Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study.

Background Early detection of breast cancer is crucial for effective treatment and minimizing mortality, requiring effective screening methods like self-examination, clinical examination, and mammography. However, not all women in Saudi Arabia comply with these examinations, and studies examining its practice and barriers of low uptake are scant. The aim of this study is to investigate factors influencing breast cancer screening behavior among women in Saudi Arabia. Methods This cross-sectional study involving 806 women from October to November 2022 used an online questionnaire for the data collection process, including questions about demographic characteristics, awareness assessment, breast cancer screening behavior, symptoms, risk factors, and screening programs. Factors affecting the screening behavior were analyzed using the logistic regression model with adjusted odds ratio (AOR) and 95% confidence interval (CI). Results Among the 806 women who participated in the study, 479 (59.4%) were under 40 years old, and half of them were urban residents (n = 394, 48.9%). Only 134 subjects (16.6%) had a history of breast screening. Social media (n = 519, 64.5%) was the predominant source of screening information. The primary obstacles to breast cancer screening were the absence of tumor symptoms (n = 333, 41.3%), insufficient knowledge about early detection (n = 249, 31%), lack of time (n = 245, 30%), fear of discovering a tumor (n = 187, 23%), and lack of awareness about screening centers (n = 155, 19%). In regression analysis, predictive factors for breast cancer screening behavior were as follows: age over 40 years old (AOR: 2.56; 95% CI: 1.70-3.87), residents of big cities (AOR: 3.57; 95% CI: 1.02-12.56), positive family history of breast cancer (AOR: 2.53; 95% CI: 1.50-4.28), proximity to the screening center (AOR: 2.56; 95% CI: 1.22-5.39), and using contraceptive pills for more than five years (AOR: 1.78; 95% CI: 1.04-3.04), and were statistically significant (all p-values < 0.05). Conclusions In this study, the most perceived barriers to BSE were the absence of tumor symptoms, followed by insufficient knowledge about early detection, lack of time, fear of discovering a tumor, and lack of awareness about screening centers. Additionally, the predictive factors for breast cancer screening behavior were as follows: age over 40 years old, residents of big cities, positive family history of breast cancer, proximity to the screening center, and using contraceptive pills for more than five years. Given the identified factors affecting breast self-examination behavior in this study, public education initiatives are crucial for raising awareness, facilitating self-examination, and ultimately improving health outcomes and reducing breast cancer treatment costs in society.

Evaluation of Tear Evaporation Rate in Subjects with a High Body Mass Index.

AIM: This study evaluated the tear evaporation rate (TER) in subjects with a high body mass index (BMI) and tested the correlation between BMI and dry eye. METHODS: Thirty male subjects aged 18 - 38 years (26.4 ± 4.0 years) with a high BMI (26.4 - 47.0 kg/m2) were enrolled in the study. In addition, a control group of 30 males aged 20 - 36 years (24.0 ± 3.6 years) with a normal BMI (< 25 kg/m2) participated in the study for comparison. Each subject completed the ocular surface disease index (OSDI), followed by the TER measurement using a handheld VapoMeter. RESULTS: Significant differences (Wilcoxon test; p = 0.002 and 0.001) were found between the median scores of the OSDI (10.3 [3.7] vs. 5.9 [7.2]) and TER (35.5 [13.1] vs. 15.5 [12.8] g/m2 h) in the study and control groups, respectively. The OSDI indicated dry eye in 60.0% of subjects in the study group (n = 18). The TER measurements showed that 76.7% of subjects in the study group (n = 23) had dry eyes. A medium correlation (r = 0.569; p = 0.001) was found between the OSDI scores and TER measurements. CONCLUSIONS: The means of the tear evaporation rate and the ocular surface disease index scores are significantly higher in subjects with a high BMI compared with the control group. Therefore, a high BMI is considered a risk factor for dry eye. The measurement of the tear evaporation rate using a handheld VapoMeter is a simple and rapid method to detect dry eyes in combination with other tools.

Correlation between osmolarity measurements using the TearLab™ and I-Pen® systems in subjects with a high body mass index.

