Prevalence and determinants of burnout syndrome and depression among medical students at Qassim University,Saudi Arabia

Objectives:To investigate the prevalence and determinants of burnout syndrome and depression among medical students at Unaizah College of Medicine (UCM), Qassim University, Qassim, Kingdom of Saudi Arabia (KSA).Methods:A cross-sectional study of all Saudi medical students studying at UCM, Qassim University, Al Qassim, KSA, between February to March 2020.Results:Of the total 305 students sampled, 153 (50.2%) fit the category of depression. Concerning burnout, only 5.6% of the total population met the Maslach Burnout Inventory diagnostic criteria for burnout, with those determined to have burnout having ranked high on the emotional exhaustion and cynicism subscales, and low on the academic efficacy subscale. Male was strongly associated with burnout, while female gender and raising children were strongly associated with the presence of depression. Emotional exhaustion and high cynicism as determinants of burnout elevate the risk of depression.Conclusion:Our results highlight the high rate of depression and burnout, as well as the need for psychological intervention programs at medical schools to prevent the deterioration of student’s mental health that has been associated with advancement in medical school.     

Effects of health literacy on type 2 diabetic patients’ glycemic control,self-management,and quality of life

Objectives:To examine the pathway in which health literacy affects diabetic patients’ quality of life (QoL) with self-care management skills and glycemic control levels (hemoglobin A1c [HbA1c]) mediating the relationship.Methods:A cross-sectional study carried out between April 2019 and September 2019. A convenience sample of participants with type 2 diabetes mellitus were recruited from 3 primary healthcare centers, Al Ahsa, Saudi Arabia. Data were collected using structured interviews and HbA1c levels were collected from medical files. Structural equation modeling was also used.Results:Among the 256 participants, 27.3% had a marginal level of health literacy and 35.5% had an inadequate level of health literacy. Health literacy positively affects self-care management, glycemic control (HbA1c), and QoL directly and indirectly. Self-care management partially mediates this relationship.Conclusion:Healthcare providers need to assess health literacy and develop interventions that enhance diabetic patients’ health literacy because it influences self-care management skills, glycemic control, and patients’ QoL. Health literacy should be considered as a key for health education and healthcare encounter to improve health outcomes.     

Physical inactivity and its predictors among adolescents in Saudi Arabia: A cross-sectional comparison between cities with and without a Healthy Cities Program

Objectives:To estimate the prevalence of insufficient physical activity and excessive screen time among adolescents living in cities participating in the Healthy Cities Program (HCP) and cities not running the program in the Qassim region of Saudi Arabia.Methods:We surveyed 1133 adolescents from the Qassim region using systematic random sampling between April and September 2017. Multivariable logistic regression analyses were conducted to investigate the predictors of insufficient levels of PA and excessive screen time.Results:The prevalence of <60 minutes of moderate- to vigorous-intensity physical activity/day was 82.4% and <3 days of vigorous intensity physical activity/week among adolescents was 59%. There was no significant association between living in healthy cities (HCPs) and insufficient levels of physical activity. The odds of excessive screen time were higher in HCPs than in cities not running the program (NHCPs) (OR: 1.49). The odds of insufficient daily PA (OR: 2.19) are higher among girls than boys. Increasing age is positively associated with insufficient weekly PA (OR: 1.19). The prevalence of excessive recreational screen time is 84.6% with higher odds in HCPs than in NHCPs (OR: 1.51).Conclusion:Our findings report a lack of evidence of any impact of the HCP on adolescents’ physical activity behaviors. This outcome warrants a further in-depth evaluation of the process and outcomes of the HCP in Saudi Arabia.     

