Saudi Med Research Articles

Addressing Gender-Related Inequality in Continence Care

Addressing Gender-Related Inequality in Continence Care

Practical tips and Stepwise guide to create and implement Rubric Based Assessment in Competency Based Medical Education: No need to google, create your own Rubric!

In a technology –driven society, it is very essential to have effective communication skills as medical graduate with patients and peer members. Assessments are vital in the process of teaching and learning. Assessing oral presentation skills is considered as assessing the behavioural skills in Millers’ prism of Clinical competence in Medical Education. In alignment with the Saudi Med competency Framework, the rubric was designed keeping the core competency at the centre like Communication & Collaboration and arranging the other auxiliary competencies around, then the parameters like dimensions were derived. An evaluation rubric for grading the presentations was designed to allow faculty evaluators to objectively score student performances in the dimensions of presentation like speech elocution, eye contact along with subject content. Rubrics create clarity for students and rubric dimensions represent various outcomes for students, giving them a realistic destination for their assignment. The students are informed about plagiarism malpractices and are instructed to maintain academic integrity. In response to the COVID-19 pandemic, the rubric scoring assessment for oral presentation was used for online assessment on Zoom webinar. This assessment tool along with online conferencing tools has provided a framework for integrated and interactive evaluation that can be used to facilitate the modification of traditional assessment methods. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 521-528

Sleep education improves knowledge but not sleep quality among medical students.

Poor sleep quality, often resulting from poor sleep hygiene, is common among medical students. Educational interventions aimed at improving sleep knowledge are beneficial for sleep quality in healthy populations. However, sleep education is often given minimal attention in medical school curriculums. The aim of the study was to explore whether a short educational intervention could improve sleep knowledge, and consequently sleep quality, among medical students. We recruited preclinical- and clinical-stage medical students during the 2017-2018 academic year. Students completed a demographic survey, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Assessment of Sleep Knowledge in Medical Education (ASKME) questionnaire. Students then attended a lecture on the physiology and importance of sleep. To assess the efficacy of the intervention, questionnaires were repeated 4 months thereafter. A total of 87 students (31 preclinical) with a mean age of 25.86 years (standard deviation [SD], 3.33), 51 of whom were women, participated in the study. At baseline, students had poor sleep quality with a PSQI mean score of 5.9 (SD, 2.37), without significant sleepiness, and a mean ESS score of 8.86 (SD, 4.32). The mean ASKME scores were consistent with poor sleep knowledge at 11.87 (SD, 4.32). After the intervention, the mean ASKME results improved to 14.15 (SD, 4.5; P < .001), whereas sleep quality did not. The effect was similar in preclinical and clinical medical students. Sleep knowledge was inadequate among medical students, who also experienced poor sleep quality. A short educational intervention improved sleep knowledge but was insufficient at improving sleep quality. Further studies are needed to determine which interventions may provide benefit in both sleep knowledge and sleep quality.

The prevalence of internet gaming disorder among medical students at King Saud University, Riyadh, Saudi Arabia

Objectives:To estimate the prevalence of internet gaming disorder (IGD) among King Saud University (KSU), Riyadh, Saudi Arabia medical students and to determine the association of IGD with gender, age, academic achievement, amount of sleep, and accommodation.Methods:We conducted a cross-sectional study between October 2019 and April 2020 on KSU medical students with a sample size of 281 medical students currently studying at KSU chosen by a stratified proportionate random sampling. The questionnaire contained the IGD short scale and questions eliciting demographic data.Results:The sample comprised of 228 responses. The prevalence of IGD was 8.8% (n=20), while 19.3% (n=44) of the participants were risky gamers. There was a significant association (p=0.0040) between IGD and gender, with 10.1% (n = 15) of males having IGD compared to 6.3% (n=5) of females. Additionally, 25% (n = 37) of males were risky gamers, as compared to 8.8% (n=7) of females.Conclusion:There is a high prevalence of internet gaming disorder among KSU medical students, with higher frequency among males. However, there was no significant association between this disorder and age, sleep, academic achievement, or accommodation.

Natural immunity to influenza A and B among Saudi blood donors in Al Madinah Al Munawarah, Saudi Arabia.

