Perception of educational environment with an assessment of motivational learning strategies and emotional intelligence as factors affecting medical students' academic achievement.

BACKGROUND: This study aimed to investigate how medical students perceive their educational environment, as well as the implications of motivation, learning strategies, and the factor of emotional intelligence on academic achievement. MATERIALS AND METHODS: In a cross-sectional study, 3384 undergraduate students were recruited from randomly selected Egyptian medical colleges. Students from second to final year, taking fundamental and clinical courses and, at a minimum, three professional exams, were enrolled and subjected to the Dundee Ready Educational Environment Measure scale, the Motivated Strategies for Learning Questionnaire, and Emotional intelligence questionnaire. RESULTS: The overall mean age of the studied students was 21.42 ± 1.61 years. Females represented 63.5%, rural residents were 52.2% and students with enough income represented 88.0%. The traditional system adopted 28.4% of the students versus 71.6% in the integrated system. Linear regression using path analysis was conducted to study the predictors of academic achievement, and it revealed that motivation was the highly significant predictor of academic achievement (ß = 2.68, CI95%:2.35-3.05, P < 0.001), followed by learning (ß = 1.09, CI95%:0.80-1.41, P < 0.001), emotional intelligence (ß = 0.92, CI95%:0.87-0.97, P < 0.001), and the educational environment (ß = 0.14, CI95%:0.13-0.15, P < 0.001). CONCLUSION: The study's findings have implications for medical educators trying to understand the personal factors that influence learning and performance in medical school. Students' motivation was the highly significant predictor of academic achievement followed by learning, emotional intelligence, and educational environment. Perception of the learning environment had improved because of the integrated student-centered system, which fosters motivation and emotional intelligence. To improve learners' EI, optimal learning, and educational outcomes, the EI components can be taught and fostered.

Trend and epidemiology of suicide attempts by self-poisoning among Egyptians.

Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63-27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10-27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90-2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45-8.42) and 14.11% (CI95%: 12.4-16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25-40 years old (OR = 27.49, CI95%: 15.28-49.64 and OR = 59.42, CI95%: 32.76-107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32-57.56 and OR = 14.11, CI95%: 10.86-18.43 respectively), students (OR = 2.91, CI95%: 1.57-5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27-5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning.

Serum uric acid as a sensitive concordant marker with lupus nephritis and new onset of renal damage: a prospective cohort study.

OBJECTIVE: The objectives of this study are to assess serum different uric acid levels among systemic lupus erythematosus patients with or without active lupus nephritis in comparison to healthy controls and to study the relation of baseline uric acid levels to the development of new-onset renal damage in lupus nephritis. METHODS: This is a case-control study followed by a prospective cohort of systemic lupus erythematosus (SLE) patients. Three groups were included; all were having normal kidney function, 25 SLE patients with recently diagnosed active lupus nephritis (LN), 26 SLE patients without LN, and 38 healthy controls. Serum uric acid (SUA)and serum creatinine were done for all groups; for SLE patients, 24-h protein in the urine, urinalysis, C3, C4 levels, anti-DNA, anti-ENA antibodies, SLE Disease Activity Index (SLEDAI), and SLICC/ACR damage index (SDI) evaluation were also calculated. Follow-up was done with clinical and laboratory assessment including SUA, with SLEDAI and SDI evaluation. RESULTS: Serum uric acid was significantly higher in SLE patients with active LN than the other two groups (p < 0.05), a cutoff value of serum uric acid associated with lupus nephritis onset was 0.41 mmol/L with a sensitivity of 58% and specificity of 100%, however, C3 and C4 showed very low sensitivity and specificity. During follow-up, all patients with LN with baseline serum uric acid ≥ 0.52 mmol/L were associated with new-onset renal damage within 43 months. CONCLUSIONS: High-serum uric acid levels showed a significant association with lupus nephritis onset and new onset of renal damage. Key Points • Serum uric acid is a cheap, rapid, and popular test available in most of the worldwide laboratories; its higher levels showed a significant association with lupus nephritis onset and new onset of renal damage • The current work is the largest study done on lupus nephritis with strict control to the confound risk factors that are associated with the increase of the uric acid levels; moreover, it is the first study to assess such relation in Saudi population • Uric acid could have a role in the pathogenesis of lupus nephritis patients and consequent renal damage.