Quality of life in vitiligo patients in central Saudi Arabia

Objectives:To assess the quality of life (QoL) in patients with vitiligo in central Saudi Arabia using the dermatology life quality index (DLQI).Methods:A cross-sectional study spanning over 6 months was conducted on 253 adult patients with vitiligo at the outpatient dermatology clinics of the National Center of Vitiligo (Light Clinics) and King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were asked to complete a self-administered questionnaire using an Arabic version of the DLQI to measure the impact of vitiligo on their QoL. The association between the demographic and diseases characteristic to the median DLQI scores was investigated using binary logistic regression.Results:The median DLQI score was 4, the range 25, min 0 - max 25 and percentiles 2-8. The unadjusted odds ratio (95%CI) showed the median DLQI score was significantly higher in married subjects 2.29 (1.33-3.94) (p<0.01), non-segmental vitiligo 2.10 (1.16-3.79) (p<0.01), and the progressive vitiligo 1.87 (1.09-3.18) (p<0.02) than their counterparts. However, after adjustment only married status predicted the high DLQI score 2.08 (1.11-3.61) (p<0.01).Conclusion:The QoL in vitiligo patients in Saudi Arabia is adverse than those with lighter skin, in other countries. Therefore, in Saudi Arabia, better management modalities to improve patients’ QoL and prevent subsequent mental distress are needed.     

Self-awareness of HbA1c and its association with glycemic control among patients with type 2 diabetes: A multicenter study

Objectives:To measure the self-awareness of hemoglobin A1c (HbA1c) prevalence among type 2 diabetic Saudi patients and its association with glycemic control, thereby identifying those factors that might affect their glycemic control.Methods:This multicenter study was carried out in outpatients’ diabetes clinics in tertiary hospitals in Riyadh, Qassim, and Jeddah, Saudi Arabia. The data was collected using questionnaires. The subject’s self-awareness on the HbA1c test was assessed based on the combined score of 4 questions. The latest HbA1c result before the time of data collection was obtained from medical records. Data was analyzed using bivariate and multivariate statistical methods.Results:The prevalence of HbA1c self-awareness was approximately 44.5%. A total of 4 participants characteristics (glycemic control, education level, monthly income and number of follow-up visits) were associated with awareness of HbA1c. Whereas for better glycemic control; type of treatment, duration of diabetes, and self-awareness of HbA1c were independently statistically significantly associated.Conclusion:There is a positive association between HbA1c self-awareness and glycemic control. Glycemic control was good among those who were educated on the meaning of the test, their levels, and their target goal. Awareness among health care providers regarding the role of the patient’s education regarding their condition might help in providing the patient with optimal care. Further studies with different experimental designs are needed to study this association, which will contribute to the development of a structured educational program.     

Utilizing diabetes registry for exploring sociodemographic and clinical characteristics of type II diabetic patients in Saudi Arabia

Objectives:To explore the sociodemographic and clinical characteristics as the process and outcomes of diabetic individuals.Methods:Hospital Saudi registry at Prince Sultan Military Medical city, Chronic Illness Clinics (Family and Community Medicine), Riyadh, Saudi Arabia database was started in February 2019 and data were collected until February 2020. The data were collected by trained diabetes nurse specialists. The registry includes all patients with type II diabetes mellitus (DM) and excluded patients with type I DM.Results:A total of 8,209 patients were enrolled in the registry with a higher proportion of females than males. The mean age was 59.3 years, BMI 32.5kg/m², and HBA1c levels was 8.2%. Significant gender differences for BMI, duration of diabetes, blood pressure, LDL, smoking status, and medication intake. From the first to the third visit, BMI was raised; however, LDL, diastolic blood pressure, and albumin creatinine ratio were reduced. The mean HBA1c values plummeted for all patients and 33% of the patients had a reduction in the HbA1c levels. However, HbA1c levels increased for 24.7% of the patients’ from baseline to the last visit.Conclusion:This registry provides great insights into the sociodemographic and clinical characteristics of diabetic patients in Saudi Arabia. This registry data can be used to investigate the associations between sociodemographic or clinical characteristics and glycemic control among T2DM patients in Saudi Arabia.     

