Center In Riyadh Research Articles

Assessing the diagnostic significance of pH studies in symptomatic patients within the Saudi community: a cohort investigation

Background: pH is a crucial physiological factor in diagnosing groups of diseases related to the gastrointestinal tract. This study delves into the critical role of pH measurement in diagnosing gastrointestinal diseases among symptomatic patients in the Saudi community. The research aims to classify patients based on pH levels, ultimately examining the impact of these findings on patient management and outcomes. Methods: A cohort observational study was conducted; a simple random sample technique was approached. The study population included 130 participants aged between 18 and 70 years. Data were collected from June to July 2021 from a specialized gastroenterology medical Center in Riyadh, receiving patients from different regions of Saudi Arabia (Human Clinic). Results: The study involved 130 participants and examined sociodemographics, clinical characteristics, and the association of symptoms and chronic diseases with pH DeMeester scores in gastroesophageal reflux disease (GERD) diagnosis. The study includes 43.8% female and 56.2% male; 76.9% had chronic diseases; 63.8% reported having GERD; 36.9% had irritable bowel syndrome (IBS); 13.1% were smokers; 84.6% were nonsmokers; 68.5% used GERD medications; 92.3% reported dyspepsia; and 37.7% had high pH scores, 41.5% had normal scores, and 20.8% had severe scores. Most associations between variables and pH scores were not statistically significant, indicating a complex relationship. Conclusion: The study showed a diverse participant profile with a high prevalence of chronic diseases, GERD, and IBS. Although the majority reported dyspepsia and used GERD medications, the associations between symptoms, chronic diseases, and pH DeMeester scores were not statistically significant, highlighting the complex nature of these relationships. Further research is needed to explore additional factors influencing pH scores and improve diagnostic accuracy.

Progressive Familial Intrahepatic Cholestasis: A Descriptive Study in a Tertiary Care Center.

Progressive familial intrahepatic cholestasis (PFIC) is a rare genetic disorder that results from defective mechanisms of bile secretion. We aim to describe different types of PFIC and their clinical features, treatment modalities, and outcomes in Saudi Arabia. Patients and Methods. This is a retrospective study of all patients diagnosed with PFIC at King Faisal Specialist Hospital and Research Center in Riyadh from January 1, 2002, to December 31, 2021. All relevant information was collected from patient charts and transferred into the REDcap® database for statistical analysis. A total of 79 patients were identified with PFIC, and PFIC type 3 was the most common (59.5%), followed by PFIC type 2 (34.2%), PFIC type 1 (5.1%), and PFIC type 4 (1.3%). Males and females were affected in 54.4% and 45.6%, respectively. Mutations in ATP8B1, ABCB11, and ABCB4 genes were observed in PFIC type 1, PFIC type 2, and PFIC type 3, and loss of function in a variant of TJP2 was detected in PFIC type 4, respectively. A total of 51 (64.6%) patients underwent liver transplantation: three patients (3/4) with PFIC type 1 (75%), twenty patients (20/27) with PFIC type 2 (74.1%), twenty-seven patients (27/47) with PFIC type 3 (57.4%), and one patient with PFIC type 4 (100%). The mean duration of disease before transplantation was 53.9 ± 67 months with a median of 30 months. Following liver transplantation, symptomatic control was achieved in 47 patients (92.2%). Recurrence after transplantation occurred in 4 patients (7.8%) within an average of 22.5 months and a median of 17 months. PFIC is considered a rare disorder in Saudi Arabia; however, early recognition of the disease is important for appropriate management and early referral for liver transplantation evaluation. The overall rate of liver transplantation in our cohort was 64.6% with an excellent five-year survival rate.

Prevalence of Post Traumatic Stress Disorder among all Emergency Workers at Saudi Tertiary Care Center in Riyadh, Saudi Arabia

Aims: Our objective for this study is to assess post traumatic stress disorder and its severity point prevalence among all emergency department workers.
 Study Design: A cross-sectional model is most appropriate for this study’s aims, objectives and time frame.
 Place and Duration of Study: This study took place at the emergency department of King AbdulAziz Medical City (KAMC) in Riyadh, Saudi Arabia, between December 2021 and November 2022.
 Methodology: Our study concluded 202 emergency department workers (94 men, 108 women: age range 24-60). A self-administered questionnaire consisting of two parts was distributed. The first part was demographic variables. The second part was the PTSD Checklist for DSM-5 - Civilian Version (PCL-5).
 Results: From our 202 ER employees, 26.7% met the criteria for PSTD. Using logistic regression, we found a relation between PTSD and verbal or physical abuse with a P value of 0.004. we also observed a significant P value of 0.018 between the age groups, indicating the younger population of our study were more prone to develop PTSD.
 Conclusion: There is a concerning high prevalence of self-reported post-traumatic stress disorder among the emergency medicine department workers, including an increased number of employees having been a victim of physical assault or verbal abuse. It is crucial at the organizational level to prioritize prevention of workplace violence.

