Evaluating patient safety research performance in Arab world countries: Changing trends and reflections.

Background and Objective: Patient safety is a major concern in health care. Research is an important tool to minimize preventable errors. Research performance and trends evaluation need to be identified for future guidance. Our objective was to evaluate the research performance in Arab World countries related to patient safety so that real picture is available to all stake holders for future application. Methods: This was a descriptive exploratory study carried at King Abdulaziz University Jeddah, using Bibliometric analyses on Web of Science extracted data, exploring the research publications related to Patient Safety from the Arab World in last two decades (2001-2020). Digital resources were used. Data collected was further explored to see the trends. Results: Only 2% of total worldwide publications on Patient Safety were from Arab World. A positive trend, however, has emerged since 2015. Out of 5940 documents identified, only 383 had single authorship. Egypt and Saudi Arab were the major contributors. Other countries had less or even zero publications. Researchers are coordinating with others in Western countries to enhance the research productivity. Cairo University with 734 publications had most affiliations. Publications on safety culture and medication safety were frequent. Hospital Acquired Infections and error reporting had limited research. Conclusion: Researches on patient safety in the Arab World are not sufficient. Countries other than Egypt and Saudi Arabia also need to contribute more frequently. Critical problems, like Hospital Acquired Infections, should have regular research from all countries to assist those treating patients and those making health related policies.

Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study.

Introduction: Skin Picking Disorder (SPD) is a skin-related disease, also recognized as psychogenic excoriation, dermatillomania, or excoriation disorder. SPD is defined as a habitual picking of skin, which in turn harms skin tissue. Given the paucity of information on SPD symptoms, their prevalence, and risk factors in Saudi Arabia, the present study seeks to fill this gap by investigating these factors in a community sample from Jeddah. Methods: This descriptive cross-sectional study was conducted in the city of Jeddah. The Skin Picking Scale-Revised (SPS-R) scale was administered to a convenience sample of 520 respondents. A partial least squares path model (PLS-PM) for "impairment" and "symptoms severity" subscales was assessed by evaluating the validity of measurement and structural models. Results: Skin picking behavior was reported by 28.8% (n=150). A significant level of skin picking disorder symptoms was present in 1.2% (n=6). Skin picking visual effect, depressive symptoms, and being unmarried were the only positive independent predictors of the total SPS-R score. Conclusion: SPD symptoms are relatively common among the adult population in Jeddah, but those with threshold symptoms indicative of SPD are relatively few. Such behavior is particularly common in vulnerable groups such as those with depressive symptoms and the unmarried. More attention to this condition by clinicians will improve the quality of life of those affected, and reduce the emotional and physical health consequences of this often unrecognized condition.

Evaluation of the virtual learning environment by school students and their parents in Saudi Arabia during the COVID-19 pandemic after school closure.

BACKGROUND: Very few previous studies have involved school students or their parents in the evaluation of virtual learning environment (VLE). Thus, this survey was performed to evaluate the satisfaction of both school students and their parents with the VLE in the Kingdom of Saudi Arabia during the COVID-19 pandemic. METHODS: A cross-sectional questionnaire-based survey was distributed online for VLE evaluation. The questionnaire was based on previous studies and expert opinions from validated instruments for assessing distance education, integrative and literature reviews of VLE environment. A median value >3 indicated participant satisfaction in each of the 5 domains of the questionnaire as well as overall VLE satisfaction. The used questionnaire was checked after its implementation by all possible statistical means and it was found to be of acceptable validity and reliability. RESULTS: Six hundred and ninety-three participants including 571 Saudi citizens and 122 non-Saudi residents participated in this survey. The number of school students who agreed or strongly agreed were significantly lower than the number of students who disagreed or strongly disagreed with preferring the VLE over traditional education (p<0.001). The participants evaluated the VLE experience as unsatisfactory with a median value ≤3 for 4 out of 5 questionnaire domains with an overall satisfaction value of 2.8. Among the 117 participants who gave further written opinions/comments, 42(35.9%) participants supported the VLE as an alternative to traditional classrooms, if equipment and internet are made available and for the safety of their children. CONCLUSIONS: This is one of few available adequate population-based studies for exploring the VLE satisfaction of both Saudi citizens and non-Saudi residents school students and their parents. This study showed the participants' unsatisfactory VLE experience. The VLE is accepted as an alternative to traditional classrooms to keep up with learning and to maintain the safety of children and it can be a supplementary learning method but many measures are still needed to develop the VLE.

