Prevalence of gastro-esophageal reflux in diabetic patients at a tertiary hospital in Central Saudi Arabia

Objectives:To estimate the prevalence of gastro-esophageal reflux disease (GERD) among diabetic patients and to investigate GERD’s potential association with diabetic complications, and patients’ sociodemographic and clinical characteristics.Methods:This cross-sectional study used the GERD questionnaire (GerdQ) in 403 diabetic patients attending the outpatient clinics at King Khalid University Hospital, King Saud University Medical City, King Saud University; a tertiary hospital in Riyadh, Saudi Arabia, between January and February 2019. On the basis of a cutoff GerdQ score of 8, we distinguished GERD and non-GERD groups.Results:Gastro-esophageal reflux disease prevalence was 44.9%. Of the diabetic patients with GERD, 76.8% were female (p<0.001). Gastro-esophageal reflux disease patients were older (mean age: 55.27, p=0.038) and had a slightly higher body mass index (BMI) than non-GERD (32.04 versus, 30.20 p=0.006), respectively. Smokers in the GERD group were 1.7% versus 7.2% in the non-GERD group (p=0.007). Peripheral numbness (p=0.023) and nephropathy (p=0.041) were more prevalent in patients with GERD, while myocardial infarction was more prevalent in non-GERD subjects (p=0.038). On multi variable analysis, the only independent GERD risk factors were female gender (p=0.013) and age >65 years (p=0.007).Conclusion:Gastro-esophageal reflux disease prevalence in diabetic patients was 45%. Diabetic patients with GERD were more often female and older >65 years. None of the other tested factors (BMI, smoking status, diabetes mellitus duration, therapeutic plan, or diabetic complications) showed significant difference between GERD and non-GERD groups.     

Characteristics of pediatric diabetic ketoacidosis patients in Saudi Arabia

Objectives:

To evaluate the clinical and biochemical characteristics of children with diabetic ketoacidosis (DKA).

Methods:

In this retrospective study conducted between June 2012 and November 2013 at the King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, we evaluated pediatric DKA admissions from 1995-2008 (Phase 1). From the case files, we obtained information related to patients’ age, gender, weight, presenting complaints, serum biochemical profile, and management.

Results:

This study included 373 DKA admissions with a median age of 11 years (interquartile range [IQR]:8-13). The patients in the subgroup of age more than 10 years old had the highest proportion of admissions (n=250, 67%, p<0.000). The median duration of diagnosis of diabetes mellitus (DM) was 3 years (IQR:2-6). New-onset DM was 47%. Predominant precipitating cause was acute illness, mostly viral syndrome in 22% of all cases, and non-compliance to insulin regimen was in 79% of the diagnosed diabetic cases. Blood glucose, pH, anion gap, serum osmolality, serum potassium, and serum phosphate showed the highest change during the initial 6 hours of management, while trends of serum bicarbonate and blood urea nitrogen demonstrated a predominant change in the initial 12 hours.

Conclusion:

The notable findings in this study, such as, higher mean age of presentation, high rate of non-compliance to insulin as the cause of precipitation, and a high prevalence of abdominal pain at presentation should be followed up with further comparative studies.Diabetes mellitus (DM) is an endocrine disease affecting millions of children worldwide.1-3 Diabetic ketoacidosis (DKA) is one of the serious complication of diabetes in the pediatric population,4 and its prevalence increases by an annual rate of 3% worldwide.3 It is associated with significant risk of life threatening complications.5-8 The criteria for diagnosis of DKA in children by the International Society for Pediatric and Adolescent Diabetes describes DKA as blood glucose >11 mmol/L, venous pH <7.3, or bicarbonate <15 mmol/L, and ketonemia with ketonuria.9 Previous studies1,2 have reported characteristics of DKA patients based on different geographical areas. Overall, there is a paucity of literature on this particular aspect. The aim of this study was to assess pediatric patients presenting with DKA regarding aspects of demographics, presentation, investigations, and management in the Kingdom of Saudi Arabia (KSA).     

Prevalence and characteristics of abnormal Papanicolaou smear in Central Saudi Arabia

Objectives:

To assess the prevalence and characteristics of abnormal pap smear in the central region of Saudi Arabia.

Methods:

In this retrospective case control study conducted in the Departments of Obstetrics and Gynecology, and Histopathology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, all pap smears screened for Saudi women between 2008 and 2011 were reviewed. Approximately 5000 pap smears are screened annually at King Abdulaziz Medical City utilizing the Bethesda III System (2001). All abnormal smears patients’ data were collected and compared to the data of randomly selected 200 normal smears’ patients.

Results:

Abnormal pap smear prevalence was found to be 4.3% (841/19,650 Saudi patients were found with atypical epithelial cells abnormalities). Its prevalence in the years 2008 was 5.7%, 2009 was 4.9%, 2010 was 4.2%, and 2011 was 2.5%. Abnormal smear patients have lower parity (p=0.001), and were less likely to use intra-uterine devices (p=0.03) compared with normal smear patients. Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities (p=0.045). The only positive history that has characterized patients with epithelial cell abnormalities was their previous history of abnormal pap smear (p=0.001). Squamous cell abnormalities were identified in 91% of the patients (767/841), and glandular cell abnormalities were identified in 9% of the patients (74/841).

