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   Table of Contents - Current issue
January-March 2023
Volume 11 | Issue 1
Page Nos. 1-116

Online since Saturday, January 14, 2023

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Prevalence of type 2 diabetes mellitus in the general population of Saudi Arabia, 2000–2020: A systematic review and meta-analysis of observational studies Highly accessed article p. 1
Mu'taman Jarrar, Mai Abdel Haleem Abusalah, Waleed Albaker, Mohammad Al-Bsheish, Adi Alsyouf, Khalid Al-Mugheed, Marwan Rasmi Issa, Arwa Alumran
Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased worldwide, including in Saudi Arabia. Objective: To systematically review the available literature and assess the pooled prevalence of T2DM in Saudi Arabia between 2000 and 2020. Methods: Observational studies that reported quantitative estimates of the prevalence of T2DM as their main outcome, included the general population of Saudi Arabia, and were published between 2000–2020 and in English were retrieved using three electronic databases (namely, CINAHL, Medline via PubMed, and Web of Science). Retrieved studies were screened, and relevant data were extracted. The Joanna Briggs Institute Critical Appraisal guideline was used to assess the methodological quality of included studies. A random-effects model was used to estimate the prevalence of T2DM. Results: Twenty-three studies were included in the systematic review, of which 19 were included in the meta-analysis (total pooled population: 258,283). The overall pooled prevalence of T2DM in Saudi Arabia was 16.4% (95% CI: 11.6–17.5). However, there was heterogeneity in the results of the studies [I2 = 99.31%, P < 0.0001] and the summary values varied from 3.18% (95% CI: 1.46–5.95) to 94.34% (95% CI: 89.53–97.38). Although the prevalence of T2DM by age varied across studies, in most studies, it was higher among the older age groups. In addition, the prevalence of diabetes widely varied across the different geographical regions of Saudi Arabia. Conclusions: This is the first meta-analysis that determined the pooled prevalence of T2DM in Saudi Arabia, and it revealed a high prevalence over the past two decades. However, owing to data collection inconsistencies in the identified studies, neither the modifiable (such as obesity, educational status, emotional support, etc.) nor the non-modifiable (such as gender and age) risk factors of T2DM could be determined, thereby indicating the need for a nationally collective effort in determining these factors.
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Advances in CGRP monoclonal antibodies as migraine therapy: A narrative review p. 11
Suruchi Aditya, Aditya Rattan
Migraine is a potentially disabling disorder, yet it remains underdiagnosed and undertreated. The release of the neuropeptide calcitonin gene-related peptide (CGRP) in the trigemino-cerebrovascular system plays a vital role in the evolution of migraine. It enhances peripheral sensitization by mediating neurogenic inflammation and also influences central sensitization. The majority of the drug classes available for migraine prophylaxis are nonspecific and associated with numerous side effects and drug interactions. Anti-CGRP monoclonal antibodies (mAb) are an innovative therapeutic class that fulfills the need for more efficacious and tolerable preventive therapy. While erenumab is a mAb to the CGRP receptor, eptinezumab, fremanezumab, and galcanezumab bind to the CGRP molecule. They decrease the number of headache days and improve disability. Upper respiratory tract infection, nausea, constipation, pain at the site of injection, and fatigue are the associated side effects. CGRP mAbs are an excellent advancement in translational research and are a promising addition in migraine therapy. This article discusses the recent advances in the development of the CGRP mAbs.
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Prevalence of obesity among children and adolescents in Saudi Arabia: A multicenter population-based study Highly accessed article p. 19
Shooq AlEnazi, Raghad AlAjlan, Hamad AlKhalaf, Mostafa Abolfotouh, Omar Alharbi, Rasha Alfawaz, Bader Aldebasi, Suliman Alghnam
Background: Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. Objective: The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. Methods: This population-based retrospective study included children and adolescents aged 2–19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to <95th percentile as overweight. Chi-square tests were used to compare frequencies across groups. Results: A total of 351,195 children and adolescents were included, of which 337,316 (96%) were Saudis. Overall, about one-fifth of the population was overweight (11.2%) or obese (9.4%). The prevalence of obesity was highest among children aged 2–6 years (12.3%), and it was higher among boys (10.4%) than girls (8.3%). In terms of region, the prevalence of obesity among Saudis was highest in the Central and Eastern regions (9.9% for both). Conclusion: The findings highlight an urgent need for national interventions to focus on the upstream determinants of childhood obesity and to improve healthy options for children and adolescents in terms of food and physical activities.