BACKGROUND: Osmolarity is used to detect symptoms of dry eye disease (DED) and can be measured using TearLab™ and I-Pen® systems. OBJECTIVES: To investigate the correlation between osmolarity measurements using the TearLab™ and I-Pen® systems in subjects with a high body mass index (BMI). MATERIAL AND METHODS: Thirty male subjects with a high BMI (27-48 kg/m2; 23.3 ±2.1 years old) participated in this study. The control group consisting of 30 healthy males (24.9 kg/m2; 22.9 ±2.1 years old) was also enrolled. Osmolarity measurements were recorded from the right eye using the TearLab™ and I-Pen® systems, and interviews were conducted to determine ocular surface disease index (OSDI) scores. RESULTS: The OSDI (p = 0.042), TearLab™ (p < 0.001) and I-Pen® (p < 0.001) scores were significantly higher in the study group than in the control group. In the study group, OSDI scores ranged from 2 to 16 (median 8.0, interquartile range (IQR) 6.8), while it was from 0 to 10 (median 6.3, IQR 4.1) in the control group. The TearLab™ osmolarity scores were in the range of 278-309 mOsm/L in the study group, whereas the I-Pen® osmolarity measurements were in the range of 294-336 mOsm/L in the study group, compared with 263-304 mOsm/L and 278-317 mOsm/L in the control group, respectively. In the study group, there was a strong correlation between the TearLab™ and I-Pen® osmolarity scores (r = 0.934; p = 0.001). In addition, strong correlations were found between the BMI and both TearLab™ (r = 0.736; p = 0.001) and I-Pen® (r = 0.707; p = 0.001) scores, as well as between the OSDI scores and both TearLab™ (r = 0.731; p = 0.001) and I-Pen® measurements (r = 0.666; p = 0.001). CONCLUSION: Osmolarity measurements using the I-Pen® system were significantly higher than those recorded using the TearLab™ system in subjects with a high BMI. The I-Pen® measurements showed large variations in osmolarity scores and were highly unreliable in correctly identifying normal eyes compared to the TearLab™ system. Also, a strong correlation was found between the osmolarity scores obtained from the TearLab™ and I-Pen® systems.

Effect of surgical face mask wearing on tear film in women with a high body mass index.

PURPOSE: Due to the COVID-19 pandemic, wearing a face mask has become an essential measure to reduce the rate of virus spreading. The aim of the study was to assess the effect of wearing a surgical face mask for a short period on the tear film parameters in subjects with a high body mass index (BMI). METHODS: Twenty-five females with a high BMI (31.4 ± 5.5 kg/m2) aged 18-35 years (22.7 ± 4.6 years) participated in the study. In addition, a control group consisting of 25 females (23.0 ± 6.7 years) with a high BMI (29.9 ± 4.1 kg/m2) participated in the study in which no mask was worn. The standardized patient evaluation of eye dryness (SPEED) questionnaire was completed first, followed by the phenol red thread (PRT) and tear ferning (TF) tests, before wearing the face mask. The subjects wore the face mask for 1 hour, and the measurements were performed again immediately after its removal. For the control group, the measurements were performed twice with one hour gap. RESULTS: Significant (Wilcoxon test, p < 0.05) differences were found between the SPEED scores (p = 0.035) and the PRT measurement (p = 0.042), before and after wearing the surgical face mask. The PRT scores have improved after wearing the surgical face mask, while the dry eye symptoms detected by the SPEED questionnaire have increased. On the other hand, no significant (Wilcoxon test, p = 0.201) differences were found between the TF grades before and after wearing a surgical face mask. For the control group, no significant (Wilcoxon test, p > 0.05) differences were found between the two scores from the SPEED questionnaire and the PRT, and TF tests. CONCLUSIONS: Wearing a surgical face mask for a short duration leads to a change in volume and quality of tears as well as dry eye symptoms in women with a high BMI.

Assessment of Tear Osmolarity in Smokers Using TearLab and I-Pen Systems.