Objectives:To investigate the seroprevalence of influenza viruses (A and B) among blood donors in Kingdom of Saudi Arabia.Methods:The present investigation was conducted between April 2019 and July 2019. Participants were healthy adults recruited from the central blood bank Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Immunoglobulin G (IgG) levels against influenza A and B were measured in serum samples using ELISA.Results:The results showed that 29.2% of the sample had significant concentrations of influenza A IgG antibody, whereas 38.6% had significant concentrations of influenza B IgG antibody. A strong correlation was found between the levels of influenza A and influenza B antibodies (r=0.708, p<0.001). The number of individuals identified as negative for influenza A IgG antibody increased with age (p<0.01). In addition, no correlations were identified between influenza A IgG and influenza B IgG and body mass index (BMI), (p>0.05). Finally, linear regression analysis showed that the level of influenza A antibody can be predicted by age (p<0.05) and body mass index (BMI) (p<0.05).Conclusion:Approximately one-third of Saudi Arabian adults presented significant levels of influenza A and B antibodies in our study. Demographic factors, including age and BMI, might contribute to influenza A antibody levels.

The relation between regular outpatient follow-up and frequency of emergency department visits in sickle cell pediatric patients.

Objectives:To evaluate the relationship between the frequency of ED visits and outpatient department (OPD) follow-up in sickle cell disease (SCD) pediatric patients.Methods:A retrospective cohort study included 247 SCD pediatric patients between January 2016 and December 2018 at the Maternity and Children Hospital, Department of Pediatrics, Al Medinah Al Munawarah, Saudi Arabia. Data were extracted from electronic medical record system; patient demographics, medications, frequency of emergency department (ED) and OPD visits. Pearson correlation coefficient, linear regression and independent sample t-test were applied.Results:There was no significant correlation (95% CI [-0.013- 0.233]; p=0.07) between the frequency of ED and OPD visits. However, a significant correlation was found between ED visits and missed OPD appointments. Thus, linear regression was applied and indicated that one missed OPD appointment is associated with 1.92 ED visits, (95% CI: 0.19-0.42; p<0.001). Also, a higher rate of ED visits was observed when compared with other studies, with a high ED reliance of 43%.Conclusion:This study found that regular OPD visits could improve SCD management, as a directly proportional relationship between the frequency of ED visits and missed OPD appointments were found, along with high ED reliance.

A retrospective study of the incidence and predisposing factors of third- and fourth-degree perineal tears

Objectives:To evaluate the rates of third- and fourth-degree tears and related predisposing factors for the tears in singleton vaginal deliveries.Methods:This was a retrospective study of third- and fourth-degree perineal tears in all women who underwent vaginal delivery in a tertiary hospital in Assir region between January 2014 and December 2019. There are approximately 5000 deliveries per year at the Abha Maternity and Children Hospital. The total number of deliveries during the study period was 31,788, of which 19,374 were delivered vaginally.Results:A total of 85 women (0.43% of all vaginal deliveries) had third-degree (n=81) or fourth-degree (n=4) perineal tears. The mean age of the women was 31 years (range: 16-46 years). Fifty-two of the 85 women (61%) were primiparous. Of the various obstetric parameters, episiotomy, occipitoposterior presentation, primigravida, multipara, and a previous episiotomy were found to be significant predisposing factors to third- and fourth-degree tears in our patients.Conclusion:The low incidence of obstetric anal sphincter injuries in this study is likely the result of proactive manual protection of the perineum, valid indications for episiotomy, and attendance of senior staff members at all difficult deliveries.

Association between preeclampsia and prostasin polymorphism in Pakistani females.

Objectives:To investigate the relationship between a prostasin gene variations and the development of preeclampsia in a Pakistani female population.Methods:This was a case-control study carried out at University of Karachi, Karachi, Pakistan between May 2018 and 2019. A single nucleotide polymorphism (SNP) at rs12597511 locus was examined with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses in 76 preeclamptic and 74 normotensive expecting mothers.Results:We observed significantly increased risk of preeclampsia associated with the CC genotype of rs12597511 polymorphism as compared to TT (p<0.001, OR=8.08, 95% CI:1.28-31.19) and TT/TC (p<0.001, OR=14.66 and 95% CI: 3.31-65.07) genotypes carriers. Calculation of the allelic distribution revealed a higher frequency of the T allele (82%) among controls; however, the C allele was more prevalent in the preeclamptic group (36%) significantly.Conclusion:The significantly higher C allele frequency in the prostasin gene at the rs12597511 locus in the preeclamptic group indicates that the distribution of the C allele of the prostasin gene is a potential risk factor contributing to the development of preeclampsia.