Knowledge, Attitude and Practice toward COVID-19 among Egyptians.

COVID-19 is a public Health Emergency of International Concern. The aim of this work was to assess the level of Knowledge, Attitude and Practice (KAP) among Egyptians toward COVID-19. A cross-sectional study was conducted from March 1st to April 1st, on 3712 participants of different ages and sex. An author designed KAP questionnaire toward COVID-19 administered online and personally was delivered. Satisfactory knowledge, positive attitude and good practice were reported among 70.2%, 75.9% and 49.2% of the participants respectively. Middle-aged participants reported high knowledge and attitude levels with poor practice level (p < 0.001). Females reported high knowledge and practice levels and low attitude (p < 0.001 and p = 0.041 respectively). Despite reporting high knowledge and attitude among urban residents (p < 0.001), practice level was high among rural residents (p = 0.001). Post-graduate education reported the highest levels of KAP (p < 0.001). Rural residents, working and non-enough income participants reported lower level of practice (p < 0.001). Logistic regression was carried out. It was found that unsatisfactory knowledge was associated with low education [Odds Ratio (OR) = 1.97, 95% CI: 1.51-2.56], and of rural residency (OR = 1.2, 95% CI: 1.05-1.41). Negative attitude was associated with not working (OR = 1.94, 95% CI: 1.61-2.35) and not enough income (OR = 1.29, 95%CI: 1.10-1.51 respectively). Poor practice is associated with young age (OR = 2.41, 95% CI: 1.94-2.98) and low education (OR = 1.19, 95% CI: 1.03-1.37) and not working (OR = 4.95, 95% CI: 4.07-6.02). Satisfactory knowledge, positive attitude and poor practice were found among the participants. A good knowledge and lower practice level were found among middle-aged, working participants, and participants with insufficient income. The demographic characters associated with KAP could be the cornerstone in directing policy-makers to target the health education campaigns to the suitable target groups.

Correction to: In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study.

The authors of the original version of the above article requested to add the name of the instrument that was used in the Intervention section.

Mobile phone use pattern and addiction in relation to depression and anxiety.

BACKGROUND: University students with heavy smartphone use are vulnerable to smartphone addiction that could be related to depression and trait anxiety. AIMS: To assess gender differences in patterns of smartphone use and addiction in relation to depression and trait anxiety among Saudi university students. METHODS: This was a cross-sectional study of 1513 students of Taif University, Saudi Arabia. A self-reported questionnaire was used to collect demographic data and data on pattern of smartphone use. The Problematic Use of Mobile Phones (PUMP) scale was used to determine smartphone addiction. The Arabic validated version of the Taylor Manifest Anxiety Scale and Beck Depression Inventory were used to assess trait anxiety and depression, respectively. RESULTS: A female predominance was found for: prevalence of depression and trait anxiety, PUMP scores, duration of daily mobile use and number of daily calls. A significant positive correlation was found between PUMP score and depression and trait anxiety scores, duration of owning a smartphone, and average duration of each daily call. The PUMP scores were significantly higher in 6th year students, those from the theoretical college, single students, and students who used a smartphone for > 4 hours/day. CONCLUSIONS: Smartphone addiction is a major problem among Saudi university students, and it is associated with depression and trait anxiety. Future studies should aim to establish the best interventions to protect university students from the negative effects of smartphones.

In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study.

