Hysterosalpingogram findings among subfertile women undergoing assisted reproductive technology.

PURPOSE: The objectives of our study included comparing reproductive histories and causes of infertility between patients with and without a hysterosalpingogram (HSG) investigation, and summarizing the prevalence and extent of tubal abnormalities among patients who underwent HSG. Outcomes following assisted reproductive technology (ART) were compared between HSG and non-HSG groups. MATERIALS AND METHODS: A cross-sectional study was conducted to review the medical records of 200 Saudi women with subfertility. In addition to information on HSG, patient data extracted included age, body mass index (BMI), infertility duration, miscarriage experience, parity, cause of infertility, and history of previous surgery, ectopic pregnancy, endometriosis, tubal surgery, pelvic inflammatory disease (PID), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), pregnancy, and live birth. RESULTS: One hundred and ninety six (98.0%) patients had either IVF (n=18; 9.0%) or ICSI (n=178; 89.0%) performed; ICSI was performed in 157 (90%) and 21 (81%) patients. Of the 12 women with tubal factor who did not undergo HSG, 3 (25.0%) became pregnant after ART, 8 (66.7%) did not, and the status of 1 (8.3%) is yet unknown. CONCLUSIONS: Our study aimed to contribute to resolving the debate regarding the continuing role of HSG in an environment where ART has become established as a successful approach to treat infertility. Most of the HSGs were done as per the attending physician's discretion, and not according to any specific policy.

Perceived stress and associated factors among medical students.

BACKGROUND: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. OBJECTIVES: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. RESULTS: Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students' stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. CONCLUSION: Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

The demographic and clinical characteristics of leprosy in Saudi Arabia.

Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom (65%) were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently (33%), and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum (E.N.L.) developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers.

Physicians' Job Satisfaction and its Correlates in a Tertiary Medical Care Center, Riyadh, Saudi Arabia.

OBJECTIVES: To measure the degree of job satisfaction among physicians working in a Tertiary Care Hospital and to identify background and work environment characteristics that affect overall and differential job satisfaction. SUBJECTS AND METHODS: This is a cross-sectional study of 340 physicians selected from a Tertiary Care Center using a stratified random sample with proportional allocation using a self-administered questionnaire with the 5-point Likert scale. From the 340 physicians requested to participate in the study, 217 (63.8%) completed the questionnaire. Descriptive statistics were used appropriately, including mean ± standard deviation for the quantitative variables, while frequency and percentages were used for the qualitative variables. ANOVA, t-test, and Chi-square were used as necessary to determine if there are any significant relationships between satisfaction scores and the predictor variables. SUBJECTS AND METHODS: This is a cross-sectional study of 340 physicians selected from a Tertiary Care Center using a stratified random sample with proportional allocation using a self-administered questionnaire with the 5-point Likert scale. From the 340 physicians requested to participate in the study, 217 (63.8%) completed the questionnaire. Descriptive statistics were used appropriately, including mean ± standard deviation for the quantitative variables, while frequency and percentages were used for the qualitative variables. ANOVA, t-test, and Chi-square were used as necessary to determine if there are any significant relationships between satisfaction scores and the predictor variables. RESULTS: A total of 217 physicians (males 75.6% females 24.4%) completed the questionnaire. Of this total, 52.5% were non-Saudis. The overall perceived satisfaction as measured by one question was 3.42 points out of 5 (68.4%) significantly lower than the overall satisfaction which took in consideration all variables 3.67 points (73.4%). Mean satisfaction scores were significantly negatively related to the number of children (P < 0.001) the physicians had, but positively correlated to stipend, duration of vacation leave, sick leave policy, health coverage for the employee and family, overall benefits package, involvement in academic work, and involvement in research work (P < 0.001). CONCLUSION: The working environment and policies of an organization play important roles in the satisfaction of its physicians. Boosting physician satisfaction is important for both the success of a Tertiary Care Center and for the high quality services offered to patients.

The independent effects of second hand smoke exposure and maternal body mass index on the anthropometric measurements of the newborn.