The Prevalence of Osteoporosis and Osteopenia Among Older Adults in a Community-Based Setting in Riyadh, Saudi Arabia.

Background Osteoporosis is a disease of bone density. It makes bones fragile and easy to break. Fragility fractures can cause significant morbidity, mortality, poor quality of life, and financial stress on medical care. Osteoporosis is overlooked and undertreated. Saudi Arabia issued a national plan promoting the early diagnosis and management of osteoporosis. Few and old studies are available in Saudi Arabia estimating the prevalence of osteoporosis in the Saudi older adultpopulation. The aim of this study is to measure the prevalence of osteoporosis and osteopenia among older adultpatients. Methodology This retrospective cross-sectional study is based on data gathered from patients ≥60years of age. Data were collected from January 1, 2016, to December 31, 2021, for patients who were attending family medicine clinics at King Faisal Specialist Hospital & Research Centrein Riyadh, Saudi Arabia, who were screened usingdual-energy X-ray absorptiometry (DEXA). Patients who have secondary causes of osteoporosis were excluded. Results A total of 1,302 patients were studied during the course of data collection. The mean age was 68.26. Out of the studied subjects, 75% were female and25% were males. The prevalence of osteoporosis was 8.2% and 11.8% in femoral and lumbar bone mineral density (BMD) results, respectively. The prevalence of osteopenia based on femoral and lumbar BMD results was 50.2% and 41.2%, respectively. Conclusion Osteoporosis and osteopenia are prevalent in the Saudi older adult population. Multiple clinical characteristics have been associated with low bone density disease. Thus, it is important to reinforce primary care physicians' efforts for early screening and treatment ofthe Saudi older adult population based on their clinical and demographic risk factors.

Risk Assessment of Cardiovascular Disease Among Adults Attending Primary Healthcare Centers in Riyadh City 2015.

The prevalence of cardiovascular disease (CVD) risk factors is expected to rise in Saudi Arabia as the prevalence of CVD risk factors rises. Effective primary CVD prevention necessitates risk assessment to categorize patients and select the most appropriate intervention for each category. To estimate the prevalence of CVD at primary healthcare (PHC) in Riyadh cityand to categorize the at-risk population as a slow, intermediate, or high risk of CVD. A cross-sectional study was carried out at seven PHC centers in Riyadh. Seven hundred participants (half of whom were males and the other half females) were selected at random from PHCs visitors, and data was collected using a structured questionnaire, as well as required measurements and laboratory investigations. The World Health Organization risk prediction charts were used to calculate CVD risk. Participants were assigned to one of three CVD risk categories (low, intermediate, high). Obesity was found to be the most common risk factor found in this study (53.2%). Overweight (31.2%), with females having higher BMI levels. The study found that 83.4% of participants had low CVD risk, 12.9% had intermediate risk, and 3.7% had high CVD risk category. Age, systolic blood pressure, cholesterol level, smoking, and prior diagnosis of diabetes were all statistically significant predictors of moderate and high CVD risk. CVD risk factors were discovered to be common among study participants. It requires healthcare decision-makers to engage in community-based interventions to decrease the risk of CVD.

Effect of age on response to anti-VEGF agents in patients with center involving diabetic macular edema in a tertiary hospital

PurposeThe aim of the current study is to evaluate the effect of age as an independent factor for the response to two anti-VEGF agents, intravitreal ranibizumab and intravitreal aflibercept, among patients presented with central-involving DME in one tertiary care center in Riyadh, Saudi Arabia.MethodsRetrospective cohort study.ResultsA total of 210 eyes of 121 patients were included in the study. The mean age was 61.2 ± 11.40 years, 50.4% were males. On characterizing groups based on age, the group of patients 60 years or younger are 48 patients (mean age 51.5 ± 9.92) and 52.1% of them are females. On the other hand, the group of patients older than 60 years are 73 patients (mean age 67.6 ± 6.85) and 52.1% of them are males. The two anti-VEGF agents used were aflibercept (88.1%) and ranibizumab (11.9%). The mean BCVA using ETDRS letter score improved after treatment (5.55238095 ± 15.9538695) and the mean change in CST decreased after treatment (− 106.91 ± 117.385 μm). Regarding age, we found that there is no significant difference in mean improvement of BCVA in patients according to their age (p = 0.5429), patients younger than 60 years old gained 5.64 ETDRS letter score and those older than 60 years old gained 5.49 improvement. Similarly, mean improvement in CST was different between patients younger than 60 years old (− 125.1 μm) and those who were older than 60 years old (− 94 μm) with a trend favoring younger patients but this difference was not statistically significant (p = 0.08).ConclusionAge is a clinically significant factor affecting the outcome of anti-VEGF injections. Patients’ CST had a difference of > 30 μm on average between the two age groups favoring younger patients. However, it was not statistically significant, maybe a bigger sample size is needed to prove statistical significance.

