Burnout among nurses working in the primary health care centers in Saudi Arabia,a multicenter study

Background: Burnout is a common psychosocial phenomenon among nursing. It has been attributed to prolonged exposure to stress in the work place. This study aimed to determine the prevalence and associated factors of burnout among nurses in the primary health care centers in Saudi Arabia. Methods: This cross-sectional study was conducted among 200 nurses by using a self-administered questionnaire. Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. Results: Most participants were females (73.0%) and aged ≤35 years (52.0%). About 39% had high emotional exhaustion, 38% had high depersonalization and 85.5% had low personal accomplishment. About 89% (178) scored high at least on one subscale of burnout. Burnout was associated with age, educational level and sources of stress in the workplace. Conclusion: Level of burnout among nurses was high and was associated mainly with stressors in the workplace. Improving work environment and management of stress in the workplace should be a priority to minimize burnout among nurses.     

Phylogenetic Analysis of MERS-CoV in a Camel Abattoir,Saudi Arabia, 2016–2018

We detected Middle East respiratory syndrome coronavirus (MERS-CoV) RNA in 305/1,131 (27%) camels tested at an abattoir in Al Hasa, Eastern Province, Saudi Arabia, during January 2016–March 2018. We characterized 48 full-length MERS-CoV genomes and noted the viruses clustered in MERS-CoV lineage 5 clade B.     

Community needs and preferences for community pharmacy immunization services

This study explored the Saudi community’s needs and preferences related to community immunization services. Community member’s expectations about the services were assessed, and their concerns, attitudes, and beliefs around the pharmacist’s role in providing immunization were examined.MethodQualitative in-depth, semi-structured interviews were conducted with a convenience sample that comprised Saudi community members who visited Saudi community pharmacies. Interviews were audio-recorded, transcribed verbatim, and then translated. Data obtained were then thematically organized and analyzed using NVivo (QSR International) Software.ResultA total of 20 interviews were conducted for this study. Seven themes emerged from the interviews and were grouped into three major categories relating to the community pharmacy immunization service: (1) community needs for the service; (2) community expectations of the service; and (3) community concerns, and beliefs around the service. Participants expressed their need for such services and acceptance of immunization performed by community pharmacists, with the expectation that it would improve their immunization uptake and community health in general. However, some participants expressed concerns about community pharmacists current level of ability and skill in providing immunization, the lack of a private area for conducting the service, the lack of female community pharmacists, and the cost of the immunization service. Some participants advocated for supervision of such services by the Ministry of Health (MOH) and Saudization of community pharmacy staff.ConclusionThe research results clearly demonstrated the Saudi community’s need for community pharmacy immunization services, described their expectations, and highlighted their concerns relating to community pharmacy infrastructure and an appropriate level of training for community pharmacist-administered immunization.     

Outcome of Chronic Myeloid Leukemia-Chronic Phase Patients Treated With Imatinib: A Local Experience

Background

Imatinib was the first tyrosine kinase inhibitor that has revolutionized the therapy of chronic myeloid leukemia. It binds breakpoint cluster region–Abelson kinase domain inducing apoptosis of the leukemic cells. In this study, we assessed the efficacy and toxicity of imatinib therapy in patients with chronic myeloid leukemia in chronic phase (CML-CP) in our hospital.

Post-shift changes in pulmonary function in a cement factory in eastern Saudi Arabia

This cross-sectional study was conducted in 1992 in the oldest of three Portland cement producing factories in Eastern Saudi Arabia. The respirable dust level was in excess of the recommended ACGIH level in all sections. Spirometry was done for 149 cement workers and 348 controls, using a Vitalograph spirometer. FEV1, FVC, FEV1/FVC% and FEF25-75% were calculated and corrected to BTPS. A significantly higher post-shift reduction FEV1, FEV1/FVC% and FEF25-75% was observed in the exposed subjects. Multiple regression analysis showed a significant relationship between post-shift changes and exposure to cement dust but failed to support any relationship with smoking. These findings may indicate an increase in the bronchial muscle tone leading to some degree of bronchoconstriction as a result of an irritant effect induced by the acute exposure to cement dust.     

Viral hepatitis markers in patients on haemodialysis in a hyperendemic area

Antibody profiles for cytomegalovirus (CMV), hepatitis A virus (HAV), hepatitis B virus (HBV) and the delta-agent were determined on 55 serum samples drawn from 55 Saudi patients on maintenance haemodialysis for periods ranging from 1.5 months to 2 years. The exposure rates for CMV, HAV, and HBV were 100%, 100%, and 72.7%, respectively. There was no intersex difference in positivity for HBV surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to HBV core antigen (anti-HBc); 15.4%, 65.4%, 3.8% in males and 6.9%, 55.2%, and 0% in females, respectively. Among six HBsAg carriers, one and three were positive for e antigen (HBeAg) and antibody to HBeAg (anti-HBe), respectively, with two negative for HBeAg and anti-HBe. The six carriers were also negative for anti-delta antibody. A comparison of the above antibody profile to the profile of voluntary blood donors and those seeking treatment for minor ailments in the local general hospital, obtained earlier using identical test procedures, revealed no difference for CMV and HAV exposure rate. The HBV exposure rate was higher in the haemodialysed patients (P less than 0.001). The epidemiological measures for preventing nosocomial viral hepatitis including immunisation of susceptibles, can be supplemented, among carriers, by interferon and acyclovir therapy for active viral replication. In HBV hyperendemic areas, haemodialysis patients exposed to HBV should be screened periodically for early signs of hepatocellular carcinoma.     