The efficacy and safety of percutaneous balloon angioplasty for aortic coarctation in children. Acute and mid-term results in a single center experience.

Objectives:To assess the efficacy and safety of balloon angioplasty (BAP) procedure for treatment of coarctation of the aorta (CoA) in children.Methods:A retrospective study included 27 consecutive children, underwent BAP for either native-CoA (Na-CoA) or recoarctation (Re-CoA). Medical records, echocardiographic findings, angiographic and hemodynamic data were collected from the hospital database. Follow-up was scheduled at 1, 3, 6, 12 months after the procedure. The study took place over a period of 4.5 years, from April 2014 to January 2019, in Madinah Cardiac Center, Madinah, Northwest region, Saudi Arabia.Results:The mean age of patients was 11.86±8.96 months. Seven children had Na-CoA and 20 children had Re-CoA. The success rate of the procedure was achieved in 23 children (85%), as BAP reduced the mean systolic pressure gradient across the CoA (Na-CoA: from 45.28± 18.3 to 9.8± 6.57 mm Hg, p=0.0009), and in Re-CoA groups (from 42.48±16.7 to 10.9±8.5 mm Hg, p<0.0001). In mid-term follow-up, the need for re-intervention occurred in 8 children of the cohort (3 children [42.8%] from the Na-CoA group, and 5 children [25%] from the Re-CoA group).Conclusions:Balloon angioplasty is considered a safe procedure for the management of CoA, but its efficacy remains questionable especially for young infants with Na-CoA type. However, it is a reliable option for managing Re-CoA children, with a lower rate of future re-intervention.

Long-stay patients in pediatric intensive care units. Five-years, 2-points, cross-sectional study.

Objectives:To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources.Methods:This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included.Results:Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%).Conclusion:A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources.

Assessment of the quality of anticoagulation management with warfarin in a tertiary care center.

Objectives:To evaluate the quality of an anticoagulation clinic in a tertiary hospital and identified factors affecting the time in the therapeutic range (TTR) and its relation to different complications.Methods:This single-center retrospective study conducted between March 2015 and June 2016 included 1914 patients receiving warfarin therapy. They were divided into 4 warfarin indication groups: non-valvular atrial fibrillation (AF) (n=403), valvular AF (n=227), prosthetic valves (n=700), and venous or pulmonary embolism (n=584).Results:The median age was 56 (25th, 75th percentiles: [45, 67]) years, and 53.2% were female. The median TTR was 0.52 (0.28, 0.76). Low hemoglobin (0.007) and high alkaline phosphatase (0.020) levels negatively affected the TTR. Venous thromboembolism (VTE) was associated with low TTRs. Minor bleeding occurred in 64 (3.35%), gastrointestinal bleeding in 14 (0.7%), and stroke in 41 (2.2%) patients, with no inter-group differences. The TTR was not associated with minor bleeding (odds ratio [OR]=0.49; p=0.09), gastrointestinal bleeding (OR=0.29; p=0.18), or stroke (OR=1.15; p=0.79).Conclusion:Reflecting the real-life experience of anticoagulation control, our patients spend less than half the TTR within the INR. The low target TTR mandates the need to improve service quality and control factors affecting the TTR, including hemoglobin levels and regular visits for patients with VTE.

Reliability of the Arabic Glasgow children's benefit inventory.

Objectives:To translate the Glasgow Children’s Benefit Inventory (GCBI) questionnaire into Arabic language and assess its validity and reliability in scoring the benefit of patients after cochlear implantation in children.Methods:A cross-sectional study for a group of consecutive pediatric patients who underwent cochlear implantation between November 2018 and February 2020. The GCBI original questionnaire was translated into Arabic language and translated back to English by 2 different experts. The patients/parents were asked to complete the questionnaire given to them.Results:Seventy children were included in the study. The age at implantation ranged from 7 months to 13 years with a mean of 3.4 years (SD=2.3 years). The mean GCBI score was 52.2 (SD=24.0) ranging from -6.25 to 100.00. The internal consistency of the questionnaire was high (Cronbach’s α=0.9). The 4-factor dimensions explained 55.1% of the variance.Conclusion:The GCBI questionnaire (Arabic version) is reliable tool to evaluate retrospectively the quality of life after an intervention in pediatric age for Arabic speaking population.

Ramadan fasting among advanced chronic kidney disease patients. Nephrologists' perspectives in Saudi Arabia.