The Rate of Appendicular Neoplasm in Patients Who Underwent Appendectomy for Acute Appendicitis at King Abdulaziz Medical City, Riyadh

Background Appendicitis is a common reason for hospitalization. Rarely do people with acute appendicitis have an appendiceal mass called an abscesses or inflamed phlegmon. The goal of this study was to determine the prevalence of different appendiceal tumors including neuroendocrine tumors, adenocarcinoma, carcinoid, and mucinous and evaluate patient demographic data (e.g., age and gender) at a major tertiary care center in Riyadh, Saudi Arabia. Materials and methods We conducted a cross-sectional analytical review of patient records of 1513 patients who received an appendectomy and were diagnosed with acute appendicitis from 2015 to 2020 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. We used nonprobability sampling to collect the sample. The study included patients older than 14 years. We also recorded patient demographic information, including age, gender, history, and final pathology. Results The mean age of our study population was 27.9 years (standard deviation [SD], 12.3 years). Our study had 958 male patients and 555 female patients. One thousand four hundred fifty-eight patients (96.3%) had right lower quadrant (RLQ) tenderness, and 228 patients had fever (15.0%). One thousand one hundred thirteen patients (73.5%) had rebound tenderness, 1,178 had nausea (77.8%), and 1,100 had high white blood cell (WBC) counts (72.7%). One thousand four hundred eighty-six patients received laparoscopic surgery (98.2%). Most patients (95.3%; n=1,443) had no postoperative complications. Appendicitis pathology was present in 1,381 patients (91.3%). Only 15 patients (1%) had tumor-related pathology, and these patients were significantly older than patients with nontumor-related pathology (p<.001) and had less RLQ pain, rebound tenderness, and pain migration but higher WBC counts. Pain migration was significantly inversely correlated with age: as age increased, pain migration was reported less often (odds ratio, 0.99, 95% confidence interval, 0.98 to 0.99; p=0.001). Conclusion This study aimed to determine the prevalence and types of appendiceal tumors in cases of acute appendicitis and the corresponding patient demographic data at a major tertiary care center in Riyadh, Saudi Arabia. According to our results, patients with appendicitis present with fever, rebound tenderness, nausea, and high WBC count. Appendiceal masses mainly occur in a later age group with less migration of pain and high WBC count. However, migration of pain is inversely related to age. Physicians treating patients with acute appendicitis should bear these data in mind and consider the presence of appendiceal tumors in appropriate patients.

Discontinuation of Tyrosine Kinase Inhibitor Therapy and Treatment-Free Remission in Chronic-Phase Chronic Myeloid Leukemia: An Observational Retrospective Multi-Center Study

