Disease phenotype and diagnostic delay in Saudi patients with primary Sjögren’s syndrome: An exploratory cross-sectional study

Objectives:To describe primary Sjögren’s syndrome (pSS) cohort in Saudi Arabiain view in of clinical/serological/histopathological phentotype, and, diagnostic delay.Methods:A cross-sectional study conducted between October 2018 and May 2019. Diagnostic delay was calculated from symptoms onset to clinical diagnosis. The European League Against Rheumatism (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI) and EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI) were calculated.Results:Forty-one patients were included in the study. There were predominantly females (78%) with a mean (±SD) age of 58.76±12.7 and disease duration of 4.6±2.28 years. The mean diagnostic delay was 2.2±2.4 (range 1-11) years. Minor salivary gland biopsy was performed on 38 (92.7%) patients with a mean focus score of 2.3± 1.2 points. Interstitial lung disease and arthritis were the most common extra-glandular manifestations (EGM) affecting 27 (65.9%) patients for both. The mean ESSDAI was 9.95±7.73 and ESSPRI was 5.17±2.4.Conclusion:Saudi primary Sjogren’s syndrome patients have a high prevalence of EGM predominantly arthritis and ILD. The diagnostic delay is variable in our cohort.     

血清结核杆菌抗体检测在结核病的临床意义

目的：探讨血清结核杆菌抗体检测在住院患者结核病诊断中的临床价值。方法150例结核病患者,80例非结核病患者以及40例健康志愿者均应用以脂阿拉伯甘露糖（LAM）为抗原的 ELISA法进行抗体阳性率的检测。并应用痰涂片和PPD实验检查对150例结核患者进行检测。结果在150例肺结核患者中,结核杆菌抗体检测的阳性检出率为72．67％（109/150）,显著高于痰涂片的51．33％（77/150）和PPD实验的58．67％（88/150）,且差异均具有统计学意义（χ2＝14．49,6．52;P＜0．001,0．011）。结核病组抗体阳性率总数为72．67％（109/150）,显著高于非结核病组的17．50％（14/80）和健康对照组的10．00％（4/40）,且与二者比较,差异均具有统计学意义（χ2＝41．15,51．45;P＜0．001,0．001）。非结核疾病组与健康人群比较,抗体阳性率的差异无统计学意义（χ2＝1．18,P＝0．27）。结论结核抗体测定对结核病的阳性检出率较高,优于传统的痰涂片和PPD实验检测,临床上具有很大的应用价值。     

Gynecological cancer incidence in a hospital population in Saudi Arabia: the effect of foreign immigration over two decades

Aim:  To determine if the incidence of female genital malignancies changed with foreign immigration.
Methods  Retrospective analysis of histopathology records of women with primary genital tract cancers attending a referral gynecological hospital over two decades from 1985 to 2004. Incidence rates for the combined population of foreign migrants and Saudi nationals were compared to rates among Saudi nationals alone. Outcome measures were incidence rates and incidence rate ratios.
Results:  The incidence of cervical cancer for the combined migrant and local Saudi population was 48.4%, while for Saudi nationals alone it was 33.5% (incident rate ratio [IRR]= 1.44, 95% CI 1.17–1.88, P  < 0.001). For vulvar cancer, the incidence was 1.2% versus 0.5% (IRR = 2.4, 95% CI 2.03–2.79, P  < 0.001). Endometrial cancer rate was lower in the combined population than in Saudi nationals alone (11.7% vs 18.0%, IRR = 0.65, 95% CI 0.27–1.02, P  < 0.04). There were no differences in incidence for gestational trophoblastic neoplasia, uterine corpus sarcoma, ovarian, and vaginal cancer. Incidence rate ratios differed between decades for cervical cancer (1.1/1.9, 0.58, 95% CI 0.21–0.89, P  < 0.001), vulvar cancer (4.2/1.8, 2.33, 95% CI 1.68–3.07, P  < 0.001), gestational trophoblastic neoplasia (1.4/1.0, 1.4, 95% CI 1.09–2.13, P  < 0.04), and uterine sarcoma (0.3/1.0, 0.03, 95% CI 0.012–0.041, P  < 0.02).
Conclusion:  The incidence of cervical and vulvar cancer increased among women presenting with gynecological malignancies. For cervical and vulvar cancer, uterine corpus sarcoma, and gestational trophoblastic neoplasia, incidence varied over time.     