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Identification and characterization of preventable adverse drug events in family medicine clinics from central Saudi Arabia p. 26
Ghadah A Assiri, Abdulelah S Bin Shihah, Mohammed K Alkhalifah, Ali S Alshehri, Abdullah H Alkhenizan
Background: Medication errors can result in adverse drug events (ADEs) and cause considerable patient harm. Limited data are available from Saudi Arabia and the Middle East regarding the prevalence of preventable adverse drug events (pADEs) in primary care settings. Objectives: To estimate the period prevalence of pADEs and assess the medication error severity in primary care setting in Saudi Arabia. Methods: This retrospective study is a continuation of a previous study where 117 of 2000 adult patients managed at the Family Medicine clinics of King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, were identified to have had least one medication error in the past 15 months. The electronic health records of these 117 patients were analyzed for a 3-month post-medication error period to explore the presence of pADE. Medication errors were categorized according to the National Coordinating Council for Medication Error Reporting and Prevention index (NCC MERP) and the occurrence of pADE was assessed using the NCC MERP scheme. Results: Of the included 117 patients, 9 (7.7% [95% confidence interval (CI): 2.79–12.59]) experienced pADE (Category E), while 108 (92.3% [95% CI: 87.97–98.35]) did not (Category C). All patients who experienced pADE were using over-the-counter medications and were on polypharmacy. Outcomes 2a and 2b (asthma and β-blocker) accounted for two and four cases, respectively, while Outcomes 6 (warfarin and international normalized ratio), 7 (lithium and lithium level), 16 (new oral anti-coagulant or warfarin and antiplatelet), and 17 (acetylsalicylic acid [aspirin] and antiplatelet) each accounted for one case. Conclusions: This study provides the period prevalence of patients with pADEs from Family Medicine clinics at a major tertiary hospital of Saudi Arabia, and highlights the need for a multicenter study of clinically important medication errors at the prescribing and monitoring stages for the development of quality improvement programs.
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Long-term psychological effects of the COVID-19 pandemic: Anxiety and depression among physicians in a tertiary referral hospital p. 36
Jumanah Abdulrahman Jarad, Fatima Mohammed Aldohilan, Raghad Zohier Ghulam, Rania Zaki Fallatah, Amal Khamess Alzahrani, Dalia Yahia M El Kheir, Noor Reyadh Alibrahim
Background: Since the COVID-19 pandemic peaked, few studies have thereafter assessed the continued effects of the COVID-19 pandemic on the mental health of healthcare workers. Objectives: To determine the rate and predictors of self-reported symptoms of depression and anxiety among physicians at a public tertiary care teaching hospital in Saudi Arabia about 2 years after COVID-19 was declared a pandemic. Methods: This cross-sectional study was conducted from September 2021 to April 2022 and targeted all physicians working at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to elicit self-reported data regarding depression and anxiety, respectively. In addition, sociodemographic and job-related data were collected. Results: A total of 438 physicians responded, of which 200 (45.7%) reported symptoms of depression and 190 (43.4%) of anxiety. Being aged 25–30 years, female, resident, and reporting reduction in work quality were factors significantly associated with both anxiety and depression. Female gender (AOR = 3.570; 95% CI = 2.283–5.582; P < 0.001), working an average 9–11 hours/day (AOR = 2.130; 95% CI = 1.009–4.495; P < 0.047), and self-perceived reduction in work quality (AOR = 3.139; 95% CI = 2.047–4.813; P < 0.001) were significant independent predictors of anxiety. Female gender (AOR = 2.929; 95% CI = 1.845–4.649; P < 0.001) and self-perceived reduction in work quality (AOR = 3.141; 95% CI = 2.053–4.804; P < 0.001) were significant independent predictors of depression. Conclusions: About half of the physicians reported symptoms of anxiety and depression. These findings are suggestive of the need for large-scale studies to determine the ongoing effects of the COVID-19 pandemic on the mental health of healthcare workers in Saudi Arabia.