Bibliometric Analysis of Global Research Productivity on Vitamin D and Bone Metabolism (2001-2020): Learn from the Past to Plan Future.

Vitamin D has long been known for preserving bone and non-skeletal health. Despite its magnitude of impact, scarce literature has explored the evolution of the relevant published literature. This study aimed at evaluating the trends and performance of Vitamin D and bone metabolism-related publications (2001−2020). All pertinent English language 16,887 articles were searched and extracted from the Web of Science (WoS) database and "R-Bibliometrix" was used for comprehensive analysis. Around 60,149 authors contributed from 114 countries, showing the USA on top with >1/4th of all articles, followed by Japan, China, and the United Kingdom. For authors, Cooper C, Dawson-Hughes B, and Holick MF were found to have written the most articles, citations and highest h-index, respectively. Corresponding authors from the top 20 countries collectively were responsible for around 84% of the articles. Among 2735 sources, Osteoporosis International (632), Journal of Bone and Mineral Research (569), and Bone (448) were foremost. Most prominent sources showed recent declining contributions. The increasing trend of publications with a higher spike from 2008 to 2014, followed by a gradual increase till 2017, was observed. Leading countries, affiliations, and authors showed collaborative publications and were mostly from developed countries with limited contributions, particularly from low- and middle-income countries.

Body Dysmorphic Disorder Symptoms: Prevalence and Risk Factors in an Arab Middle Eastern Population.

Background: The present study examined the prevalence of and risk factors for symptoms of body dysmorphic disorder (BDD) in the general population of Jeddah, a large port city in Saudi Arabia. Methods: This cross-sectional study surveyed a convenience sample of 520 adults. We used a validated self-screening measure to assess BDD, the body dysmorphic disorder questionnaire (BDDQ). Results: The prevalence of significant BDD symptoms among the general Saudi population was 8.8% (ie, those scoring above the cut off for BDD on the BDDQ). Over half (52%) of all respondents reported concerns about the attractiveness of their body parts, and of those expressing such concerns, 66% were preoccupied with these thoughts. Only 3% of all respondents opted for cosmetic surgery because of these concerns, and most of those individuals (69%) had only one surgery. Nearly 9% of all respondents reported that these concerns affected their relationships with family and friends. Almost 15% of all participants spent an hour or more each day thinking about these concerns. Patients who reported a history of depression were 3.8 times more likely to have BDD. Other variables included in the model predicting high BDD scores (eg, age, job status, and marital status) did not achieve statistical significance. Conclusion: Significant symptoms of BDD (based on the BDDQ) are not uncommon among the general population of Jeddah, Saudi Arabia. Risk factors for this condition were female gender, younger age, being unmarried, and in bivariate and multivariate analyses, history of depression and female gender. These findings underscore the need for increased awareness by clinicians of this disorder, particularly when treating patients with depressive disorder, particularly among women.

The long-term impact of neck scar satisfaction among thyroid surgery patients.

This study evaluated scar satisfaction in Arabic patients who underwent thyroidectomy surgery using validated assessment tools. We aimed to assess the relationship between scar length and scar satisfaction, and validate Arabic versions of the universally used scar satisfaction questionnaires. In this retrospective cohort study, 60 patients who underwent thyroidectomy at King Abdulaziz University Hospital were enrolled. Scars were evaluated in two stages: firstly, by a clinician, and secondly, by a naïve observer. Ratings of disfigurement were measured using the validated Patient and Observer Scar Assessment Scale (POSAS) that was translated into Arabic. Results: The Arabic version of the POSAS showed good or excellent reliability. Average POSAS scores were 12.88, 18.02, and 7.53, respectively, indicating that most patients were satisfied. Incision size and POSAS scores (but not Patient and Naïve Observer scores) were positively correlated, and larger incisions resulted in greater dissatisfaction. Fitzpatrick Skin Type score and Observer scores were positively correlated, but there were no significant correlations between Patient and Naïve Observer scores with skin type. In conclusion, this study validated the Arabic version of universally used questionnaires for scar satisfaction. Most patients were satisfied with their neck scars regardless of scar length. Our findings pave the way for further research into patient postoperative scar satisfaction in Arabic-speaking populations.

Psychosocial, cultural, and academic challenges to Saudi Arabian students in Australia.