BACKGROUND: Exposure to tobacco smoke during pregnancy, whether as active smoking or by exposure to secondhand smoke (SHS), is associated with adverse pregnancy outcomes including low birth weight (LBW) and small for gestational age infants due to the effect of tobacco on the anthropometric measurements of the newborn. This effect might be masked by maternal obesity as it increases fetal weight. The objectives of this study were to estimate the independent effects of maternal exposure to SHS and maternal body mass index (BMI) on the anthropometric measurements and on the prevalence of macrosomia and LBW among term infants. METHODS: Data were collected from women in the postnatal ward following delivery. Participants were stratified into six groups based on the BMI (underweight <18 kg/m², non-obese 18-29.9 kg/m2, and obese ≥30 kg/m²) and the SHS exposure status (exposed and non- exposed), to examine the independent effects of BMI and SHS on infants' anthropometry. Multiple regression analysis was used to explore the independent associations between the six groups and the risk of delivering a macrosomic or LBW infant. RESULTS: Infants of women exposed to SHS had significantly reduced anthropometric measurements compared to infants of unexposed women. The odds of delivering a macrosomic baby increased to 9-fold for women with BMI of ≥30 kg/m² compared to non-obese women; odds ratio (OR) 9.18, 95% Confidence Interval (CI) (1.01, 9.37); p = 0.04, this risk was attenuated to 1.5-fold in women exposed to SHS, OR 1.53, 95% CI (1.19, 12.1); p < 0.0001. The odds of delivering an LBW infant were more than doubled in underweight women compared to non-obese women, OR 2.15, 95% CI (1.001, 4.57); p = 0.034, and were further increased to almost 3-fold for women who were exposed to SHS, OR 2.71, 95% CI (1.82,4.045); p = 0.02. CONCLUSION: Exposure to SHS was associated with reduced anthropometric measurements of the newborn and increased rate of LBW infants, irrespective of maternal BMI. Maternal obesity was associated with increased risk of delivering a macrosomic infant; conversely maternal underweight was associated with increased risk of delivering an LBW infant.

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey.

This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension.

Smoking pattern among female college students in Dammam, Saudi Arabia.

BACKGROUND: Smoking is the most important avoidable cause of premature morbidity and mortality in the world. The estimated annual death rate of 4.9 million people in 1999 is expected to rise to 10 million by the 2020s and 2030s, 7 million of which will occur in developing countries. AIM: The aim of the present study was to estimate the prevalence of smoking and assess its pattern among non-medical female college students in Dammam, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted of 1020 female students selected from the literature and science colleges by multi-stage stratified random sampling technique with proportional allocation. Data were collected using a self-administered modified WHO Global Youth Tobacco Survey questionnaire. RESULTS: Results revealed that occurrence of smoking among female college students was 8.6%. It was significantly higher among literature college students (12.1%) than among Science College students (3.4%). The mean age at which smoking started was 16 ± 2.4 years, with a minimum of 11 years. More than half of the students who smoked were cigarette smokers, while 43.2% were shisha smokers. There was a strong relationship between parents who smoked and daughters who smoked. The main motive for smoking was curiosity (44.3%), followed by relief of tension (26.1%). CONCLUSIONS: It may be concluded that smoking is increasing among female college students in Saudi Arabia. Accordingly, it is recommended that a preventive comprehensive health education program on smoking be initiated for females in middle schools, that stricter tobacco control measures be adopted by the government, and that anti-smoking clinics be established in colleges.

Pilgrims satisfaction with ambulatory health services in Makkah, 2008.