Introduction: Discontinuation of tyrosine kinase inhibitor (TKI) therapy and achievement of treatment-free remission (TFR) in chronic-phase chronic myeloid leukemia (CP-CML) patients is feasible and can be implemented in clinical practice. We conducted a retrospective study at 3 tertiary care centers in Riyadh, Saudi Arabia of all CP-CML patients who discontinued TKI therapy. Methods: All CP-CML patients being followed at participating centers who discontinued TKI, were eligible. TKI discontinuation was carried out as per clinical practice guidelines. Criterion to restart TKI therapy in relapsed patients was loss of major molecular response (MMR; BCR-ABL > 0.1). We collected data on gender, age, prognostic risk-score, type(s) of TKI therapy, type and duration of last TKI before discontinuation, total duration of TKI therapy and response, time to achieve MMR, relapse data including time to relapse and response to re-initiation of TKI therapy, and analyzed the risk factors for relapse. Study was approved by the institutional review boards of all participating centers. Results: Fifty-five patients (35 females) with a median age of 40 years (range 16-74) were included in the study. Median age at TKI stop was 48 years (range 21-80). Majority of the patients (48; 87.27%) received imatinib as first line therapy; 29 (53.74) patients were receiving imatinib at TKI-stop, and 26 (47.27) a second-generation TKI (dasatinib or nilotinib). Fifty-two (94.5%) patients discontinued TKI as per clinical practice (shared decision between treating physician and the patient), and 3 (5.5%) stopped because of pregnancy; 2 patients fulfilled the criteria to stop post-delivery as they remained in deep MR, they were offered to continue stopping. One patient refused to restart TKI (dasatinib) after delivery although she had only 24 months of deep response but continues to have deep remission after 91 months of follow up. Median time to achieve MMR after diagnosis was 12 (range 2-164) months. All the patients had achieved MR4.5 or better (complete molecular response) before stop. Median time from diagnosis to TKI stop was 86 months (IQR 60;132) and median time of last TKI before stop was 66 months (IQR 47;114). After a median follow up of 42 months (IQR 12.5;69) post TKI-discontinuation, 15 (28%) patients relapsed. Median time to relapse was 5 months (range 3-38). Most of the relapses occurred during the first 6 months, except 3 patients who relapsed after 10, 11, and 38 months. Most of the relapsed patients had intermediate or high risk Sokal score. All the relapsed patients achieved MMR after a median of 3 months (range 2-6) after restarting TKI. None of the patients progressed to advanced phase. Conclusion: In real-life practice, TKI discontinuation was possible without relapse for CP-CML patients in deep molecular response, with over two-third of patients continuing in TFR. Majority of the relapsed patients belonged to the intermediate/high-risk score Sokal category at diagnosis. Although this study has the limitation of a retrospective study, our experience in this population confirms that discontinuation of TKI therapy in CP-CML patients is feasible and safe in clinical practice.

The Prevalence of Dry Eye Disease and Related Factors Among Adult Patients Attending Primary Healthcare Centers in Riyadh, Saudi Arabia.

Objective In this study, we aimed todetermine the prevalence of dry eye disease (DED) and its related factors among adult patients in Riyadh, Saudi Arabia. Methodology We conducted a cross-sectional studybased on a pre-designed, validated questionnaire (the McMonnies questionnaire)at primary healthcare centers in Riyadh in January-May 2019. Participants were classified into two groups: those with and without a diagnosis of DED. Factors related to the diagnosis were derived using univariate analysis. A backward stepwise logistic regression model was used to further explore predictors of DED and included all variables that were significant in the univariate analysis. Results A total of 276 patients participated in this study. About half (53.3%) were males, and 47.8%were aged 25-45 years. While more than two-thirds of the participants (70.3%) had some symptoms indicative of DED, only 42% were diagnosed with DED. A higher prevalence of DED was found in females. About half (47.5%) had been prescribed eye drops or other treatments for dry eyes. Univariate analysis showed a significant correlation between the incidence of DED and living in southern Riyadh (p=0.017). Additionally, all age groups were significantly associated with DED, and a higher prevalence was reported in those older than 45 years. Backward stepwise logistic regression revealed that using dry eye drops was among the most significant predictors of DED [odds ratio (OR): 339, 95% confidence interval (CI): 73.2-1577.3, p<0.001]. Conclusion Based on our findings, DED was more common among women and with advancing age. DED was associated with the presence of dry eye symptoms, arthritis, usage of dry eye drops, and living in southern Riyadh. There is a need to design and implement health awareness programs to prevent such medical issues among the population.

The Association between Diabetic Retinopathy and Diabetic Nephropathy among Patients with Type 2 Diabetes Attending PSMMC Primary Health Care Center in Riyadh, Saudi Arabia

The Association between Diabetic Retinopathy and Diabetic Nephropathy among Patients with Type 2 Diabetes Attending PSMMC Primary Health Care Center in Riyadh, Saudi Arabia

Relationship Between Vesicoureteric Reflux and Nephrocalcinosis in Children: A Case-Control Study at a Tertiary Medical Center in Saudi Arabia.

