Adherence to Eye Examination Guidelines Among Individuals With Diabetes in Saudi Arabia.

BACKGROUND: Individuals with diabetes are at risk of developing diabetic retinopathy, a vision-threatening complication. Regular eye examinations are crucial for early detection and management. Ensuring adherence to eye examination guidelines is essential to prevent visual impairment and blindness in this at-risk population. METHODS: This was cross-sectional study, and a validated questionnaire was physically administered among adult individuals with diabetes (both males and females) in Saudi Arabia. The data were gathered and analyzed using Statistical Product and Service Solutions (SPSS, version 26.0) software (IBM SPSS Statistics for Windows, Armonk, NY). This study took approximately three months from the period August 2023 to November 2023. RESULTS: This study found that most participants had type 1 diabetes (46.1%, n=83) and had been diagnosed for more than 10 years (49.4%, n=89). The most used management strategy (48.9%, n=88) was lifestyle changes and anti-diabetic medications. Most of the participants (93.3%, n=168) were fully aware of the severe eye complications of diabetes, as well as diabetic retinopathy and its complications (48.9%, n=88). The most common source of information about the importance of eye exams was healthcare professionals (56.7%, n=102). Most of the participants had annual eye exams (58.3%, n=105) and within the previous year, specifically related to their diabetes (62.8%, n=113). Adherence to eye examination guidelines was higher in those who had diabetes for more than 10 years (p=0.009), those who were on lifestyle changes and insulin therapy or anti-diabetic medications (p=0.030), those who were fully aware of severe eye complications and diabetic retinopathy (p=0.017 and p=0.020, respectively), and those with type 2 diabetes (p=0.001). In addition, participants who understood the importance of eye examinations had better glucose control (p=0.017), had eye examinations within the previous year (p=0.001), and had heard about the importance of eye examinations from healthcare professionals (p=0.020). The findings revealed the most common reasons for not getting an eye exam were a lack of awareness (37.8%) and distance from the hospital. CONCLUSION: To summarize, many people with diabetes do not get regular eye exams often because they are unaware of how important these exams are. Long-term diabetics who are aware of the dangers of diabetic retinopathy are more likely to heed this advice. However, adherence was linked to more frequent eye exams and better glucose control. Adherence and wide awareness must be created to improve retinopathy outcomes.

Physical activity levels among undergraduate students at the College of Applied Medical Sciences, King Saud University, Riyadh: A prevalence study.

Physical inactivity and sedentary behavior pose significant health concerns, particularly among young adults like college students. However, little research exists on the attitudes towards physical activity among Saudi Arabian healthcare students. This study aimed to assess the prevalence of physical activity and determine the reason for being physically inactive among students and interns across all programs in the College of Applied Medical Sciences (CAMS) at King Saud University (KSU), Riyadh, Saudi Arabia. A cross-sectional online survey was conducted between March and May 2023. CAMS students aged 18 and above, fluent in Arabic or English, and willing to participate were included. The Global Physical Activity Questionnaire (GPAQ) was used to measure physical activity. Descriptive statistics were used for data analysis. Out of 433 respondents, 377 met the inclusion criteria (response rate: 89.3%). Physical activity prevalence was 54.60%, with walking being the most common activity (42.70%). Lack of time was the primary reason for inactivity (51.40%). On average, students engaged in 1.5 hours/day of vigorous-intensity activities and 1.3 hours/day of vigorous-intensity sports and fitness activities at work. Sedentary behavior, characterized by continuous sitting, averaged 5.37 hours per day. Approximately half of CAMS students are physically active, while 20% rely solely on short walks due to time constraints, limited activity hours, or sedentary habits. A lack of time was cited as the primary reason for inactivity by most students. Future research should focus on strategies to enhance physical activity among healthcare students. In addition, academicians and policymakers should propose time-efficient initiatives that accommodate the demanding and busy schedules of healthcare students.

Does a window of opportunity for rheumatoid arthritis-associated interstitial lung disease exist?