Shoulder adhesive capsulitis, also called frozen shoulder, is a musculoskeletal disorder associated with pain and functional disability. This study aimed to compare the effectiveness of shoulder ultrasound-guided hydrodilatation with corticosteroid, via rotator interval (RI) anteriorly, versus posterior approach, in adhesive capsulitis patients. All patients received exercise program following injection. PATIENTS AND METHODS: A prospective randomized controlled study among 60 consecutive adhesive capsulitis patients was randomized into two equal groups. Group I received ultrasound-guided hydrodilatation with corticosteroid, saline, and local anesthetic via posterior intra-articular approach; group II received the same ultrasound-guided hydrodilatation via anterior rotator interval approach. Both groups received guided stretching exercises for 3 months after injection. Baseline and 3 months evaluation of pain by visual analogue scale (VAS), shoulder pain and disability index (SPADI), and range of motion (ROM) had been recorded for all patients. RESULTS: Both groups showed significant improvement 3 months after hydrodilatation regarding VAS pain, external rotation, and SPADI. Only in group II (RI anterior approach) improvement was observed regarding flexion and abduction. There was no improvement regarding extension or internal rotation in either group. When comparing the improvement in both groups after hydrodilatation, group II (anterior approach) showed a statistically significant higher level of improvement regarding VAS pain (p = 0.003), SPADI, flexion, abduction, and external rotation, compared to group I (p < 0.001). Extension, internal rotation, and adduction were not different. CONCLUSIONS: Ultrasound-guided anterior rotator interval hydrodilatation for adhesive capsulitis, followed by guided exercise, is clinically and functionally more effective than the conventional posterior approach.

New onset of axial spondyloarthropathy in patients treated with isotretinoin for acne vulgaris: incidence, follow-up, and MRI findings.

INTRODUCTION: Oral isotretinoin is commonly prescribed for acne vulgaris. Several case reports and observational studies have reported serious musculoskeletal side effects; however, the incidence, imaging findings, and longitudinal follow-up data are limited for patients who develop inflammatory back pain (IBP). OBJECTIVE: To assess the incidence of isotretinoin-triggered axial spondyloarthropathy (SpA) in acne vulgaris patients based on clinical features and MRI findings and to examine clinical and radiological outcomes following drug withdrawal. METHODS: Five hundred thirteen acne patients receiving isotretinoin were screened for IBP; IBP patients were assessed for CRP, plain radiographs, and MRI of the sacroiliac joint. MRI-proven sacroiliitis was scored semi-quantitatively. Patients were followed longitudinally to assess SpA clinical course and longitudinal MRI sacroiliac joints, and CRP levels were reassessed 3 weeks after patients were symptom-free, following isotretinoin discontinuation. RESULTS: Of the 513 patients, 23.98% developed IBP. MRI-proven sacroiliitis was detected in 42.3% of the symptomatic patients or 10.1% of the cohort. Among MRI-proven sacroiliitis cases, 51.9% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA. Mean CRP level was 32.05 ± 17.23 mg/L at pain onset and 3.4 ± 2.7 mg/L after symptom resolution. MRI findings completely resolved within 9 months (mean 6.27 ± 1.7) after isotretinoin discontinuation. MRI scores positively correlated with baseline CRP levels and global acne grading system score, pain, and the Ankylosing Spondylitis Disease Activity Score. CONCLUSION: Isotretinoin-induced axial SpA is a prevalent side effect in acne vulgaris patients. Early detection and follow-up of isotretinoin-induced sacroiliitis can be facilitated by MRI. Cessation of isotretinoin resulted in complete resolution in all affected patients.Key Points• Detection of underdiagnosed isotretinoin side effects which are common but not always correctly diagnosed and managed.• Incidence, diagnosis, and management of these side effects in a real-world setting.• This is the first large prospective longitudinal cohort study to report on axial manifestations in patients treated with isotretinoin as well as the effect of drug cessation upon the clinical, laboratory, and radiological findings.

Migraine, tension-type headache, and depression among Saudi female students in Taif University.