Vesicoureteral reflux (VUR), one of the most common pediatric congenital urogenital abnormalities, refers to the abnormal backflow of urine from the urinary bladder back into the ureter or to the kidney. This causes urinary tract infections. Nephrocalcinosis (NC) refers to abnormal deposits of calcium within the renal parenchyma and/or in the renal cortex.Patients with NC are mostly asymptomatic and severe disease may progress to renal failure. Early diagnosis through examinationssuchas radiography, computed tomography, and ultrasonography, is crucial for therapeutic treatment. Ultrasonography is the preferred method for scanning and grading nephrocalcinosis in children, primarily because it emits no radiation. This study aimed to increase the body of knowledge regarding VUR and nephrocalcinosis by determining its prevalence and assessingthe relationship between VUR and nephrocalcinosis in children presenting at our institution. ​​​​Methods:A case-control study was conducted using data from the medical records of 632 children younger than 14 years in a tertiary medical center in Riyadh, Saudi Arabia. Eligible participants were assigned to two groups: Group 1 consisted of 316 patients with VUR, while Group 2 consisted of 316 sex- and age-matched patients without VUR. The difference in the prevalence of nephrocalcinosis between the two groups was assessed. Frequency and percentage were used to present the categorical variables; Pearson product-moment correlation was utilized to establish the association between VUR and nephrocalcinosis. Statistical significance was established at p<0.05. ​​​​​Result:Only two cases in Group 1 were positive for nephrocalcinosis (0.63%, one male and one female), while four cases in Group 2 were positive for the condition (1.26%, two males and two females). There was no significant difference in the incidence of nephrocalcinosis between the two groups (p=0.873), indicating no relationship between VUR and nephrocalcinosis in children. There is no relationship between VUR and nephrocalcinosis in children under the age of 14 years.

Medication Adherence Among Multimorbid Patients With Polypharmacy and Its Relation to Social Support at National Guard Primary Health Care Centers, Riyadh.

The aim of the present study was to estimate the prevalence of nonadherence to medication in multimorbid patients with polypharmacy and its relationship to social support in primary healthcare centers in Riyadh, Saudi Arabia. We conducted a cross-sectional, convenience-sample, non-randomized study in three primary healthcare centers managed by National Guard Health Affairs. The participants included 417 adult patients - (a) with two or more chronic illnesses and (b) who were taking two or more medications. The primary outcome variable was the prevalence of medication nonadherence in multimorbid patients with polypharmacy as measured by the modified Morisky Medication Adherence Scale (MMAS-8). The second main variable was the impact of functional social support, as measured by the Duke-UNC Functional Social Support Questionnaire (FSSQ), on medication adherence. The level of medication adherence was low for 194 (46.5%) of the 417 patients, medium for 127 (30.5%), and high for 96 (23%). There were 256 (61.4%) male participants and 161 (38.6%) females, and their mean age was 59.15 (SD ± 11.186) years. Additionally, 171 (41%) participants used two or three medications, 127 (30.5%) used four or five medications, and 119 (28.5%) used more than five medications; 178 (42.7%) of the patients had two comorbidities, 136 (32.9%) had three comorbidities, 69 (16.5%) had four comorbidities, and 31 (7.5%) had five comorbidities. Some social support data from the Duke-UNC Functional Social Support Questionnaire (FSSQ) was missing for 58 (13.9%) of the participants. Among the rest of the sample, reported levels of social support levels were high for 246 (59%) patients, medium for 101 (24.2%), and low for 12 (2.9%) patients. None of the differences between social support and medication adherence were statistically significant. However, 61 (24.8%) patients reported both high social support and high medication adherence; 173 (48.2%) had low social support and low medication adherence (p = 0.470). We found that medication nonadherence in multimorbid patients with polypharmacy was high (46.5%). Although there were no statistically significant relationships between social support and medication adherence, certain patient characteristics were associated with low medication adherence - age over 60 years, male gender, and number of medications.

Quality of Life and Well-being in Patients with Lower-limb Amputation Using a Prosthetic Limb: A Cross-sectional Study in a Major Center in Riyadh, Saudi Arabia

ABSTRACT Introduction Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP). Methods A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ). Results A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P &lt; 0.001; R s = 0.657), AP (P &lt; 0.001; R = 0.547), and AM (P &lt; 0.001; R = 0.634). Conclusion Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required. Clinical Relevance There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives.

Evaluation of Knowledge of Immunotherapy Toxicities Among Emergency Physicians in Riyadh, Saudi Arabia

Introduction Immunotherapy is considered a new modality in the treatment of cancer with emerging different toxicity profiles. It is essential for healthcare practitioners to be aware of these side effects. Emergency medicine physicians are first-line health providers and should have the required knowledge and understanding of immunotherapy-related adverse effects to be able to identify and manage such patients. The study aimed to assess the level of knowledge of immunotherapy toxicity among emergency medicine physicians in Riyadh. Methods This cross-sectional study was conducted at the largest emergency medicine training centers in Riyadh. In total, 106 emergency medicine physicians participated. The questionnaire contained multiple-choice questions that assessed the knowledge and management of immunotherapy-related toxicities. Results The majority of the participants were male residents. The response rate varied for the selected training centers. Regarding the level of knowledge regarding the toxic side effects of cancer immunotherapy, the majority were likely to choose "I don't know." Conclusion This study, in support of the literature, revealed the gap in knowledge of the basic principles of cancer immunotherapy, despite increasing uses and indications of immunotherapy. The findings indicate the need for non-oncologist health practitioners, including emergency physicians, to enhance their knowledge of immunotherapy-related adverse events in order to improve their clinical decision-making skills.