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammatory synovitis, eventually leading to joint destruction. Remarkable advancements in the emergence of molecular targeted therapies and the treatment strategy based on treat-to-target have made it possible for patients to lead their daily lives without disabilities. Specifically, early diagnosis and appropriate treatment without missing a 'window of opportunity' are crucial for improving joint outcomes. On the other hand, interstitial lung disease (ILD) is an extra-articular complication of RA and has an impact on life prognosis. Importantly, it has become evident that achieving remission of arthritis is critical not only for joint outcomes but also to prevent the irreversible progression of pulmonary fibrosis in RA-ILD. Therefore, a 'window of opportunity' may exist not only for joints but also for RA-ILD. However, within RA-ILD, there are cases that progress from an NSIP pattern or airway involvement to a UIP pattern, while there are cases without progression, suggesting that their disease behavior may be diverse. Thus, accumulating evidence is necessary to accurately determine the disease behavior of RA-ILD. This review provides an overview of clinical and radiological features and treatment strategies for RA-ILD, incorporating the latest findings.

Psychosocial Development in Saudi Adolescents With Type 1 Diabetes Mellitus: A Descriptive Comparative Study.

Background Diabetes mellitus imposes a significant psychological and social burden on the affected individuals. The impact of type 1 diabetes mellitus (T1DM) on psychosocial development has not been well investigated in the literature. We aim to fill the aforementioned gap by conducting a comparative study to accurately assess the impact of this chronic disease on psychosocial development among adolescents in Saudi Arabia. Methodology This structured, phone-based, comparative, and cross-sectional study targets adolescents with T1DM and those without diabetes in Jeddah, Saudi Arabia. Our study utilized a validated instrument psychosocial inventory of ego strengths (PIES), to assess the psychosocial development among the participants. An IRB approval has been granted for this study. The data were analyzed using SPSS. The data collection spanned the duration from November 1, 2020, until June 8, 2021. Results A total of 310 individuals were included in the study, 90 of whom were adolescents living with diabetes, and 220 were adolescents not living with diabetes. This study indicates that the individuals with diabetes showed significantly lower development in the Hope and Care subscales compared to the control group. We found no significant correlation between HbA1C levels and scores on the psychosocial development subscales. With regards to comorbidities, adolescents living with T1DM had significantly higher rates than the control group, with asthma being the most frequently reported comorbidity. Conclusion This study in Saudi Arabia found that adolescents living with diabetes demonstrated lower scores in Hope and Care subscales compared to adolescents not living with diabetes. It highlights the importance of healthcare professionals monitoring and addressing the psychosocial needs of T1DM patients through a multidisciplinary approach and referral to specialized support services when necessary. Further research and interventions are needed to promote the psychosocial well-being of individuals with T1DM.

Pharmacists' Knowledge and Intention to Provide Palliative Care Services in Saudi Arabia: Using the Theory of Planned Behaviour.

Providing palliative care to patients with life-threatening illnesses requires multidisciplinary efforts from different healthcare providers. Identifying the attitude, knowledge, and intentions of pharmacists to provide this service in Saudi Arabia is essential. Therefore, this study aimed to identify the palliative care knowledge, intentions, attitudes, subjective norms, and perceived behavioural control of pharmacists and what factors predict their intentions. Cross-sectional questionnaires based on the theory of planned behaviour were distributed to pharmacists in hospitals and community pharmacies. They included items that measured palliative care knowledge, attitudes, intentions, subjective norms, and the perceived behavioural control of pharmacists and identified other sociodemographic and pharmacy-practice-related items. In total, 131 pharmacists completed the questionnaires, showing an average score on palliative knowledge (8.82 ± 1.96; range: 1-14), strong intentions (5.84 ± 1.41; range: 1-7), positive attitudes (6.10 ± 1.47; range: 1-7), positive subjective norms (5.31 ± 1.32; range: 1-7), and positive perceived behavioural control (5.04 ± 1.21; range: 1-7). Having completed a pharmacy residency program, working longer hours per week, having a more positive attitude, and perceived stronger subjective norms were significantly associated with a strong intention to provide palliative care services. Therefore, enabling and motivating pharmacists to complete pharmacy residency programs and improve their attitudes could increase their intentions to provide these services.