Purpose: Smoking has a negative effect on health and ocular tear film. The purpose of the current study is to investigate the correlation between the TearLab and I-Pen osmolarity scores in smokers and compare them with those of non-smoking healthy males. Methods: Thirty male smokers (25.3 ± 2.2 years) participated in the study. An age-matched (22.9 ± 2.0 years) control group of non-smoking healthy males (N = 30) was also recruited for comparison purposes. The ocular surface disease index (OSDI) was completed first, followed by the TearLab and I-Pen osmolarity measurements. Results: The median TearLab osmolarity score was lower (P < 0.001) than that obtained using the I-Pen in both the study and the control groups. The OSDI scores and osmolality measurements were higher (P < 0.001) in smokers than in the control subjects. In the smoker group, there were moderate correlations between the OSDI scores and the measurements obtained using the TearLab (Spearman's correlation coefficient, r = 0.463; P = 0.010) and I-Pen (r = 0.449; P = 0.013) systems. In addition, there was a strong correlation between the osmolarity scores obtained from the TearLab and I-Pen systems in smokers (r = 0.911; P < 0.001). Conclusion: The I-Pen scores in smokers were significantly higher than those obtained using TearLab. The TearLab scores showed small variations compared with those obtained using I-Pen. A strong correlation was found between the TearLab and I-Pen scores in smokers. The osmolarity TearLab and I-Pen scores were significantly higher in smokers compared with normal eye subjects.

Assessment of the Effect of Wearing a Surgical Face Mask on Tear Film in Normal Eye Subjects.

Purpose: To assess the effect of wearing a face mask for a short time on the tear film parameters in normal eye subjects. Methods: Fifty-four normal eye subjects (14 female and 40 male) aged 18-40 years (23.8 ± 4.4 years) were recruited. A standardized patient evaluation of eye dryness was completed first, followed by noninvasive tear break-up time, phenol red thread, and tear ferning tests. A 5-minute gap was allowed between the tests. The subjects were asked to wear a surgical mask for one hour. The measurements were taken both before wearing a face mask and immediately after its removal. Results: Significant (Wilcoxon test) differences were found between the standardized patient evaluation of eye dryness (p=0.002) and the noninvasive tear break-up time scores (p < 0.001) before and after wearing face masks. No significant differences (Wilcoxon test, p > 0.05) were found between the phenol red thread scores and tear ferning grades before and after wearing face masks. Strong correlations (Spearman's rank correlation coefficient, r) were found among the standardized patient evaluation of eye dryness score (r = 0.590; p < 0.001), noninvasive tear break-up time measurements (r = 0.631; p < 0.001), and the tear ferning grades (r = 0.517; p < 0.001) before and after wearing the mask. A medium correlation (r = 0.377; p=0.005) was found between the noninvasive tear break-up time scores and tear ferning grades before wearing the mask. Conclusions: Wearing a surgical face mask for a short duration of one hour has an effect on ocular tear film in normal eye subjects. Dry eye symptoms and tear break-up increased after wearing a face mask compared with those experienced before wearing one.

Assessment of Tear Film Parameters in Smokers and Subjects with a High Body Mass Index.

SIGNIFICANCE: The current study compares the ocular tear film parameters in three different groups using a single noninvasive, practical, and easy-to-use tool. PURPOSE: This study aimed to assess the tear film in smokers, those with a high body mass index (BMI), and healthy subjects using the EASYTEAR view+. METHODS: Thirty men with a high BMI (>25 kg/m2; 24.4 ± 6.4 years), 30 smokers (25.1 ± 6.1 years), and 30 healthy subjects (22.2 ± 3.5 years) were recruited. Each subject completed the Ocular Surface Disease Index, followed by the assessment of noninvasive tear breakup time, tear meniscus height (TMH), and lipid layer patterns (LLPs). RESULTS: Significant differences were found in the median TMH scores between smokers and healthy subjects (P = .03) and between subjects with a high BMI and the healthy ones (P = .04). The median LLP score was significantly (P < .001) higher in normal subjects (4.0 [1.0]) than in smokers (2.4 [1.0]) and subjects with high BMI (2.0 [1.3]). For subjects with a high BMI, the noninvasive tear breakup time score was strongly correlated (Spearman rank correlation coefficient; r) with TMH (r = 0.552, P = .002) and LLP (r = 0.555, P = .001). The LLP showed that grade B (lipid layer thickness, 30 to 50 nm; more compact) was common in subjects with a high BMI, grade C (50 to 80 nm, gray waves) was predominant in smokers, and grade D (~80 nm, dense white-blue layer) represented the majority of normal eye subjects. CONCLUSIONS: Smokers and individuals with a high BMI showed significantly lower lipid layer grades and tear meniscus height scores compared with the control group. The assessment of tear film parameters using the EASYTEAR view+ supports the findings of previous studies that implicate smoking and high BMI as risk factors for dry eye.