Chronic Disease Patterns and Their Relation With Age, Gender, and Number of Visits in Three Primary Care Centers of Riyadh, Saudi Arabia.

Background and objective Chronic diseaseis a major health burden and is a leading cause of both morbidity and mortality. However, there is little information regarding this topic in the region of Riyadh, Saudi Arabia. The objective of this study is to assess the pattern of chronic diseases and the role of age, gender, and number of visits in three primary care centers in this region. Methods This cross-sectional study was conducted with patients treated at large three primary care centers in Riyadh, Saudi Arabia. The study included all patients who attended one of the three centers within the past four years with one or more chronic diseases, and both genders were included. Results There were 700 patients included, of which 437 (62.4%) were female, 263 (37.6%) were male, 327 (31.8%) were diagnosed with type 2 diabetes mellitus (T2DM), and 212 (20.6%) were diagnosed with primary hypertension. There was a significant association between the number of visits and number of diseases and betweenage and the number of visits. The mean age of patients was 50.7 ± 16.3 years. There was no significant association betweengender andthe number of diagnoses ornumber of visits. Conclusion This study found a significant relationship betweenage and the number of visits and number of diseases. T2DM was the most common disease in the population. There was no significant association betweengender and the number of diseases or number of visits.

Predictors of pregnancy-associated venous thromboembolism: A case-control study.

BackgroundVenous thromboembolism (VTE), manifesting as pulmonary embolism (PE) or deep vein thrombosis (DVT), is the most common cause of morbidity and death during pregnancy and the postpartum period. We conducted this study to describe the predictors of pregnancy-associated VTE (DVT and PE).MethodsA case-control study was conducted at a tertiary care center in Riyadh. A total of 380 patients were included in this study, 180 of whom were diagnosed with pregnancy-associated thrombosis and 200 of them showed no VTE. Demographic data and data on risk factors of VTE were collected by reviewing the medical charts and the risk assessment tool of the Royal College of Obstetricians and Gynecologists, respectively. The main outcome measures were VTE, manifesting as PE or DVT.ResultsThe following factors were identified as the predictors of VTE through multivariate analysis: family history [Odds ratio (OR) = 50.47, 95% Confidence Interval (CI): 6.78–375.64, P < 0.0001)], thrombophilia (OR = 21.99, 95% CI: 2.83–170.63, P = 0.003), and presence of gross varicose veins (OR = 17.15, 95% CI: 3.93–74.87, P < 0.0001).ConclusionsThe findings of this study showed that family history, thrombophilia, and the presence of gross varicose veins were risk factors for VTE, exceeding other transient risk factors. Hence, prophylaxis is highly recommended for those women who present with any of these factors.

Peripapillary atrophy classification using CNN deep learning for glaucoma screening.

Glaucoma is the second leading cause of blindness worldwide, and peripapillary atrophy (PPA) is a morphological symptom associated with it. Therefore, it is necessary to clinically detect PPA for glaucoma diagnosis. This study was aimed at developing a detection method for PPA using fundus images with deep learning algorithms to be used by ophthalmologists or optometrists for screening purposes. The model was developed based on localization for the region of interest (ROI) using a mask region-based convolutional neural networks R-CNN and a classification network for the presence of PPA using CNN deep learning algorithms. A total of 2,472 images, obtained from five public sources and one Saudi-based resource (King Abdullah International Medical Research Center in Riyadh, Saudi Arabia), were used to train and test the model. First the images from public sources were analyzed, followed by those from local sources, and finally, images from both sources were analyzed together. In testing the classification model, the area under the curve’s (AUC) scores of 0.83, 0.89, and 0.87 were obtained for the local, public, and combined sets, respectively. The developed model will assist in diagnosing glaucoma in screening programs; however, more research is needed on segmenting the PPA boundaries for more detailed PPA detection, which can be combined with optic disc and cup boundaries to calculate the cup-to-disc ratio.