OBJECTIVE: The main objective of this study was to assess the level and correlates of patients' satisfaction with ambulatory health services provided for pilgrims during Hajj period in 2008. MATERIALS AND METHODS: This was a facility-based, cross-sectional study conducted in the Makkah region during the Hajj season in December 2008. A two-stage technique was used to select 500 patients from those who attended the ambulatory health services. One hundred subjects were selected by systematic random sampling (every fifth) from each of the five hospitals included in the study and asked to fill in a pilot-tested self-administered questionnaire. A total of 487 questionnaires were analyzed. Descriptive statistics and t-test, Mann Whitney test and ANOVA, or Kruskal-Wallis test was used as appropriate after checking for normality. Level of significance level was set to be <0.05 throughout the study. RESULTS: From 478 subjects analyzed, 390 (81.6%) were man, 345 (72.2%) were married, 28.9% had either intermediate or high secondary school education, and 2.4% were skilled laborers. The total satisfaction score for health facilities was 20.45 ± 4.03 of 25. The satisfaction scores were 20.15 ± 4.7 of 25 for patient satisfaction with physicians and 21.35 ± 4.5 for patient satisfaction with paramedical personnel. The overall satisfaction score was 61.5 ± 4.5 of 75 points. There were significant relations between total satisfaction of health facilities with education level and with occupation (P = 0.012, 0.001, respectively). The total satisfaction of patients with physicians was significant only with education level. The overall satisfaction score had a significant relation with occupation (P = 0.03), but a borderline relation with the education level (P = 0.056). CONCLUSION: Satisfaction with ambulatory Hajj health services is acceptable. Some physicians and waiting area services need special attention to improve satisfaction levels with ambulatory health in the subsequent Hajj seasons.

Health-related quality of life in type 2 diabetic patients.

BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQOL) is an important health outcome, representing one of the most important goals of all health interventions. The objectives of this study were to determine HRQOL and the factors affecting it in type 2 diabetic patients. PATIENTS AND METHODS: This cross-sectional study was conducted in five primary health care (PHC) centers in the Al-Khobar area. From a random sample of 225 type 2 diabetic patients, 216 patients were included in the study along with 216 age- , sex- and nationality-matched controls. Nine patients refused to participate. Type 2 diabetic patients and controls were interviewed with the translated Arabic SF-12 questionnaire. RESULTS: The mean ages were 50.0A+/-10.0 years for cases and of 49.3+/-10.3 years for controls (P=.526). Type 2 diabetic patients had lower socioeconomic status and educational level than controls. Obesity was significantly higher in diabetics than controls. HRQOL in type 2 diabetic patients was significantly lower than controls. The mean physical component score was 41.3+/-8.9 for cases vs. 47.5+/-9.5 for controls (P<.001), and the mean mental component score 47.8+/-9.1 in cases vs. 51.5+/-9.4 in controls (P<.001). HRQOL was significantly lower in females than males (P<.001). HRQOL was impaired in uncontrolled patients (fasting plasma glucose [FPG]>130 mg/dL) in comparison with controlled patients (FPG

Images in clinical medicine congenital neural malformations related to their embryological background.

UNLABELLED: Congenital neural malformations are complex anomalies, which stem from an abnormality in the embryological development of the nervous system. The development of the nervous system begins by the formation of the neural tube and its subsequent closure. The failure of closure results in neural tube defects (NTD). Defect in the formation of prosencehalon or rhombencephalon will result in holoprosencephaly or Dandy walker complex respectively. The formation of neuroblasts and their migration to cerebral cortex may be altered by many neuronal migration disorders. Lissencephaly, schizencephaly, and heterotopic gray matter are the most prominent. CONCLUSION: The objective of the study is relating congenital neural malformations to their corresponding embryological background, and so helping in better understanding the time and the way of the occurrence of such anomalies.

Risk factors and co-morbidity of skin disorders among female schoolchildren in Eastern Saudi Arabia.

The aim of this study was to determine the risk factors of skin disorders among female schoolchildren in primary and intermediate schools in Al-khobar city, Eastern Saudi Arabia. This is a cross-sectional study conducted in Al-Khobar city during the period of January to March 2003. It involved 2239 female schoolchildren randomly selected from 30 regular public and private primary and preparatory schools. A multi-stage stratified random sampling technique with proportional allocation was used. Data was collected using a pre-designed structured questionnaire and clinical examination. Dandruff was negatively associated with private schools and positively associated with age, body mass index and overcrowding. The association of atopic dermatitis with family history of atopy and bronchial asthma was documented in this study. Those who were at high risk of getting acne were schoolchildren who had more baths per week and lived in villas with a high number of rooms (in other words the high socioeconomic class). Pediculosis had a negative association with a high level of father education and high socioeconomic status and a positive association with living in a flat and the number of siblings. It was concluded that sex, socioeconomic status, family history, parents' education, home type, and overcrowding were found to be risk factors for some skin disorders. Accordingly, it is recommended that a preventive health education program for schoolchildren with different levels of skin diseases be started considering the predictive variables that increase the prevalence of these diseases.

