalocele. The patient was discharged 1 week after the surgery with no complaints. Conclusion: Spontaneous meningoencephalocele of within the sphenoid wing is a rare clinical entity that usually requires surgical repair. Minimally invasive endoscopic transpterygoid repair is a new technique with minimum tissue destruction compared to standard endoscopic approach.


  Assessment of School Readiness for Medical Emergencies Top


Feras Alsuwaida, Abdulaziz Abdullah Almanie, Abdullah Mohammed Alsultan, Osama Mohammad Abdulqader, Sultan Musaid Alotaibi, Nasser Theeb Alqahtani, Fahad Alzamil

King Saud University, Riyadh, Saudi Arabia

Background: Children are the cornerstone and the future of every society, spending third of the day in schools and being more susceptible to physical injuries due to lack of awareness of dangerous life-threatening situations. Objective: in this study, we aim to evaluate primary and middle schools in different districts of Riyadh, Saudi Arabia, to handle medical emergencies and to compare equipment and staff skills, knowledge, attitude, and willingness to attend life-supporting course between private and governmental schools. Methodology: We conducted a cross-sectional observational study on a sample size of 196 school staff with a previously validated paper-based self-administered questionnaire. Results: The study included 196 school staff from 39 different primary and intermediate schools, nineteen private and twenty governmental. The total number of school staff who had basic life support (BLS) training was 83 (44.1%), of those 39 were in governmental and 44 in private. the private sector had significantly lesser time passed since training compared to governmental schools (P =.027). The private sector had higher practical training (63%) than government sector (33%). Private and government sectors have a significant difference in case of bronchodilators and epinephrine auto-injector availability; in favor of knowledge, the private sector had a higher score than the government sector, while the regions showed no significant difference. The mean score of attitude was highest in the east and lowest in the west. Conclusion: This study showed insufficient knowledge and skills in both primary and secondary sections. The private sector has greater knowledge and skills than the government sector with no significant difference in the trained and untrained individuals, without any significant difference between Riyadh regions. A positive attitude was recorded toward BLS and first aid.


  Assessment of Fluid Intake in Saudi Adults' Population Top


Ziyad Altasan, Hussein Saad Amin, Abdullah Alyahya, Mubarak Aldosarie, Abdurrahman Aldhubib, Talal Almutairi

King Saud University, Riyadh, Saudi Arabia

Introduction: Water plays a role in almost all body functions and is a major component of every cell, tissue, and organ. Adequate hydration is critical for optimal body function. Our objectives are to estimate the daily consumption of fluid (water and all other beverages) by selective sample of adult Saudi population to observe if it meets with the European Food Safety Authority (EFSA) recommendations and to assess the knowledge and attitude toward fluid intake among our study population. Methods: A cross-sectional study was conducted in Riyadh city at hospitals' outpatient building, mosques, malls, coffee shops, streets, and King Saud University with 900 participants. It took place between February and March of 2016 with average temperature around 18°C. Data collection was done by a self-administered questionnaire to assess the fluid intake in the last 24 h, knowledge, and attitude. Results: Water intake from different types of beverages was below the EFSA recommendations (2 ml for males and 1.6 ml for females) in 31.75% of the whole population (31% male and 32.5% female). In total, 1.5% of the study population (1% male and 0.5% female) consumed 100% of EFSA recommended for total fluid intake. 16.15% of the whole population (16.7% of males and 15.6% of females) consumed between 90% and 110% of the total EFSA recommendations, and 62.2% of the whole population (58.6% of males and 76.1% and females) consumed >110% of the EFSA recommendations. 60.5% and 65.4% of male and female population, respectively, does not know if drinking fluids is equivalent to water. 37.2% and 31% of male and females, respectively, drink water only when they are thirsty. Conclusion: The outcome of this study revealed that most of our population met the EFSA recommendations, but still do not know that drink water and other fluids are equivalent.