تقييم استخدام التطبيقات الصحية لمرتادي العيادات الخارجية ومراكز الرعاية الصحية الأولية في مدينة الرياض

ملخص لقد أصبحت التقنية المتنقلة تربط المريض مع المَرفِق الصحي والفريق القائم على رعايته صحيّاً. من ذلك أصبحت أجهزة الهواتف المتنقلة وغيرها تساعد الفرد على متابعة حالته الصحية وتدير يومه صحيّاً. خلال جائحة كورونا (كوفيد-١٩) وجد مجتمع السكان في المملكة العربية السعودية مساعدة ودعماً كبيرين من قبل الدولة في تبني استخدام تطبيقات الهواتف المتنقلة بشكل يومي في أداء أعماله اليومية. وإلى جانب التطبيقات اليومية الأخرى، استأثرت التطبيقات الصحية باهتمام كبير، وصارت شغل الفرد الشاغل، وأصبحت أعدادها في تنامٍ متوالٍ جعل كلّ جهة من جهات القطاع الصحي تُعنى بإطلاق تطبيق أو أكثر للاهتمام بحالة الفرد الصحية. نشأ الغرض من الدراسة لتحديد مدى اهتمام المجتمع بالتطبيقات الصحية، وأيّها أكثر استخداماً فيما يتعلق بالوضع الصحي للسكان. لقد تكونت عينة الدراسة من 517 ممارسا صحيا ومراجعا للعيادات الخارجية لمدينة الملك عبد الله الطبية، وخمسة مراكز للرعاية الصحية الأولية في الرياض. واستخدم المنهج الوصفي المسحي في هذه الدراسة. أظهرت النتائج انخفاض اهتمام أفراد المجتمع بالاعتماد على التطبيقات الصحية لمتابعة أوضاعهم الصحية. كما أثبتت وجود علاقات تغايرت بين طردية وعكسية بين الجنس والعمر والاستخدام. ولكن لم يكن للمَرفِق والمراجعين تأثير كبير. وحددت النتائج أيضاً أكثر التطبيقات الصحية استخداماً بجانب التطبيقات المُستخدَمة يوميّاً للتواصل الاجتماعي. لقد أوضحت النتائج أنّ ٩٧٪ من أفراد العَيِّنَة كانوا مواطنين، في حين أنّ ٣٪ فقط كانوا من المقيمين. كما أنّ ٧٠٪ منهم كُنّ إناثاً و٣٠٪ تقريباً كانوا من الذكور. كما أوضحت الدراسة أنّ ٦٤٪ من أفراد العَيِّنَة يستخدمون التطبيقات الصحية لمتابعة حالاتهم الصحية. ومن ناحية أخرى وُجِد أنّ ٤٠٪ فقط من أفراد العَيِّنَة تأثرت أوضاعهم الصحية إيجاباً باستخدام التطبيقات الصحية، الامر الذي يستدعي توجه افراد المجتمع للاهتمام باقتناء التطبيقات الصحية واستخدامها أكثر. قد لا تكترث شريحة كبيرة من افراد المجتمع لشراء التطبيقات الصحية، إذ أفاد جميع من أجابوا عن السؤال بأنهم يحملون التطبيقات مجاناً ولا يأبهون بشرائها. ومِمّن أجاب عن تساؤل البحث عن مصادر أخرى غير التطبيقات لمتابعة الحالة الصحية توعية أو علاجاً، تساوت الفئتان تقريباً بين مَن يبحث في المواقع أو غيرها وبين من لا يكترث، ولم يكن هناك فرق واضح إحصائيّاً بينهما. وقد انتهت الدراسة إلى عدة توصيات من شأنها رفع مستوى الوعي الصحي لدى افراد المجتمع لتحسين جودة الحياة. كما وضّحت الباحثة أنّ دراسةً مثل هذه تفتح آفاقاً لدراسات أخرى من شأنها اضافة قيمة كبيرة إلى استخدام التطبيقات الصحية، وإثراء المكتبة العربية بمعلومات من شأنها أن تعزز موقف الباحث العربي في استخدام تطبيقات الهواتف المتنقلة، وعلى الأخصّ التطبيقات الصحية. Mobile technology connects patients with health facilities and health care teams. Hence, smart devices help individuals to monitor their health conditions and manage wellness. During the Covid-19 pandemic, the community in Saudi Arabia found great support from the government in adopting the use of mobile apps including newly launched health apps to manage individuals’ health status. The purpose of this study is to assess the extent of the society&apos;s interest in health apps and which ones are most used. The study sample consisted of 517 health practitioners and outpatients from King Abdullah Medical City and five primary health care centers in Riyadh. The descriptive survey method was used in this study. The results showed a low usage level of health apps and found positive and inverse correlations between gender, age and apps use. However, the facility and its visitors did not have a significant impact. The results also identified the most used health apps besides the usage of social applications. It was revealed that: 97% of the respondents were citizens while only 3% were expats; 70% were females and approximately 30% were males; and 64% used health apps. On the other hand, 40% of them had their health conditions impacted positively by using health apps, which shows the positive impact of this type of apps in raising awareness of the public towards health promotion. The community would not pay for health apps as all who responded to the related question stated that they download the free apps and are not interested in the paid-for ones. Whoever answered the question of searching for health information via internet sources and not via health apps, the two categories were almost equal between those who do on websites and those who do not, but there was no statistically clear difference between them.The study provided several recommendations that would raise the level of awareness of the health status of individual to improve the quality of life. The researcher also explained that a study like this opens prospects for other studies that would add great value to the use of health apps and enrich the Arabic library with information that would promote the Arab researchers in using health applications.

