Medical Students' Perspectives Regarding the Use of a Slit-Lamp Smartphone Adapter for Clinical Slit-Lamp Photography.

Background This study aimed to investigate medical students' perspectives regarding the ease and utility of smartphone slit-lamp photography. Methodology In this prospective experimental study, fourth and fifth-year medical students who were in or had finished ophthalmology rotation were included to attempt slit-lamp smartphone anterior segment photography on adult patients after a brief hands-on instruction course. Each medical student attempted to record five supervised slit-lamp videos of the anterior segment of five patients using the described adapter and their own smartphone. The time taken until photography was calculated for each attempt. After the fifth attempt, each medical student rated the ease of the use of this method of slit-lamp photography as well as their perspective regarding its utility as a potential means of medical education and telemedical consultations on a five-point Likert scale. Results A total of 33 medical students participated, with each successfully recording five slit-lamp examinations using their smartphones. The time used for the application of the adapter until the image capture ranged from 6 to 278 seconds (average = 39.51 ± 34.7 seconds) and markedly improved by the fifth attempt (30.5 ± 25.7 seconds) compared to the first attempt (67.3 ± 49.3 seconds). Learning this skill was perceived to be relatively easy (2.2 ± 1), with high potential in clinical education (4.6 ± 0.75) and teleconsultations (4.7 ± 0.65). Conclusions Smartphone slit-lamp photography is a relatively easy process. It can be quickly acquired by medical students and has the potential to enhance their medical education and telemedical consultation capabilities.

Impact of Corticosteroid Therapy on ICU Patient Outcomes in Severe COVID-19 Cases: A Retrospective Cohort Study in Saudi Arabia.

BACKGROUND: The COVID-19 pandemic has presented significant challenges in clinical management, and intensive care units (ICUs) worldwide have become epicenters of high-stakes treatment decisions. Among these, corticosteroid therapy has risen as a pivotal, yet controversial, treatment modality. In Saudi Arabia, where unique demographic and health system characteristics intersect, understanding the specific effects of corticosteroids on ICU patient outcomes is not just critical but a pressing necessity in tailoring effective COVID-19 management strategies. OBJECTIVE: This study aims to elucidate the effects of corticosteroid therapy on the outcomes of severe COVID-19 patients in Saudi Arabian ICUs, providing critical insights into treatment efficacy and guiding future clinical practices. MATERIALS AND METHODS: In this cohort study, we meticulously reviewed the medical records of 1085 severe COVID-19 patients admitted to Saudi Arabian ICUs. Our analysis focused on demographic details, ICU outcomes, and the extent and implications of corticosteroid therapy. The study employed comprehensive methods for data collection, evaluation criteria, and statistical analysis, ensuring a thorough understanding of the impact of corticosteroids in this context. RESULTS: The study encompassed 1085 patients, predominantly male (74.5%, N=806), with an average age of 56 and a mean BMI of 30.07. A significant portion (72.3%, N=784) received corticosteroid therapy. These patients generally experienced longer ICU (mean 23 days) and hospital stays (mean 16 days), along with higher rates of microbiological cure (72.3%, N=648) and increased ICU discharge likelihood. Conversely, corticosteroid recipients showed higher mortality rates at ICU discharge. The statistical analysis confirmed the significance of these findings, reinforcing their importance in managing COVID-19 in ICUs. CONCLUSION: The research highlights the intricate dynamics of corticosteroid use in treating severe COVID-19 cases in ICUs. While associated with prolonged ICU stays and increased mortality, corticosteroids also correlate with higher microbiological cure rates and discharge likelihood. These insights call for careful deliberation in applying corticosteroid therapy, with implications for enhancing clinical protocols and guiding future research in severe COVID-19 treatment.

The Use of Infrared Auto Refractometer for Meibomian Gland Imaging.

