Knowledge of Antibiotic Use and Resistance Among Medical Students in Saudi Arabia.

Introduction: The World Health Organization (WHO) has placed great importance on providing thorough, hands-on training to medical students regarding responsible and appropriate antibiotic prescription. Accordingly, this study aims to gain a better perspective on the knowledge of antibiotic use and resistance among medical students in Jeddah, Saudi Arabia. Methods: A questionnaire-based cross-sectional study was conducted among medical students in Jeddah, Saudi Arabia, from 1 September to 30 November 2023. The categorical variables are presented as frequencies and percentages. Mann-Whitney and Kruskal-Wallis tests were used to compare the outcomes, and generalised linear regression models were constructed to predict the students' knowledge of antibiotics and antibiotic resistance. A p-value of < 0.05 was taken to indicate statistical significance. Results: The study included a total of 353 medical students. First-year medical students represented 28.60% of the participants, while females represented 76.80%. Most participants (92.40%) agreed that antibiotics are effective against bacteria, whereas only 25.20% agreed about antibiotics' effectiveness against viruses. More than half of the participants (53.80%) believed that bacterial infections can be resolved without antibiotics. A significant majority (78.20%) agreed that the unnecessary use of antibiotics makes them less effective. More than half of the participants (56.90%) acknowledged that infections caused by resistant bacteria are increasing in Saudi Arabia, and two-thirds (75.10%) believed that healthcare workers could effectively reduce antibiotic resistance in Saudi Arabia. Male students had low knowledge about antibiotics [Beta = -1.429, 95% CI (-2.618, -0.241), P value = 0.019]. Conclusion: Improving the curriculum by incorporating topics like resistance mechanisms and responsible antibiotic usage can address the knowledge gap among male students. This comprehensive training, utilizing various educational methods, is essential for fostering responsible antibiotic practices among future healthcare professionals.

Prescribing Renally Inappropriate Medication to Hospitalized Geriatric Patients in Makkah, Saudi Arabia.

Introduction: As a result of the physiological decline in renal function that comes with age and the common failure to recognise renal insufficiency, older adults aged 65 and above are at increased risk of receiving medications that are inappropriate for their level of renal function which in turn lead to increased risk of adverse effects. Little is known about how many older adults receive medications that are inappropriate for their level of renal function. This study aimed to determine the prevalence of renally inappropriate medications in elderly adults by reviewing patient files and evaluating the appropriateness of medication doses relative to renal function in patients aged ≥ 65 years at inpatient healthcare departments. Methods: A retrospective cross-sectional study of patients aged ≥ 65 years was conducted, covering cases from 2015 to 2021. Patient's medical records were reviewed, their renal function and medications lists were evaluated, determined whether they had been prescribed at least one renally inappropriate medication based on drug-dosing recommendations for different degrees of renal function. Results: A total of 317 elderly inpatients were included, 10% of whom had received inappropriate doses relative to their renal function. Glomerular filtration rate was associated with inappropriate dosing in this study. Of the patients CKD stage 5, 36.8% had at least one drug administered at an inappropriate dose, while this figure was 6.5% among the patients at CKD stage 1; this difference was statistically significant (p = 0.001). Conclusion: A notable portion of older adults may be at risk of adverse effects due to inappropriate medication dosing related to their renal function. Further studies with large samples, drug use analyses based on comprehensive geriatric references and a prioritisation of actual outcomes over potential outcomes are needed to further determine elderly adults' exposure to inappropriate drugs.

Propranolol Use Among Healthcare Students in Saudi Arabia.