The trends of cancer patients’ perceptions on the causes and risk factors of cancer over time

Objectives:To evaluate patients’ perceptions on the causes and outcomes of cancer and the changes observed over a decade (2006-2016) at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods:Patients diagnosed with cancer and treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were enrolled in a cross-sectional study. The patients were enrolled in 2 cohorts: cohort 1 from 2006-2008 and cohort 2 from 2016-2018. The trends of the perceptions related to the causes and outcomes of cancer were compared between the 2 cohorts.Results:In total, 1416 patients were enrolled in the 2 cohorts: cohort 1 included 464 patients and cohort 2 included 952 patients. The patients in cohort 2 had a higher level of education, higher unemployment rate, and more solid tumors. There was a significant increase in the belief of the “evil eye” as a cause of cancer from 1.3-33.1% between cohort one and cohort 2. A higher proportion (23.5%) of cohort 2 reported scientific causes for cancer, compared to 13.6% in cohort 1 (p<0.0001). Younger age, male gender, having a job, and being in cohort 2 were significantly associated with providing a scientific answer in a multivariate analysis (modeling scientific cause).Conclusion:In this study, a frequent misperception related to the causes of cancer was revealed. To tackle this issue, a systematic approach towards education for patients and the public is required to minimize the potential detrimental effects on patient care and patient outcomes.     

Functional somatic illnesses in patients with functional bowel disorders: A cross-sectional cohort study in western Saudi Arabia

Objectives:To study the prevalence of functional gastrointestinal disorders (FGID) in Saudi patients with irritable bowel syndrome (IBS).Methods:A cross-sectional study was conducted in patients with IBS treated at a private tertiary medical center in western Saudi Arabia between 2013 and 2017. We used ROME 3 criteria with data from the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire-9 (PHQ-9) depression scale, and International Classification of Headache Disorders (ICHD) to assess the prevalence of psychosomatic illness. Statistical analysis of frequency and statistical correlation was performed using Chi-square.Results:The final analysis of 307 patients revealed a combined 425 diagnoses of psychosomatic illness, including diagnoses of headache in 104 patients (34%), migraine in 93 patients (30.5%), fibromyalgia in 169 patients (55%), and depression in 59 patients (19%). There was a statistically significant correlation between patients’ ages and diagnoses of joint pain and migraines.Conclusion:Fibromyalgia and headache disorders were common in this cohort of Saudi patients with IBS. This coexistence of illness is partly explained by the functional nature of these illnesses. Collective efforts to provide multidisciplinary care is needed for these patients.     

Complete blood cells count abnormalities in COVID-19 patients and their prognostic significance: Single center study in Makkah,Saudi Arabia

Objectives:To evaluate the role of different peripheral blood count parameters as a cheap and rapid test in determination of coronavirus disease -19 (COVID-19) severity and patients’ outcome.Methods:The data of 462 confirmed COVID-19 patients who attended at the Security Force Hospital, Makkah, Saudi Arabia, from October 2020 to March 2021 was retrospectively reviewed and C. Patients with viral infection and respiratory diseases other than COVID-19 were excluded from the study. Complete blood count parameters were compared in accordance with the severity of the clinical presentation, age, and disease outcome.Results:A total of 277 (60%) were male and 185 (40%) female. Clinically, 32 (6.9%) had severe illness and 430 (93.1%) showed moderate clinical disease. Organ failure occurred in 2.8% of the patients. There was significant leucocytosis, neutrophilia, lymphopenia, high neutrophil-lymphocyte (N/L) ratio, and anemia in patients with severe COVID-19 diseases as well as in non-survivors’ cases (p<0.001). Similarly, the inflammatory markers (C-reactive protein [CRP] and serum ferritin) were significantly elevated in the above-mentioned 2 groups (p<0.001). Significant decrease of the platelets count was detectable in clinically severe cases and non-survivors (p<0.01). Older age (>60 years) was associated with high leucocyte, neutrophil count, lymphopenia, anemia, organ failure, and poor outcome.Conclusion:Leucocytosis, neutrophilia, lymphopenia, and high N/L ratio together with elevated serum level of ferritin and CRP are eminent features of COVID-19 severity. The inclusion of these parameters in the regimens for patients’ categorization on admission will enable early effective intervention and proper decision making during clinical case management.     