Assessment of knowledge and challenges toward the use of subcutaneous self-injecting insulin among diabetes patients during COVID-19 pandemic in Saudi Arabia

BackgroundThe COVID-19 pandemic has revolutionized the delivery of chronic health care. For diabetic patients, maintaining regular contact with healthcare providers and visiting healthcare centers are crucial to patients’ overall ability to control their glycemic status.ObjectiveTo assess patients’ knowledge regarding the use of insulin injection devices and the challenges these patients face in obtaining medical advice, as well as to suggest alternative solutions for addressing these challenges among diabetic patients self-administering their injections during the COVID-19 pandemic.MethodologyAn observational cross-sectional study was conducted among a sample population (N = 178) of diabetic patients attending Security Forces Hospital–Riyadh, Saudi Arabia, from which the Institutional Review Board (IRB) was granted. Data was collected using a self-administered questionnaire, which was distributed from August to September 2020. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) program (version 21). Significant P-value = < 0.05.ResultsThe majority of patients had good knowledge and practice explained with values 73.6% of total papulation. Sixty-four percent of patients with type 1 diabetes and 59% of patients with type 2 diabetes reported experiencing moderately severe challenges obtaining counseling. There was no correlation between severity of disease and knowledge levels (p-value = 0.36). The most appropriate means of obtaining counseling was determined to be conversations with healthcare providers; this strategy received an overall average score of 4.9 ± 0.4 (p-value < 0.0001).ConclusionRegardless of whether knowledge is high among patients with diabetes, continuous support and counseling from healthcare providers is critical. The creation of innovative approaches to facilitate communication between diabetes patients and healthcare providers is recommended for continued patient care during the COVID-19 pandemic.     

Periodontal risk assessment in a teaching hospital population in Saudi Arabia’s Eastern Province

ObjectiveWith this cross-sectional study, we aimed to evaluate factors associated with moderate and high risk of periodontal disease (PD) progression in the Saudi population.MethodsWe reviewed 281 patients’ clinical charts from predoctoral periodontal clinics at the dental teaching hospital in the College of Dentistry (COD) at Imam Abdulrahman Bin Faisal University (IAU) in Dammam, Saudi Arabia. After obtaining ethical approval, we determined the Periodontal Risk Assessment (PRA) of the included patients based on the modified criteria developed by Lang and Tonetti (2003). We used logistic regression on stratified data and divided the results into two categories (low-moderate and high risk) to assess the effect modifier for potential risk factors. We used SPSS version 22 for data analysis, and considered a P-value ≤ 0.05 to be statistically significant.ResultsOut of the 281 patients, 104 (37.0%) were male and 177 (63.0%) were female, with a mean age of 39.9 ± 14.0 years; 78.1% were Saudi nationals, 77% were married, and 44.6% were in the age group of 30 to 49. The PRA revealed 86 (30.5%) to represent high risk, 108 (38.3%) denoted moderate risk, and 88 (31.2%) signaled low risk for periodontitis. Logistic regression analysis showed that males were three times more likely to have high PRA (OR = 3.24) and to be married (OR = 2.77), as well as to be active smokers (OR = 8.87). The highest predictive factors of high PRA were 8 or more pockets ≥ 5 mm (OR = 29.0), those with active diabetes mellitus (DM; OR = 10.2), and those with 8 or more missing teeth (OR = 9.15).ConclusionSaudi males who are married and have residual periodontal pockets, are actively diabetic, and with missing teeth are at high risk of PD. Further research is needed with a larger sample size comparing the general population with and without PD.     