OBJECTIVES: This study investigated the perceptions of Saudi Arabian medical disciplines students undergoing training in various institutes of Australia regarding psychosocial, cultural, and academic challenges. METHODS: This cross-sectional study was from March 15 to June 15, 2019. Data were collected by an online questionnaire. It consisted of questions regarding demographic, psychosocial, cultural, and academic challenges. Two hundred nineteen students studying in Australia responded to our questionnaire. RESULTS: Of the total 219 students, 13(6.0%) were undergraduate, 167(76%) were postgraduate, and 39(18%) were Ph.D. students. For most students (171[79.2%]), Australia was the country of choice for studying. Most of them were satisfied with their academic performance and adjustment to the Australian way of living. Most of the students (180[82.2%]) showed satisfaction over the availability of fair chances of their religious practices in Australia. Few of them faced difficulties coping with the Australian climate (25[11.4%]), homesickness (59[26.9%]), and food and dietary sources (44[20.1%]). Students were overall satisfied with the student advisory system (156[71.2%]), university assessments (147[67.2%]), and available research facilities (170[77.6%]). Among participants, 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively. CONCLUSIONS: Our findings showed that Saudi students in Australia had strong psychosocial well-being, cultural integration, and academic success. Most of them were satisfied and adjusted well to Australian culture.

Medical Schools' Ophthalmology Course: An Appraisal by Ophthalmology Residents.

OBJECTIVE: To investigate the perception and satisfaction of ophthalmology residents with the currently provided ophthalmology curricula to medical students. METHODS: A cross-sectional survey involving first to fourth year ophthalmology residents (N = 106) from all regions of Saudi Arabia was conducted between December 2018 and February 2019. An online questionnaire explored opinions about the ophthalmology course regarding three dimensions. Firstly, adequacy in covering essential parts of the specialty; secondly, improvements required; and thirdly, effectiveness. A score (0-21) was calculated, indicating the overall suitability of the ophthalmology course. In addition, factors of good overall suitability (score ≥10) were analyzed. RESULTS: Regarding adequacy, respondents opined that the ophthalmology course did not reasonably cover the basic part (35.8%), clinical part (61.3%), common disease (26.4%), and emergencies (39.6%). Concerning improvements required, more than 80% of the participants expressed that the course required to be improved for all its features, including duration (80.2%), objectives (85.8%), content (82.1%), organization (83.0%), and supervision (81.1%). As to effectiveness, half of them deemed the course unhelpful in familiarizing general practitioners with common ophthalmic diseases and emergencies. Overall, the ophthalmology course was generally deemed suitable (score ≥10) for only 27.4% of the participants, with no differences across gender, level, or region. CONCLUSION: Ophthalmology residents perceived multiple deficits in the current Saudi ophthalmology teaching course. Significant improvements in ophthalmologic curricula are required, besides coping with unprecedented technological advancement in the ophthalmological field.

How Relevant is Obstetrician and Gynecologist Gender to Women in Saudi Arabia?

BACKGROUND: The patient-doctor relationship is one of the most important factors in determining the outcome of healthcare. The first step in establishing this relationship is choosing a physician. This study sought to identify patient preferences concerning the gender of their obstetrics and gynecology (OB-GYN) physician and the effect of religion and society on these choices. METHODS: A cross-sectional study was conducted at the OB-GYN outpatient clinics at King Abdulaziz University Hospital in Jeddah between February 2017 and June 2017. A total of 227 female patients were recruited. Eligible were women ages 18 years or older who had attended the clinic at least three times. A 30-item questionnaire was administered. RESULTS: Significantly, more female doctors were preferred for pelvic examination in lower income group (p=0.003), while male doctors were preferred for surgery (p=0.010) in higher income group. Significantly more male doctors were preferred for pelvic examination and gynecological surgery in >35-year age group (p=0.015 and p=0.017, respectively). With regard to predictors, embarrassment was the most significant factor reported for not choosing a male obstetrician/gynecologist (OB-GYN) in the younger age group. Nearly three-quarters (71.2%) of respondents with age ≤35 reported embarrassment as a factor for not choosing a male OB-GYN; 79.7% of this subgroup indicated that female doctors were more knowledgeable about women's health issues. CONCLUSION: Participants expressed a strong preference for female providers overall, although some women preferred male providers during certain circumstances (gynecologic surgery). Despite these gender preferences, more important to women in their choice of OB-GYN provider was the doctor's experience, qualifications, and reputation. Such trends are consistent with those culturally similar countries and in line with trends worldwide. These findings have the potential to significantly impact the personal health for women in Saudi Arabia and elsewhere in the Middle East where religious and cultural traditions are so important in decision-making.