BACKGROUND: Studies done in Saudi Arabia showed a high prevalence of headache among university students. Limited research was done to assess the relationship between headache and psychiatric disorders. The aim of this study was to assess the prevalence and association between migraine, tension-type headache, and depression among Saudi female students in Taif University. PARTICIPANTS AND METHODS: A cross-sectional study using self-administered questionnaires about headache and depression was conducted at the Taif University on 1340 female students in the academic year 2016-2017. The Beck Depression Inventory, the ID Migraine™ screening tool, and the criteria of the International Headache Society were used to investigate the depressive symptoms and headache types. RESULTS: The self-reported headache prevalence was 68.4%, and the prevalence of migraine, tension-type headache (TTH), and depression was 32.5%, 29.5%, and 6.2%, respectively. The main migraine trigger was stress or anxiety; 86.6% of migraineurs had a positive family history, and only 11.9% sought medical care for headache. Of students with TTH, 61.1% reported family history and only 12.4% sought medical care. Paracetamol was the commonly used analgesic for all headache types. Medical students and students in older grades showed significantly higher levels of all headache types. Depression prevalence was significantly higher among migraineurs and students who suffered higher headache frequencies. CONCLUSION: The study demonstrated a high prevalence of headache among the studied students and an association between headache and depression. The study calls for increasing awareness towards headache and the importance of seeking medical consultation. Management strategies should be planned for the observed headache and depression comorbidity.

Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two years.

OBJECTIVE: To evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psoriasis patients, without clinical arthritis or enthesitis compared with healthy controls, with a 2-year follow-up to study the associated incidence of psoriatic arthritis (PsA). METHODS: A total of 109 consecutive psoriasis vulgaris patients without clinical signs of PsA and 90 healthy controls were included from two tertiary medical centers. Subjects underwent dermatological examination, PASI score evaluation for severity of psoriasis, musculoskeletal examination using 68/66 joints count for tenderness and swollen joints. Patients were assessed for CRP, musculoskeletal ultrasound (MSUS) in the form of grayscale ultrasound (GSUS), and power Doppler ultrasound (PDUS) for eight entheses and 34 joints to detect MSUS subclinical enthesitis and synovitis. All patients were followed-up for 2 years to detect evolving PsA. RESULTS: Subclinical enthesitis and synovitis were detected in 39.5% of psoriasis patients and 10% of controls (P < 0.001). CRP was significantly higher in psoriasis patients with MSUS manifestations (P < 0.01). PDUS and GSUS subclinical synovitis and/or enthesitis were detected at least in one site in psoriatic patients more than in controls (P < 0.05). During a 2-year follow-up of patients, the annual PsA incidence was 4.3%. Psoriasis patients who developed PsA showed a higher prevalence of baseline enthesitis, higher PDUS and GSUS synovitis scores, and higher baseline CRP level than those who did not develop PsA. CONCLUSIONS: MSUS subclinical synovitis and enthesitis are quite common in psoriasis patients. The incidence of PsA in Saudi's psoriasis patients was slightly higher than worldwide reports. Subclinical enthesitis, PDUS, and GSUS synovitis could predict PsA development.

Eating Disorders Among Female Students of Taif University, Saudi Arabia.

BACKGROUND: Eating disorders are a common health problem among adolescents, and females are especially vulnerable to them. There is lack of information on the prevalence of eating disorders in Saudi Arabia. The current study aimed to investigate the prevalence of eating disorders among female undergraduate university students in Taif city, Saudi Arabia. METHODS: The study was undertaken in the female section at Taif university from November 1, 2016 to March 30, 2017. Eating Attitudes Test (EAT-26) was used to determine the prevalence of eating disorders. The questionnaire was distributed among undergraduate students and their anthropometric measurements were assessed after obtaining their consent. The sample included 1200 university students with a median age of 21 years (range 17-33). Nonparametric tests were used to assess relationship between variables. Chi-squared test was used to compare items of the disordered eating attitudes and behaviors between positive and negative EAT respondents. RESULTS: Using the cutoff score of 20 on EAT-26 test, 35.4% of the students were classified at risk for eating disorders. Medical and obese students achieved the highest significant EAT scores. CONCLUSION: A high prevalence of eating disorders was found among females at Taif university, Kingdom of Saudi Arabia. Our findings call for prevention of these disorders and we recommend establishing a national screening program among Saudi university female students for early detection and management of these problems.