Introduction This study proposes the utility of an infrared auto refractometer for meibography and compares miebographs obtained by an auto refractometer to meibographs obtained by a designated meibography machine. Methods A prospective observational comparative study of meibographs of patients with clinical signs of meibomian gland dysfunction (MGD) using a designated meibography machine and an infrared auto refractometer. Five masked, experienced interpreters graded the images of the two machines. The Kappa test was used to calculate Intra-rater and inter-rater agreements between the meibography machine and automated refractor grading of meibomian gland dysfunction. Results High-quality photos of all 30 eyes delineating the meibomian glands (MG) were successfully obtained with both the meibography machine and the autorefractor. Both methods had a good intra-rater agreement (κ= 0.667 to 0.784, average 0.738). Poor to fair interrater agreement was noticed in the grading of autorefractor images (k= -0.030 to 0.343, average 0.092) and poor to moderate agreements between investigators for meibography machine images (K= -0.016 to 0.420, average 0.173). Conclusion A commercially available auto refractometer could capture high-quality non-contact IR digital meibographs.

Impact of Using Antiviral Therapy on COVID-19 Progression in ICU Patients: A Saudi Arabian Retrospective Analysis.

Background The COVID-19 pandemic has posed an unprecedented challenge to the global healthcare system, necessitating effective therapeutic strategies to mitigate its impact. This study investigates the significance of early antiviral therapy in the context of intensive care units (ICUs) and its potential to influence the progression and outcomes of severe COVID-19 cases. Methodology This retrospective cohort study leveraged a diverse patient population with confirmed severe COVID-19 admitted to ICUs. A total of 1,250 patients were included in the analysis, and their medical records were comprehensively reviewed. The study aimed to assess the impact of early antiviral therapy on patient outcomes, focusing on the administration of remdesivir within the first 48 hours of ICU admission. Results In a study of 1,250 COVID-19 patients, early antiviral therapy with remdesivir significantly reduced ICU admissions by 30% (N = 225) compared to standard care (N = 525). The early therapy group also exhibited a 20% lower mortality rate (N = 120) than the control group (N = 150). Demographic associations with antiviral usage were observed. Kaletra was favored by females, non-Saudi individuals, and healthcare workers, while favipiravir was associated with gender. Remdesivir and ribavirin use were linked to gender and Saudi nationality, while oseltamivir was related to gender, Saudi nationality, and body mass index. Microbiological cure rates were 15.4%, with 84.6% not achieving it. ICU outcomes included 37.7% deaths, 55.7% home discharges, and 6.6% transfers, while hospital outcomes featured 38.5% deaths, 54.4% home discharges, and 7.1% transfers. Conclusions This study presents a comprehensive analysis of COVID-19 patient demographics, antiviral medication associations, and clinical outcomes. The findings highlight the significance of tailoring treatment strategies based on patient characteristics and viral history. These insights contribute to a deeper understanding of COVID-19 management and can inform clinical decision-making and further research in this field.

Prevalence and Visual Consequences of Non-adherent Patients Receiving Anti-vascular Endothelial Growth Factor (VEGF) Injections at King Fahad Specialist Hospital (KFSH), Qassim Region.

BACKGROUND: Anti-vascular endothelial growth factor (VEGF) injection treatment is a widely utilized therapy for various retinal diseases, including diabetic macular edema (DME). Therefore, the importance of compliance and follow-up should be discussed with the patient. There have been no studies conducted in the Qassim region to estimate the prevalence of patients missing their anti-VEGF appointments. To fulfill this need, we conducted this study to evaluate the compliance rate of patients treated with anti-VEGF injections for DME as well as to determine the visual consequences of the delay in anti-VEGF treatment in the Qassim region. METHODOLOGY: This observational retrospective cohort study was conducted at King Fahad Specialist Hospital (KFSH) in the Qassim region of Saudi Arabia. We extracted all file numbers of patients who were using intravitreal anti-VEGF injections to treat DME. The data were managed and analyzed using the IBM Statistical Package for the Social Sciences (SPSS) software (IBM Corp., Armonk, NY, USA). RESULTS: In the current study, we were able to collect data from 198 patients who received anti-VEGF treatment in the hospital. Among the participants, 57.6% were male, with a mean age of 61.7 years old (standard deviation (SD) = 10.23). Among the patients, we found that the rate of non-adherence to the anti-VEGF injection was 54.5%, and those patients delayed their scheduled doses for more than 56 days. In 47.5% of the patients, delaying or stopping their appointments had no known reason; however, blepharitis was the main reason for delaying or stopping the dose in 27.7% of the patients, followed by endophthalmitis in 18.7% of the patients. There is no significant difference between before and after stopping the treatment, considering visual acuity (VA) or optical coherence tomography (OCT). However, regarding the disease progression, we found that 15 out of the 30 patients had worsened in the OCT after they missed their injections (mean increase in the VA was 6.069 (SD = 97.45), t = -0.278, P = 0.783, and decrease in the OCT was -14.9667 (SD = 133.87, P = 0.454). CONCLUSION: There is a high rate of patients who missed their appointments for an anti-VEGF injection. This resulted in the worsening of OCT in half of the 30 patients who were enrolled in the visual consequences study, which had a negative impact on treatment and disease progression.