The Effect of the Addition of Electrolyte Solutions on the Ferning Patterns of Tears Collected from Normal Eye Subjects.

SIGNIFICANCE: The current study is the first report to describe the improvement of ferning patterns of human tears using electrolyte solutions. The results can help in the production of new artificial tears to improve the quality of tears. PURPOSE: This study aimed to investigate the effect of the addition of different volumes of various electrolyte solutions on ferning patterns of human tears. METHODS: Tear samples (20 µL) were collected from the right eye of 13 subjects (5 men and 5 women) aged 19 to 36 years (27.1 ± 5.1 years) with normal eyes. Then, 1 µL of each tear sample was dried on a microscopic glass slide, and obtained ferns were observed using light microscopy and graded using the 5-point tear ferning (TF) grading scale. Homogenous mixtures of each tear sample (0.5 µL) and different volumes (0.5 to 5 µL) of each electrolyte were prepared. A sample (1 µL) of each mixture was dried, and the ferns obtained were graded and compared with those of the corresponding tears collected from subjects before the addition of electrolyte solutions. RESULTS: After the addition of electrolyte solutions, the TF grades of tears collected from healthy humans were generally improved. Significant (Wilcoxon test) improvements have been seen in the TF grades of the tear samples after the addition of a solution of potassium chloride (P = .03), calcium chloride (P = .01), magnesium chloride hexahydrate (P = .002), and sodium dihydrogen phosphate (P = .002). No significant improvements in the TF grades were seen after the addition of sodium chloride solution (P = .33). CONCLUSIONS: Ferning grades of human tears improved with most of the electrolytes used.

Remineralizing Effects of Resin-Based Dental Sealants: A Systematic Review of In Vitro Studies.

The incorporation of remineralizing additives into sealants has been considered as a feasible way to prevent caries by potential remineralization through ions release. Thus, this systematic review aimed to identify the remineralizing additives in resin-based sealants (RBS) and assess their performance. Search strategies were built to search four databases (PubMed, MEDLINE, Web of Science and Scopus). The last search was conducted in June 2020. The screening, data extraction and quality assessment were completed by two independent reviewers. From the 8052 screened studies, 275 full-text articles were assessed for eligibility. A total of 39 laboratory studies matched the inclusion criteria. The methodologies used to assess the remineralizing effect included microhardness tests, micro-computed tomography, polarized-light microscopy, ions analysis and pH measurements. Calcium phosphate (CaP), fluoride (F), boron nitride nanotubes (BNN), calcium silicate (CS) and hydroxyapatite (HAP) were incorporated into resin-based sealants in order to improve their remineralizing abilities. Out of the 39 studies, 32 studies focused on F as a remineralizing agent. Most of the studies confirmed the effectiveness of F and CaP on enamel remineralization. On the other hand, BNN and CS showed a small or insignificant effect on remineralization. However, most of the included studies focused on the short-term effects of these additives, as the peak of the ions release and concentration of these additives was seen during the first 24 h. Due to the lack of a standardized in vitro study protocol, a meta-analysis was not conducted. In conclusion, studies have confirmed the effectiveness of the incorporation of remineralizing agents into RBSs. However, the careful interpretation of these results is recommended due to the variations in the studies' settings and assessments.

Measurements of Tear Evaporation Rate in Subjects with Refractive Errors Using a Portable Evaporimeter.

Dry eye symptoms are associated with refractive errors. We aimed to measure the tear evaporation rate (TER) in subjects with refractive errors (RE) using a portable evaporimeter. This nonrandomized, case-control, and observational study included 75 subjects, including 25 subjects aged 18-38 years (28.8 ± 6.8 years) with myopia (-0.75 to -3.75 D) and 25 subjects aged 18-39 years (27.7 ± 5.5 years) with hyperopia (+0.50 to +3.75 D). In addition, a control group of 25 subjects with emmetropic eyes aged 20-30 years (23.6 ± 2.6 years) was recruited. The ocular surface disease index (OSDI) was completed, followed by the TER measurements using a portable evaporimeter. The OSDI score and TER measurements showed dry eye symptoms in 36% and 48% of myopic subjects, respectively. For hyperopic participants, dry eye was observed in 24% and 56% of the subjects based on the OSDI and TER scores, respectively. Significant differences (Mann-Whitney U test; p < 0.001) were found among the OSDI and TER scores recorded within the study (myopic and hyperopic subjects) and control groups. Significant strong positive correlations were detected between the OSDI and TER scores in both myopic (p = 0.004; r = 0.559) and hyperopic (p = 0.001; r = 0.619) subjects. The TER scores were significantly higher in subjects with RE (myopic and hyperopic) as compared with individuals with normal eyes.