Conclusion:

Prevalence of abnormal pap smears in central Saudi Arabia is relatively low, while advanced glandular abnormalities prevalence was observed to be high.Cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (CC) are documented to be less common in Saudi Arabian women community, as compared with some western communities.1-4 This observation was based on studies carried out in Al Baha in the southern region, and Jeddah in the western region of the Kingdom of Saudi Arabia (KSA). No similar recent study was performed in the central region of KSA that allows a clear view on the prevalence of the disease and its characteristics. It is important to mention here that up-to-date, CC screening program has not been implemented in KSA, and pap smear screening is still performed on an opportunistic basis. Moreover, CIN is known to be related to high risk human papilloma virus (HPV) infections, in particular HPV types 16 and 18.5,6 These particular infections are proven to be preventable by available tested vaccines.6 However, there is not enough published data on the prevalence of HPV and its genotypes in KSA that justify cervical cancer preventive vaccination program. Over the last few decades, the financial status of the Saudi population has improved,7 resulting in change in lifestyle, higher mean female age, and more expatriates are mixing with the Saudi population.8 We believe that the prevalence of abnormal pap smear in KSA might be increasing. National alertness and governmental work for preventive program implementation might be an urgent requirement. Such preventive program may assist in early detection and mortality/morbidity reduction of CC.9,10 In this research, we aimed to report an assessment of the prevalence of abnormal pap smears in the central region of KSA, smears cytology findings, and the clinical and personal characteristics of patients who were diagnosed with abnormal pap smears.     

Prevalence of stress and its determinants among residents in Saudi Arabia

Objectives:

To examine perceived stress among residents in Saudi Arabia and its associated risk factors.

Methods:

A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS).

Results:

Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession.

Conclusion:

Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.The healthcare profession needs adequate medical residency training programs to increase its members’ professional qualifications and to maintain patient safety. However, residency training is a difficult and stressful stage of development in a professional career.1 Residents are often subject to prolonged working hours, prolonged sleep deprivation, uncontrolled schedules, high job demands, and inadequate personal time.2 High job demands are combined with poor job resources, such as poor opportunities for professional development and low supervisor support. These factors may cause burnout, which is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment.3,4 Additionally, residency may impact the residents’ quality of life5 and cause them to experience sleep disorders,6 family problems,7 and even psychiatric disorders.8 These stress symptoms may in turn negatively impact patient care and result in frequent medical errors9 and suboptimal care practices.10 Some countries have implemented mandatory work hour limitations to improve residents’ quality of life with promising results, but this approach may diminish patient care and educational outcomes.11,12 We categorized the stressors that residents face into the following categories: institutional stressors, such as heavy workload, sleep deprivation, and poor learning environments; personal stressors, such as social problems, family problems, and financial difficulties; and professional stressors, such as career planning issues and information overload.13 Several studies from various parts of the world have already evaluated the presence of stress symptoms or their risk factors among medical residents in different programs.14-18 However, we struggled to compare the findings from these studies, because they employed different tools to assess the presence of stress. The study populations also varied considerably. In recent years, universities, and other major healthcare providers have been implementing additional recognized residency programs and have been enrolling more residents in Saudi Arabia to fix the huge deficiency in the number of Saudi-National practicing physicians.19 Yet no data pertaining to the stress among residents in Saudi Arabia exists. This information is a critical step toward occupational stress management, so the objective of the present study is to examine perceived stress among residents in Saudi Arabia and its associated risk factors, including personal and work-related stressors.     

Prevalence and outcome of isoniazid-monoresistant tuberculosis at a university hospital in Saudi Arabia

Objectives:To determine the prevalence and outcome in patients with isoniazid-monoresistant Mycobacterium tuberculosis complex and compare them to those in patients with non-isoniazid-monoresistant Mycobacterium tuberculosis.Methods:This cross-sectional analytical study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. The data were retrospectively collected from the electronic medical records of patients who tested positive for Mycobacterium tuberculosis between May 2015 and April 2019.Results:We identified 105 patients infected with Mycobacterium tuberculosis. The prevalence proportion of isoniazid-monoresistant tuberculosis was 8.6% (n=9). Five patients with isoniazid-monoresistant tuberculosis (55.6%) were successfully treated, while one patient died. In the nonresistant population, 51 (53.1%) patients were successfully treated. However, 12 (12.5%) patients with no isoniazid resistance had an unsuccessful treatment outcome. The resistant group had a longer treatment duration with a mean of 12 months compared to the non-isoniazid-resistant group, with a mean treatment duration of 9.5 months. Twenty-eight patients (26.7%) had adverse events, with the majority of them being in the non-isoniazid-resistant group.Conclusion:Isoniazid monoresistance is the most common form of drug resistance found in our population. Our study has not shown any significance in the outcome of isoniazid-resistant cases compared to non-isoniazid-resistant cases. This may be due to the low number of isoniazid-monoresistant cases in our population.     

Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh,Saudi Arabia

Objectives:

To assess the prevalence of pseudoexfoliation syndrome (PEX), and associated ophthalmic complications among Saudi patients.

Methods:

The prevalence of PEX and associated ocular co-morbidities were determined among the Saudi patients visiting the Primary Care Clinic of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2009 and January 2010. A total of 1967 patients were examined biomicoscopically by ophthalmologists to determine the presence of PEX and associated ocular complications.

Results:

Sixty-nine of the 1967 examined patients (3.5%) showed the presence of PEX with no significant gender difference. There was an age dependent increase in the prevalence of PEX after the age of 50 years. Pseudoexfoliation syndrome was associated with higher intraocular pressure, cataract, and poor vision. There was no significant difference in the prevalence of PEX in male and female Saudi patients.

Conclusion:

Pseudoexfoliation syndrome is an age-related disorder, and its prevalence increases with age. Further larger population based studies are warranted to assess the prevalence of PEX and associated risk factors.The pseudoexfoliation syndrome (PEX) is an age related systemic disease primarily manifesting in the eyes. It is characterized by the accumulation of dandruff like fluffy deposits of fibrillar granular material.1,2 The basic etiologic concept of PEX is a pathological process of the extracellular matrix characterized by the excessive production of an abnormal extracellular material, which aggregates and accumulates and is not degraded in vivo. The unique fibrillar PEX material is composed of a microfibrillar core surrounded by an amorphous matrix. In the eye, PEX material is produced primarily by the nonpigmented epithelium of the ciliary body, the posterior iris pigment epithelium, and the preequatorial lens epithelium, while the corneal endothelium, trabecular cells, vascular endothelia, and smooth muscle cells of the iris have also been implicated. Besides its age related manifestations in ocular tissue, the PEX material has been observed in extraocular tissues including skin, heart, lung, liver, kidney, gall bladder, blood vessels, optic nerve, and meninges.Diagnostic features of PEX include deposition of PEX material, endothelial pigmentation, loss of pupillary ruff, iris sphincter transillumination, Sampaolesi line, and pigment deposition in the trabecular meshwork. Pseudoexfoliation syndrome is associated with various ocular complications including elevated intraocular pressure, glaucoma, poor mydriasis, zonular weakness, corneal endotheliopathy, higher rate of vitreous loss during cataract surgery, postoperative complications such as capsular phimosis, and opacification. However, in most cases PEX remains asymptomatic. Since increased ocular pressure is generally painless, patients may be unaware of the disease until the condition becomes advanced. In some cases the patient may complain of impaired visual acuity (VA) or changes in their visual field. Pseudoexfoliation syndrome becomes problematic when the granular flakes become enmeshed in trabecular meshwork and block normal drainage of aqueous humor resulting in a build-up of increased ocular pressure, loss of vision, and even damage of the optic nerve.Data on the clinical profile and prevalence of PEX is important due to the fact that the world population is aging, and the proportion of elderly is increasing globally. Exfoliation syndrome occurs worldwide, although reported prevalence rates vary extensively.1-6 Reasons for this variation reflect a combination of true differences in prevalence on the basis of racial, ethnic, the age and gender distribution of the patient cohort or population group examined; the clinical criteria used for making a diagnosis of exfoliation syndrome; the ability of the examiner to detect early stages and/or more subtle manifestations of the disorder; and the thoroughness of examination, or other as yet unknown reasons. In particular, many cases go undetected because of failure to dilate the pupil, or to examine the lens with the slit lamp after dilation, and because of a low index of suspicion on the part of the examiner. The primary aim of this study was to assess the prevalence of PEX and associated ophthalmic complications among Saudi patients.     

Hemoglobinopathies: An update on the prevalence trends in Southern Saudi Arabia

Objectives:To investigate trends in hemoglobinopathies following the establishment of a mandatory premarital screening program (MPMSP) in the southern region of Saudi Arabia, where they are considered highly predominant.Methods:A retrospective analysis was performed on data from 32,130 high-performance liquid chromatography (HPLC) tests between November 2017 and October 2020. The data was obtained from the Hematology section, Laboratory Department, Armed Forces Hospital, Southern Region.Results:Despite the establishment of the MPMSP, our data showed that sickle cell disease remains a predominant hemoglobinopathy accounting for more than 7% of total tests in Southern Saudi Arabia. Observed HPLC hemoglobin fractions among the tested population showed a reduction in Hb A mean indicating a high rate of hemoglobin abnormalities. In addition, the prevalence of hemoglobin variants, including sickle cell and thalassemia, was higher in the younger population born after the MPMSP than in older subjects.Conclusion:Even with the implementation of the MPMSP, hemoglobin abnormalities remain prevalent in southern Saudi Arabia. A longer time frame is recommended to verify the validity of the program.