Quality of Life in Thyroid Cancer Patients.

Thyroid cancer ranks as the ninth most common cancer worldwide and third in Saudi Arabia. Given thyroid cancer's high incidence, thyroid cancer patients' quality of life (QoL) has been a concern for many years. However, no study has been dedicated to assessing thyroid cancer patients' QoL in Saudi Arabia. Thus, we aimed to fill this gap by assessing thyroid cancer patients' QoL in Saudi Arabia. This cross-sectional study was conducted among thyroid cancer patients attending outpatient clinics at the Diabetes and Endocrinology Centre, King Fahad Specialist Hospital, Qassim region, Saudi Arabia, from 2017 to 2023. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) assessed the patients' QoL through an individual interviewer-administered technique. We used RStudio to perform statistical analysis. Statistical differences between groups based on QoL scores were assessed using the Wilcoxon and Kruskal-Wallis rank-sum tests. Our results showed that for QoL scores of functional domains, the lowest was in social functioning, and the highest was in cognitive functioning. Regarding the subscales of symptoms, the highest scores were fatigue and insomnia. In conclusion, numerous factors affect thyroid cancer patients' QoL. Recognition and appropriate management of these factors will improve the overall QoL; there is a need to understand what is driving these factors in further clinical studies.

Association of a single nucleotide polymorphism in SOD2 with susceptibility for the development of diabetic nephropathy in patients with type 2 diabetes: A Saudi population study.

INTRODUCTION: One of the complications of diabetes mellitus (DM) is diabetic nephropathy (DN), which plays a significant role in the progression of end-stage renal disease. Oxidative stress is implicated in DN pathogenesis, and genetic variations in antioxidant enzymes such as superoxide dismutase 2 (SOD2) and catalase (CAT) may contribute to the susceptibility. This study aimed to investigate the potential association between single nucleotide polymorphisms (SNPs) in antioxidant enzymes, specifically SOD2 rs4880 and CAT rs769217, and the risk of T2D and susceptibility to DN within the Saudi population. METHODS: This case-control study included 150 participants, comprising 50 patients with T2D without DN (group 1), 50 patients with T2D with DN (group 2), and 50 healthy participants (group 3). The samples were genotyped using real-time PCR for SOD2 rs4880 and CAT rs769217 SNPs. Sanger sequencing was used for validation. Statistical analyses were performed to explore associations between these SNPs and T2D with or without DN. RESULTS: No significant difference was observed in CAT rs769217 expression between the groups. However, a significant difference was observed in SOD2 rs4880 expression between the healthy controls and patients with T2D with DN (p = .028). Furthermore, SOD2 rs4880 was associated with approximately threefold increased risk of DN in patients with T2D compared to that in healthy participants (odds ratio [OR] = 2.99 [1.31-6.83]). Validation through Sanger sequencing further confirmed these findings. CONCLUSIONS: The findings of this study provide evidence that SOD2 rs4880 SNP may contribute to inadequate defence by the antioxidant enzyme, SOD2, against DM-induced oxidative stress and thus cause DN in Saudi patients with T2D. Therefore, SOD2 rs4880 may serve as a predictive marker to prevent the development and progression of DN in patients with T2D.