Sensitivity Assessment of Wilms Tumor Gene (WT1) Expression in Glioblastoma using qPCR and Immunohistochemistry and its Association with IDH1 Mutation and Recurrence Interval.

PURPOSE: Wilms tumor 1 (WT1) gene has recently shown a role in gliomagenesis, making it a potential immunotherapy target in glioblastomas. We aimed to investigate the most sensitive method to detect WT1 expression in glioblastoma and explore the relationship between WT1 expression, IDH1 mutation and recurrence interval. PATIENTS AND METHODS: Clinical data were collected from 44 patients with glioblastomas, treated with adjuvant therapies. WT1 expression was assessed in all cases using immunohistochemistry (IHC), while its gene expression was assessed in 13 clustered samples using polymerase chain reaction (qPCR). IDH1 mutation was assessed using IHC. The sensitivity between IHC and RT-qPCR was examined. Kaplan-Meier curves were used to compare the recurrence-free interval (RFI) between IDH1 and WT1 expression groups. RESULTS: IDH1wildtype was found in 26 cases (59.1%) and the remaining 18 cases (40.9%) were IDH1mutant. Through IHC, WT1 was overexpressed in 32 cases (72.7%), partially expressed in 9 cases (20.5%) and not expressed in only 3 cases. For the 13 cases tested by qPCR, 6 cases showed WT1 upregulation and 7 cases showed WT1 downregulation. There was no significant difference in WT1 expression among cases with different RNA concentrations regardless the testing method (p-value >0.05). However, the difference between IHC and qPCR was significant. IDH1mutant cases with WT1 overexpression showed significant difference in RFI (p-value =0.048). CONCLUSION: Parallel testing for WT1 expression using IHC and qPCR is not reliable. However, IHC provides more accurate results. Moreover, IDH1mutant glioblastomas with WT1 overexpression are associated with late RFI particularly if temozolomide with additional chemotherapies are used.

Epidemiological distribution of primary central nervous system tumors in the Western Province of Saudi Arabia: a local registry from neuroscience-affiliated centers.

OBJECTIVES: Central nervous system (CNS) tumors are a major and growing global healthcare challenge. Western Saudi Arabia has an inconsistent data registry; therefore, the epidemiology of CNS tumors is unclear across the country. This study is aimed to assemble the epidemiological matrix of CNS tumors in the Western Province of Saudi Arabia. METHODS: A retrospective analysis was performed using clinical data obtained from 3 neuroscience centers in Western Saudi Arabia in the period 2014-2019. The sample size included 663 adult and pediatric cases from the local and expatriate populations diagnosed with CNS tumors. The distributions of age, sex, clinical presentation, tumor location, type of surgery, histological subtype, genetic characteristics, and recurrence rate were explored. RESULTS: The analysis included 500 adult cases and 163 pediatric cases up to 18 years of age with a male-to-female ratio of 1.16. The mean age at diagnosis was 38.0±22.6 years. The supratentorium was the most common location (n=515, 77.7%). Most patients presented with headache (n=298, 44.9%), followed by a focal neurological deficit (19.9%). The most common primary CNS tumor was glioblastoma (n=234, 35.3%), followed by meningioma (n=100, 15.1%). The recurrence rate after surgery was estimated to be 40.9% among all CNS tumors. CONCLUSIONS: This is the first tumor registry of Western Province of Saudi Arabia that describes the distribution of primary CNS tumors and highlights their epidemiological matrix. Several incidence trends in terms of histological type, age group, sex, location, and recurrence were determined, and some genetic characteristics were recognized.

Prognostic value of TP53 expression and MGMT methylation in glioblastoma patients treated with temozolomide combined with other chemotherapies.