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Burnout, stress, and stimulant abuse among medical and dental students in the Western Region of Saudi Arabia: An analytical study p. 44
Mohannad A Bahlaq, Iman K Ramadan, Bahaa Abalkhail, Ahmad A Mirza, Malak K Ahmed, Khalid S Alraddadi, Mai Kadi
Background: High levels of burnout, stress, and stimulant abuse have been reported among medical and dental students worldwide, with country-specific factors being contributors. The association, risk factors, and predictors of these three variables have not sufficiently been reported from Saudi Arabia, especially from the Western region. Objective: To determine the prevalence, association, and predictors of burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia. Methods: This cross-sectional study included all second to sixth year medical and dental students enrolled at Taibah University, Madinah, Saudi Arabia, during the 2019–2020 academic year. A self-administered, closed online questionnaire was administered. Data regarding stress were elicited using Cohen's 10-item Self-Perceived Stress Scale and regarding burnout using the Oldenburg Burnout Inventory Student Version questionnaire. Multiple logistic regression model to identify the risk of burnout was conducted, and univariate and multiple linear regression models were carried out to identify the predictors of stress. Results: Of 1016 eligible students, 732 responded (medical: 511; dental: 221). About half of the students experienced burnout (51.5%), with both high disengagement (49%) and exhaustion (45%). Most participants (90.3%) experienced moderate levels of stress. Eight (1.1%) respondents had experienced stimulant abuse; there was a no significant association between stimulant abuse and burnout in the multivariate analysis. Stress, age, gender, body mass index, GPA, study field, smoking, family income, and birth order were significant predictors of burnout, while burnout, age, gender, GPA, and physical exercise were significant predictors of stress. Conclusion: The findings in this study highlight the need for policymakers to devise strategies that target early identification as well as reduction of the high levels of burnout and stress.
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Burnout among ICU healthcare workers at two tertiary care hospitals in Makkah during the Hajj Season p. 54
Asia Rugaan, Tharwat Aisa, Kasim H Alkhatib, Moamen Abdel Baky, Faisal Al Tatar, Ibrahim Ramadan, Soha Elmorsy, Adel Hussein
Background: The Hajj season results in increased workload and longer shift hours for healthcare workers at the intensive care units (ICUs), which may result in burnout. Objective: To determine the point prevalence of professional burnout and its predictors among healthcare workers at the ICUs of two tertiary care hospitals in Makkah during the Hajj season. Methods: This cross-sectional descriptive study included all healthcare professionals working at the ICU departments of two of the largest tertiary care hospitals in the Makkah region during the 1439/2018 Hajj season. The original Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout. Logistic regression models were fitted to estimate the effect size of the associated risk factors. Results: A total of 354 participants completed the questionnaire. Moderate to severe burnout was found in each of the three subscales: emotional exhaustion, 56%; depersonalization, 82%, and impaired personal achievement, 72%. Nurses were significantly more likely to experience burnout compared with physicians (P = 0.017). Independent predictors of moderate or severe burnout were being aged ≤40 years (odds ratio [OR]: 2.1, 95% CI: 0.395–4.002; P = 0.045), female gender (OR: 2.2, 95% CI: 0.242–4.346; P = 0.037); work having a negative impact on family (OR: 3, 95% CI: 0.164–5.504; P = 0.019); unsatisfaction with salary (OR: 2.8, 95% CI: 0.28–5.056; P = 0.025); and working at the cardiac critical care unit (OR: 2.6, 95% CI: 0.440–4.467; P = 0.035). Conclusion: This study revealed that the point prevalence of burnout is common among ICU healthcare workers during the Hajj season. These findings can be used by policymakers to devise strategies to mitigate the risks of burnout during the Hajj season.