Improving tear ferning patterns collected from goats and camels after adding various electrolyte solutions.

BACKGROUND: Good quality of tear film is essential for healthy vision in both animals and humans. Therefore, improving the quality of tears through the addition of electrolytes is important. OBJECTIVES: To assess the effect of adding various electrolyte solutions on tear ferning (TF) patterns collected from goats and camels. MATERIAL AND METHODS: Tear samples (20 ƒÊL) were collected from 5 goats (2 males and 3 females; 3.4 }1.6 years) and 5 camels (2 males and 3 females; 4.0 }1.1 years) using microcapillary tubes. A tear sample (0.5 ƒÊL) from each animal was mixed with various volumes (0.5.5 ƒÊL) of each electrolyte solution to produce homogenous mixtures. A sample (1 ƒÊL) of each mixture was dried on a microscopic glass at 22°C with a humidity .40%. The obtained TF pattern was observed, graded and compared with those obtained for the corresponding pure tear samples. The effect of dilution using purified water on the TF patterns of animals was also tested. RESULTS: The TF grades of animals were generally enhanced when mixed with electrolyte solutions. Specifically, the TF grade for tears collected from a goat was improved from 1.4 to 0.7 and to 0.8 when magnesium chloride hexahydrate and calcium chloride were added, respectively. Similarly, the TF grade for tears collected from a camel was improved from 1.8 to 0.9 and to 1.1, when calcium chloride and sodium dihydrogen phosphate solutions were added, respectively. CONCLUSIONS: The TF grades of tears collected from both goats and camels were improved after adding electrolyte solutions, and they were most remarkably improved when divalent electrolyte solutions were added, followed by the hydrogenated electrolyte.

Evaluation of Tear Evaporation Rate in Patients with Diabetes Using a Hand-Held Evaporimeter.

Diabetes is a very common disease and is considered a risk factor for many diseases such as dry eye. The aim of the current work was to evaluate the tear evaporation rate (TER) in patients with diabetes using a hand-held evaporimeter. This observational, case-control and non-randomized study included 30 male patients with diabetes (17 controlled and 13 uncontrolled) with a mean ± standard deviation (SD) of 33.1 ± 7.9 years. An age-matched (18-43 years; 32.2 ± 6.5 years) control group consisting of 30 male subjects was also enrolled for comparison. Subjects with thyroid gland disorder, a high body mass index, high blood cholesterol, or thalassemia, contact lens wearers, and smokers were excluded. The TER was measured after the completion of the ocular surface disease index (OSDI) by each participant. The OSDI and TER median scores were significantly (Wilcoxon test, p < 0.05) higher in patients with diabetes (median (interquartile range; IQR) = 12.0 (8.3) and 46.4 (36.7) g/m2h, respectively) compared to the subjects within the control group (5.6 (7.0) and 15.1 (11.9) g/m2h, respectively). The median scores for the OSDI and TER measurements were significantly (Wilcoxon test, p < 0.05) higher among uncontrolled diabetes patients (13.0 (11.5) and 53.4 (14.2) g/m2h, respectively) compared to those obtained for patients with controlled diabetes (11.0 (8.0) and 27.3 (32.6) g/m2h, respectively). The tear evaporation rate in patients with diabetes was significantly higher compared to those obtained in subjects without diabetes. Uncontrolled diabetes patients have a higher tear evaporation rate compared to controlled diabetes patients. Therefore, diabetes can lead to eye dryness, since these patients possibly suffer excessive tear evaporation.

Primary total hip arthroplasty with a fully porous-coated uncemented stem: up to twenty-eight years. Retrospective cohort study.