Objectives:To explore nephrologists’ concerns and recommendations in counseling their advanced chronic kidney disease (CKD) patients on Ramadan fasting.Methods:This cross-sectional study was carried out in King Khalid University Hospital, Riyadh, Saudi Arabia between January 2019 and January 2020. An electronic survey was completed by 48 nephrologists practicing in Saudi Arabia. The questionnaire focused on demographics, clinical experience, and factors to consider when advising CKD patients about fasting. Statistical analysis was performed by the Statistical Package for Social Sciences for Windows, version 21 (IBM Corp, Armonk, NY, USA). Statistics include frequency and percentages using multiple response dichotomy analysis and thematic analysis.Results:Most respondents were consultant nephrologists (75%), practicing nephrology for over 10 years (68.8%). The majority of responding nephrologists (85.4%) were concerned about estimated glomerular filtration rate (eGFR), diabetes (68.8%), patient age (64.6%), use of diuretics (62.5%), body fluid volume (60.4%), and blood pressure (60.4%).Conclusion:This research addresses nephrologists’ perspectives about Ramadan fasting for patients with advanced CKD. It highlights factors they consider when advising CKD patients about fasting, which were used to suggest applications in practice. Further studies are needed to comprehend nephrologists’ and CKD patients’ perspectives on fasting.

Role of fine-needle aspiration cytology in evaluating thyroid nodules. A retrospective study from a tertiary care center of Western region, Saudi Arabia.

Objectives:To evaluate the accuracy and efficacy of fine-needle aspiration cytology (FNAC) in diagnosing thyroid nodules, correlating it with the histopathological findings.Methods:A retrospective evaluation of 314 patients was undertaken at a tertiary referral center of King Abdullah Medical City (KAMC), Makkah, Kingdom of Saudi Arabia, between 2010-2019. Patients who presented with thyroid swellings underwent ultrasonography and FNAC. If indicated, surgery was performed. The FNAC findings were compared to the final histopathological reports.Results:The findings for FNAC from our data set of 314 patients showed a sensitivity value of 79.8%, specificity of 82.1%, accuracy of 74.8%, positive predictive value of 74.8%, and negative predictive value of 85.9%.Conclusion:Our study showed that FNAC has high sensitivity and specificity in the initial evaluation of patients with thyroid nodules. When guided by ultrasonography, the accuracy can be markedly improved. Molecular markers once widely available can improve the diagnostic power of FNAC to be no less than the histopathologic evaluation of thyroid tissue.

Outcomes of multidisciplinary team interventions in the management of sickle cell disease patients with opioid use disorders. A retrospective cohort study.

Objectives:To identify the magnitude of opioid use disorder (OUD) among sickle cell disease (SCD) patients; emphasize on multidisciplinary team (MDT) role; estimate cost-effectiveness following the proper use of therapeutic guidelines; and facilitate the reduction of emergency room (ER) visits and the length of stay (LOS).Methods:This retrospective cohort study included SCD patients aged 14 years and above, who have OUD. Data was collected between January 2016 and December 2018. Data included ER visits, hospital LOS, opioid consumption, and narcotic prescription tracking. The target group was followed with a set of interventions for pain management and healthcare resource utilization.Results:Twenty one SCD patients were identified with OUD. Following the interventions, there was a statistically significant decrease in ER visits of these OUD patients (from 8709 visits in 2016 to only 94 in 2018). Morphine consumption decreased by 82% and meperidine by 60%, over the 3-year period. Moreover, there was a huge reduction in both ER and LOS costs for this cohort of patients.Conclusion:Establishing an MDT and a series of interventions for SCD patients with OUD, including educational activities for caregivers and patients; establishing a palliative/pain clinic and a SCD addiction clinic; and implementing an adequate opioid prescription tracking system resulted in a significant reduction in both the cost and number of ER visits and hospital LOS and dramatically decreased opioid consumption.

Validation and inter-rater reliability testing of the Arabic version of speech intelligibility rating among children with cochlear implant.