  The Prevalence of Social Media Uses for Medical Consultations and Health Information in Saudi Arabia Top


Rand Alhumaidhi, Lolo Aldhwaihy, Nada Bin-Semaih, Noura Albulushi, Shahad Al-Qahtani, Sheikhah Aldossari

King Saud University, Riyadh, Saudi Arabia

Background: Social media is a newly developing field influencing people in many aspects of their life. Recently, there was a huge increase of users in Saudi Arabia. Researches showed that the significance of random users' search in social media about medical consultation and health information has an effect on their health since those consultations were not based on a qualified health-care provider. Methods: A total of 385 social media users in Saudi Arabia were evaluated in a cross-sectional quantitative study from December 2016 to April 2017. Data were gathered through an online self-administrated questionnaire via Twitter and WhatsApp. Chi-square was used to examine significant associations between the sociodemographic characteristics of participants, their health status, and their uses of social media applications for medical consultation and health information. Results: Two hundred and ninety-five (76.6%) users search in social media for medical consultation and health information. The reason behind people using these apps is mostly to learn more about their condition in 253 (65.7%) users or because it is difficult to find time to visit a doctor in 117 (30.4%). 306 (79.5%) users reported that they got beneficial information from social media regarding health where 150 (39.0%) found an effect of these apps on their lifestyle habits. 64 (16.6%) users felt it enhanced their ability to manage their health without visiting a doctor. Conclusion: Physicians and patients should be aware of social media consequences on health. Hence, we recommend the development of a well-designed application with free access under the supervision of the Ministry of Health to the entire Saudi society.


  The Prevalence of Psychiatric Disorders among Narcolepsy Patients Top


Ahmed BaHammam, Salman AlQazlan, Ahmad AlHadi, Haitham Alasim, Alwalid AlBuraik, Abdulaziz AlSalhi, Saleh Albanyan, Awad Olaish

King Saud University, Riyadh, Saudi Arabia

Background: Narcolepsy is a neurological sleeping disorder characterized by excessive daytime sleepiness (EDS) and abnormal rapid eye movement sleep manifestations such as cataplexy, sleep paralysis, and hallucinations. Many of the psychological and economic consequences of narcolepsy can be directly attributed to sleep attacks and EDS. The association between narcolepsy and psychiatric disorders remains understudied in many aspects. Methods: This cross-sectional study was conducted in the University Sleep Disorders Center (USDC) at King Khalid University Hospital, Riyadh, Saudi Arabia, from November 2016 to September 2017. We included all USDC Arabic-speaking patients aged 18 years and above and diagnosed with narcolepsy between March 2007 and February 2017. The results were compared to historical controls from previous studies. Recruited patients were interviewed in person by trained examiners using a validated Arabic version (Version 6) of the Mini International Neuropsychiatric Interview, diagnostic statistical manual-IV. Demographic data of age, sex, and nationality were obtained from the USDC patient's files. All study participants have received written informed consent. Results: Seventy-four patients met the inclusion criteria and agreed to participate. The mean age was 29 years. Male patients represented 81.1% of the study sample. At least one psychiatric disorder was present in 44.6% of patients with narcolepsy. Major depression disorder was the most prevalent (21.6%). Lifetime and current psychotic disorder were 9.5% and 8.1%, respectively. Suicidality was 9.5% and the majority of them had low severity, generalized anxiety disorder was 6.8%, and bulimia nervosa was 2.7%. Bulimia nervosa was significantly more prevalent in the female group with 14.3% compared to the male group. Conclusion: Certain psychiatric disorders were studied and showed a higher prevalence in narcolepsy patients compared to the normal population. Major depressive disorder was the most prevalent among other studied psychiatric diseases.


  The Adherence to Cholecystectomy Timing Guidelines and Its Effect on Health Care and Patient-Centered Outcomes Top