Initial Pain Assessment and Management in Pediatric Burn Patients Presenting to a Major Trauma Center in Saudi Arabia.

Pediatric burn injury is a traumatic experience for affected children and their families. Burn pain is frequently undertreated and may adversely affect patient experience and outcomes. The aim of this study was to investigate the current practice of initial pediatric burn pain assessment and management at a major trauma center in Riyadh, Kingdom of Saudi Arabia. We conducted a retrospective cohort study that included children 14 years and younger who visited King Saud Medical City in the Kingdom of Saudi Arabia with a presenting complaint of burn injury from January 01, 2017 to August 30, 2018. Variables were reported using descriptive statistics as appropriate. The 309 patients who were analyzed were classified into 3 age groups ranging from 0 to younger than 3 years (61%), 3 to 7 years (24%), and older than 7 years (15%). They included 145 (47%) female and 164 (53%) male patients. Pain levels of 182 patients (59%) were documented using an age-appropriate tool. In 75 children (24%), pain levels were documented using an alternate tool, and the tool used was not defined for 44 children (14%). Pain assessment was not documented for 8 children. Of those with an age-appropriate tool, the median initial pain score was 4 (interquartile range [IQR], 2-4). Analgesia was recorded to have been administered to 139 patients (45%), within a median time of 50 minutes (IQR, 17-154 minutes) to first analgesia. Among patients who had appropriate assessment of pain, 92 (50.3%) received analgesia compared with 52 (41.3%) who did not have appropriate assessment (P = 0.12). Among patients who had appropriate pain assessment, time to analgesia was 42 minutes (IQR, 15-132 minutes) compared with 53 minutes (IQR, 17-189 minutes) among patients who did not have appropriate assessment (P = 0.48). Most pediatric patients presenting with burns had pain assessment, but a substantial proportion of children were not managed using recommended age-specific tools. The use of age-specific tools was not necessarily associated with delivery of analgesia. For pediatric burns, prompt delivery of analgesia should be prioritized with pain assessment using age-appropriate tools being recommended, but optional.

Empathy among Saudi Residents at a Tertiary Academic Center during the COVID-19 Pandemic and Its Association with Perceived Stress.

Background and Objectives: Empathy is an important attribute of a healthy doctor–patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels of empathy and to identify if there is an association with stress in general and across the demographic and training characteristics of residents. Materials and Methods: A cross-sectional questionnaire-based study was carried out from December 2020 to March 2021 among residents training at a tertiary academic center in Riyadh, Saudi Arabia. Empathy and perceived stress were measured using the Jefferson Scale of Empathy (JSE) and the Perceived Stress Scale (PSS). Results: A total of 229 residents participated. The mean JSE score was 105.25 ± 15.35. The mean JSE scores were significantly higher among residents training in pediatrics (mean difference (MD) = 17.35, p < 0.001), family medicine (MD = 12.24, p = 0.007), and medical specialties (MD = 11.11, p = 0.012) when compared with surgical specialties and anesthesia. In addition, residents who worked 1–4 on-calls per month had a higher mean JSE score (MD = 11.23, p = 0.028) compared with those who worked 7 or more on-calls. Lastly, no correlation between empathy and perceived stress was detected in the whole sample (r = −0.007, p = 0.913); however, there was a correlation among residents training in medical specialties (r = −0.245, p = 0.025). Conclusion: Residents in our study had empathy levels comparable with Asian but lower than Western residents. We recommend qualitative studies that explore potential factors that might affect empathy among residents and studying the association between empathy and perceived stress among medical residents. Postgraduate curricula should incorporate interventions that foster a more empathetic doctor–patient relationship.