Occupational stress, anxiety and depression among Egyptian teachers.

Occupational stress (OS) among teachers predispose to depression and anxiety. No study was done to assess these problems among Egyptian teachers. This study aimed to assess the prevalence of OS, depression and anxiety among Egyptian teachers. A cross sectional study was done on 568 Egyptian teachers. The respondents filled a questionnaire on personal data, and the Arabic version of the Occupational Stress Index (OSI), the Arabic validated versions of Taylor manifest anxiety scale and the Beck Depression Inventory (BDI) were used to assess OS, anxiety and depression respectively. The prevalence of OS, anxiety and depression among teachers was (100%, 67.5% and 23.2%) respectively. OS, anxiety and depression scores were significantly higher among teachers with an age more than 40years, female teachers, primary school teachers, those with inadequate salary, higher teaching experience, higher qualifications and higher workload. A significant weak positive correlation was found between OS scores and anxiety and depression scores. This study indicated the need for future researches to address risk factors of OS and mental disorders among Egyptian teachers, and the need of periodical medical evaluation of teachers and medical and psychological support for the identified cases.

The Relation between Exposure to Environmental Tobacco Smoke and the Quantity of Cotinine in the Urine of School Children in Taif City, Saudi Arabia.

Environmental tobacco smoke (ETS) is a major public health problem for all ages. Despite the high prevalence of smoking among the Saudi population, there is limited information about levels of urinary cotinine in Saudi children exposed to SHS. The aim of the study was to assess the exposure of schoolchildren to ETS, and measure their urinary cotinine levels. Multistage cluster sampling was carried out, where schoolchildren from 4 schools were randomly chosen from primary schools in Taif city. A questionnaire including questions on SHS exposure and smoking rules in the residence were sent to students parents/guardians. Urine samples were taken and analyzed for total cotinine using chemiluminescent immunoassay. Of the studied children, 38.4% had a smoking father, 61.8%, 41.2% and 49.3% of them were exposed to ETS indoors, outdoors and both indoors and outdoors respectively. The mean urinary cotinine was significantly higher among children exposed to ETS compared to unexposed children. Urinary cotinine levels in children with both indoor and outdoor exposure was significantly higher compared with its level in children with single exposure. A significant positive correlation was found between urinary cotinine concentrations and the number of cigarette packs smoked by parents, and the number of smokers in the residence. The mean urinary cotinine level was significantly higher in children who reported no smoking rules at the residence.. The study revealed a high exposure of Saudi children to ETS. An antismoking media awareness campaign on the harmful effects of ETS should be carried out, in addition to family counseling programs targeted to parents to protect their children from ETS.

Environmental, urinary iodine status and prevalence of goitre among schoolchildren in a high altitude area of Saudi Arabia.

OBJECTIVE: This study aimed to assess the iodine deficiency, prevalence of goitre among schoolchildren and measuring environmental iodine in Taif city, Saudi Arabia. METHODS: A cross-sectional multistage cluster-sampling methodology was done on 1887 schoolchildren. Their urinary iodine concentration (UIC) and goitre prevalence was assessed. Blood level of triiodothyronin, thyroxine and thyroid-stimulating-hormone was carried out for students with normal, mild; moderate and sever iodine deficiency. The iodine content of salt, water and soil was also assessed. RESULTS: Goitre prevalence was 7.4% and about 71% of the participants had UIC less than 100µg/L. An inverse relationship between median UIC and the percent prevalence of goitre was found. The mean serum T3, T4 and TSH were 1.05ng/dL, 6.81µg/dL, and 5.69mIU/L, respectively. A significant positive correlation was found between the mean value of urinary iodine and the mean value of both T3 and T4. While a significant negative correlation between the mean value of urinary iodine and the mean value of TSH was also noted. CONCLUSIONS: The results revealed the presence of a potential public health problem of iodine deficiency among school going children in high altitude areas of Saudi Arabia. There is a need to monitor and evaluate the salt iodization process, and distribute adequately iodized salt in the affected areas.