Amal Afrah, Mazin Hassanain, Sara Al Bqami, Nourah Al Beeshi, Rawa Al Ohali

King Saud University, Riyadh, Saudi Arabia

Background: Laparoscopic cholecystectomy is a commonly performed surgical procedure. Early intervention has been proven to lower the complication rate and reduces hospital stay. The purpose of this study was to assess our institutional adherence to the timing guidelines and its effect on clinical and patient-centered outcomes and the associated cost in patients with symptomatic gallstones. Methods: Data were collected from the electronic medical records of symptomatic gallstones patients over a year period. Predefined definitions were used to divide patients into biliary colic, persistent biliary colic, early cholecystectomy for acute cholecystitis and delayed cholecystectomy. A random group of patients were interviewed using the RAND 36-Item Health Survey 1.0 following the procedure. Results: Five hundred and thirty-four patients were identified; 79.9% were females. 76.8% of our patients had biliary colic, 13% had persistent biliary colic, 5.9% with early cholecystectomy, and 3.2% with delayed cholecystectomy. Persistent biliary colic had a significant delay from diagnosis to surgery (P < 0.05), more length of hospital stay (P < 0.0001), and more patients' productivity loss (P < 0.02) when compared to biliary colic with a median $266.65/patient cost increase. Delayed cholecystectomy for acute cholecystitis patients had more delay from diagnosis to surgery (P < 0.0001) and more readmission rates (P < 0.0001) when compared to the early group with a median $533.29/patient cost increase. There was no statistical significance in complications or in the quality of life parameters. Conclusion: Despite being in an academic center, adherence to the treatment guidelines of symptomatic gallstones is low. The increased cost is worth investment in measures to reduce such burden on the patients and the health-care system.


  Interaction of Clinicians with Patients: Consultation Models Used by the Clinicians at Four Different Tertiary Care Hospitals in Riyadh, Saudi Arabia Top


Hamza Mohammad Abdulghani, Rakan Alsalem, Kamran Sattar, Mohammed Alruwaite, Nasser Alkhraiji, Ghanem Alghamdi, Anas Alkhulaifi

King Saud University, Riyadh, Saudi Arabia

Background: A sound doctor–patient relationship is a cornerstone of a positive patient health outcome. It highly affects patient satisfaction, which in turn affects compliance positively and results in fewer malpractice complaints. Clinicians practice different consultation models with their patients, and patients expect a certain attitude from his/her treating clinician. This study aimed to identify and explore the consultation models being practiced by four different specialties. Methodology: This is a quantitative, observational, questionnaire-based cross-section study. The questionnaire consisted of 22-item 7 questions for the demographic and 5 questions for each model. It was conducted at King Khalid University Hospital, King Fahad Medical City, Prince Sultan Military Medical City, and King Saud Medical City, Riyadh, Saudi Arabia. All clinicians from the four specialties (surgery, internal medicine, family medicine, and psychiatry) and newly graduated physicians (interns) were included in the study. A convenient sampling technique was used, and the questionnaire was distributed to the available physicians. Data were entered using Microsoft Excel and analysis was done by SPSS version 21. Results: There were a total of 263 responses. The majority of the participants (46%) practiced ambiguous consultation models, followed by deliberation model (41.4%), modern paternalism (9.5%), classic paternalism (1.5%), and (1.5%) consumer model. Conclusion: Majority of the physicians from the targeted hospitals in Saudi Arabia preferred to utilize the deliberation model. This is in total alignment with the majority of the patients' preference. Preferably, a physician should never adopt a single model for all his/her patients, and instead, adopting an attitude that is flexible and empathetic matches patients' expectations and needs.


  Psychological Stress among Medical Students of Jouf University using Kessler-10 Psychological Distress Scale Top


Thamer Abdullah Alanazy

Jouf University, Sakakah, Saudi Arabia

Background: Psychological stress is common among medical students all over the world. The medical students in Kingdom of Saudi Arabia (KSA) are different in their social and cultural norms. We carried out the study to estimate the prevalence of stress among medical students in northern region of KSA. Methods: A cross-sectional study was carried out in the College of Medicine, Jouf University, Sakaka. We included 192 medical students enrolled in undergraduate medical course using nonprobability consecutive sampling. Data were collected using Kessler-10 Psychological Distress Scale (K10). Sociodemographic characteristics were cross-tabulated with stress to find out the significant factors. Results: The average of age of our study population was 21.3 ± 2.2 years. Nearly 91% of them were single. Among included students, 17.7% were current smokers. 67.2% of them were living with their family while 31.8 of them were living in hostels. Among 192 medical students, 89% were found stress free according to K10 criterion. Fourteen (7.3%) students reported mild stress, 5 (2.6%) students had moderate, and 2 (1%) students had severe stress. Final-year students were found more stressed as compared to preclinical years (P = 0.04 using Fischer's exact test). Stress among medical students was not associated with gender, smoking status, or living status (with family or alone). Conclusion: It is concluded that the prevalence of stress among medical students of Jouf University is low as compared to other regions.