Objectives:To validate and assess the reliability of the new version of an Arabic speech intelligibility rating among different raters.Methods:This cross-sectional analysis was carried out between December 2018 and January 2019. Thirty cochlear-implant (CI) children (study group) and 30 subjects (control group) were enrolled. Study candidates’ speech skills were evaluated using the translated Arabic SIR by parents and original SIR by professions such as speech-language pathologists (SLPs). Inter-rater agreement, test–retest reliability, pre- and post-intervention score (responsiveness test), patient versus control score comparison (discriminant validity), and cross-validation of Arabic SIR have all been assessed.Results:There was a good sense of agreement between the post-operative SIR parents’ assessments and the professional SLPs’ assessments (r=0.920, p<0.001). The mean of study subjects pre- and post-implantation score of Arabic SIR showed a statistically significant difference (p<0.001).Conclusion:The Arabic SIR demonstrated excellent reliability with strong consistency. It showed its clinical ability in distinguishing healthy subjects from patients along with follow up of speech development skills over time. The Arabic SIR can be used by parents to evaluate post-CI progress of their children.

The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?

Objectives:To determine the current pattern of using angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in diabetic nephropathy (DN), and assess physician awareness of using vitamin D in the prevention and treatment of DN.Methods:A cross-sectional study implementing a validated questionnaire, which was distributed to physicians in the aforementioned specialties in 3 hospitals in Saudi Arabia (Almanee Hospital, King Saud Medical City [KSMC], and Riyadh Care Hospital [RCH]) between April 2019 and November 2019. We used IBM SPSS 26.0 to perform descriptive statistical analyses and comparisons were based on the Chi-square test.Results:Forty-one physicians (30%) reported the use of combination therapy of ACEi and ARBs. Fifty-six (41%) physicians reported that they never used vitamin D in the treatment of DN, and 48% agreed that vitamin D can benefit patients with DN. 52% of the respondents reported the existence of guidelines. The vast majority (94%) recommended clearer guidelines on monitoring renal function in patients treated with ACEi or ARBs.Conclusion:There is a universal agreement among physicians regarding the use of ACEi and ARBs for the treatment of DN with limited awareness of the benefits of using vitamin D. Hence, the development of specific guidelines for its use are recommended.

The effect of laryngoscope types on hemodynamic response and optic nerve sheath diameter. McCoy, Macintosh, and C-MAC video-laryngoscope.

Objectives:This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC video-laryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation.Methods:This prospective randomized study was conducted in Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation.Results:The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p>0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p>0.05).Conclusions:In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® video-laryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure.

The association between plasma homocysteine level and metabolic syndrome

Objectives:To investigate the association between plasma homocysteine (Hcy) status and metabolic syndrome (MS) among Saudi patients attending King Abdulaziz Medical City in Riyadh, Saudi Arabia.Methods:A record-based cross-sectional study of 446 patients was carried out. All consecutive plasma Hcy levels from 2015 to 2018 were extracted. International Diabetes Federation criteria for MS were used to classify the patients. A multivariate regression model was developed to examine the associations between plasma Hcy and MS.Results:The mean plasma Hcy level was 10.52 µmol/L, and 40% of the patients exhibited elevated Hcy status. Male patients had significantly elevated Hcy levels compared to female patients (p<0.001). In addition, plasma Hcy levels were significantly higher in patients diagnosed with diabetes (p=0.021) and hypertension (p<0.001). The prevalence of MS within the study population was 51%. Homocysteine levels were associated with the presence of MS independent of demographic, anthropometric and biochemical variables (odd ratio 1.018; 95% confidence intervals 1.011 -1.047).Conclusion:Plasma Hcy levels were elevated in 40% of the MS patients. Homocysteine had weak association with the presence of MS. Additionally, it was associated with some of its components individually. This study has raised the importance of investigating the association between Hcy status and MS among a representative sample of Saudi population. Additionally, examining possible association and interaction between Hcy level and specific component of MS is suggested to be explored in future studies.

Time of appearance of ossification centers in carpal bones

Objectives:To find reference data for the time of appearance of ossification centers in carpal bones and the lower ends of the radius and ulna in the Saudi population. In addition, to check the sequence of appearance of carpal bones and the relation of this sequence to the appearance of distal epiphyses of the radius and ulna.Methods:A retrospective radiological study was carried out between 2012 to 2020 at King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. A sample of 279 hand/wrist plain radiographs of Saudi children was analyzed.Results:The first bones at the wrist region to appear in Saudi children are the capitate, hamate, and distal epiphysis of the radius, and these appear during the first year of life. The other bones develop subsequently at yearly intervals, and the last one to appear is the pisiform, which arises at the end of the first decade of life.Conclusion:The sequence of appearance of carpal bones in the Saudi population is similar to what is described in the literature. However, the time of appearance of some of these bones is earlier than that in other populations.