Successful Treatment of Corneal Opacification with Associated Thickened Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH)

PurposeTo study clinical and histopathological findings of corneal opacification caused by thickened epithelium leading to reduced vision and topographical changes and to evaluate the outcome of its removal.MethodsTwelve patients (17 eyes) with central, paracentral or peripheral corneal opacification were reviewed to obtain their visual acuity, describe their slit lamp (SL) appearance (depth, extent and density) and document their topographic changes before and after peeling of the epithelium under SL or surgical removal under the microscope. Specimens of six cases were available for histopathological examination and immunohistochemical staining.ResultsMost of the eye opacifications were secondary to corneal procedures in 10 [Penetrating keratoplasty (PKP) in 7 for congenital glaucoma, keratoconus or adherent leukoma – usually over graft-host junction –, Photorefractive keratectomy (PRK) in 2 and Phototherapeutic keratectomy in one], chronic inflammation following trachoma or non-specific causes (3), and herpetic scar (1). Three cases were considered to be idiopathic. All cases presented with decreased vision, astigmatism or changes in topography or refraction. Their vision, clinical symptoms and topography improved after treatment. Histopathologically, all six cases shared findings that are similar to what have been described as peripheral hypertrophic subepithelial corneal degeneration (PHSCD) rather than Salzmann’s nodular degeneration. None of the cases showed inflammation or subepithelial pannus formation in the excised tissue. However, our cases did not fit into the diagnosis of PHSCD because of the location of the corneal opacification (being peripheral in 41% of the corneas, the presence of underlying primary etiologic factors in 82% of the eyes and the bilateral occurrence in 5 patients.ConclusionsMeticulous SL examination aided by corneal imaging may accurately diagnose and determine the depth of corneal opacification as a cause for reduced vision. Histopathologically, the removed tissue is similar to PHSCD, but cases differ in their clinical profile. Peeling the thickened epithelial/subepithelial tissue is curative in most patients, improves visual and clinical outcome and avoids unnecessary corneal grafting.     

The impact of surgical training on the practice of recently graduated ophthalmologists at Riyadh’s ophthalmology residency program

PurposeTo evaluate how well the training residency program prepared recent graduates to practice comprehensive ophthalmology with special focus on surgical competency.MethodsThis is a cross-sectional study that included Ophthalmologists who graduated from Riyadh ophthalmology residency program between the years 2002–2012. A total of 126 graduates were invited through e-mails and electronic social media platforms to anonymously complete an electronic survey. The survey included questions that aim to assess the surgical competency of graduated ophthalmologists in doing various surgical procedures that were among the requirements of residency training.ResultsNinety participants in the mean age of 38.7 years completed the survey. The majority of respondents (93%) joined fellowship programs and around half of them sub-specialized in anterior segment. More than half (55.6%) of the respondents reported that the acquired surgical skills during residency training were adequate. By the end of the residency period, the respondents’ competency in doing extra capsular cataract extraction was better than phacoemulsification while 52% of them reported incompetence in both glaucoma and strabismus surgeries whereas the majority were incompetent in oculoplastics’ procedures (e.g. entropion repair). However, the majority felt competent in doing primary repair, minor and laser procedures. Lack of exposure was the major cause of such incompetency.ConclusionThis self-reported survey showed that the lack of adequate surgical exposure during residency training was the main reason of incompetency. This resulted in reduction of ophthalmologists’ future practice of surgical procedures outside the scope of their sub-specialty. This emphasizes that physicians mainly practice what they surgically acquire during their fellowship training.     

Challenges in the diagnosis of microbial keratitis: A detailed review with update and general guidelines

The incidence of microbial keratitis (MK) is variable worldwide with an estimated 1.5–2 million cases of corneal ulcers in developing countries. The complications of MK can be severe and vision threatening. Therefore, proper diagnosis of the causative organism is essential for early successful treatment. Accurate sampling of microbiological specimens in MK is an important step in identifying the infective organism. Corneal scrapping, tear samples and corneal biopsy are examples of specimens obtained for the investigative procedures in MK. Ophthalmologists especially in an emergency room setting should be aware of the proper sampling techniques based on their microbiology-related basic information for each category of MK. This review article briefly describes the clinical presentation and defines in details the best updated diagnostic methods used in different types of MK. It can be used as a guide for ophthalmology trainees and general ophthalmologists who may be handling such cases at initial presentation.     

Vitrector induced lens injury during peripheral iridectomy in implantable collamer lens surgery

A 38-year-old female underwent bilateral implantable collamer lens (ICL) implantation for hyperopic astigmatism. While performing intraoperative peripheral iridectomy (PI), iris and anterior lens capsule was drawn to anterior vitrectomy cutter which result in large PI and injury to anterior lens capsule. Anterior lens capsule injury closed by fibrosis and the patient has 20/20 vision and static traumatic lens changes without any undesirable sequelae at the last follow up. Performing PI preoperatively by laser or alternatively by scissor intraoperatively is advisable to avoid above mentioned complication and a close observation is recommended when lens injury encountered.