Insulin resistance and prediabetes in hepatitis C virus patients.

BACKGROUND: Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world and is facing an epidemic of type 2 diabetes mellitus. The objective of this study was to assess the prevalence of insulin resistance (IR) and prediabetes among HCV patients. METHODS: A cross-sectional case-control study was performed on 188 HCV patients admitted to the Internal Medicine Department in Menoufia University Hospital during the period from May to August 2014. Seventy persons were taken as controls. Body mass index (BMI), serum fasting glucose and fasting insulin were determined. IR was calculated by the Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR), where a value of >2.0 was considered as IR and that >4.0 was considered as prediabetic state. RESULTS: Prediabetes was significantly higher among HCV group compared with the control group. Serum fasting glucose, fasting insulin and HOMA-IR levels were significantly higher among prediabetic HCV group compared with both non-prediabetic HCV and control groups. CONCLUSIONS: HCV patients should be assessed for IR and prediabetes in their routine evaluation to avoid the double burden of diabetes mellitus and HCV.

Effects of a training program about breast cancer and breast self-examination among female students at Taif University.

BACKGROUND: Breast cancer is the most common type of cancer in Saudi women. It is spreading three times faster in the Kingdom than in other countries. One-third of breast cancers are preventable through healthy life styles. OBJECTIVE: This study aimed to assess the impact of a training program on breast cancer and breast self-examination (BSE) among female students at Taif University. PARTICIPANTS AND METHODS: This study was carried out using a pre-post test design on a sample of female university students from seven colleges in Taif University (Faculty of Science, Faculty of Economics and Management, Faculty of Art, Faculty of Education, Faculty of Medicine, Faculty of Pharmacy, and the Faculty of Applied Medical Sciences) in the academic year 2012-2013. RESULTS: None of the participants had ever practiced BSE before training, and only 16% of them believed that BSE is necessary, whereas 8.7% were willing to teach others BSE. There was limited knowledge of breast cancer. After the training program, a significant improvement was observed in all knowledge items, and 83.6% of the students practiced BSE compared with 0% practice before training. CONCLUSION: This study showed the effectiveness of the intervention program in improving students' knowledge of breast cancer and their practice of BSE. Thus, campaigns focusing on females in this age group should be carried out in the Saudi society.

Prevalence and comorbidity of depression, anxiety and obsessive compulsive disorders among Saudi secondary school girls, Taif Area, KSA.

BACKGROUND: Previous Saudi studies have shown the psychiatric comorbidity among adolescent girls. This article was done to assess the prevalence and comorbidity of psychiatric disorders among secondary school girls in Taif area. METHODS: A cross-sectional multistage cluster-sampling methodology was carried out on 1024 secondary school female students. Psychometric evaluation of students was carried out using the Beck depression inventory, Castello and Comery Anxiety scale and Obsessive - compulsive disorder scale. RESULTS: Out of the 1024 participants, 42.9%, 54.9%, and 23.1% had significant depression, anxiety and obsessive compulsive symptoms, respectively. In addition, 64.7% of them had symptoms of the three studied disorders. A highly significant positive correlation was found between depression score and both anxiety and OC symptoms scores and between anxiety score and OC symptoms score. CONCLUSIONS: There is a need for a national intervention program for promotion of adolescent mental health. The program should include screening of students using the psychometric scales.