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Emergency physicians' awareness of medico-legal case management: A cross-sectional study from Saudi Arabia p. 60
Shahad Alabdulqader, Rana Alabdulqader, Mohammed Madadin, Haider Kashif, Mohammed A Al Jumaan, Abdullah Abdulsalam Yousef, Ritesh G Menezes
Background: Emergency department physicians often encounter medico-legal cases when patients initially present to the hospital, and thus there is a strong need for them to have robust medico-legal management and reporting knowledge. Objective: To assess the awareness of emergency department physicians of two major hospitals in the Eastern Province of Saudi Arabia in managing medico-legal cases. Methods: This descriptive cross-sectional survey-based study included all adult and pediatric emergency physicians working at King Fahd Hospital of the University and King Fahd Specialist Hospital, two major government hospitals in the Eastern Province of Saudi Arabia. The questionnaire included questions about demographic information, the workload in the emergency department, previous medico-legal training, and information about physicians' perspectives regarding medico-legal situations. Results: A total of 85 physicians completed the questionnaire, with most being Saudis (78.8%) and consultants (44.7%). Most participants (84.7%) immediately notified the police authority through the official procedure on suspicion of a case being criminal. However, only 28.2% of the participants were aware of how to complete the medico-legal report, and the majority (82.4%) had not received any specific training or attended specific courses in writing medico-legal reports. Most participants (91.8%) expressed the need for additional medico-legal case training programs, with continuous education (29.4%) being the preferred mode. In addition, 60% of the consultants were dissatisfied with the current medico-legal reporting and management workflow in their hospital. About half of the participants did not obtain photographs in medico-legal cases and did not know if their workplace provided a protocol for collecting evidentiary material such as clothes, swabs, bullets, remnants of foreign bodies, etc. Conclusions: The results of the present study indicate the necessity to consider periodical continuing medical education programs and workshops for emergency department physicians in the Eastern Province of Saudi Arabia to help them in appropriately handling medico-legal cases.
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Predictors of repeat cesarean section in women with one previous lower segment cesarean section: A retrospective study from Malaysia p. 67
Wan Mohd Hazman Wan-Nur-Hajidah, Ab Hamid Siti-Azrin, Bachok Norsa'adah, Jummaat Fauziah, Wan Adnan Wan-Nor-Asyikeen
Background: The rates of repeat cesarean section (CS) among women with previous CS are increasing worldwide. The predictors of a repeat CS can vary across different populations. Objective: To determine the predictors of repeat CS among women from Malaysia with one previous lower segment CS (LSCS) who underwent trial of labor (TOLAC). Materials and Methods: This retrospective cohort study included women with one previous LSCS who followed up and delivered their current pregnancy at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between January 01, 2016, and December 31, 2017. Women with singleton pregnancies were included while those who had a history of classical CS, current pregnancy with preterm birth, non-cephalic pregnancy, lethal fetal anomalies, uterine rupture, and severe preeclampsia or planned for elective CS were excluded. Logistic regressions were performed. Results: The study included 388 women who underwent TOLAC and successfully gave childbirth through vaginal birth after cesarean (VBAC) (n = 194) or emergency LSCS (n = 194). Factors significantly associated with repeat CS were no history of vaginal delivery (adjusted odds ratio (aOR): 2.71; 95% confidence interval (CI): 1.60, 4.60; P < 0.001), estimated fetal weight ≥3500 grams (aOR: 4.78; 95% CI: 2.45–9.34; P < 0.001), and presence of meconium-stained liquor (aOR: 2.40; 95% CI: 1.33–4.35; P = 0.004). Conclusion: The above-mentioned predictors of a repeat CS among women from Malaysia with one previous LSCS who underwent TOLAC can be useful for clinicians in making an informed decision.
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The immediate effect of Kinesio tape on hamstring muscle length and strength in female university students: A pre–post experimental study p. 73
Zainab Saeed Albeshri, Enas Fawzy Youssef
Background: Kinesio tape has been proposed to improve the muscle extensibility. However, there are contradictory results in the literature. Objective: To investigate the effect of Kinesio tape on hamstring muscle lengthening and on hamstring and quadriceps muscle strengthening in university students with hamstring muscle tightness. Methods: In this pre–post experimental study, 96 female students with hamstring muscle tightness were recruited from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, and randomly assigned to Kinesio tape, sham tape, or control groups (32 in each group). The inhibition technique was used for the Kinesio tape application, with the tape being applied from the muscle insertion to the origin. Measurements were taken before and 15 min after the intervention. Outcome measurements included active knee extension test to measure the hamstring muscle length, and isometric strength measurements of hamstring and quadriceps muscles using a handheld dynamometer. Results: A significant increase in the immediate hamstring muscle length was found in both the Kinesio (P = 0.001) and sham (P = 0.004) tape groups, while no difference was noted in the control group (P = 0.066). The muscle lengthening was significantly greater in the Kinesio tape group than the sham tape (P = 0.001) and control (P = 0.001) groups. There was no difference in the pre- and post-measurements in the quadriceps and hamstring muscle strengths in all three groups. Conclusions: These results demonstrate that applying Kinesio tape has an immediate effect on hamstring muscle extensibility, but has no effect on the quadriceps and hamstring muscle strengths. ClinicalTrials.gov identifier (NCT number): NCT03076840.