T follicular helper cells and T peripheral helper cells in rheumatic and musculoskeletal diseases.

Recent technological progress has greatly advanced our understanding of human immunology. In particular, the discovery of human T follicular helper (Tfh) and T peripheral helper (Tph) cells has significantly advanced our understanding of human adaptive immune system. Tfh and Tph cells share similar molecular characteristics and both play critical roles in B cell differentiation and maturation. However, they differ in their functional properties, such as chemokine receptor expression and cytokine production. As a result, Tfh cells are mainly involved in B cell differentiation and maturation in germinal centres of secondary lymphoid tissues, while Tph cells are involved in B cell differentiation and tissue damage in peripheral inflammatory lesions. Importantly, the involvement of Tfh and Tph cells in the pathogenesis of rheumatic and musculoskeletal diseases has become clear. In rheumatoid arthritis and systemic lupus erythematosus, Tph cell infiltration is predominant in peripheral inflammatory lesions, whereas Tfh cell infiltration is predominant in the affected lesions of IgG4-related disease. Therefore, the contribution of Tfh and Tph cells to the development of rheumatic and musculoskeletal diseases varies depending on each disease. In this review, we provide an overview of human Tfh and Tph cells and summarise the latest findings on these novel T cell subsets in various rheumatic and musculoskeletal diseases.

Barriers Facing Physicians in Opioids Prescribing for the Management of Moderate to Severe Pain in a Tertiary Care Center in Saudi Arabia.

Although several interventions are utilized for pain management, opioids remain the most effective intervention for moderate to severe pain. Despite opioids being the most potent analgesics used in different pain settings, several factors impede the optimal prescribing of opioids.The study seeks to identify and address the barriers physicians face to prescribing opioids in managing pain.This study was conducted in a tertiary care center in Riyadh, Saudi Arabia. It involved distributing questionnaires to the participants. The questionnaires sought to identify prescribers' knowledge and current practices as well as obstacles that they face when prescribing opioids. A total of 109 questionnaires were completed by participants.More than half [59.6%] of the respondents thought that opioid use was an optimal way to treat moderate to severe pain. About 33% chose "never" when asked if they fear legal sanctions when prescribing opioids. Fear of side effects limited almost 90% of the respondents from prescribing opioids.The study confirmed the perception that opioids are the most potent pharmacological intervention in treating pain. Several barriers were identified and discussed in this study. Further studies from different settings to understand these barriers are highly recommended.

Safety and Efficacy of Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangioma: A Systematic Review.

Circumscribed choroidal hemangioma (CCH) is a sort of non-malignant hamartomatous tumor that occurs in the choroidal layer of the eye. It is a rare condition that affects people between their second and fourth decades of life, leading to significant deterioration of vision. One of the most catastrophic consequences of CCH is exudative retinal detachment (ERD), which has a severe impact on vision. This review aims to comprehensively assess the safety and efficacy of photodynamic therapy (PDT) using verteporfin as a therapeutic approach. Using the eligibility criteria, we analyzed the findings of 18 published articles from PubMed, Web of Science, Scopus, and Cochrane. The standard PDT protocol was used in all included studies, except two (one used half-dose, the other one used the double-dose) with an average of 1-2 sessions. PDT induced substantial tumor regression, with a mean thickness range from 0 to 2.3 mm. However, this contrasted with a previous study that reported a thickness of 3.46 mm as an indication of PDT failure. The mean tumor diameter varied from 4.8 mm to total tumor flattening. A suboptimal effect with a mean diameter ranging from 6mm to 8mm was found in two clinical studies. Significant improvement in vision was observed during the last follow-up, ranging from a normalization of Best Corrected Visual Acuity (BCVA) 20/20 to 20/80; counting finger vision persisted in two patients even after treatment. PDT successfully achieved complete subretinal fluid (SRF) resolution in 14 studies and resolved ERD in nine articles. Most studies did not report serious adverse events, but some reported macular atrophy, microcystic degeneration of the retina, transient visual disturbances, Retinal pigmented epithelium (RPE) metaplasia, and cystic degeneration of the retina. This systemic review demonstrated PDT's effectiveness and safety as a first-line management modality for CCH. Photodynamic therapy efficiently induced tumor regression, resulting in a notable reduction in both tumor diameter and thickness, with optimal efficacy to improve vision and resolution of the consequences of CCH, such as SRF and ERD.