PURPOSE: The use of cementless prosthesis has increased in the last 30 years with the aim of improving the long-term results of total hip arthroplasties in young and active patients. Encouraging results have recently been reported for cementless titanium and cobalt chromium stems. However, there are few studies with long-term follow-up, and the majority have analysed several models of uncemented stems due to their modifications over the years. Therefore, the aim was to assess the long-term survival rate of the Mittelmeier Mark III or Autophor 900-S stem. METHODS: A retrospective cohort study of both gender patients under 70 years old with at least one implanted Mittelmeier Mark III uncemented stem was performed. Survival rate was defined as the proportion of stems that did not need a surgical revision from any cause. Clinical status was evaluated using the Merle d'Aubigne scale modified by Matta (excellent/good/fair/poor). RESULTS: Between 1990 and 1999, 73 stems were implanted. The mean (SD) age at surgical time was 49.3 (9.9) years, and the median (range) of follow-up was 22 (1-28) years. The overall survival rate was 93% (68/73, 95%CI: 85-97%). The stem revisions were due to stem breakage (n = 2), to aseptic loosening (n = 2) and to septic loosening (n = 1). Clinical results were: excellent 84%, good 15% and fair 1.5%. CONCLUSIONS: The Mittelmeier Mark III stem had an excellent survival rate with a stable long-term fixation and excellent clinical outcomes.

Evaluation of the Significance of Tear Ferning Patterns in beta-Thalassemia Patients.

AIM: This study was designed to evaluate the tear film in beta-thalassemia patients using tear ferning (TF) and phenol red thread (PRT) tests. METHODS: Forty beta-thalassemia patients, aged 18 - 38 years (25.7 ± 6.0 years), along with a control group of 40 age-matched subjects with healthy eyes completed the study. All subjects completed the ocular surface disease index (OSDI) first, followed by the TF and PRT tests with a 5-minute gap between the tests. RESULTS: Significant differences (Wilcoxon test, p < 0.05) were observed between the beta-thalassemia and control groups in all scores. Among beta-thalassemia patients, OSDI scores indicated eye dryness in 35 subjects (87.5%). PRT showed dryness in 31 subjects (77.5%) in the right and left eyes, and the TF grades were ≥ 2 for the tears collected from 35 subjects (87.5%). There was a strong correlation (r = 0.851, p = 0.001) between the PRT measurements in the right and left eyes. There was a medium correlation between OSDI and TF scores (r = 0.309, p = 0.026) and between OSDI and age (r = 0.365, p = 0.010). Age had a moderate negative correlation (r = - 0.328, p = 0.019) with the PRT obtained from the right eye. CONCLUSION: Significant ocular dryness symptom was observed in beta-thalassemia patients, based on the scores collected from TF and PRT tests. Beta-thalassemia patients develop dry eyes, possibly due to several factors, including reduced tear secretion. Therefore, it is important to regularly evaluate both the quality and quantity of tears in patients with beta-thalassemia.

Improvement in Tear Ferning Patterns of Sheep Tears After Addition of Various Electrolyte Solutions.

Objective: This study aimed to improve the tear ferning (TF) patterns in the sheep tears after the addition of various electrolyte solutions in different proportions. Animal Studied: Sheep were located at a small farm in the outskirts of Riyadh, Saudi Arabia. The sheep had no ocular disorders or diseases, and none of the female sheep were pregnant. Methods: Tear samples (20 µl) were collected from the right eyes of seven healthy sheep (five female sheep and two male sheep; age 7-36 months with an average of 17.0 ± 10.3 months). A tear sample (1 µl) from each sheep was dried on a microscopic glass slide at 22°C and <40% humidity. The TF patterns were graded based on the five-point grading scale in 0.1 increments. Homogenous mixtures were prepared by mixing tears from each sheep (0.5 µl) with various electrolyte solutions in different proportions (1:1, 1:2, 1:4, 1:6, 1:8, and 1:10). A sample of each mixture (1 µl) was dried on a glass slide, and the TF patterns for each mixture were observed, recorded, graded, and compared with those of the corresponding pure sheep tears. In addition, each sheep tear sample (0.5 µl) was diluted with pure water (0.5 µl) and the TF images were recorded and graded to test the dilution effect. Results: General improvement was noted in TF grades after the addition of electrolyte solutions, ranging from 1.7-1.4 to 1.3-0.3 regardless of the ratio between the electrolyte solutions and sheep tears within the mixture. TF grades of sheep tear samples improved significantly after adding different volumes of calcium chloride solution. Similar improvements in TF grades were observed when magnesium chloride hexahydrate and sodium dihydrogen phosphate solutions were used as the electrolytes. Some improvements in the TF grades occurred with the addition of potassium chloride to sheep tear samples. There was little improvement in TF grades after the addition of sodium chloride solution. Conclusion: Tear ferning grades of sheep tear samples improved when mixed with a number of electrolyte solutions at different volumes, in particular with calcium chloride or magnesium chloride solutions. Some improvements in TF grades were seen with sodium dihydrogen phosphate or potassium chloride solution added as the electrolyte. Clearly, divalent electrolytes lead to a greater improvement in TF grades of sheep tear samples as compared with sodium dihydrogen phosphate or monovalent electrolytes.