BACKGROUND: The learning performance and overall health of students might be impacted by excessive academic stress. While the right amount of stress can help improve learning and performance, too much stress can harm one's mental and physical health as well as academic performance. This research aims to assess the prevalence and use of the beta-blocker propranolol among healthcare students in Saudi Arabia. METHODS: A cross-sectional study was conducted among healthcare students at Umm Al-Qura University in Makkah, Saudi Arabia. The participants were sent an electronic questionnaire at random over three months, from June 10 to September 10, 2023. The data were analyzed using RStudio (version 4.2.2), and the categorized data were presented in frequencies and percentages. Fisher's exact test was used to determine the factors associated with propranolol use. The results were reported as odds ratios (OR) and 95% confidence intervals (CI). A p-value of < 0.05 was considered statistically significant. RESULTS: The study comprised 582 participants, of whom (51.7%, n=301) fell within the age range of 24 to 26 years, (63.1%, n=367) were male, and (59.3%, n=345) were enrolled in the College of Medicine and Surgery. The majority of respondents (73.7%, n=28) reported that educational materials such as medical books were their primary source of information regarding the impact of beta-blockers on anxiety. Among those who used propranolol, over two-thirds (68.4%, n=26) had taken it before the Objective Structured Clinical Examination (OSCE). About a quarter of the participants (26.1%, n=151) believed that propranolol was being misused by healthcare students, and (21.3%, n=123) believed that the drug could enhance academic performance. CONCLUSION: The primary motives for taking propranolol were to alleviate anxiety before OSCEs and enhance performance during presentations. The participants showed some understanding of the impact of propranolol. Nevertheless, it is imperative to impart knowledge to them about the potential hazards linked to the misuse of beta-blockers.

Association of Psychological Stress With Skin Symptoms Among the Population in Saudi Arabia: A Cross-Sectional Study.

Background and aim Studies have shown a significant relationship between psychological stress (PS) and health, and it is widely believed that factors such as stress and anxiety may not only be the result of certain diseases but can also cause and exacerbate some diseases. There is a lack of research on PS and its association with other skin conditions. Thus, this study aimed to examine the association of PS with skin symptoms using objective scales in the general population in the Kingdom of Saudi Arabia (KSA). Methods A cross-sectional study was carried out between February 6, 2023, and April 4, 2023. We administered an electronic questionnaire survey, consisting of Cohen's perceived stress scale and a self-reported skin complaint questionnaire, distributed via an online platform in the KSA. In all, 629 completed questionnaires were returned. Statistical analysis was conducted using RStudio. The results were presented as beta coefficients and their respective 95% confidence intervals (95% CIs). A p-value of <0.05 indicated statistical significance. Results The majority of the participants were female (71.7%, n=388), of Saudi nationality (93.2%, n=504), had a bachelor's degree (68.6%, n=371), were aged 18-29 years (58.8%, n=318), and were residing in the Western region (39.9%, n=216). Acne (26.8%, n=145) and eczema (12.8%, n=69) were the most commonly reported skin conditions. The stress level was low in 30.5% of the respondents (n=165), moderate in 64.9% of the respondents (n=351), and high in 4.6% of the respondents (n=25). The average skin symptom score was significantly predicted by the presence of psoriasis (p < 0.001), eczema (p < 0.001), acne (p < 0.001), rash (p < 0.001), and baldness (p = 0.041). Furthermore, the average skin symptoms scores were significantly higher among participants with high stress (median = 1.6, interquartile range (IQR) = 1.4, 1.8) than among those with moderate (median = 1.4, IQR = 1.2, 1.8) and low stress (median = 1.4, IQR = 1.1, 1.4, p < 0.001). Conclusion The general population of Saudi Arabia reported multiple skin symptoms associated with stress. PS can cause various common skin conditions including loss of hair, eczema, and acne. This study highlights the importance of assessing common skin problems in the general population in the KSA and their strong association with PS. Various skin conditions including loss of hair, eczema, and acne can be caused by PS. Dermatologists should be aware of the context of PS when assessing patients with these conditions.

Awareness About the Benefits of Post-bariatric Surgery in Diabetic Patients in Makkah Almukarramah, Saudi Arabia.

