Urinary incontinence among Saudi women: prevalence, risk factors, and impact on quality of life.

OBJECTIVE: This study was done to determine UI prevalence among women in Saudi Arabia and identify the associated risk factors. PATIENTS AND METHODS: This cross-sectional study was conducted from January 2020 to September 2020 in Saudi women who came to the Urology Department at King Khalid Hospital, Majmaah, Saudi Arabia. In the age group of 20 to 50 years, Saudi women who are not seriously ill or pregnant or in the postnatal period or diagnosed with pelvic organ prolapse were included as participants. A semi-structured questionnaire modified from the International Consultation Incontinence Questionnaire-Short Form was used to collect data on frequency, the severity, consequences, and impact of UI on quality of life. Data were analyzed by SPSS 23 (IBM, Armonk, NY, USA) with the calculation of mean and standard deviation for quantitative variables. Logistic regression analyses were applied to determine the predictors of UI. RESULTS: A total of 451 participants were included in the final analysis. The mean age of the study population was 42.52 years (SD 11.75). Among risk factors, 45 (10%) had diabetes, 56 (12.4%) had hypertension, 36 (8%) had asthma, 80 (17.7%) had UTI/STDs. Out of 451 participants, 188 (41.7%) had urinary incontinence (UI). Sociodemographic characteristics and risk factors like family income, urinary and genital infections (UTI/STDs), pelvic/uterine prolapse, any other disease, and cough were found to have a statistically significant association with urinary incontinence (p-value <0.05). CONCLUSIONS: The prevalence of UI was 41.7% among the study population. The various risk factors associated with UI are older age, parity, multiple vaginal deliveries, hypertension, history of asthma, and chronic cough. Poor health-seeking behavior was observed. Creating awareness and the need for early diagnosis with timely intervention is recommended.

Quasi-simultaneous 3D printing of muscle-, lung- and bone-equivalent media: a proof-of-concept study.

3D printing is a promising solution for the production of bespoke phantoms and phantom components, for radiotherapy dosimetry and quality assurance (QA) purposes. This proof-of-concept study investigated the use of a dual-head printer to deposit two different filaments (polylactic acid (PLA) and StoneFil PLA-concrete (Formfutura BV, Nijmegen, Netherlands)) at several different in-fill densities, to achieve quasi-simultaneous 3D printing of muscle-, lung- and bone-equivalent media. A Raise 3D Pro 3D printer (Raise 3D Technologies Inc, Irvine, USA) was used to print one thoracic and one cranial phantom slab. Analysis using in-house 3D print QA software showed that the two humanoid phantom slabs geometrically matched the stereolithography (STL) files on which they were based, within 0.3 mm, except in one area of the thoracic slab that was affected by thermal warping by up to 3.4 mm. The 3D printed muscle, lung and bone materials in the two humanoid phantom slabs were approximately radiologically-equivalent to human muscle, lung and bone. In particular, the use of StoneFil with a nominally constant in-fill density of 100% resulted in regions that were approximately inner-bone-equivalent, at kV and MV energies. These regions were bounded by walls that were substantially denser than inner bone, although generally not dense enough to be truly cortical-bone-equivalent. This proof-of-concept study demonstrated a method by which multiple tissue-equivalent materials (eg. muscle-, lung- and bone-equivalent media) can be deposited within one 3D print, allowing complex phantom components to be fabricated efficiently in a clinical setting.

Risk Associated with Malaria Infection in Tihama Qahtan, Aseer Region, Kingdom of Saudi Arabia: 2006-2007.