Arabic Version of short form of the Speech,Spatial, and Qualities of Hearing Scale (SSQ12)

Objectives:To translate and validate the short form of the speech, spatial, and qualities of hearing scale (SSQ12). This will help in the assessment of hearing disability in the daily life of hearing-impaired populations, as well as the improvement of their quality of life.Methods:This cross-sectional study was conducted at the King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia, between April and June 2021. The study included 102 hearing-impaired participants as the patient group and 84 normal-hearing participants as the control group. The English SSQ12 was translated according to the International Quality of Life Assessment method. Internal consistency and reliability of the Arabic SSQ12 were then assessed using Cronbach’s alpha (α) and test-retest reliability. Discriminant validity was also assessed by comparing the patients’ scores with the control participants.Results:The overall internal consistency of the Arabic SSQ12 was excellent (α=0.9), with good test-retest reliability (intraclass correlation coefficient [ICC]=0.8). There was a significant difference between the Arabic SSQ12 scores of the patient and control groups (p<0.0001).Conclusion:The Arabic version of the SSQ12 appears to be a valid and reliable tool that can be used to assess the communication ability of hearing-impaired patients in audiology clinics.     

Child neglect in Saudi Arabia: The neglected form of child maltreatment

Objectives:To shed light on types, family profiles, risk factors, and outcomes of child neglect in Saudi Arabia.Methods:A retrospective chart review was carried out at King Abdullah Specialized Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Cases of child neglect diagnosed by the Suspected Child Abuse and Neglect (SCAN) team were reviewed. Data were extracted from patients’ electronic charts and SCAN team records.Results:A total of 309 cases of child neglect were diagnosed between 2015-2019. Mean age of victims was 4.4±4.1 years, and 51.8% were male gender.Supervisory neglect was the most common form (63.1%), followed by medical neglect (39.2%), emotional neglect (6.8%), physical neglect (5.5%), and educational neglect (3.2%). Children between the ages of one and 3 years were 3.3 times more likely to be victims of supervisory neglect and girls were 4.5 times more likely to be victims of educational neglect. Children living with ≥4 siblings were 7 times more likely to be victims of physical neglect and 1.9 times of medical neglect. With regard to emotional neglect, children of unemployed fathers were 3.5 times more likely to be parentally neglected than children of employed fathers. Worsening of the underlying disease (30%) and internal injuries (23.5%) were the most common consequences of neglect. Mortality attributed to neglect was documented in 8 (2.6%) children.Conclusion:Although child neglect is common in Saudi Arabia, it has not been recognized as an important cause of morbidity and mortality of children. This implies the need for a national protocol that would help identify high-risk families for early detection and implementation of prevention programs.     

Quality of life assessment among patients suffering from different dermatological diseases

Objectives:To assess the quality of life (QoL) of patients with different dermatological diseases. Multiple international studies have evaluated the QoL among patients with different dermatological diseases; however, few studies of this kind have been conducted in Saudi Arabia.Methods:This quantitative, observational, cross-sectional study was carried out in the dermatology outpatient clinics of King Saud University Medical City, Riyadh, Saudi Arabia, from September 2019 until February 2020. Data was collected using the validated Arabic version of the Dermatology of Life Quality Index (DLQI).Results:A total of 391 patients ≥18 years participated in the study. The mean age of participants was 33 years (18-75 years). Most participants in this study reported that their dermatological disease had a small or no effect on their QoL (62.5%). The majority of patients who had acne vulgaris (79.7%), vitiligo (79.3%), hair disorders (76.9%), or rosacea (71.5%) reported a small to no effects on their QoL. However, diseases that reflected the largest percentages of a large to extremely large effect on QoL were urticaria (37.1%), eczema (26.6%), and psoriasis (24%). A total of 42.9% of the participants suffered from lichen planus and 66.7% of participants suffered from cutaneous neoplasms reported a moderate effect on their QoL.Conclusion:Understanding the impact of different dermatological diseases on QoL can help dermatologists to improve thier patients’ QoL. Therefore, we recommend that further studies on this topic be conducted in multiple health centers.     