Order out of chaos: Sense of coherence and the mediating role of coping resources in explaining mental health during COVID-19 in 7 countries.

In the midst of the COVID-19 pandemic and the universal chaos created by it, this study explores the role of sense of coherence (Soc, Antonovsky, 1979) and how it enables coping with a stressful situation and staying well. SOC is a generalized orientation which allows one to perceive the world as comprehensible, manageable, and meaningful. In an attempt to understand 'how does the SOC work' we employed the salutogenic assumption that a strong SOC allows one to reach out in any given situation and find those resources appropriate to the specific stressor. Thus, we hypothesized that the positive impact of SOC on mental health outcomes would be mediated through coping resources that are particularly salient in times of crisis. One resource is related to the micro level (perceived family support) and the other concerns the macro level (trust in leaders and social-political institutions). Data collection was conducted in different countries during May-June 2020 via online platforms. The data included 7 samples of adult participants (age 18-90) from Israel (n â€‹= â€‹669), Italy (n â€‹= â€‹899), Spain (n â€‹= â€‹476), Germany (n â€‹= â€‹708), Austria (n â€‹= â€‹1026), Switzerland (n â€‹= â€‹147), and the U.S. (n â€‹= â€‹506). The questionnaires included standard tools (MHC-SF, SOC-13) as well as questionnaires of perceived family support and trust that were adapted to the pandemic context. As expected, SOC was associated with mental health in all the samples. Perceived family support and trust in leaders and social-political institutions mediated the relationships between SOC and mental health, controlling for age, gender, and level of financial risk. It appears that SOC has a universal meaning, not limited by cultural and situational characteristics. The discussion focuses on the theoretical, social, and political applications of the salutogenic model - and its core concept of SOC - in the context of coping with a global pandemic across different cultural contexts and countries.

Impact of COVID-19 pandemic on urology residency training.

CONTEXT: The COVID-19 pandemic has led a lot of countries worldwide to go on lockdown. Potential collateral damage is the impact of residency. AIMS: The aim of this study is to assess the impact of COVID-19 pandemic on urology training aspects, study habits of residents, and their awareness and training regarding COVID-19. SETTINGS AND DESIGN: A questionnaire aiming to assess the impact of COVID-19 pandemic on different urology training aspects. The questionnaire was sent to all urology residents under the Saudi Commission for Health Specialties (SCFHS) programs. SUBJECTS AND METHODS: Urology residents under SCFHS programs, excluding 1st-year residents. The questionnaire included the following sections: demographic data, studying habits during the pandemic, involvement in training before the pandemic, involvement in training during the pandemic, and training related to COVID-19. STATISTICAL ANALYSIS USED: Using the SPSS software, frequencies of all data were calculated, and a Wilcoxon-signed rank test was done to assess the change in ordinal data. RESULTS: A total of 77 residents completed the survey (38% response rate). Most residents (40.5%) reported that they "strongly agree" with the statement that they have more time for reading. There has been a decrease in on-call duties, outpatient visits, diagnostic procedures, endoscopic surgeries urology, minimally-invasive surgeries, and major open surgeries in comparison to before the pandemic, with a decrease in mean scores in all domains, especially in diagnostic procedures. CONCLUSIONS: There has been a decrease in residents' involvement in all training domains, and this has been similar to the results of other studies. E-learning sources, during these times, present themselves as a valuable source to compensate for what has been missed in training.

Survey of Saudi urology program directors: What do you look for in a candidate?