INTRODUCTION: Since 2004, the Kingdom of Saudi Arabia has pursued a policy of malaria elimination. The distribution of malaria at this time was constrained to regions located in the South Western part of the country. The present study aimed to understand the risk of malaria infection and factors associated with these events between March 2006 and August 2007 in one part of Aseer region. METHODS: The study was carried out in Tihama Qahtan area in the far southeastern part of Aseer, historically the most malaria endemic area of this region. The area covers 54 villages served by three primary health care centres (Wadi Alhayah, Alfarsha and Albuqaa). Malaria cases were detected using passive case detection (PCD) at the three health centres for 18 months from March 2006, each positive case was investigated using patient and household level enquiries. In addition, four cross-sectional surveys in 12 villages were undertaken using rapid diagnostic tests within the catchments of each health centre coinciding with malaria transmission seasons. RESULTS: Among 1840 individuals examined in the PCD survey, 49 (2.7%) were positive for malaria, most were Plasmodium falciparum cases and one was a P. vivax case. The majority of these infections were likely to have been acquired outside of the area and represent imported cases, including those from the neighboring region of Jazan. Among the 18 locally acquired cases, the majority were adult males who slept outdoors. 3623 individuals were screened during the cross-sectional surveys, 16 (0.44%) were positive and infections only detected during peak, potential transmission periods. CONCLUSION: There was evidence of local malaria transmission in the Tihama Qahtan area in 2006-2007, however prevalence and incidence of new infections was very low, making the future ambitions of elimination biologically feasible. The constant source of imported infections must be considered in the area's elimination ambitions, alongside strong behavioural community messages about sleeping outdoors unprotected and travel to malaria endemic areas outside the region.

Prehypertension and undiagnosed hypertension in a sample of dental school female patients.

OBJECTIVE: This study was conducted to assess prevalence of hypertension and prehypertension in a sample of female dental patients. METHODS: A total of 208 consecutive female patients aged ≥ 18 years provided information about sociodemographics, history of hypertension and other systemic diseases, antihypertension medication use and smoking history. Two blood pressure measurements were taken by a dentist and the average measurement was utilized in the present analysis. RESULTS: The mean age of the study sample was 38 (±13) years. Thirty-seven per cent of the sample had prehypertension (ranging between 120/80 and 139/89 mmHg). High blood pressure (HBP) measurement (≥140/90 mmHg) was recorded on 18% of the study population. Of those, 66% were unaware of their HBP prior to their dental visit (represent 12% of the study sample). The mean systolic and diastolic blood pressure of those with elevated blood pressure were 154 (±16) and 94 (±12), respectively. Furthermore, 26% of those 30 years of age or older had HBP measurements. History of hypertension was reported by 13% of the study sample. Of those, 48% had HBP measurement. The use of antihypertension medications was reported by 10%. CONCLUSIONS: There is a high prevalence of undiagnosed hypertension and prehypertension in the present sample. These results underscore the importance of routine blood pressure measurements in the dental clinics.

Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

BACKGROUND: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed. METHODS: Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not. RESULTS: Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P <0.001), and serum TNF-alpha (P <0.05). There was no statistically significant decrease in these parameters in patients not receiving periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI. CONCLUSIONS: Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

Ex vivo sentinel lymph node biopsy in colorectal cancer: a feasibility study.

BACKGROUND AND OBJECTIVES: Sentinel lymph node (SLN) biopsy may improve staging of colorectal cancer. We tested the feasibility of ex vivo SLN dissection. MATERIALS AND METHODS: Patients undergoing resection of a primary colorectal cancer were included in this study. SLN identification involved ex vivo injection of 1 cc isosulfan blue dye subserosally in the colon or submucosally in the rectum on a separate field. SLNs were cut at 2 mm intervals. Three hematoxylin and eosin-stained (HE) sections were prepared in addition to a middle level for cytokeratin immunostaining. RESULTS: Twenty-six patients with varying tumor location and stage were enrolled and the SLN was identified in 88% (23/26) cases. Three failures occurred in patients with rectal cancer. The average number of SLN harvested was 2.5. The status of the nodal basin was accurately predicted in 91% (21/23) of patients. Two false negative sentinel lymph nodes were harvested in 2 of 3 patients with stage III/IV colorectal cancer. The SLN upstaged 2 patients as a result of HE stained step sections (n = 1) and immunostaining (n = 1). CONCLUSIONS: This data suggests that ex vivo SLN biopsy is feasible in colorectal cancer. Although ex vivo SLN biopsy does not alter the lymphatic dissection, it may upstage a subset of patients. The ex vivo technique may be less applicable in rectal cancer and false negative results may occur.