Risk factors and co-morbidity of skin disorders among female schoolchildren in eastern Saudi Arabia

El propósito de este estudio fue determinar los factores de riesgo de las enfermedades dermatológicas en escolares femeninas de escuelas primarias e intermedias en la ciudad de Al-Khobar, Arabia Saudita Oriente. Se realizó un estudio transversal en la ciudad Al-Khobar durante el período de enero a marzo de 2003. se estudiaron 2239 niñas en edad escolar, seleccionadas al azar de 30 escuelas primarias y preparatorias regulares, públicas y privadas. Se utilizó una técnica de muestreo al azar, estratificada de múltiple fase, con distribución proporcional. La data se colectó mediante el uso de un cuestionario estructurado pre-diseñado y evaluación clínica. La caspa estuvo asociada negativamente con las escuelas privadas y positivamente con la edad, el índice de masa corporal y el nacimiento. Este estudio documentó la asociación de dermatitis atópica con historia familiar de atopia y asma bronquial. Las escolares que tuvieron más alto riesgo de padecer acné‚ son aquellas que tuvieron más baños por semana y que vivían en villas con un alto número de habitaciones (en otras palabras, de la clase socioeconómica alta). La pediculosis tuvo una asociación negativa con un alto nivel de educación y alto estrato socieconómico del padre y una asociación positiva con el habitar en un apartamento y el número de hermanos. Se concluye que el género, el estrato socieconómico, la historia familiar, la educación de los padres, el tipo de vivienda y el hacinamiento fueron factores de riesgo para algunos desórdenes dermatológicos. En consecuencia, se recomienda que se comience un programa de educación sanitaria preventivo para escolares con diferentes grados de enfermedades dermatológicas , considerando las variables presdecibles que incrementan la prevalencia de estas enfermedades.

Prevalence and pattern of skin disorders among female schoolchildren in Eastern Saudi Arabia.

OBJECTIVE: To determine the prevalence and pattern of skin disorders among female schoolchildren in primary and intermediate schools in Al-Khobar city, Eastern Saudi Arabia. METHODS: This is a cross-sectional study conducted in Al-Khobar city, Kingdom of Saudi Arabia during the period from January-March 2003. It involved 2239 female schoolchildren randomly selected from 30 regular public and private primary and preparatory schools. We used a multi-stage stratified random sampling technique with proportional allocation. We collected data using a pre-designed structured questionnaire and clinical examination. RESULTS: The prevalence of skin diseases among female schoolchildren in Al-Khobar city was 98.6%. The most common skin disease and conditions group was the pigmentary disorders (91.6%), followed by a group of dermatitis/eczema and related conditions (26.7%), and disorders of skin appendages (25.3%). The common skin diseases and conditions in this study were melanocytic nevi (MN) (68%), post-inflammatory pigmentation (56.6%), scars (26.8%), acne (22.5%), dandruff (18.1%), pediculosis capitis (5.2%) and eczema (3.1%). Postinflammatory hyper/hypo pigmentation was more common among primary schoolchildren, whereas MN, dandruff, keratosis pilaris, acne and folliculitis were significantly more common among preparatory schoolchildren. CONCLUSION: The prevalence of skin disorders among female schoolchildren in Al-Khobar city was very high. Therefore, we recommended the introduction of a preventive health education program for schoolchildren at different levels and their families and teachers on skin diseases.

Attitudes of medical laboratory technology graduates towards the internship training period at king faisal university.

OBJECTIVES: The objective of this present survey was to look into the attitudes of medical laboratory technology (MLT) graduates towards the internship training period of the MLT Department, College of Applied Medical Sciences, King Faisal University. MATERIAL AND METHODS: A self-administered questionnaire was designed and distributed for this purpose. The study period was from December 1(st) 2002 - 31(st) December 2004. Two-hundred questionnaires were distributed to recent graduates, and 115 were returned completed. RESULTS: All respondents agreed with the importance and necessity of the internship period, and felt it should not be reduced or eliminated. The most favorite laboratory where they liked to work was microbiology (70%). They all agreed that evaluation report with hospital staff and laboratory set up were vital in achieving the goals of the internship period. The majority stressed the significance of safety precautions and the application of theoretical knowledge before performing technical assignments. CONCLUSION: The respondents had very positive attitudes towards the internship-training period stressing its importance. The most favorite laboratory rotations were in rank order: Microbiology, Serology followed by Histotechnology, Hematology, Blood Banking and finally Clinical Chemistry. The majority of graduates had a very positive attitude also towards medical laboratory technology as a profession.

