Prevalence of Health Problems Targeted by the National School-Based Screening Program among Primary School Students in Saudi Arabia, 2019.

The Saudi Ministry of Health (MOH) established a National School-Based Screening Program (NSBSP) for health screening of schoolchildren. Students from specific grades were systematically screened for several health problems, including obesity, visual and auditory problems, dental cavities, scoliosis, and attention-deficit/hyperactivity disorder (ADHD). This cross-sectional study aimed to determine the prevalence of these health problems among primary school students based on secondary data obtained from the NSBSP. We included 444,259 screened school children from the first and fourth grades of 50% of the selected schools (both private and public) across the Kingdom of Saudi Arabia (KSA) during the academic year 2018-2019. Among them, the most prevalent health problems identified were dental cavities (38.7%), eye refractory errors (10.9%), and overweight and obesity (10.5%); the less prevalent problems included ADHD (2.81%), auditory problems (0.6%), and scoliosis (0.48%). A greater prevalence of most health problems was observed in girls more than boys. The NSBSP successfully aided the detection of health conditions with high and low prevalence among primary school students in the KSA, and thus, the identification of health problems of specific concern. Implementation of effective school health services for the prevention, early detection, diagnosis, and treatment of these health problems are imperative.

The validation and cross-cultural adaptation of the Arabic version of the pregnancy physical activity questionnaire.

OBJECTIVES: To translate the pregnancy physical activity questionnaire (PPAQ) into Arabic language, cross-culturally adapt and test its reliability and validity among Saudi pregnant women. METHODS: Pregnancy physical activity questionnaire, which consisted of 36 items, was translated to Arabic following the World Health Organization's guidelines for tool translation (forward translation, expert panel and back translation, pretesting and cognitive interviewing, and final version), followed by validation by experts. This is a cross-sectional study and data were collected from 118 healthy pregnant Saudi women from May to June 2019. Validity included content validity indices (CVI) and construct validity by Rasch analysis. Reliability was assessed by test-retest reliability and Cronbach's alpha coefficient. RESULTS: The mean age of the participants was 30.15 ± 5.59 years; 38.2% of them had normal pre-gestational body mass index (n=45). The median of total energy expenditure in physical activity was 356.1 METs.h/week (IQR=162.3-648.3). Item content validity index was good ranging between 0.8-1. Rasch analysis showed good construct validity and excellent reliability for all types of physical activity (>0.89). CONCLUSION: This Arabic PPAQ is a reliable and valid tool that can be used in Arab countries.

Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study.

OBJECTIVE: To evaluate the accuracy of the four malignancy risk indices to distinguish benign from malignant ovarian masses MATERIALS AND METHODS: This was an observational cross-sectional study conducted on 155 patients between January 2016 and January 2019. Women with ovarian masses planned for surgical management were recruited from the outpatient Gynecology clinic of the hospital. The risk of malignancy index (RMI 1-4) was calculated for all women with ovarian masses. Biopsies obtained from the ovarian masses after the surgical intervention was sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses was considered the gold standard for diagnosis. RESULTS: The participants' mean age in the group of patients with benign masses was 33.50 ± 14.53 years versus 45.09 ± 13.67 years in the malignant group. The two most prominent features in the malignant group were solid areas in 85.3 % of malignant masses and about 91.2 % of malignant masses showing size <7 cm in their largest diameter. The RMI's most sensitive individual parameter was the CA-125 level, while the lowest sensitivity was for the menopausal status. RMI 2 had the highest sensitivity of 76.47 %, while RMI 1 and 3 had the highest specificity, 92.56 %. RMI 2 had the highest AUC, 0.83. CONCLUSIONS: RMI 2 is a simple and reliable tool and had the best performance among all RMIs in benign discrimination from malignant ovarian masses with high sensitivity and accuracy.

Transumbilical Vaginoplasty Through Fractionated Miniports: A Sutureless Procedure.

BACKGROUND: Vaginal agenesis is a müllerian anomaly characterized by congenital absence of the vagina. In this case series, the authors describe a novel, minimally invasive technique using microport entry for treatment of complete vaginal agenesis. TECHNIQUE: A balloon catheter is passed through a fenestrated perfluoroalkoxy polymer resin-supporting platform, then tied by a silk suture over the caudal end of the inserter. Two 4-mm microports are created intraumbilically; one to insert the scope and the other to introduce the catheter inserter that is advanced under direct vision. The inserter loaded with a catheter is passed across the pelvic floor to position the balloon at the vaginal dimple. The balloon is inflated and tightly positioned against the dimple. The perfluoroalkoxy polymer resin piece is clamped at the umbilicus. Traction is applied to the catheter stem and increased progressively to achieve desired vaginal depth. EXPERIENCE: Twenty-two women aged 17-28 years with vaginal agenesis underwent microport vaginoplasty. Twenty-one women were diagnosed with müllerian agenesis and one patient with androgen insensitivity syndrome. Preoperative vaginal depth ranged between 0.5 and 3 cm. The procedure was well tolerated with no intraoperative or postoperative complications. Patients achieved neovaginal depth between 9 and 11 cm and penetrations scores increased to 80-90%. CONCLUSION: Microport vaginoplasty is a feasible and effective procedure for management of vaginal agenesis.