The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study

Objectives:To assess the neutrophil-to-lymphocyte ratio (NLR) diagnostic and prognostic value in the context of Coronavirus disease-2019 (COVID-19) infection in Saudi Arabia.Methods:A case-control study in which 701 confirmed COVID-19 patients (of which 41 were intensive care unit [ICU]-admitted) and 250 control subjects were enrolled. The study was conducted retrospectively in October on patients admitted to 3 separate hospitals in Saudi Arabia namely: King Abdullah Bin Abdulaziz University Hospital (Riyadh), Ohud Hospital (Madinah), and Nojood Medical Center (Madinah) between May and September 2020. Neutrophil-to-lymphocyte ratio was calculated based on absolute neutrophil and lymphocyte count. Institutional ethical approval was obtained prior to the study.Results:Patients (median age 35 years), of which 54.8% were females, were younger than the control cohort (median age 48 years). Patients had significantly higher NLR compared to the control group. Intensive care unit admitted patients had significantly higher platelet, WBC and neutrophil counts. The ICU patients’ NLR was almost twice as of the non-intensive patients. The NLR value of 5.5 was found to be of high specificity (96.4%) and positive predictive value (91.4%) in diagnosing COVID-19. Furthermore, it had a very good sensitivity (86.4%) in predicting severe forms of disease, such as, ICU admission.Conclusion:Neutrophil-to-lymphocyte ratio is an important tool in determining the COVID-19 clinical status. This study further confirms the prognostic value of NLR in detecting severe infection, and those patients with high NLR should be closely monitored and managed.     

Application of natural language processing techniques to identify off-label drug usage from various online health communities

ObjectiveOutcomes mentioned on online health communities (OHCs) by patients can serve as a source of evidence for off-label drug usage evaluation, but identifying these outcomes manually is tedious work. We have built a natural language processing model to identify off-label usage of drugs mentioned in these patient posts.Materials and MethodsSingle patient posts from 4 major OHCs were considered for this study. A text classification model was built to classify the posts as either relevant or not relevant based on patient experience. The relevant posts were passed through a spelling correction tool, CSpell, and then medications and indications from these posts were identified using cTAKES (clinical Text Analysis and Knowledge Extraction System), a named entity recognition tool. Drug and indication pairs were identified using a dependency parser. Finally, if the paired indication was not mentioned on the label of the drug approved by U.S. Food and Drug Administration, it was tagged as off-label use of that drug.ResultsUsing this algorithm, we identified 289 off-label indications, achieving a recall of 76%.ConclusionsThe method designed in this study identifies and extracts the semantic relationship between drugs and indications from demotic posts in OHCs. The results demonstrate the feasibility of using natural language processing techniques in identifying off-label drug usage across online health forums for a variety of drugs. Understanding patients’ off-label use of drugs may be able to help manufacturers innovate to better address patients’ needs and assist doctors’ prescribing decisions.     

Validation and clinical application of the Arabic rhinoplasty outcomes evaluation questionnaire

Objectives:To carry out translation, cross-cultural adaptation, and validation of the rhinoplasty outcome evaluation (ROE) into Arabic.Methods:This non-randomized, prospective study included 50 patients from the Otorhinolaryngology Department, King Saud University, Riyadh, Saudi Arabia who underwent primary rhinoplasty from January to October 2020 and a control group of 89 healthy individuals. The reliability of the Arabic (ROE) was tested using Cronbach’s alpha. The test-retest reliability was assessed by estimating the intra-class correlation coefficient for the total Arabic (ROE) score and individual items. Discriminant validity was used to examine the validity of the Arabic (ROE) by comparing the scores of the patients and the control group. The Friedman test was used to measure differences in Arabic (ROE) ratings within the study patients’ group, including preoperative, and 2 weeks, and 3 months postoperative ratings.Results:The internal consistency and reliability of the Arabic (ROE) were good. There was a significant difference in ratings between rhinoplasty patients and the control group regarding both the individual questions and total scores. Significant improvement was observed in the patient group ratings at 2 weeks and 3 months postoperatively compared to the preoperative rating (p<0.0001).Conclusions:The Arabic version of the (ROE) showed good reliability and validity and can be used in the assessment of rhinoplasty outcomes in the Arabic population.     