Gunshot injuries in adults in the Abha region of Saudi Arabia.

In the four-year period from 1996 to 1999, 42 adult patients (age 12 years and above) were admitted to the Assir Central Hospital, Abha, Saudi Arabia, following gunshot injuries. The mean annual admissions for gunshot injuries was 10.5 +/- 4.04 (range = 8-16 cases/annum). All the patients were males. The distribution of the patients' nationalities were: Saudis 66.7%, Yemenis 11.9%, Ethiopians 11.9%, Eritreans 7.1% and Sudanis 2.4%. In 38 cases, others shot the patient, while only one patient (2.4%) admitted to shooting himself accidentally. A pistol was used in 81% of cases while an air gun was used in 9.5% of the cases. Wound of entry analysis showed that gunshots were to the lower limbs in 20 cases (47.2%), the upper limbs in 22% and the chest in 13% of cases. Gunshots to the head and neck occurred in 7% and 2% of cases, respectively, while the abdomen was hit in 4% of cases. The injuries sustained included: superficial wounds (64.3%), haemothorax (9.5%), nerve injury (9.5%), lower limb fractures (9.5%), haematoma (7.1%), liver and kidney injuries (2.4%, respectively). Management included wound debridement and suturing (76.2%), thoracostomy tube drainage (14.3%), bullet removal (11.9%), internal fixation of fractures of long bones (9.5%), laparotomy and repair of gut (7.1%), nerve repair (4.8%), ulnar nerve graft (2.4%), and external fixation compound fracture of the tibia (2.4%). All the patients survived. The mean hospital stay was 15.45 +/- 23.06 days (range = 1-150 days). Although gunshot injuries are increasingly being reported from Saudi Arabia, the injuries are accidental and the morbidity appears to be low.

Carcinoid tumourlets associated with diffuse bronchiectasis and intralobar sequestration.

Innumerable carcinoid tumourlets may develop within pulmonary lobes should there be scarring from intralobar sequestration; these tumourlets may, in turn, be the cause of chronic lung disease. This report documents the incidental detection of multifocal carcinoid tumourlets in the lung of a 65-year-old man who had repeated episodes of lung infection, progressive dyspnea and haemoptysis; he lived at high altitude. The left lower lobe of the lung was resected surgically, during which procedure an aberrant systemic arterial supply was noticed. The patient had diffuse bronchiectasis and intralobar sequestration. The latter implies the development of abnormal lung tissue located within lobar tissue--but which does not communicate with the bronchial tree; it is supplied with arterial blood from a branch of the aorta--arising either above or below the diaphragm. There was loss of demarcation between the sequestered lung and the surrounding lower lobe lung parenchyma. The proliferation of pulmonary neuroendocrine cells in the form of tumourlets, had probably occurred as an adaptive response to the chronic hypoxia experienced. The combination of intralobar sequestration, bronchiectasis and carcinoid tumourlets, although uncommon, may arise when intralobar sequestration of the lung has not been resected at an incipient stage.

Healthcare risk waste in Saudi Arabia. Rate of generation.

OBJECTIVE: To assess the amount of healthcare risk waste generated by health establishments in Saudi Arabia METHODS: A healthcare waste management questionnaire was applied in 27 hospitals, and 16 primary health centres and clinics. The total quantity of healthcare risk waste collected in 24 hours in each of these establishments was weighed. Calculations were carried out to get hospitals rate of healthcare risk waste generation and primary healthcare centres risk waste generation. The total national estimate of healthcare risk waste production in kilograms/year for the whole health establishments in the Kingdom was then calculated. RESULTS: The mean hospital healthcare risk waste rate of generation was 1.13+/-0.96 kg/bed/day. The mean primary healthcare centres and clinics healthcare risk waste rate of generation was 0.08+/-0.08 kg/visitor/day. The estimated mean amount of all healthcare risk waste generated in the Kingdom of Saudi Arabia is 25,207 tons/year. CONCLUSION: Healthcare establishments in Saudi Arabia produce healthcare risk waste. Much care is given by the responsible authorities for the management of that type of waste. A program is being established to formulate standards for healthcare waste management

Antibiotic prescribing by pediatricians for respiratory tract infection in children.