Medication Adherence in Palliative Care Patients.

Background In palliative care, therapeutic benefit and desired health outcome might be affected by non-adherence to medications, especially among patients with advanced illnesses, such as cancer. The consequences of non-adherence to medications could include poor health outcomes, recurrent admissions, medication waste, as well as increased morbidity and mortality. The aim of this study was to measure the level of medication adherence in palliative care patients visiting the outpatient clinic at King Fahad Medical City. Methods Inclusion criteria comprised all palliative care patients visiting the outpatient clinic in King Fahad Medical City. Medication adherence was assessed among the participants using the Morisky Medication Adherence Scale (MMAS). Data analysis was conducted using SPSS and GraphPad Prism. Results A total of 84 responses were recorded. Among the respondents, 58.3% were female. The most common underlying diseases among participants were breast cancer. Of the 84 participants, 59 (70.2%) patients reported good adherence, while 25 (29.7%) reported poor adherence. Conclusion Non-adherence to medications among palliative care patients is a significant public health problem. Results indicated that the overall level of medication adherence in palliative care patients was moderate to good. Further studies are required to design new techniques for increasing medication adherence in palliative care patients.

Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour.

Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists' intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists' willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.

Sensitivity and Specificity of Pulmonary Artery Pressure Measurement in Echocardiography and Correlation with Right Heart Catheterization.

OBJECTIVE: Echocardiography is helpful in assessment of pulmonary hemodynamic, however its correlation with Right heart catheterization (RHC) is conflicting. We conducted a study to evaluate sensitivity and specificity of pulmonary hemodynamic parameters measured in echocardiography. Furthermore its correlation with the values measured in RHC was assessed. METHOD: Retrospective, cross-sectional study conducted at King Fahad medical City, Riyadh, Saudi Arabia. 95 adult patients referred for right heart catheterization were enrolled in the study. All the patients had echocardiography and RHC within one week of each other. RESULT: Diabetes mellitus, hypertension and dyslipidemia were present among 55%, 66% and 41% of patients respectively. 85% of the study participants were diagnosed to have pulmonary hypertension and 79% of the study participants had postcapillary pulmonary hypertension. Sensitivity of pulmonary artery systolic pressure (PAPs), mean pulmonary artery pressure (PAPm) using PAPs and pulmonary artery acceleration velocity (PAcT) were 86%, 93% and 89% respectively. Correlation of PAPs, PAPm using PAPs and PAcT on echo with invasive hemodynamic in RHC were 0.56, 0.43 and 0.24 respectively. Among patients with moderate to severe Tricuspid Regurgitation (TR) and tricuspid annular plane systolic excursion (TAPSE) <1.5cm correlation of PAPs, PAPm using PAPs and PAcT on echocardiography with right heart catheterization were 0.31, 0.24 and 0.42 respectively. CONCLUSION: Echocardiographic assessment of PAPs and PAPm has high sensitivity and weak to moderate correlation with hemodynamic data in RHC. PAPs measurement on echocardiogram has best correlation with invasive measurement followed by PAPm measurement using PAPs. Among patients with moderate to severe TR and TAPSE <1.5cm PAPm measurement using PAcT has better correlation than using PAPs.

Anterior cruciate ligament injury patterns and their relationship to fatigue and physical fitness levels - a cross-sectional study.