  The Impact of Vitamin D Fortification of Staple Food for Children: A Systematic Review and Meta-analysis Top


Nora AlHelali, Reem Al Khalifah, Rawan Alsheikh, Rana Alsheikh, Nora Alhelali, Ammar Naji, Yossef Alnasser

King Saud University, Riyadh, Saudi Arabia

Background: Vitamin D deficiency is a public health problem. We aimed to assess the effectiveness of Vitamin D fortification of staple food for improving Vitamin D level in children. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of Vitamin D-fortified food products compared to no fortification in healthy children aged 0–18 years. The primary outcomes are Vitamin D level and Vitamin D deficiency prevalence. The secondary outcomes are school performance and infection rate. It was screened for titles and abstracts, assessed full text for eligibility, and performed data extraction. We performed meta-analysis using a random effects model and reported effect estimates with 95% confidence interval (CI). Results: We identified 2224 articles and screened 1776 after removing duplicates. Eighty-six articles were assessed eligible for full-text assessment, and 17 RCTs were included for data extraction with 3157 patients. The RCTs were performed in ten different countries. The interventions included fortification of milk, juice, bread, and yogurt compared to no fortification. Vitamin D fortification improved the Vitamin D level by Mean Deviation (MD) 17 nmol\L (95% CI: 5.32–28.67) and reduced Vitamin D deficiency prevalence by relative risk of 0.61 (95% CI: 0.49–0.76). Vitamin D level improved more in lower middle-income countries – MD 25.66 nmol/l (95% CI: 24.71–26.61) and when used in school-based programs – MD 31.20 (95% CI 30.20–32.21) compared to clinic-based programs – MD 16.07 (95% CI: 11.63–20.50). Conclusion: Our systematic review is the first to assess the impact of fortification of staple food on Vitamin D status for children. Vitamin D fortification is an effective way to reduce Vitamin D deficiency prevalence, specially in low middle-income countries and school-based programs.


  The Association between Psychosocial Factors with Medical Comorbidity and Quality of Life among Diabetic Foot Patients of King Saud University Hospitals Top


Fahad AlOsaimi, Reem Mohammed Labani, Norah Khalid Alhelali, Nouf Fahad Almasoud, Dhaherah Mani Aljohani, Lamya Althawadi

King Saud University, Riyadh, Saudi Arabia

Background: In 2013, the prevalence of diabetes was 20% among Saudi population and deaths related to diabetes were 22,113 people. The prevalence of diabetic foot worldwide is 6.3%. Diabetic foot complications are associated with medical morbidities and mortalities as well as psychosocial and financial outcomes that affect the patient's quality of life. Objectives: The goal of our study was to determine the association between the quality of life and the psychosocial factors (depression, anxiety, self-management, and somatic symptoms) among diabetic foot patients and nondiabetic foot patients in Saudi Arabia. Methods: A sample of 212 participants were enrolled in our study, including 44 diabetic foot ulcer patients in different stages (case group), and nondiabetic foot patients (control group) consisted of 168 patients with no history of diabetic foot or serious late complication of diabetes from King Saud University Hospitals. Our variables were assessed by the following scales: (1) Depression and anxiety using Hospital Anxiety and Depression Scale; (2) quality of life using the World Health Organization Quality of Life-BREF; (3) self-management using summary of diabetes self-care activities; and (4) severity of somatic symptoms using Patient Health Questionnaire-15. Finally, the data were entered and analyzed through the Statistical Package for the Social Sciences. Results: Significance was found on both groups' quality of life that was negatively affected by depression, anxiety, and somatic symptoms, and on the other hand, self-management was not affected. In addition, diabetic foot group was affected more by psychosomatic factors when compared with the nondiabetic foot group quality of life. Conclusion: The quality of life in both groups was approximately the same. However, our study revealed that depression, anxiety, and somatic symptoms had negative effect on quality of life in both groups. Our results will encourage further researches to look into different aspects regarding the management of diabetic foot patients and therefore improve in health journey and economize financial expenditure of diabetic patients in Saudi Arabia.