INTRODUCTION: Prospective urology applicants in Saudi Arabia must go through a rigorous matching process. Defining which aspects of an applicant's portfolio or interview will get them matched is difficult. Our objective is to provide information on which aspects of an application are the most important. SUBJECTS AND METHODS: In this cross-sectional study, an electronic survey was sent out to all urology program directors (PD). The survey included 27 items from an application that were rated by the respondent using a 5-point Likert scale. RESULTS: Twenty-three urology PD completed the survey (79.3% response rate). Most of the PD subspecialized in endourology and minimally invasive surgery. The three most important aspects as perceived by all responding PD were as follows: performance during rotation at the respondent's centre, publications in urology, and the total number of electives in urology. The three least important factors were as follows: presentations in fields other than urology, recommendation letters from nonurologists, and quality reference letters from nonurologists. CONCLUSION: Performance during rotations has been shown in our and other studies to be one of the most important factors in an application. Surveying PD on what they value the most in an applicant, provides valuable information and more transparency regarding the match processes. We also recommend that our colleagues from different specialties conduct similar studies.

Investigation of the repeatability of tear osmolarity using an I-PEN osmolarity device.

PURPOSE: To investigate the repeatability of tear osmolarity in healthy Saudi subjects using an I-PEN osmolarity device. MATERIALS AND METHODS: Thirty typical male subjects with healthy eyes (27.4 ± 4.9 years) participated in the study. Eye abnormalities were tested with a slit lamp, and eye comfort was determined with the surface disease index. Measurements of the tear break-up time and phenol red thread tests were used for as exclusion criteria. The tear osmolarity test, using an I-PEN osmolarity system, was performed three times in the right eye of each subject with a 5 min' gap between tests. RESULTS: The average osmolarity test score was 303.8 ± 4.8 mOsm/L. Tear osmolarity measurements showed tear osmolarity of 280-299 mOsm/L, 300-309 mOsm/L, and 310-329 mOsm/L in 14 (46.7%), three (10%), and 13 (43.3%) subjects, respectively. Correlations among the three I-PEN measurements were significant (Spearman's correlation coefficient; r = 0.036, 0.501, and 0.603; P = 0.050, 0.006, and 0.001, respectively). The mean coefficient of variance among the three measurements was 4.4%. CONCLUSION: The mean measurement of an I-PEN tear osmolarity was 303.8 ± 4.8 mOsm/L which is in agreement with the range of those reported for healthy subjects. The I-PEN is reliable and has the advantage of portability (hand-held) compared to the other osmolarity systems.

Analysis of Tear Ferning Patterns in Young Female Subjects with Refractive Errors.

To evaluate the dry eye symptoms and ocular tear film in young female subjects with refractive errors (RE) using the ocular surface disease index (OSDI), phenol red thread (PRT) and tear ferning (TF) tests. Methods. A group of 50 young female subjects (mean ± standard division = 20.3 ± 1.1 years) with RE (-0.25 to -6.00D) completed the study. An age-matched control group consisting of 50 healthy normal eye female subjects (22.2 ± 1.5 years) was recruited for comparison. The OSDI was completed first, followed by PRT and TF tests. Results. Median OSDI and TF scores were significantly higher (Mann-Whitney test; P < 0.001) among the study group subjects [median (interquartile range (IQR)) = 13.5 (15.3) and 1.6 (1.3), respectively] compared to the control group [6.0 (4.0) and 0.9 (0.8), respectively], whereas the median PRT score was significantly lower (Mann-Whitney test; P=0.003) in the study group [(27.5 (6.3) mm] compared to the control group [29.5 (5.0) mm]. For subjects within the mild RE group (N = 30), significant differences (Mann-Whitney test, P < 0.001 to 0.005) were found between the median OSDI, PRT, and TF scores and those recorded within the control group. For the subjects with moderate RE (N = 20), significant differences (Mann-Whitney test, P < 0.001 to 0.002) were found between the median OSDI and TF scores, and those recorded within the control group. Conclusion. The presence of RE in young females has a negative effect on tear film in terms of dry eye symptoms, tear volume, and TF grades. Dry eye symptoms experienced by subjects with RE and the TF grades were significantly higher compared with the control group. In addition, the tear volume was significantly lower in the study group. Clearly, RE has a risk factor for dry eye.