To examine antimicrobial prescribing rates for viral respiratory tract infections by primary care pediatricians in the greater Toronto area, charts were reviewed for the week of 17-21 February 1997 at 61 pediatricians' offices. Antibiotics were considered appropriate if the diagnosis was compatible with bacterial infection. A total of 3,585 patient visits were reviewed. The common cold was the most common respiratory tract syndrome leading to an office visit (1,317 visits). The overall rate of appropriate antibiotic prescribing was 89.5%. There was no significant difference in prescribing when physicians were compared by year of graduation from medical school, sex, or location of training. Diagnostic codes (ICD-9 [International Classification of Diseases, 9th edition] codes) did not match the chart diagnosis in 41% of cases. Toronto primary care pediatricians appear to have a lower rate of inappropriate antibiotic prescribing than do primary care physicians in other regions of Canada and the United States.

Attitudes of saudi media towards world health events.

INTRODUCTION: Mass media are very important in health education programmes. Health promoters rely on them to play a crucial role in their campaign. AIM: The aim of the study was to study the patterns of contribution of the Saudi daily newspapers on two international health occasion during the year 1416H (World AIDS Day 1995 and World Health Day 1996). MATERIAL AND METHODS: The study was retrospective, carried out by reviewing eight daily Saudi newspapers including all issues covering three months before and extending three weeks after each occasion. All newspaper materials concerning the two occasions were specified, and data obtained from them included types of materials, topics and characteristics of the paper. RESULTS: The study revealed that the newspapers gave more coverage to World AIDS Day than on World Health Day. This meant that journalists considered that AIDS was more interesting to the readers than the environmental topic of World Health Day. Most of the materials especially in World Health Day were published in the inner pages. These findings are in consonance with previous work, which showed that Saudi journalists had little interest in environmental issues. Nearly two thirds of the materials were news items about ministerial and activities of other organizations. Informative articles on health education and readers' participation were minimal. CONCLUSION: It was concluded that newspapers took not much interest on health matters especially health education.

Leishmania major: in vitro ultrastructural study of the paraxial rod of promastigotes.

The flagellum of Leishmania major promastigotes has an intraflagellar structure known as the paraxial rod (PAR) which extends from a point halfway in the flagellar pocket to the tip of the flagellum, lying opposite the axonemal microtubule doublets 4-7. An expansion of the axonemal plasma membrane envelops the PAR and may provide desmosomal attachment at the orifice of the flagellar pocket. The complex organization of the 4-6 nm thick filaments in the PAR was studied by us in cross, oblique, longitudinal and tangential sections by electron microscope. These filaments are disposed in two parallel lamellae, one alongside the axoneme (ca. 45 nm thick), and the other alongside the plasma membrane (ca. 65 nm thick), with an interlamellar gap of about 22-28 nm. In each lamella, 8-12 parallel series of longitudinal filaments at ca. 30 nm intervals interdigitate with coplanar parallel series of oblique filaments at ca. 25 nm intervals and inclined to the long axis of the flagellum at ca. 48 degrees, and ca. 55 degrees, in the inner (paraxonemal) and outer lamella, respectively. The parallel filaments in each of the longitudinal and oblique series are spaced at ca. 8 nm intervals. They are cross-striated at ca. 30 nm intervals by transverse filaments which terminate occasionally on adjacent axonemal microtubules 5 and 6 in the inner lamella, and the plasma membrane in the outer lamella. Extending across the interlamellar gap is a set of parallel rows of 7-12 nearly parallel filaments at ca. 20 nm intervals. The part of the flagellar plasma membrane enclosing the PAR has a subplasmalemmal cytoskeleton consisting of a layer of longitudinal 2 nm filaments at 8 nm intervals, obliquely striated by parallel 2 nm filament doubles at ca. (-65) degrees with the long axis of the flagellum and ca. 20 nm periodicity. Each filament doublet stria apparently gives origin to collinear short filament doublet extensions that curve into juxtaposed meshes of the outer lamella. Microtubules of the axonemal doublets 5 and 6 are connected to electron-dense (ca. 12 nm thick) strips of the inner lamella of the PAR by longitudinal series of ca. 4 nm cross-links across a ca. 12 nm cleft.