ABSTRACT: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that leads to many consequences such as early osteoarthritis and knee joint instability.To explore the association of the types of ACL tear (complete and partial) and side of injury (dominant vs nondominate) with types of playing surfaces, sports, shoes, and mechanism of injuries as well as to determine whether higher levels of fatigue and physical fitness are risk factors for complete ACL tear.This cross-sectional study used a questionnaire to collect information from young male adults with a confirmed ACL injury who were attending rehabilitation programs. The outcomes of interest were patterns of ACL injury, levels of fatigue before the injury on a 0 to 10 scale, and levels of physical fitness (hours per week). Mann-Whitney U and Kruskal Wallis tests were used to assess the differences between groups, while the odds ratios were calculated to evaluate risk factors for complete ACL tear.One hundred thirteen young male adults with a confirmed ACL injury were enrolled. Most of the reported ACL injuries in this study were complete tear (80.5%) and occurred more frequently in the dominant leg (74.6%) due to noncontact mechanism (63.6%). More ACL injuries happened while playing soccer (97.2%) on artificial turf (53.3%). The level of fatigue before ACL injury was significantly higher in partial ACL tear injuries compared to complete ACL tear injuries (P = .014). For every 1-point increase in the level of fatigue on a 0-10 scale, there was a 25% reduction in complete ACL injury risk (P = .023).The pattern of ACL types of tear and side of injury varies in different playing surfaces and mechanisms of injuries. Higher levels of fatigue seem to be associated with a partial tear of the ACL and reduction of a complete ACL tear risk factor.

Augmentation Rhinoplasty Using Iliac Crest Graft in Saddle Nose Deformity.

Autologous bone graft is one of the management solutions for saddle nose deformity. This helps from both functional and esthetic perspective. Several features of autologous graft specify the best material used to repair bony and cartilaginous nasal defects. This article describes a case of a female who presented with saddle nose deformity after incidental insertion of a button battery in her nostril during childhood which was followed by depressed nasal dorsum. It was managed with good outcomes by augmentation rhinoplasty using an iliac crest bone graft.

Merocel Surgicel Wrap Technique to Manage Diffuse Epistaxis in Patients with Comorbidities.

Epistaxis, or nasal bleeding, occurs in over half of the general population. It is caused by various etiological factors and affects both sexes and all age groups. The simplest treatment for a nosebleed is pinching of the ala nasi, referred to as the Hippocratic technique. In this study, we adopted different treatment protocols dependent on the severity of bleeding and assessed the etiology and efficacy of these modalities. This was a prospective study. We recruited 25 patients (24 adults and 1 child) who presented with epistaxis in the ENT departments of two tertiary care hospitals. We evaluated the cause of epistaxis and efficacy of the treatments used. All patients had experienced several episodes of epistaxis and were managed using anterior nasal packing with gauze and ointment or with Merocel packs alone. The incidence of epistaxis was more common in males than in females. It was effectively managed by anterior nasal packing with Surgicel-wrapped Merocel. Patients did not experience further episodes of bleeding following the removal of Merocel and retention of Surgicel in place.

Internal jugular vein aneurysm: a case report.

Venous aneurysms rarely present as a painless mass; they are usually symptomatic and present with pain, swelling, and sometimes, embolism. We present a 41-year-old man who presented with a painless swelling involving the right side of the neck. Examination of the neck revealed a soft, compressible, non-pulsatile and non-tender swelling above the right sternoclavicular joint. Doppler ultrasound showed a well-defined compressible cystic lesion measuring 4.2 × 1.9 cm causing indentation of the right sternocleidomastoid muscle. Further imaging studies confirmed the diagnosis of an aneurysmal dilation in the right internal jugular vein. An excisional biopsy of the aneurysm was performed using a longitudinal incision in the skin at the anterior border of the right sternocleidomastoid muscle and excisional venotomy was performed. Histopathological examination showed a cystic structure containing organizing blood clots surrounded by a thick fibrous wall. A follow-up neck ultrasound performed postoperative showed a patent internal jugular vein.

Pretruncal Nonaneurysmal Subarachnoid Hemorrhage with Underlying Hemophilia C.