Utilization of evidence-based guidelines for prevention of obesity and hypercholesterolemia among primary healthcare physicians in southwest of Saudi Arabia

To evaluate knowledge and use of evidence-based guidelines for prevention of obesity and hypercholesterolemia among primary healthcare physicians in Jazan, Saudi Arabia.This cross-sectional study targeted 170 primary healthcare centres (PHCs) in Jazan. Measurement of study''s variables was completed during personal interviews. The content of the study instrument was based on The Saudi Guidelines on the Prevention and Management of Obesity and The Cholesterol Management Guide for Healthcare Practitioners.A total of 234 physicians participated in this study. The age of the physicians varied between 25 and 65 years and 51.7% of them were females. Knowledge of the physicians about the eat-well plate recommendations was very low, with none of the physicians reporting the recommended daily portions of fruits and vegetables. Less than 20% of the physicians knew the cutoff points for considering central obesity among male and female individuals. Only 21% of the physicians reported adherence concerning screening for obesity and 42% reported adherence to the guidelines concerning screening for hypercholesterolemia. Only 9% of the physicians were adherent to the guidelines concerning reducing the risk of obesity and only 13% reported adherence to the guidelines related to the reduction of hypercholesterolemia risk.The current investigation detected a low level of knowledge and adherence concerning the evidence-based practice related to prevention of the obesity and hypercholesterolemia and therefore limited role of PHC physicians in the prevention of obesity or hypercholesterolemia.     

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.     

Translation,cultural adaptation,and evaluation of the psychometric properties of an Arabic diabetes distress scale: A cross sectional study from Saudi Arabia

Objectives:To translate, validate, and adapt the diabetes distress scale (DDS)-17 to a Saudi Arabian (SA) DDS (SADDS-17). Also, to evaluate the psychometric properties of the newly adapted SADDS-17.Methods:This was a cross-sectional study evaluating the psychometric properties of the DDS. The DDS was translated using the forward-backward translation from English to Arabic at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in January 2016. Statistical analyses included exploratory factor analysis, internal consistency, testretest reliability, and construct validity. Moreover, contingent validity was evaluated using hospital anxiety and depression scale, visual analogue scale, and the World Health Organization quality of life assessment instrument.Results:A total of 109 participants were included in this study. The exploratory factor analysis of our Arabic scale supported the original DDS with 4 sub-scales. Correlations ranged from 0.376 to 0.718 for items in regimen-related distress, 0.327 to 0.533 for items in emotional burden, 0.413 to 0.722 for items in physician-related distress, and 0.492 to 0.556 for items in interpersonal distress. The Cronbach’s alpha value of the SADDS was 0.848 for the total scale. The test-retest reliability value was 0.78.Conclusion:Our SADDS is a valid and reliable instrument for detecting diabetes distress among Saudi Arabian patients with type 2 diabetes.     

Assessment of disaster preparedness at general hospitals in Al-Madinah Al-Munawarah Province,Western Region of Saudi Arabia: A study of pre intervention and post intervention test scores from 2017 to 2019

Objectives:To evaluate the Ministry of Health (MoH) hospitals preparedness for potential disasters and crisis events using the World Health Organization (WHO) hospital emergency response checklist.Methods:A cross-sectional study was conducted at MoH hospitals in Al-Madina, Saudi Arabia using the WHO hospital emergency response checklist. The overall level of hospital preparedness was categorized as unacceptable if the rating is between 0-64, insufficient if it is between 65-129 and effective preparedness if the score is between 130-184. The study conducted in 3 phases. First phase, the preintervention assessment was conducted from August 23 to 27, 2017. Second phase, intervention strategies were implemented between 2018 and 2019 to enhance the hospitals preparedness for any potential disaster situation. Third phase, the postintervention assessment was conducted from September 5 to 7, 2019, using with the same checklist.Results:The preparedness score of key components at the participating hospitals showed an “insufficient” level of preparedness. The mean preparedness score of the participating hospitals was 81.5±11.39 (range: 65-91), which is lower than the recommended WHO cut-off level of effective preparedness. The preparedness score of the post-recovery component was very low 01±1.15 compared to the WHO range (0-18).Conclusion:A total of 4 hospitals participated in the study. The participated hospitals showed insufficient levels of preparedness for potential disasters and crisis events.