OBJECTIVE: To assess the recurrence interval and predictive significance of TP53 expression and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas treated with radiotherapy and combined chemotherapies, including temozolomide, lomustine, procarbazine and bevacizumab. METHOD: We reviewed the clinical outcomes of 52 totally resected glioblastoma patients, who received conventional radiotherapy and temozolomide with other chemotherapeutic agents. Correlation of TP53 expression and MGMT promotor methylation with recurrence interval was analyzed using Kaplan Meier estimates. RESULTS: No significant association was found between MGMT promotor methylation and TP53 expression in glioblastomas (P-value = 0.158). Patients with non-methylated MGMT who received temozolomide chemotherapy with other chemotherapeutic agents showed significantly later recurrence (P-value = 0.007) compared with patients with non-methylated MGMT who received temozolomide alone. No significant difference was found in recurrence interval among glioblastoma patients with methylated MGMT who received temozolomide alone or with other chemotherapies (P-value = 0.667). Moreover, patients with non-TP53-expressing tumors who received temozolomide with other chemotherapies had significantly later recurrence (P-value = 0.04) compared with patients who received temozolomide alone. CONCLUSION: Totally resected glioblastoma patients, with non-methylated MGMT or non-TP53-expressing tumors treated with radiotherapy and combined chemotherapies had a reduced chance of tumor recurrence and a more favorable outcome. Furthermore, both MGMT and TP53 are independent prognostic factors for glioblastoma.

A scientometric analysis on coronaviruses research (1900-2020): Time for a continuous, cooperative and global approach.

Infectious diseases remain a complex, recurring, and challenging public health hazard. Coronaviruses have led to multidimensional consequences on health, mobility, and socio-economic conditions. Despite the significance and magnitude of impact from epidemics to the pandemic, literature is sparse on comprehensive coronaviruses related research performance over time. This study aimed at a scientometric evaluation of coronaviruses related literature including COVID-19. Data related to Coronavirus research was extracted from the Web of Science (WoS). All types of publications (28,846) were included and retrieved. To measure the quantity and quality of the publications, "R-Bibliometrix" package was used for detailed analysis exploring a wide range of indicators. Generally, an increasing trend was observed over time led by the USA and China followed by the United Kingdom, Europe, and few other developed countries. The last two decades contributed around 39.5% of documents while only 06 months of 2020 additionally contributed around 46.5% of total documents. Earlier shorter spikes of increased post epidemic publications followed by decreased productivity were detected in the last 2 decades and showed a lack of continuity-'a research epidemic following a disease epidemic'. Articles (53.4%) were the most common publication type. Journal of Virology, British Medical Journal (BMJ), and Virology were leading sources while BMJ, and Lancet showed increased contributions recently. Overall, similar trends of top authors were observed in terms of productivity, impact, collaborations, funding sources, and affiliations with few exceptions mainly from affected regions. Top 20 countries contributed >89% of documents suggesting a lack of global efforts. Networking was found to be mainly among developed nations with limited contributions from resource-limited countries perhaps requiring more cooperation. Recent post-COVID publications rise is highest, unprecedented, and rapidly growing. Authors strongly recommend recent COVID-19 pandemic as a call for continuous, more cooperative, and collective global research.

The Assessment of Major Histocompatibility Complex (MHC) Class-I Expression in Different Neuromuscular Diseases.

BACKGROUND: Major histocompatibility complex (MHC) class-1 antigen is a glycoprotein expressed in all nucleated cells. The aim of this study was to assess MHC class-I expression in different neuromuscular diseases. METHODS: The authors reviewed the data of 54 patients with neuromuscular diseases. Anti MHC class-I antibody was performed on the frozen muscle tissues using immunohistochemistry. MHC class-I was scored based on its expression on muscle fibers (0: normal, 1: expression <5 fibers, 2: expression in 5-10 fibers, 3: expression in >10 fibers). The pattern was only assessed in cases with MHC class-I scored 3 as: (1: Sarcocapillary, 2: Sarcocapillary and necrotic fibers, 3: Perifascicular). The relationship between MHC class-I expression and neuromuscular diseases was statistically analyzed. RESULTS: The mean age of the patients was 39.1 ± 18.5 years. Around 50% of patients showed normal CK levels and 5% of the cases showed elevated CK levels. There was a significance difference in MHC class-I expression between cases with normal and elevated CK levels when MHC class-I score was 3 (p= 0.020). There was a significant difference in MHC class-I expression among different neuromuscular diseases (p<0.001). All cases with idiopathic inflammatory myopathies (IIMs) have expressed MHC class-I in more than 10 fibers. MHC class-I was expressed in 15 cases of non-IIMs. CONCLUSION: MHC class-I cannot be solely used as a biomarker to distinguish IIMs from non-IIMs. The presence of MHC class-I molecules in non-IIMs might be related to immunoproteasomes mechanism. Further studies, with different muscle proteins expression and genomic sequencing, must be conducted to understand the role of MHC Class-I in neuromuscular diseases.