  The Effects of Short-term versus Long-term Exposure of Reactive Oxygen Species on Coronary Endothelium Top


Maan Awad, Sarah Aldosari, Bonnie Colantuono, Isabella McCormack, Ruhul Abid

Alfaisal University, Riyadh, Saudi Arabia

Background: Reactive oxygen species (ROSs) have been associated with the pathogenesis of several diseases including cardiovascular disease (CVD). However, several clinical trials using antioxidants have failed in producing beneficial results for CVD patients. Previous experiments from our group examined the effects of short-term (4–8 weeks) exposure to higher levels of ROS using isolated mouse heart endothelial cells (MHECs). They demonstrated that increase in ROS have activated NOX2-AMPK-eNOS-mediated endothelial-dependent coronary vasodilatation and NOX2-AMPK-mTOR protective autophagy response. These findings suggested the beneficial effects of short-term exposure of high levels of ROS on endothelial cells (ECs). Methods: Mice were separated into two groups: short-term (8 weeks) and long-term (20 weeks) exposure of high levels of ROS, and then we harvested the heart to carry out the following: Polymerase chain reaction assay to confirm the presence of both genes (Tet-NOX2; VE-Cad-tTA); Western blot to demonstrate the increased levels of phosphorylated AMPK and eNOS; Citrulline Assay as a measure of nitric oxide (NO) synthesis; microvessel reactivity assay as a measure of endothelial-dependent vasodilatation using acetylcholine (ACH) and vascular endothelial growth factor (VEGF) as EC agonists; and proliferation assay to examine MHEC proliferation. Results: Both groups showed activation of AMPK and eNOS. Consequently, there was increase in the levels of NO. Using Ach and VEGF, short term demonstrated an increase in endothelium-dependent vasodilatation. However, the long term demonstrated a reduction in vasodilatation compared with Tet-ON littermates. Incorporating EdU in the DNA of EC, we demonstrated that only short term increases EC proliferation, whereas long term does not. Conclusion: High levels of ROS induced the expression of NOX2, and thereafter activation of AMPK-eNOS-NO axis. However, only short-term showed beneficial effects. In the future, we will examine the subcellular communication between cytosolic ROS and mitochondrial ROS as results have shown a correlation between the endogenous increase in ROS and mitochondrial ROS.


  The Incidence Rate of Indwelling Central Venous Catheter Bloodstream Infection in Cancer Patients at King Khalid University Hospital from 2009 to 2014 Top


Mohammed Binaskar, Maen Alherbish Sakhar Albader Abdulelah Alhabib Suliman Alobaid Abdulhamid Alghamdi

King Saud University, Riyadh, Saudi Arabia

Background: Central venous catheter (CVC) is a widely used management tool that is used in the care of hospitalized patients, especially cancer patients for delivering nutrients, chemotherapies, and other therapeutic agents as well as getting body fluid samples and blood transfusion/draw. However, it can lead to a variety of complications ranging from simple thrombophlebitis up to severe sepsis and death. We conduct this study hoping to calculate the incidence on catheter-associated bloodstream infection (CABSI) among cancer patients in King Khalid University Hospital (KKUH) and the most important contributing factors to this problem as long as such kind of important information are lacked in our area. Objectives: (1) To determine the incidence of bloodstream infection caused by CVC among cancer patients in KKUH from 2009 to 2014. (2) To identify the most important determinants and contributing factors of CVC-associated infection. Methods: A retrospective cohort study of total 271 cancer patients (≥12 years old) was conducted at KKUH by referring to patients' medical files. Data were collected and analyzed by Chi-square test in order to find a significant association between different types of variables and the presence of CABSI among those patients. Results: CABSI among those patients was found to be 21%; factors that were found to be associated with the presence of infection include type of cancer where leukemia and lymphoma patients were most affected (P = 0.001), presence of comorbidities (P < 0.001), and vein in which the catheter was inserted (P = 0.045). On the other hand, age, sex, side of catheter insertions, and type of catheter showed no significant association with the presence of infection. Conclusion: CVC should only be used for appropriate indications and should be removed as soon as they are no longer needed. Prospective studies with larger sample sizes are required to determine most frequent type of bacteria affecting those individuals.