Knowledge and attitude of the general population regarding infant hearing loss in Saudi Arabia.

Background: Ear health and hearing loss (HL) among infants has devastating outcomes. With most HL being deemed preventable, the assessment of one's knowledge and attitude regarding this impairment is important. In Saudi Arabia, the state of the general population's knowledge on infant HL remains unknown. Objectives: To determine and further elucidate the general population's knowledge and attitude with regard to HL in Saudi Arabia. Methods: This is a cross-sectional survey-based study conducted on the general population of Saudi Arabia. A predetermined questionnaire was translated into Arabic. This was distributed among the targeted participants in several provinces of Saudi Arabia (central, northern, eastern, western, and southern) by using an online survey via social media. The data were collected and analyzed via the SPSS program. Results: The knowledge with moderate, poor, and good was determined among 60.9%, 29.6%, and 9.4% of the participants, respectively. The participants with positive and negative attitudes were detected among 92.6% and 7.4% of respondents, respectively. Increasing age was associated with better attitude, while increased knowledge was directly related to higher educational attainment. Those who have a child with HL had nearly twice as poor knowledge as those who do not have a child with HL (P < 0.001). Conclusions: Although most of the respondents possessed a positive attitude toward infant HL, their knowledge about it seems to be lacking. Thus, there is a need to address these knowledge gaps regarding infant HL.

Prevalence of Asymptomatic Hiatal Hernia in Obese Patients During Preoperative Upper Gastrointestinal Endoscopy Assessments and Correlation With Body Mass Index.

Introduction In obese patients, hiatal hernia (HH) can be asymptomatic or may present with one or few symptoms, such as heartburn, nausea, or vomiting. Routine upper gastrointestinal (GI) endoscopy is the most frequent method used to determine the presence of any abnormalities, including HH. This study aimed to assess the prevalence of asymptomatic HH in obese patients during routine upper GI endoscopy assessments and to examine the correlation with body mass index (BMI). Materials and methods This was an observational, retrospective cohort study conducted at King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia. The data were extracted from the medical records and electronic charts of all obese patients who underwent preoperative upper GI endoscopy assessment between January 2017 and December 2019. Data were tabulated in Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) Version 21 (IBM Corp., Armonk, NY, USA). Results Among the 690 obese patients, HH was found in 103 (14.9%) patients. The chi-square test revealed that abdominal pain (X2=3.885; p=0.049), shortness of breath (X2=8.057; p=0.005), vomiting (X2=4.302; p=0.038), nausea (X2=4.090; p=0.043), and other HH symptoms (X2=3.897, p=0.048) were the most frequently reported HH related symptoms, but BMI was not (X2=2.126; p=0.345). In the multivariate regression model, the use of PPI (proton-pump inhibitor) medication (adjusted OR [AOR]=0.237; 95% CI=0.074-0.760; p=0.023) was found to be higher in those with HH. Vomiting (AOR=1.722; 95% CI=1.025-2.890; p=0.040) and nausea (AOR=1.698; 95% CI=1.012-2.849; p=0.045) were the most frequently reported symptoms related to HH. Conclusion Asymptomatic HH among obese patients is not widely prevalent in our region. The use of PPI medications was found to decrease the symptoms associated with HH, such as vomiting and nausea. However, there was no evidence linking BMI to the development of HH.

Medical Students and COVID-19: Knowledge, Preventive Behaviors, and Risk Perception.

BACKGROUND: The coronavirus disease (COVID-19) pandemic is an international public health threat. This study aimed to evaluate COVID-19-related knowledge, preventive behaviors, and risk perception among Saudi Arabian medical students and interns. MATERIALS AND METHODS: This cross-sectional study was conducted among fourth- and fifth-year medical students and interns between June and August 2020 at three colleges of medicine in Qassim Region, Saudi Arabia. A previously validated questionnaire was distributed as an online survey. RESULTS: The total mean knowledge score was 12.5/15 points; 83.9% achieved a high score. The mean score of self-reported preventive behavior was 8.40; 94.1% achieved a high score. The overall mean risk perception score was 5.34/8 points; 31.6% achieved a high score. CONCLUSION: Medical students assessed in this study displayed sufficient knowledge and preventive behaviors regarding the COVID-19 pandemic and an average level of risk perception. Lower scores by younger medical students suggest that they must improve their COVID-19 knowledge and risk perception, as they are a potential source of health information in their communities.