Obstructive sleep apnea syndrome among a snoring community.

OBJECTIVE: To evaluate the relation between snoring and the presence of obstructive sleep apnea (OSA) in terms of relevant health parameters and questionnaire responses. METHODS: Selective random sampling within a household survey in the cities of Al-Khobar and Dammam, Kingdom of Saudi Arabia over a 3 month period during the year 2000, was carried out. One hundred and fifty-two persons, aged 17-62 years, with a positive history of snoring as determined by the spouse or other members of the family were selected. RESULTS: The presence of OSA was determined using the Epworth sleepiness scale (ESS). The predictors included age, gender and body mass index. Snoring was found to be more associated with OSA as suggested by ESS in the study sample. The severity of snoring and its pattern are more associated with apneic patients. CONCLUSION: Snoring is common and may be a serious medical problem. This study revealed that snoring is associated with symptoms suggesting OSA syndrome as detected by ESS. The family doctor and his team should be aware of the condition, using simple screening test such as ESS, improves the patient care, and finding of suspected cases.

Treatment-related misconceptions among diabetic patients in Western Saudi Arabia.

OBJECTIVE: To describe the types and pattern of treatment-related misconceptions among Primary Health Care Centers (PHCCs) registered diabetic patients in Makkah, Kingdom of Saudi Arabia. METHODS: A sample of 1039 PHCCs registered diabetic patients were interviewed using a structured questionnaire, concerning diabetic treatment-related misconceptions. This cross-sectional study was carried out in Makkah city, Kingdom of Saudi Arabia from May 2000 to September 2000. A scoring system was used to document the frequency of misconceptions. The relationship of misconceptions to socio-demographic and diabetes-related variables were assessed using chi-squared tests. RESULTS: Four hundred and five (39%) patients had a high treatment misconception score. The score was significantly higher among females than males (P< 0.00001), and also among patients older than 35 years (P< 0.05). There were no statistically significant differences between Saudis and non-Saudis, or in association with different education levels. Also, the score was significantly higher among patients with a shorter disease duration (P<0.04), and among patients who did not enjoy continuity of care (P<0.00001). Patients' misconceptions were mostly related to reasons for stopping medications. Moreover, patients thought that cure from diabetes was expected following a short course of treatment (16.5%) and that one could eat what he or she liked as long as medications were taken (23%). CONCLUSION: The results of this study showed the rate of treatment-related misconceptions to be high. It stresses the need for constant motivation and one on one level education at frequent intervals to encourage better knowledge regarding the disease and subsequent compliance to treatment.

Conservative treatment of idiopathic detrusor instability in elderly women.

OBJECTIVE: The aim of this paper is to give an overview of the conservative treatment of idiopathic detrusor instability in elderly women. It describes the clinical and urodynamic features of the over-active bladder and the role of physiotherapy as well as the various physiotherapeutic techniques in the management of this condition. METHODS: This is a prospective, uncontrolled clinical trial in which 20 older women aged 55-75 years participated for 8 weeks duration. The study was started on April 2000 at King Fahad Hospital of the University, Kingdom of Saudi Arabia. Therapeutic modalities including bladder training, pelvic floor exercise and electrical stimulation were applied for all subjects. RESULTS: The first desire to void, maximum capacity, flow rate and voiding intervals was increased in its mean at the end of the study period (P<0.0001), while the means of residual volume and frequency of micturation had significantly decreased at the end of the study (P< 0.0001). CONCLUSION: The study shows that correctly taught pelvic floor exercise, combined with bladder training, electrical stimulation and restriction of fluids' intake are effective treatment modalities for the idiopathic detrusor instability in elderly women.

Low back pain among Saudi school workers in Jeddah.

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