Leishmania infecting man and wild animals in Saudi Arabia. 9. The black rat (Rattus rattus) a probable reservoir of visceral leishmaniasis in Gizan province, south-west Saudi Arabia.

Twenty-two black rats (Rattus rattus) were captured in houses where parasitologically confirmed cases of human visceral leishmaniasis had been recorded in Al-Arda Emara, Gizan province, south-west Saudi Arabia. Four of the rats were found to be infected with Leishmania; isoenzyme characterization showed that 3 were infected with L. donovani sensu lato zymodeme LON42 and the fourth with L. infantum zymodeme LON49. L. donovani s.l. LON42 has also been isolated from human visceral leishmaniasis patients living in this area, while dogs, but not humans, have been found to be infected with L. infantum LON49 in this part of Saudi Arabia.

Leishmania infecting man and wild animals in Saudi Arabia. 6. Cutaneous leishmaniasis of man in the south-west.

Cutaneous leishmaniasis (CL) is common on the high plateaux and foothills of the Asir range in the south-west of Saudi Arabia and Yemen. In 1987 1198 and 1104 cases were reported among the Saudi populations of Asir and Al-Baha provinces, representing an estimated annual incidence of 12 and 38 per 10,000 respectively. The incidence rises from October to December, then declines to a minimum between May and August. The prevalence of Phlebotomus sergenti, a proven local vector in the highlands, is roughly in inverse proportion. Cases occur at all ages, over 60% have only a single lesion, and the head and neck are most commonly affected. Apart from a few patients who develop leishmaniasis recidivans, most respond well to sodium stibogluconate, or self-heal. Of 44 isolates typed by isoenzyme electrophoresis, 42 were Leishmania tropica belonging to 5 distinctive zymodemes. LON-72 (34 isolates), LON-73 (1), LON-71 (2) and LON-10 (2) were found at altitudes around 2000 m, 3 of them in a single village. Three isolates of LON-63 were found at altitudes between 600 and 1000 m in widely separated foci. L. tropica LON-10 and LON-71 have been isolated also from P. sergenti from highland foci. LON-72 failed to produce lesions in BALB/c mice and gave rise to only transitory lesions in the footpads of hamsters.(ABSTRACT TRUNCATED AT 250 WORDS)

Leishmania infecting man and wild animals in Saudi Arabia. 5. Diversity of parasites causing visceral leishmaniasis in man and dogs in the south-west.

Kala-azar (VL), mainly affecting infants and young children, is being increasingly reported in the south-west of Saudi Arabia, 305 cases being diagnosed in 1988. Most cases arise in scattered locations in the foothills west of the Asir mountains at altitudes between about 500 and 1000 m, although case clusters are apparent in some villages. Some cases also occur between the foothills and the Red Sea coast. The incidence in the south-west was calculated to be of the order of 6 to 8/10,000 population per year, but a random serological survey using the enzyme-linked immunosorbent assay and direct agglutination techniques indicated a seropositivity rate of about 3.7% in 706 apparently healthy children. Most patients are Saudi or Yemeni and cases are being increasingly identified also in the Yemen Arab Republic. In the foothills of both countries the causative organism is Leishmania donovani s.l. zymodeme LON-42, which also occurs on the eastern littoral of Ethiopia. By isoenzyme electrophoresis, it is readily separated from L. infantum, which has been identified in feral dogs, the 2 organisms being sympatric. The infection was found in 6.7% of 89 dogs, but their seropositivity rate was 19.3%. Although L. infantum has not yet been recognized in man in Saudi Arabia, it has been identified in a child in the coastal plain of the Yemen Arab Republic. Further research needed to provide a rational basis for control is discussed.