  Preference toward Treatments of Depression among the General Public in Saudi Arabia Top


Ahmad AlHadi, Mohammed Alsubaie, Abdullah Aljumaiah, Abdulrahaman Alkaff, Faisal Aljebreen, Abdulrahman Alarfaj, Samia Abdelati

SABIC, Psychological Health Research and Applications Research, King Saud University, Riyadh, Saudi Arabia

Background: By the year of 2020, depression is going to be the second major cause of disability worldwide. The patient preference regarding the management of depression has shown a significant effect on the outcome as well as it was considered by the American Psychological Association and other health-care organizations as an essential part of depression management. We aimed to assess the preference toward different types of depression treatment among the general public in Saudi Arabia. Methods: The was a cross-sectional study with a convenient sample using an electronic questionnaire for data collection including people who live in Saudi Arabia, 18 years or older, and not actively seeking treatment for depression. A detailed description about one of the five treatments for depression (psychotherapy, antidepressants, guided self-help, bibliotherapy, and Internet-based self-help) was provided randomly to the participants to read. Then, they were asked to read brief descriptions of all five treatments, and finally, they were asked to rank them accordingly. Results: The total number of participants was 2342; psychotherapy was significantly the most preferred type of treatment (mean = 3.65), followed by guided self-help (mean = 2.46), bibliotherapy (mean = 2.78), and Internet-based self-help (mean = 2.29); and antidepressant was the least preferred type of treatment (mean = 2.18).Gender and job were the factors which have a significant impact on the preference. Conclusion: Nonpharmacological treatments were preferred over the pharmacological type, and psychotherapy was the most preferred one. Further studies to assess choosing the preferred treatment of depression and its effect on the outcome are recommended.


  High Incidence of Silent Ischemic Infarct after Diagnostic Conventional Cerebral Angiogram: A Systematic Review Top


Lamees Altamim, Fawaz Al Hussain, Yousef Mohammad

King Saud University, Riyadh, Saudi Arabia

Background: The invasive conventional angiogram has been considered the gold standard technique to evaluate for cerebrovascular diseases, and they associated with stroke or death in 1% of all procedures. Preliminary data show that there may be high rate of angiogram-related ischemic events as shown on magnetic resonance imaging (MRI) diffusion images and reported by multiple research papers. However, each of these studies included only small number of patients; hence, there is a need of a systematic review that will include all of the published studies in the literature. Objective: To determine the risk of new ischemic events, demonstrated by MRI, in patients undergoing diagnostic conventional cerebral angiogram. Methods: We searched the MEDLINE, EMBASE, Current Contents, Cochrane Central, expert files, and bibliographies of included articles to identify prospective studies that reported MRI findings after diagnostic angiogram. Eligibility criteria include the following elements: manuscripts written in English and published between 1999 and 2017; prospective design, pre- and post-procedure diffusion-weighted MRI (within 1 week before and within 1 week after procedure); number of new diffusion-weighted imaging (DWI) documented after each procedure; and document occurrence of stroke with clinical manifestation within 1 week after the procedure. Case studies, letter editorials, and review articles were excluded. Results: A total of six studies were identified published between 1999 and 2017 that met the eligibility criteria. The total number of diagnostic angiogram reported was 386. DWI after the procedure was identified in 106 (27%) patients. Mean time fluoroscopy, procedure by resident operator, and vascular risk factors were the recognized independent risk factors for silent cerebral ischemia after diagnostic angiogram. Conclusion: New ischemic lesions are frequently detected on MRI after diagnostic angiogram. Caution must be exerted to minimize the mean time fluoroscopy, especially in patients with vascular risk factors. In addition, more keen supervision of resident performing the procedure is strongly advised.


  Doctors' Attitudes toward Becoming Mentally Ill in Saudi Arabia: Disclosure and Treatment Preferences Top


Ahmad Alhadi, Areej A. Alaman, Areej E. Alwehaib, Albatoul A. Alsuhaibani, Hala I. Alaskar, Nuha H. Alhomayed