AIM: To measure awareness about the benefits of post-bariatric surgery, which is a shortening of the gut in order to lose weight in diabetic patients in the Makkah region, Saudi Arabia. METHODS: A cross-sectional survey was conducted among diabetic patients aged 18-65 from February to July 2023. An online questionnaire via Google Forms was distributed and used to assess the participants' awareness of the benefits of post-bariatric surgery for diabetic patients. RESULTS: Overall, 388 participants (56.40% female, 43.60% male) were surveyed. Most participants (91.5%) showed awareness of gastric sleeve surgery, while a significant proportion (85.8%) recognized obesity as a disease. A majority of participants (80.90%) showed awareness of the association between obesity, diabetes, and high blood pressure. However, only 46.10% of participants showed awareness of eligibility criteria associated with bariatric surgery. The majority recognized the effectiveness of bariatric surgery for weight loss but did not consider it the first choice, emphasizing a preference for non-surgical weight loss strategies. CONCLUSION: Participants demonstrated good knowledge about obesity and its implications for health. They also demonstrated good knowledge about bariatric surgery as an effective weight reduction method but expressed a preference for non-surgical methods, which reflects their awareness of the complications of bariatric surgery. However, the results showed a lack of awareness of postoperative indications and lifestyle changes, thus highlighting the need for comprehensive patient education and counseling.

Awareness and Perception Toward Nicotine Replacement Therapy Among Medical Students at Umm Al-Qura University.

Background Tobacco smoking is a leading cause of premature mortality worldwide, with most deaths attributed to smoking-related diseases. Quitting smoking can have significant health benefits and increase one's lifespan. Nicotine, the addictive component of tobacco, can lead to cravings and withdrawal symptoms. Nicotine replacement therapy (NRT) can be an effective aid in easing these symptoms. This study aimed to estimate the awareness, acceptance, knowledge, and perception of NRT among medical students at Umm Al-Qura University in Makkah City. Methodology A cross-sectional survey method using Google Forms was utilized to distribute a questionnaire among medical students. The data were analyzed data using RStudio with statistical significance set at p-values <0.05. Results Of the 310 students included in this study, the majority were males (56.5%) and were aged between 21 and 24 years. Overall, 31.9% of the participants were in their fourth year of study. Regression analysis showed that being in the fifth or sixth academic year significantly predicted awareness of NRT. Conclusions Senior-year medical students had more knowledge and awareness about NRT than their junior colleagues. Future recommendations are vital for medical students to increase their knowledge, awareness, and practice regarding NRT.

Knowledge and Attitude of Human Monkeypox Viral Infection Among Healthcare Practitioners and Students in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Human monkeypox (Mpox) is a viral zoonotic infectious disease occurs mostly in central and western Africa that can be transmitted to humans and animal. On July 2022, the World Health Organization declared the global Mpox outbreak, which considered as a huge health issue. The prevalence of Mpox in Saudi Arabia has been very low until now. AIM: This research aims to assess knowledge and attitudes of healthcare practitioners and students toward human Mpox in Saudi Arabia. METHODS:  A cross-sectional study conducted among healthcare practitioners and students in Saudi Arabia assessing knowledge, practice and attitudes towards Mpox infection. We conducted descriptive statistics for all variables. RESULTS: A total of 212 participants were included in the study. The majority of participants provided correct responses about the type of microorganisms that cause human Mpox infection and were aware about the low prevalence of the Mpox in Saudi Arabia, but they were not able to identify the correct number of cases in Saudi Arabia. About the symptoms of Mpox, participants showed good knowledge about the common symptoms like skin rash but poor knowledge about less common symptoms like lymph-node swelling. About 70% of participants were aware of the effectiveness of antiviral drugs to treat Mpox. CONCLUSION: Gaps in knowledge were detected among participants. Therefore, increasing knowledge of Mpox by providing educational courses for healthcare practitioners and healthcare students is crucial.

Case Reports Study on Methanol Poisoning in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia.

Methanol poisoning is a challenging issue due to its inducing acute multiple organ failures, and especially due to a lack of preparedness, available antidotes, and management protocols. The current study presents six cases of methanol poisoning that attended the emergency department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, between March and November 2022. All of the patients suffered from severe metabolic acidosis and visual impairment following the ingestion of homemade alcoholic beverages and colonia. Three patients were comatose, suffered from post-cardiac pulmonary arrest, and, finally, died, while the other three were non-comatose and discharged from the ICU after improvement. Management was based on clinical symptoms and other laboratory findings due to a shortage of methanol level measurement resources. The antidote, fomepizole, was not given to all of the cases due to its deficiency, and ethanol was given only to one patient due to difficulties in administering it without monitoring its concentration. Methanol poisoning and its outbreak provide insights into the dangers of hazardous homemade alcohol and other pharmaceutical preparations that might be adulterated with methanol, particularly to the shortage of suitable diagnostic testing and antidotes in addition to poor resources for management of intoxicated patients in some regions of Saudi Arabia.