BACKGROUND: Pretruncal nonaneurysmal subarachnoid hemorrhage (PNSAH) accounts for 15%-12% of all case of subarachnoid hemorrhage. Its precise etiology is not yet established. Multiple theories and risk factors have been investigated to address the possible cause of this type of hemorrhage including basilar tip dissecting aneurysms, high spinal arteriovenous fistula, venous stenosis/hypertension or venous bleeding. Hereditary coagulopathies and hemophilias have rarely been reported in the literature as a potential cause of PNSAH. CASE DESCRIPTION: Here, we reported a rare case of PNSAH with negative angiogram and magnetic resonance imaging who was also found to have hemophilia C (factor XI deficiency) confirmed by laboratory investigation. We also included a literature review of hereditary coagulopathies and their role as a possible cause of PNSAH. CONCLUSIONS: Detailed medical history and physical examination of patients with PNSAH may lead to further hematologic evaluation for this group of patients, as in this case, and may reveal more cases of mild coagulopathy that require treatment.

Retinopathy of Prematurity Incidence and Risk Factors in a Tertiary Hospital in Riyadh, Saudi Arabia.

PURPOSE: The purpose of the study was to determine the incidence of retinopathy of prematurity (ROP) in preterm infants in the neonatal intensive care unit (NICU), to identify the risk factors that predispose to ROP, and to assess the outcome of these infants. MATERIALS AND METHODS: This was a retrospective cohort study on premature infants with a birth weight (BW) of <1501 g or gestational age (GA) of <32 weeks. These infants were admitted to the NICU at a tertiary hospital in Riyadh, Saudi Arabia, from January 2010 to December 2014. RESULTS: Five hundred and ninety-three infants were included; data were available for 581 infants. Of them, 224 infants (38.6%) had ROP. Of these, 22 infants (10.4%) had stage 3 ROP. The mean BW of infants with ROP was 938.4 ± 257.9 g, and the mean GA at birth was 27 ± 2.4 weeks. A significant relationship with a P < 0.05 was found between the occurrence of ROP and small GA at birth, low BW, low APGAR score at 1 min, and long duration of receiving oxygen (O2) therapy. Based on charts review, none of the infants had blindness. CONCLUSION: The incidence of ROP in our study falls in the range of incidence in developing countries. The low BW and small GA were the most significant risk factors. Furthermore, it is also recommended to control the amount and duration of O2 therapy to as little as needed.

A Rare Incidental Finding of a Foreign Body in the Nasopharynx during Adenotonsillectomy.

Diverse foreign bodies may become lodged in the aerodigestive tract, and the discovery of such foreign bodies is an expected scenario for health-care practitioners. The foreign body insertion may be accidental or deliberate, and the object may be organic or inorganic. Most accidental foreign body aspirations occur in children, and some such cases are potential threats that go unnoticed. Very few cases of foreign bodies in the nasopharynx have been reported. Herein, we describe an unusual case in which a foreign body in a child's nasopharynx went unnoticed for 1 year and was detected intraoperatively.

Aplasia Cutis Congenita of the Scalp with a Familial Pattern: A Case Report.

Aplasia Cutis Conginita (ACC) is a condition characterized by congenital absence of skin, usually on the scalp. ACC can occur as an isolated condition or in the presence of other congenital anomalies. Here we describe a case of a 16 days old baby girl with an isolated ACC of the scalp. Her elder two siblings have been diagnosed with ACC with concomitant cardiac or limb anomalies. The patient was managed conservatively until the defect has scarred 6 months later.

Aplasia Cutis Congenita of the Scalp with a Familial Pattern.

Aplasia Cutis Congenita (ACC) is a condition characterized by congenital absence of skin, usually on the scalp. ACC can occur as an isolated condition or in the presence of other congenital anomalies. Here we describe a case of a 16-day-old baby girl with an isolated ACC of the scalp. Her elder two siblings have been diagnosed with ACC with concomitant cardiac or limb anomalies. The patient was managed conservatively until the defect has formed scar tissue 6 months later.