Consistency of child self-reports with parent proxy reports on the quality of life of children with attention-deficit/hyperactivity disorder in Riyadh, 2016.

BACKGROUND: The quality of life (QoL) of children with attention-deficit/hyperactivity disorder (ADHD) has not been addressed in Saudi Arabia despite the considerable attention it has on account of its prevalence, duration of illness, and sociopsychological effects. The aim of this study was to report on the QoL of children with ADHD and test the concord between children's and parents' reports. MATERIALS AND METHODS: Using the generic PedsQL™ (version 4.0) from both children's and parents' perspectives, a cross-sectional study of 112 children was conducted on children aged 5-18 years with an established diagnosis of ADHD attending child psychiatry clinics of three referral hospitals in Riyadh between December 2015 and May 2016. RESULTS: A total of 112 children with an established diagnosis of ADHD were recruited from the Child Psychiatry Clinic of Al Amal Mental Health Complex (41.1%), Prince Sultan Military Medical City (PSMMC), (33%), and King Khalid University Hospital (KKUH), (25.9%). The majority were boys (74.1%) and Saudi nationals (93.8%). The mean age of children with ADHD was 10.45 ± 3.06 years (Range 5 - 18 years). One-fourth of the mothers of children with ADHD had completed high school and 41.1% had a diploma, university, or postgraduate degree. One-third of the fathers of these children had completed high school (34%) and 38.4% had a diploma, university, or postgraduate degree. The intra-class correlation coefficients between the scores of children and parents were good for physical functioning, fair for social functioning, but moderate for school, emotional, and psychosocial functioning. Children rated themselves significantly better than their parents for emotional, social, school, and psychosocial functioning. The standardized response means indicated a small difference for social functioning and medium differences for the other three domains. The only significant discrepancy was observed in social functioning in relation to the child's age. CONCLUSION: Parents mirrored adequately the observable physical component of the QoL of their children. The QoL report of children with ADHD with respect to communications and intellectual abilities should be taken into account whenever possible and their parents' report also should be sought to provide a more comprehensive view of the child's status.

Effectiveness of injecting lower dose subcutaneous sterile water versus saline to relief labor back pain: Randomized controlled trial.

INTRODUCTION: The aim of this study was to investigate the effect of a lower dose subcutaneous sterile water injection technique versus subcutaneous saline injection, on the relief of low-back pain for women during childbirth, and to explore the lasting effects of pain relief after administration (followed at 15, 30, 45, 90 and 120 minutes). METHODS: A prospective randomized controlled single-blinded study was conducted, with trial registration (NCT02813330). Women received one-time injections (sterile water or saline) and the effectiveness was observed at 15, 30, 45, 90 and 120 minutes after the intervention. RESULTS: The intervention group had statistically significant pain reduction. Assessment of subsequent pain, followed at 30, 45, 90 and 120 minutes, reflected an increasing change with a statistically significant difference. The intervention group had more burning sensations than the control group with a statistically significant difference. CONCLUSIONS: The modified technique of double injections of subcutaneous 'water/ saline' resulted in significant relief of low-back pain during childbirth.

Effect of female genital mutilation/cutting; types I and II on sexual function: case-controlled study.

BACKGROUND: The existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women. METHODS: We recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM. RESULTS: Female sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%). FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control. CONCLUSION: In this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.

A Cost-Effective Method to Assemble Biomimetic 3D Cell Culture Platforms.

METHODS: We utilized the hAM to provide the biological and the three dimensional (3D) topographic components of the prototype. The 3D nano-roughness of the hAM was characterized using surface electron microscopy and surface image analysis (ImageJ and SurfaceJ). We developed additional macro-scale and micro-scale versions of the platform which provided additional shear stress factors to simulate the fluid dynamics of the in vivo extracellular fluids. RESULTS: Three models of varying complexities of the prototype were assembled. A well-defined 3D surface modulation of the hAM in comparable to commercial 3D biomaterial culture substrates was achieved without complex fabrication and with significantly lower cost. Performance of the prototype was demonstrated through culture of primary human umbilical cord mononuclear blood cells (MNCs), human bone marrow mesenchymal stem cell line (hBMSC), and human breast cancer tissue. CONCLUSION: This study presents methods of assembling an integrated, flexible and low cost biomimetic cell culture platform for diverse cell culture applications.

Laparo endoscopic single site balloon vaginoplasty (LESS-BV).