The relationship between CD204 M2-polarized tumour-associated macrophages (TAMs), tumour-infiltrating lymphocytes (TILs), and microglial activation in glioblastoma microenvironment: a novel immune checkpoint receptor target.

BACKGROUND: Tumour associated macrophages (TAMs) and tumour infiltrating lymphocytes (TILs) are considered dominant cells in glioblastoma microenvironment. AIM: The purpose of this study was to assess the expression of CD204+ M2-polarized TAMs in glioblastomas and their relationship with CD4+TILs, Iba+microglia, and IDH1 mutation. We also exploreed the prognostic value of these markers on the recurrence-free interval (RFI). METHODS: The expressions of CD204+TAMs, CD4+TILs, and Iba1+microglia were quantitively assessed in 45 glioblastomas using immunohistochemistry. Kaplan-Meier analysis and Cox hazards were used to examine the relationship between these factors. RESULTS: CD204+TAMs were highly expressed in 32 tumours (71%) and the remaining 13 tumours (29%) had reduced expression. CD4+TILs were highly expressed in 10 cases (22%) and 35 cases (77.8%) had low expression. There was an inverse correlation between CD204+TAMs and CD4+TILs, in which 85% of tumours had a high expression of CD204+TAMs and a low expression of CD4+TILs. Nevertheless, there was no significant difference in IDH1 mutation status between the two groups (p = 0.779). There was a significant difference in Iba1+microglial activation between IDH1mutant and IDH1wildtype groups (p = 0.031). For cases with a high expression of CD204+TAMs and a low expression of CD4+TILs, there was a significant difference in RFI after treatment with chemoradiotherapy or radiotherapy (p = 0.030). CONCLUSION: Glioblastoma with a dense CD204+TAMs and few CD4+TILs is associated with IDH1wildtype. These findings suggest that TAMs masks tumour cell and suppress T-cell tumoricidal functions via immunomodulatory mechanisms. Blockade of the CD204-TAM receptor may prevent this mechanism and allow the evolution of TILs.

Scientometric Evaluation of Research Productivity on Diabetes from the Kingdom of Saudi Arabia over the Last Two Decades (2000-2019).

MATERIALS AND METHODS: Data was extracted from the Web of Science (WoS) platform and later bibliometric analysis performed using the "R-Bibliometrix" package. A wide range of indicators was explored to measure the quantity and quality of the publications related to diabetes from KSA. RESULTS: Saudi Arabia was 28th in rank with 2600 documents (0.83% of global share). Articles were the main document type (76%). The total number of authors was 9715 from 104 countries. Three authors showed >50 publications and >100 total citations while 2 authors showed an H-index of ≥20. The USA, UK, and Egypt were other leading contributive countries in terms of corresponding authors and total citations per country. King Saud University was the major contributing affiliation followed by King Abdulaziz University. Among 865 sources, Saudi Medical Journal was the leading and consistent source over the years. Diabetes, Diabetes Mellitus, and Type 2 Diabetes were the most frequently used keywords. CONCLUSION: This study provides a macroscopic overview of diabetes-related research output from KSA. Overall, similar identifications and trends of top authors were observed in terms of productivity, impact, international collaborations, and organizational affiliations. Generally, an increasing productivity trend was observed with the majority published in the last 5 to 10 years. Study findings can benefit relevant stakeholders to better understand the trends and performance of diabetes-related regional research.

Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia.