Toxicity of Nab-Paclitaxel Compared to Paclitaxel in a Tertiary Hospital in Jeddah, Saudi Arabia: A Retrospective Cohort Study.

Background Nanoparticle albumin-bound paclitaxel has been developed to avoid the toxicities associated with Cremophor-solved paclitaxel. Although many studies confirm this hypothesis, there is recent evidence showing no difference between paclitaxel and nab-paclitaxel in their efficacy and safety profile. This study further assesses the toxicity of both paclitaxel and nab-paclitaxel in adult patients with breast and pancreatic cancer in a tertiary hospital in Jeddah, Saudi Arabia. These toxicities include neutropenia, anaemia, and effects on kidney and liver functions. Methods The study is a retrospective cohort study done at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2018 to December 2021, conducted on patients diagnosed with breast or pancreatic cancer treated with paclitaxel or nab-paclitaxel. Results There is a statistically significant difference between the two groups in developing anaemia, renal, and liver toxicity (P<0.05). On the other hand, there are no statistically significant differences in developing neutropenia between the two groups (P=0.084). Conclusions Nab-paclitaxel might not be better than paclitaxel in reducing the risk of neutropenia, anaemia, and liver toxicity, as predicted. Nevertheless, both medications require that the patient's renal functions be monitored during the treatment. Further studies conducted in multiple oncology centres with a larger sample are needed to evaluate the toxicity of paclitaxel and nab-paclitaxel in adult patients with breast and pancreatic cancer.

Risk of Polypharmacy and Its Outcome in Terms of Drug Interaction in an Elderly Population: A Retrospective Cross-Sectional Study.

The simultaneous use of multiple drugs-termed 'polypharmacy'-is often required to manage multiple physiological and biological changes and the interplay between chronic disorders that are expected to increase in association with ageing. However, by increasing the number of medications consumed, the risk of undesirable medication reactions and drug interactions also increases exponentially. Hence, knowledge of the prevalence of polypharmacy and the risk of potentially serious drug-drug interactions (DDIs) in elderly patients should be considered a key topic of interest for public health and health care professionals. Methods: Prescription and demographic data were collected from the electronic files of patients who were aged ≥ 65 years and attended Al-Noor Hospital in Makkah, Saudi Arabia, between 2015 and 2022. The Lexicomp® electronic DDI-checking platform was used to evaluate the patients' medication regimens for any potential drug interactions. Results: A total of 259 patients were included in the study. The prevalence of polypharmacy among the cohort was 97.2%: 16 (6.2%) had minor polypharmacy, 35 (13.5%) had moderate polypharmacy, and 201 (77.6%) had major polypharmacy. Of the 259 patients who were taking two or more medications simultaneously, 221 (85.3%) had at least one potential DDI (pDDI). The most frequently reported pDDI under category X that should be avoided was the interaction between clopidogrel and esomeprazole and was found in 23 patients (18%). The most frequently reported pDDI under category D that required therapeutic modification was the interaction between enoxaparin and aspirin, which was found in 28 patients (12%). Conclusions: It is often necessary for elderly patients to take several medications simultaneously to manage chronic diseases. Clinicians should distinguish between suitable, appropriate and unsuitable, inappropriate polypharmacy, and this criterion should be closely examined when establishing a therapeutic plan.

Polypharmacy among patients with hypertension attending primary healthcare centres.