OBJECTIVE: To evaluate feasibility, advantages, and disadvantages of the laparo-endoscopic single site surgery (LESS) technique for balloon vaginoplasty (BV). STUDY DESIGN: Cohort study. SETTING: Tertiary care facility. RESULTS: LESS-BV was successfully performed in 6 patients with Mullerian aplasia and one with androgen insensitivity syndrome (AIS). Patients presented with failure of intravaginal intercourse and/or dyspareunia. The procedure was performed successfully in conjunction with gonadectomy for the AIS case. The total operative time was 50-75 minutes. No operative complications were reported. Postoperative pain scores ranged from 0 to 2 points at rest and from 20 to 60 points during dressing change, increasing distension, and traction. The depths of the constructed neovaginas measured up to 12.8 cm. Sexual intercourse was initiated on the day of catheter removal. Penetrations and satisfactions scores increased to up 90 points for both partners. CONCLUSIONS: LESS-BV is technically feasible. LESS-BV allows better, stronger midline and long traction pass along the anatomic longitudinal axis of the hypoplastic vagina. Surgical outcomes should be compared prospectively to conventional laparoscopic BV.

A rescue management plan for ruptured balloons during balloon vaginoplasty.

OBJECTIVES: To present the first repeat procedure and a simple way for management of balloon rupture during balloon vaginoplasty (BV) procedures. STUDY DESIGN: Repeat BV (reBV) procedure was done for one case, and a ruptured catheter's end to new catheter's end (ENE) procedure was done for two cases. The anatomic and functional outcomes of reBV and ENE are presented. RESULTS: Balloon rupture and deflation were encountered in a total of 3/45 cases who had undergone BV procedures. Replacement time was 22 min for reBV, and 9 and 10 min for ENE. General anesthesia was needed in the reBV case. Post-operative course and final outcomes were generally good but objectively less favorable in the ENE than in the reBV case (neovaginal depths were 8.5 and 9.4 cm versus 11 cm, respectively). Penetration and satisfaction scores were increased up 85 points for both couples. CONCLUSIONS: Balloon ruptures were reported in 3/45 cases undergoing balloon vaginoplasty. End to new catheter end replacement was a very fast and simple rescue procedure but its preliminary anatomical outcomes were less favorable than the outcomes obtained with the original or repeat procedure.

Hybrid septate uterus, coexistence of bicornuate and septate varieties: a genuine report.

AIM: To highlight the coexistence of a uterine septum in cases diagnosed as bicornuate uterus on the basis of the external shape of the uterine fundus and to present the outcomes of its hysteroscopic management. METHODS: Descriptive clinical report. Cases with two-chambered uterine cavities were recruited with exclusion of cases with pure bicornuate uteri. The differentiation between hybrid and pure septate uterine varieties was based on clinical evaluation, transvaginal ultrasonic evaluation, hysterosalpingography and in addition to bimanual examination under anesthesia. The final diagnosis was confirmed by combined hysteroscopy-laparoscopy examinations. Cases with pure and hybrid septate uteri were managed by hysteroscopic metroplasty and the outcomes were compared. RESULTS: Out of 357 cases of double chambered uteri, 18 cases (5%) were found to be a pure bicornuate variety (PBV), 322 (90.2%) cases were found to have pure septate variety (PSV) and 17 cases (4.8%) were found to have hybrid septate variety (HSV). In HSV, there was external fundal depression dividing only the upper part of the corpus giving an imprecise impression of a bicornuate uterus with a laparoscopic view, but there was a long extension of the dividing interface. Nine cases with HSV were associated with a complete utero-cervico-vaginal septum, and five cases had a complete uterine septum. The diagnosis of asymmetric horns, hemi-obstruction or bicervical uterus was made in three cases with HSV. All cases with a septate uterus were offered hysteroscopic metroplasty, and cases with fundal depression were operated under laparoscopic monitoring. In cases with HSV, the procedure was performed safely and successfully in 16/17 cases (94%). One uterine perforation was encountered, giving a six-fold increase in the perforation risk, and passed uneventfully. Successful reproductive outcomes were reported in 178/189 cases (94.1%) with PSV and in 12/15 (80%) with HSV. CONCLUSIONS: External fundal depressions of variable depths are associating with a septate uterus, indicating coexistence of the two anomalies. These cases are candidates for hysteroscopic metroplasty under appropriate sonographic and/or laparoscopic monitoring.

Successful canalization of a noncommunicating uterine horn by horn-vaginal anastomosis: preliminary findings of a novel approach for an unclassified anomaly.

PURPOSE: The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS: Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS: The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS: Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods.

NMR structure of the 101-nucleotide core encapsidation signal of the Moloney murine leukemia virus.

The full length, positive-strand genome of the Moloney Murine Leukemia Virus contains a "core encapsidation signal" that is essential for efficient genome packaging during virus assembly. We have determined the structure of a 101-nucleotide RNA that contains this signal (called mPsi) using a novel isotope-edited NMR approach. The method is robust and should be generally applicable to larger RNAs. mPsi folds into three stem loops, two of which (SL-C and SL-D) co-stack to form an extended helix. The third stem loop (SL-B) is connected to SL-C by a flexible, four-nucleotide linker. The structure contains five mismatched base-pairs, an unusual C.CG base-triple platform, and a novel "A-minor K-turn," in which unpaired adenosine bases A340 and A341 of a GGAA bulge pack in the minor groove of a proximal stem, and a bulged distal uridine (U319) forms a hydrogen bond with the phosphodiester of A341. Phylogenetic analyses indicate that these essential structural elements are conserved among the murine C-type retroviruses.