INTRODUCTION: Heart failure (HF) affects about 320,000 Saudi individuals and is associated with a considerable negative impact on the patients' quality of life. In literature, there is a lack of data about the echocardiographic abnormalities of HF patients in Saudi Arabia. AIM OF WORK: To describe the echocardiographic findings of HF patients in Western Saudi Arabia. METHODOLOGY: This was a retrospective record review study conducted on 2000 patients with chronic HF in Saudi Arabia. Demographic, clinical and echocardiographic data were collected and compared among patients with HF with reduced ejection fraction (HFrEF), ie, EF≤40%; HF with mid-range EF (HFmrEF), ie, EF=41-49%; and HF with preserved EF (HFpEF), ie, EF≥50%. RESULTS: Among the 2000 patients studied, females constituted 46.3% of the sample. About 52% of females had HFpEF, whilst 70% of males had HFrEF (p<0.0001). Diastolic dysfunction occurred in 98% of HFpEF versus 78% of HFrEF (p<0.0001). Patients with HFrEF had higher left-ventricular diastolic (LVd) volume (1536 versus 826), higher left-ventricular systolic (LVs) volume (1660 vs 772), higher left atrial volume (1344 vs 875), higher aortic root dimension (1144 vs 929) and lower fractional shortening (FS) (267 vs 1213) than patients with HFpEF (p<0.0001). CONCLUSION: HFpEF was more common among females and was associated with higher rates of diastolic dysfunction and higher FS. HFrEF was prevalent among males and associated with higher LVd, LVs, left atrium volume and aortic root dimensions.

Assessing reliability and validity of Revised Biggs Two-Factor study process questionnaire to measure learning approaches among undergraduate medical students in Lahore, Pakistan.

OBJECTIVE: To assess reliability and validity of Revised Biggs Two-Factor Study Process Questionnaire to measure Learning approaches among medical students. METHODS: The cross-sectional study was conducted at Shaikh Zayed Medical College, Lahore, Pakistan, from November 15, 2014, to January 15, 2015. The 20-item Revised Biggs Two-Factor Study Process Questionnaire was used to assess medical students enrolled from the first to the final year of their studies. Data was analysed using SPSS 20. The reliability of the questionnaire was assessed by Cronbach's alpha, and confirmatory factor analysis was done to confirm the factor model. RESULTS: Of the 480 students approached, 284(59.2%) completed the questionnaire. Cronbach's alpha value was found acceptable at 0.79 and 0.72 for the deep approach and surface approach scales respectively. Comparative Fit Index value (0.858) confirmed a good fit for the model. CONCLUSIONS: Revised Biggs Two-Factor Study Process Questionnaire was found to be a reliable and valid instrument to measure learning approaches among medical students.

Medical students' preferences towards learning resources and their study habits at King Abdulaziz University, Jeddah, Saudi Arabia.

OBJECTIVE: The purpose of the present study was to explore why our medical students are avoiding the study of professional textbooks. We conducted this study from 10th March to 15th May 2017 at the King Abdulaziz University (KAU), Jeddah, to investigate their preferences towards learning resources, their study habits and correlation of academic achievements as a result of these trends. A questionnaire was provided as a web link. The participants of the study included medical students and data was analyzed on SPSS-Version 21. RESULTS: A total of 347/500 medical students participated in the study. Among our participants, there were 123 (35.5%) males and 224 (64.6%) were females. Female students' spent most of their time reading textbooks as compared to males (P-value = 0.001). Males mostly preferred the lecture handouts provided by their teachers. One-third of students admitted that, due to lack of a good grasp of English, they do not readily understand textbooks and consequently 67 (19.3%) students' showed a lack of interest in textbooks. Majority of the males 103 (84%) spent twice a time (66 vs. 33%) watching television as compared to the females. WhatsApp and Facebook kept both the sexes busy in most of their spare time.

Awareness of diabetic retinopathy among people with diabetes in Jeddah, Saudi Arabia.

BACKGROUND: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the foremost cause of blindness. This study aimed to assess the level of awareness of DR and its related risk factors among patients with DM in Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted among patients with DM attending primary health care centers at the Ministry of Health in Jeddah. A structured, pretested, self-administered questionnaire was used to collect information on the sociodemographic and DM- and DR-related characteristics of the patients. RESULTS: A total of 377 patients were enrolled. About 82.6% of the patients were aware that DM can affect their eyes, and they listed physicians, ophthalmologists, television, and family members as common sources of information on the topic. About 36% of the patients reported that their doctors had not advised them about it. More than half responded that they did not feel their vision to be affected by DM. More than 58% had never been diagnosed with DR. About 35% did not go to their eye checkups, even though around 59% thought that DR could lead to blindness. Of the 64% of patients whose DM was well controlled, 11% and 25% listed surgery and laser treatment, respectively, as available treatment options for DR. The following factors were found to be significant in relation to the subjects' awareness that DM can affect their eyes: the patients' perception of their doctors' advice about DR; the experience of having their vision affected by DM; the knowledge that DR may lead to blindness; the practice of going to eye checkups. CONCLUSIONS: Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.