King Saud University, Riyadh, Saudi Arabia

Background: One in four people in the world will experience a mental illness at some point in their lives. Compared to the general population, doctors are more likely to be affected. This study would evaluate doctors' attitudes to disclosure and treatment preferences if they were to develop mental illness. It also examines the impact of some factors that might influence the construction of that attitude. Preliminary data from this ongoing study are presented here. Methods: A quantitative, observational, cross-sectional study was carried out at the College of Medicine, King Saud University, Riyadh. This study included all physicians (consultants, registrars, and residents) of various specialties who work in Saudi Arabia and registered in Saudi Commission for Health Specialties. A self-administered online questionnaire was sent via short message service to 90,000 physicians and 823 responds till now. As the survey is still ongoing, the data have not yet been analyzed in depth. The results are based on an interim evaluation using (SPSS) version 22. Results: Nearly 572 (71.5%) of respondents agreed that the incidence of psychiatric illness among doctors is higher than the general population. Twelve percent of doctors in Saudi Arabia stated that they have experienced a mental illness which affected their lives, and majority of them were residents. In the context of disclosing a mental illness, approximately 364 (45.5%) of respondents would disclose their mental illness in the first instance to psychiatrist. Among the factors that influence disclosure preference, career implication appeared to be the most influencing factor (36.5%). In case of developing mental illness requiring in-patient treatment, the majority would select an out of area mental health facility (457, 57.1%), and their choice is affected by the issues of confidentiality. Conclusion: In this preliminary data, physicians showed positive attitudes besides the awareness of the high incidence of mental illness among themselves. Residents were more likely to experience mental illness and seek help.


  Patients' Reasons for Obtaining Psychotropic Medications without a Prescription at Retail Pharmacies in Central Saudi Arabia Top


Fahad D. Alosaimi, Fay S. Alruwais, Nuha S. Alsalameh

King Saud University, Riyadh, Saudi Arabia

Background: People in developing countries are obtaining prescription-only medications from community pharmacies without seeking medical advice. Pharmacists are dispensing prescription-only medications in general without prescription in Saudi Arabia. Methods: A cross-sectional study was conducted from November 2014 to August 2015. A convenience sample was taken by distributing a self-administered questionnaire among participants who had obtained psychotropic medications without a prescription from retail pharmacies during the 4 weeks before study intake in Riyadh, Kingdom of Saudi Arabia. In addition to the study questionnaire, the 9-item Patient Health Questionnaire was used to screen for major depressive disorder, and the 7-item Generalized Anxiety Disorder Scale was used to screen for general anxiety disorders. Results: Of the 302 subjects, 42.4% attributed their use of psychotropic medications without a prescription to the nonseriousness of their symptoms and 28.5% to the high cost of psychiatric services. Escitalopram was the most commonly used medication (31.8%), and three atypical antipsychotics were used by more than one-fifth of the study participants. The prevalence for major depressive disorder was 46.0% and 41.7% for generalized anxiety disorder. Conclusions: Most of the participants were able to easily obtain psychotropic medications without a prescription. We recommend implementing strong policies to prevent retail pharmacies from dispensing psychotropic medications without a prescription.


  The Molecular Profile of Active and Inactive Lupus Nephritis Classes III and IV and Its Clinical Outcomes among Saudi Population Top


Musab Abdulaziz Alageel, Rawa Mosaed AlOhali, Reem Mohammed Labani, Husain Morad Alkaff

King Saud University, Riyadh, Saudi Arabia

Background: Systemic lupus erythematosus (SLE) is a progressive autoimmune disease affecting most of the body's organs. Lupus nephritis (LN) can be presented in 40%–70% of SLE patients. It is divided into five types, each one classified into active, active/inactive, and inactive. Mutated genes play an important role in the initiation of LN by changing levels of autoantibody, expression of cytokines, and causing an imbalance between T helper 1 and 2. Methodology: A total of 162 samples of renal biopsy were collected from the record files of LN Classes III and IV patients of 2010–2015. Active cases were 32, 64 were active/inactive, and 66 samples were neither active nor active/inactive. The DNA was extracted in the Molecular Genetics Lab at KSUMC. The extracted DNA was analyzed for the purpose of addressing the mutated genes expression by DNA sequencing technique that has been identified in the previous studies. Finally, the files were reviewed to check the clinical status of LN patients. Results: Of all the 162 samples, only 50 samples met the DNA extraction criteria. 50% were active, 29% were active/inactive, and 25% were others (lupus I, II, V, and VI). Based on the hypothesizes, we suspect an elevation of interferon due to overexpression of LY6E, OAS1, OASL, MX1, and ISG15 genes in the active LN. Conclusion: We hypothesize that there is a difference between active and inactive LN Type III and IV at biomarker and genetic levels. Moreover, there is a direct correlation between the molecular/pathological findings and clinical outcomes.