Evaluation of hematological parameters in dyspepsia patients infected with Helicobacter pylori : A retrospective study from the Central Region of Saudi Arabia

Objectives:To evaluate the hematological parameters in dyspepsia patients infected with Helicobacter pylori (H. pylori) infection from Al Qassim province of Kingdom of Saudi Arabia (KSA).Methods:This retrospective study was carried out in Dr. Sulaiman Al-Habib Hospital, Al Qassim, KSA. The data of dyspepsia and epigastric pain patients were derived from the hospital based registration system between 2020-2021. Logistic regression models were used to investigate the correlation between the onset of H. pylori infection and anemia.Results:Among 810 enrolled patients, there were 202 (24.9%) patients with H. pylori infection and 144 (17.8%) with anemia. The prevalence of anemia in the H. pylori (+) group was not statistically higher than the H. pylori (-) group after adjusting age, red blood cell count, serum ferritin, mean corpuscular volume, platelet count, and mean corpuscular hemoglobin (p>0.05). The level of hemoglobin was almost identical in both the H. pylori (+) group and the H. pylori (-) group (p>0.05).Conclusion:The findings show that H. pylori infection may not be related to anemia in dyspepsia patients from the Central region of KSA.     

The pattern of gynecological malignancies in Al-Madinah Al-Munawarah region,Saudi Arabia: An overview of 6 years

Objectives:To describe the frequency and spectrum of different types of gynecological malignancies (malignant tumors of the female genital tract) and to characterize the pattern of gynecological neoplasms in different age groups in Al-Madinah Al-Munawarah, Saudi Arabia.Methods:This 6-year retrospective-design research was carried out on different age groups in Al-Madinah Al-Munawarah region, from June 2015 until June 2021. The patients’ information of all 200 specimens, including age, nationality, tumor site, and pathological disorders was obtained from the Maternity and Children Hospital, Al-Madinah Al-Munawarah.Results:Endometrial cancer was the most common malignancy for women of 31 years and above (69.0%). Tumors of the uterine corpus were mostly epithelial (86.7%) and possessed an endometrioid carcinoma histology (90.6%). There was only a small decline in gynecological cancer incidences in Al-Madinah Al-Munawarah over the past 6 years.Conclusion:Most of the cancer incidences, regardless of the pathological diagnosis, either increased or remained unchanged over time, is a possible indication of the current state of health programs and information available to the citizens in Al-Madinah Al-Munawarah. Further studies exploring the economic background of diagnosed patients may be of interest to future research.     

Public awareness,beliefs and attitude towards depressive disorders in Saudi Arabia

Objectives:To investigate the degree of public awareness, beliefs, and attitudes regarding major depression and available treatment options in the Saudi population.Methods:A community-based cross-sectional study of 1,188 participants was carried out from March to April 2021 in Ha’il, Saudi Arabia using an online self-administered questionnaire. Using a snowball sampling technique, the authors targeted the Saudi population living in Ha’il region.Results:Overall, 65.6% of the participants had good awareness regarding depression disorder in total. Of the participants, 72.9% had good awareness regarding general awareness, 85.4% regarding depression symptoms, 12.3% regarding risk factors, and 15.7% regarding treatments. Of the participants, 67.3% believed that depression was caused by lack of faith and 45.5% believed that depression was caused by “the evil eye” or black magic. Of the participants, 56% believed in faith healers as a legitimate treatment approach. Of the participants, 63.9% were willing to work with individuals with depression, 62.7% were willing to establish friendships with them, and 27.9% believed that individuals with depression had weak personalities.Conclusion:The general population exhibited good general awareness regarding depression and its symptoms, but knowledge of risk factors and treatments was poor. Our findings underscore the need for public educational programs to increase public awareness about the risk factors and treatment options for depression.