Saudi Arabia has several hypertensive patients who require close attention and specialised care for their medications. Polypharmacy is one of the reasons for the failure of patient compliance with antihypertensive medications. Therefore, this study aims to gain a better perspective on polypharmacy in hypertensive patients attending primary healthcare (PHC) centres in Makkah, Saudi Arabia. Methods: This was an observational, cross-sectional, descriptive study of hypertensive patients followed up at 10 PHC centres in Makkah, Saudi Arabia, from 1 July 2019 to 30 June 2022. Frequencies and percentages were used to present categorical data, and Pearson's χ 2 test was used to measure differences. A P value less than 0.05 was considered statistically significant. Results: A total of 506 patients were included in this study. The mean age of the patients was 60 years, and more than half (69%) were females. Regarding antihypertensive medication use, 64% were on antihypertensive combination therapy, 76% on dual therapy, 21% on triple therapy, and 3% on quadruple therapy. Moreover, 21% of the hypertensive patients were exposed to polypharmacy. There was a significant relationship (P<0.001) between the overall number of chronic medications used per day and the duration of hypertension. Conclusion: More clinical research is needed to identify the impact of polypharmacy on the quality of healthcare in PHC centres in general and hypertensive patients specifically in different regions of Saudi Arabia.

Over-the-Counter Medication Use among Parents in Saudi Arabia.

Introduction: Self-medication is a growing public health concern worldwide. Studies have shown a gap between best practice and the current practice of using over-the-counter (OTC) medications. Despite being a well-recognised problem in Saudi Arabia, few studies have investigated OTC medication use in Saudi Arabia. Therefore, this study aimed to investigate the attitudes and knowledge of parents regarding OTC medication use in the Jeddah region, Saudi Arabia. Method: A cross-sectional study was carried out via an electronic questionnaire sent randomly to parents over four months, from 1 January to 30 April 2022. The participants' characteristics and categorical variables were represented descriptively by frequency and percentage. A Chi-square test was used to test the relationship between the variables. Results: In total, 211 questionnaires were included in this study. Females represented 54.5% of the participants included in the study. Parents belonging to the 18-to-30-year-old group comprised the highest percentage (37.9%), and most of the parents (72.9%) had received an undergraduate education. Family physicians were the most common source (37.3%) of information about OTC medications, whereas more than half of parents purchased OTC medications from the community pharmacy (58.8%). While almost half of the parents (52.1%) visited a family physician when side effects of OTC medications appeared in their children, only (33.6%) stopped giving their children the OTC medicine. The relationship between the sociodemographic characteristics (including educational level, marital status, and employment status) and OTC drug consumption was significant (p < 0.001). Conclusion: Educational campaigns are needed to guide patients about the proper use of OTC medications. Studies on OTC medication use are lacking in Saudi Arabia in terms of its frequency, reasons for use, type of self-medication, and contributing factors.

Beliefs About the Use of Herbs Before and After COVID-19: A Cross-Sectional Study in Saudi Arabia.

BACKGROUND: The COVID-19 pandemic was declared a public health emergency of international concern by the World Health Organization on March 12, 2020. Natural products and herbal medicine have been used since ancient times to relieve and treat disorders and infections, as well as increase immunity. Despite the beneficial effects of herbal medications, there are many side effects or interactions with other medications or foods that might occur. AIM: This study aims to explore the beliefs of Saudi people towards the use of herbal medicine for COVID-19 infection. METHOD: A cross-sectional study using an online survey was conducted in Saudi Arabia between January 2021 and January 2023. This survey was generated based on a deep review of the literature on COVID-19 as well as the use of medicine and herbal medicine to treat this infection. SPSS software was used to analyze the data, with a significance level of p < 0.05. RESULTS: A total of 1,230 individuals participated in this study. More than half (67.6%, n = 831) were females. Around 32.4% (n = 399) of the participants were aged 20-40 years. The majority were married (77.2%, n = 947), Saudi (96.5%, n = 1186), and living in central provinces (62.5%, n = 768) of the Kingdom. More than half of them (70.0%, n = 861) were bachelor's degree holders; 42.3% and 2.4% (n = 29) reported that they had been or were currently infected with COVID-19. Around 33.0% (n = 405) of the participants reported that they had used herbal products or nutritional supplements during the pandemic period to protect themselves from the disease. CONCLUSION: Our study showed that Saudi Arabia's public takes dietary supplements or herbal products to fight against the illness. We recommend that the Ministry of Health conduct more educational efforts to raise public awareness about disease transmission pathways and preventive actions. Furthermore, to guarantee patient safety, the use of herbal products should be supported by a professional counselor.