Work-Related Musculoskeletal Disorders Among Medical Practitioners in the Hospitals of Al'Qassim Region, Saudi Arabia .

Introduction Work-related musculoskeletal disorders (WMSDs) have a significant impact on the workplace; they have been growing as a problem in our population, especially among healthcare practitioners. The aim of the study was to determine the prevalence of the condition, evaluate the WMSDs experienced by practitioners in different specialties in different hospitals in the Al'Qassim region, and study various risk factors that contribute to the development of WMSDs. Methods After gaining the Institutional Review Board (IRB) approval, a cross-sectional study was conducted among all medical care practitioners at hospitals in the Al'Qassim region. Data were collected using a validated, standardized, and self-administered questionnaire. The data were analyzed using the SAS software version 9.4 (SAS Institute Inc., Cary, NC). Results  The study result revealed that out of 382 participants, just over half (209, 54.7%) experienced WMSDs. Among them, 103 (27.54%) were males, and 271 (72.54%) were females. The average age of participants was 31.25 ±6.82 years. Participants with experience of 6-10 years were twice as likely to develop WMSDs compared to participants with fewer years of experience [odds ratio (OR): 2.342; 95% confidence interval (CI): 1.062-5.168; p = 0.0350]. There was no significant difference in terms of past medical history between the two groups except for the history of having low back pain, which was more common in participants with WMSDs (77.59% versus 22.41%; p: <0.0001), and neck pain (74.19% versus 25.81%; p = 0.0003). Almost all job risk factors varied significantly between the groups (p: <0.05). Prevalent risk factors included performing the same task over and over again (134, 37.96%), treating an excessive number of patients in one day (127, 35.88%), and working in the same positions (126, 35.8%). Conclusions Based on this study findings, we can conclude that WMSDs affect a high proportion of healthcare professionals; the female gender and more than six years of experience were found to be major predictors for WMSDs. Pain in the lower back, shoulders, and neck were the most frequently reported musculoskeletal complaints (MSCs). Hence, we recommend the incorporation of musculoskeletal disorder prevention programs in the hospitals' educational programs as they will reduce the rate of WMSDs and ensure the health and well-being of healthcare practitioners.

Medical students' knowledge, attitudes, and practices concerning diabetes-related retinopathy.

CONTEXT: Diabetes-related retinopathy (DR), the most common complication of diabetes mellitus (DM), is a severe and preventable cause of visual loss and blindness that has been reported to be the fourth leading cause of blindness among four million cases globally. AIMS: This study aimed to evaluate the knowledge, attitudes, and practices of fourth- and fifth-year medical students concerning patients with DR. METHODS AND MATERIALS: This cross-sectional descriptive study was conducted at a College of Medicine in Saudi Arabia, in November 2018, and comprised 153 fourth- and fifth-year medical students of both sexes. Participants were required to complete a previously validated hard copy questionnaire. RESULTS: In total, > 50% of participants showed good knowledge of DR (poor participant knowledge, n = 65, 42.5%). We found 16 (10.5%) participants had poor attitudes to DR compared to 137 (89.5%) of participants with good attitudes, and 32 (20.9%) participants showed poor practices compared to 121 (79.1%) participants showing good practices. There was a statistically significant difference between the sexes and the level of practice (P = 0.021). CONCLUSIONS: More than 50% of participants in our study showed good knowledge concerning DR, with excellent attitudes and practices. Moreover, participants' age was identified as a significant factor affecting practice regarding DR. More targeted education is required to improve their knowledge base in regard to DR. Medical faculties have a significant role in the education of medical students to ensure greater awareness of DR.