  The Effect of a Physical Activity Intervention Using WhatsApp on Daily Steps, Body Mass Index, and Waist Circumference among Female University Students in Al-Qassim, Saudi Arabia: A Randomized Controlled Trial Top


Amal Lafi Alazmi, Ghadah Saleh Alhamed, Fatmah Ali Almohaimeed, Asma Abdullah Alsowiyan, Ashwaq Mohammed Alharbi, Homaidan AlHomaidan, Nazmus Saquib, Abdulrahman AlMohaimeed, Juliann Saquib

Qassim University, Buraydah, Saudi Arabia

Background: Physical inactivity and obesity is a major health problem among women in Saudi Arabia. It has been estimated that 60% of female university students are physically inactive and 34% are obese. Objective: To investigate the effect of a physical activity intervention on body mass index (BMI), waist circumference, and daily walking among female university students. Methods: Using parallel–group, randomized controlled trial, 207 participants were enrolled (intervention = 103 and control = 104). Assessments (at baseline and 3-month follow-up) included height, weight, waist circumference, 7-day step average (based on pedometer), and a survey on demographics and lifestyle factors. After random allocation, the intervention participants wore pedometers and received health-promotion messages for 12 weeks, while the control participants received an equivalent set of messages unrelated to health. Change scores were computed by subtracting the baseline values from the follow-up average for each outcome. T-tests were used on the respective change scores to evaluate group differences, with an alpha level of 0.05. Results: The sample mean age (years) and BMI (kg/m2) were 22.6 ± 1.3 and 24.6 ± 5.9, respectively, and there were no significant differences between groups at baseline. There were no significant differences between them either for changes in BMI (+0.01 vs. −0.23; P = 0.69) or in waist circumference (−1.35 vs. +0.06; P = 0.27). Intervention participants increased daily steps significantly more than the control participants (+576 vs. −525; t = 2.23, P = 0.03). Conclusion: Participation in a walking intervention did not result in significant changes in obesity indices among the Saudi female students, but it resulted in a meaningful improvement in daily steps. Daily activity has many benefits to health and this intervention should be tested in other groups of Saudi women, particularly among obese women.


  Risk Factors of Stroke among Young Adults in KSA Top


Wejdan Nasser Al Magbul, Amina Abdo Salhi, Sarah Naif Aldewish, Sarrah Awad Alshammari, Maram Mohammed Al Yami, Ahmed Maashi Alanazi

Almaarefa College, Riyadh, Saudi Arabia

Background: Current literature suggests that hospitalization rates kept increasing with time because stroke risk factors such as high blood pressure, diabetes, and obesity have been increasing in the general population. Moreover, stroke is particularly devastating among young people because of its disabling effects, which can last a lifetime. Stroke in young adults is often missed by less experienced clinicians due to its unexpectedness, leading to lost opportunities for intervention. Objective: To assess the awareness of young adults in KSA of the risk factors and signs and symptoms of stroke. Methods: The present cross-sectional study enrolled 150 Saudi males and females who were randomly selected during the period from November 2017 to January 2018. A self-report questionnaire was used to evaluate stroke awareness among participants while the Statistical Package for the Social Sciences method was used for data analysis. Results: Our study revealed that the majority of participants were able to relate stroke to the correct underlying risk factors, particularly obesity and smoking which score 85.3% and 84.0%, respectively. Likewise, 75% of participants agreed that fatty food is a contributing risk factor for stroke while only 61% thought that diabetic patients are at a higher chance for developing stroke. As for the signs of cerebral stroke, the majority of participants had basic knowledge on the signs and symptoms of stroke such as hypertension (83%), face drop, difficulty speech, and arm weakness (76%). In the meantime, overall, an average of 13% of participants declared no knowledge across all questions. Conclusion: Our study revealed improved yet still insufficient knowledge of brain stroke among the study group of young Saudi female and male adults, regardless of the age group since the majority of participants were able to correlate stroke with the key predisposing risk factors as well as the signs of stroke. This indicates that proper intervention was in place to spread the awareness of this crucial medical emergency. However, this effort needs to continue to further improve knowledge about stroke, risk reduction, and appropriate stroke response and prevention.






 

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