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Quality of life of end-stage kidney disease patients undergoing dialysis: A multi-center study from Saudi Arabia p. 81
Abdullah H Alghamdi, Abdullah A Alaryni, Khalid I Almatham, Nada H Alzahrani, Razan I Alabdullah, Raneem A Alnutaifi, Sara S Alawam, Abdullah S. Bin Shulhub, Othillah M Moazin
Background: Limited studies from Saudi Arabia have assessed the quality of life (QoL) of end-stage kidney disease (ESKD) patients on hemodialysis and its associated factors. Objective: To determine the physical, psychological, familial, and social factors that impact the QoL of ESKD patients in Saudi Arabia. Materials and Methods: This cross-sectional study included adult patients with ESKD who underwent hemodialysis at King Salman Center for Kidney Disease and King Fahad Medical City, Riyadh, Saudi Arabia, between June and July 2021, and had been on dialysis for ≥1 year were included. The Arabic version of the Quality of Life Index–Dialysis (QLI-D) version III was used, which has four sub-scales. Results: A total of 173 respondents completed the questionnaire. The overall mean (±SD) QoL score was 22.2 (±4.30), while the scores for the sub-scales ranged from 20.8 (±5.25) (Health and Functioning subscale) to 26.0 (Family subscale). Respondents aged >70 years had significantly lower average score (P < 0.05) and lower Health and Functioning subscale score (P < 0.05). Education and higher income had significant positive correlation with the Social and Economic subscale (r = 0.234, P < 0.01; and r = 0.162, P < 0.05, respectively). Diabetes was significantly associated with lower scores in the Health and Functioning subscale (P < 0.05). There was a positive linear trend in the association between the number of years on dialysis and the overall QLI-D score and the subscales of QLI-D (P < 0.05). Conclusion: Higher education level and income and longer duration of dialysis were factors associated with better QoL, while older age and having diabetes were associated with poorer QoL. Awareness among healthcare providers regarding these factors can help improve the QoL of these patients.
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Mucormycosis and cryptococcosis with gastrointestinal involvement in a patient with poorly managed diabetes p. 89
Bader A Aldahash, Mohammed A Alnemer, Khaled O Alsaad, Fahad I Alsohaibani
Mucormycosis and cryptococcosis are invasive fungal infections that mostly infect immunocompromised patients and are associated with high mortality rates. Here, we report a case of a 54-year-old male with poorly controlled diabetes mellitus who was initially admitted with a complaint of right frontal headache and vomiting for 5 days. The patient was found to have paranasal sinuses mucormycosis, and later developed gastrointestinal cryptococcosis. A multidisciplinary approach and early management are important to avoid any delay in managing these life-threatening infections. To the best of the authors' knowledge, this is the first case reporting concurrent invasive fungal infections in a patient.
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Endometrioid adenocarcinoma within an endometriotic cyst in the mesosalpinx: A case report and review of the literature p. 93
Nouf Faisal Alharbi, Mohammed Mubarak Hajla, Tarek Elsharkawy, Ashraf Alharbi, Randa Abdelsayed, Fathia Ebrahim Aljama
Endometriosis-related neoplasms may arise within endometriotic cysts of organs of the female genital tract or other organ systems. Herein, we present a case of endometrioid adenocarcinoma arising within an endometriotic cyst in the mesosalpinx. A 27-year-old single female presented to the clinic with a history of right hypochondrial pain. Pelvic MRI revealed a bulky uterus with three intramural uterine fibroids and a complex cyst in the mesosalpinx. The excised cyst showed predominantly confluent growth of relatively well-defined glands resembling proliferative-phase endometrium in a background of endometriosis. The tumor was diagnosed as endometrioid adenocarcinoma within an endometriotic cyst, pathologic stage pT1a. She was referred to the oncology team, where a positron emission tomography scan showed unremarkable results. Although these neoplasms have been reported in various locations within the female genital tract, endometrioid adenocarcinoma arising from endometriosis in the mesosalpinx is seldom reported.
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List of Reviewers, 2022 p. 98

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Arabic Abstracts p. 99

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Abstracts of “Institute for Research and Medical Consultations (IRMC) - Summer Research Program - 2022” presented at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, on September 14, 2022 p. 103

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