Association of esophageal motility disorder symptoms with Chicago classification versions 3.0 and 4.0 using high-resolution esophageal manometry: A single-center experience from Saudi Arabia.

BACKGROUND: Esophageal motility disorders (EMDs) can significantly impact patients' quality of life. The Chicago Classification (CC) was developed as a robust framework to enable clinicians to better understand and classify the nature of motility disorders. Previous studies have primarily focused on the CC version 3.0 (CCv3.0), and data regarding the correlation between symptoms and CC version 4.0 (CCv4.0) in the Saudi Arabian population are lacking. This study aimed to assess the correlation between symptoms and CCv3.0 and CCv4.0 using high-resolution esophageal manometry (HRM) in Saudi Arabia, to evaluate the diagnostic performance of both classifications. METHODS: A total of 182 patients presenting with esophageal symptoms were included in this study. HRM was performed to assess esophageal motility, and patients' reported symptoms were recorded. The association between HRM findings and symptomatic variables was analyzed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Variability was observed in the diagnostic performance of symptomatic variables for major EMDs. CCv4.0 demonstrated a higher sensitivity for dysphagia than CCv3.0; however, it exhibited lower sensitivity to atypical gastroesophageal reflux disease (GERD) symptoms. Noncardiac chest pain (NCCP) exhibited the highest specificity and PPV, whereas typical GERD symptoms showed lower specificity. CONCLUSION: CCv4.0 demonstrated potential improvements in sensitivity for dysphagia, but lower sensitivity for atypical GERD symptoms, compared with CCv3.0. These insights provide guidance for clinicians in Saudi Arabia and contribute to understanding the diagnostic performance of CCv3.0 and CCv4.0.

Did the COVID-19 Pandemic Influence the Awareness About Vitamin D Among the General Population in Jeddah, Saudi Arabia?

Background Vitamin D deficiency has been a major health concern over the last decade. With the coronavirus disease 2019 (COVID-19) pandemic, health officials and social media have stressed the importance of vitamin D and its role in immune systems. This research focused on the level of vitamin D awareness in Jeddah after the pandemic in 2022. Methodology A cross-sectional study was conducted among the adult general population in Jeddah, Saudi Arabia. Data were obtained through an electronically distributed questionnaire designed to collect information on self-reported knowledge questions about vitamin D, which was previously validated and used in a similar study on the same population before the pandemic. The validated questionnaire included sociodemographic characteristics and questions assessing the knowledge about vitamin D. Ethical approvals were obtained from the Biomedical Research Ethics Committee, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Results Of the 385 total participants, 198 (51.4%) were aged 18-28 years, 331 (86%) were of Arab ethnicity, 289 (75.1%) had a university degree, 86 (22.3%) had completed high school, 186 (48.3%) were married, and 197 (51.2%) had no children. The overall mean knowledge score was 67.12%, and the mean knowledge score for vitamin D benefits was 73.51%. The mean knowledge score for vitamin D sources was 51.53%, and the mean knowledge score for toxicity was 86.49%. When comparing knowledge scores based on demographic variables, only a few variables were significant. Regarding vitamin D awareness following the COVID-19 pandemic, most participants (54.55%) believed the pandemic had affected or increased their vitamin D awareness. Approximately 52.85% had used vitamin D supplements before the pandemic, and 53.25% were currently using vitamin D supplements. Conclusions In general, compared to pre-COVID-19 studies conducted in Saudi Arabia, this study revealed a greater understanding of vitamin D. Participants who had completed high school or more displayed a higher level of knowledge than other groups. It is still recommended that primary care physicians educate their patients and families about the benefits of vitamin D, the effects of its deficiency, and its toxicity.

Helicobacter pylori (H. pylori) Infection-Associated Anemia in the Asir Region, Saudi Arabia.

H. pylori (ubiquitous) and anemia together represent one of the growing health concerns globally. Gastroduodenal sequelae of H. pylori infection are distinguished; however, for the H. pylori infection and its implication in the development of anemia, iron has a significant health impact. We aimed to evaluate H. pylori infection-associated anemia by employing a logistic regression analysis model. A retrospective (case-control) study design-based assessment of the H. pylori associated-anemia. The study area was geo-referenced by QGIS/QuickMapServies. Descriptive and inferential statistical analyses were accomplished using the R-base-R-studio (v-4.0.2)-tidyverse. A p-value < 0.05 was the statistical significance cut-off value. A ggplot2 package was used for data representation and visualization. Mean ± SD age, Hb, MCV, ferritin, and RBC for overall study participants were measured to be 44.0 ± 13.58, 13.84 ± 2.49, 83.02 ± 8.31, 59.42 ± 68.37, and 5.14 ± 0.75, respectively. Decreased levels of Hb (infected vs. uninfected: 13.26 ± 2.92 vs. 14.42 ± 1.75, p < 0.001) ferritin (infected vs. uninfected: 48.11 ± 63.75 vs. 71.17 ± 71.14, p < 0.001), and MCV (infected vs. uninfected: 81.29 ± 9.13 vs. and 84.82 ± 6.93, p < 0.05) were measured to be associated with H. pylori infection when compared with H. pylori uninfected control group. Moreover, the magnitude (prevalence) of anemia (infected vs. uninfected: 78% vs. 21%, p < 0.001), iron deficiency anemia (IDA) (infected vs. uninfected: 63.3% vs. 36.6%, p < 0.001), and microcytic anemia (infected vs. uninfected: 71.6% vs. 46.1%, p < 0.001) were significantly different among the H. pylori-infected participants. The higher likelihood of developing anemia (AOR; 4.98, 95% CI; 3.089-8.308, p < 0.001), IDA (AOR; 3.061, 95% CI; 2.135-4.416, p < 0.001), and microcytic anemia (AOR; 3.289, 95% CI; 2.213-4.949, p < 0.001) by 398%, 206.1%, and 229%, respectively, was associated with H. pylori-infected. We recommend the regular monitoring of hematological parameters and eradication of H. pylori infection to minimize the extra-gastric health consequences of H. pylori infection.

Level of participation in public health volunteering and its determinants among ministry of health primary health care workers in Jeddah 2019.

CONTEXT: Volunteering is an important practice for health care systems globally and contributes to the development of health care services as well. AIMS: To estimate the level of participation in public health volunteering and its determinants among healthcare workers in ministry of health primary care sector, Jeddah. SETTINGS AND DESIGN: A randomized quantitative cross-sectional self-administered survey involving all primary healthcare workers in 15 centers. METHODS AND MATERIAL: The survey included socio-demographics and 33 determinants of volunteering (values, career development, enhancement, social, and protection) ranked by importance using a seven-point scale. The research committee of the joint program for family medicine in Jeddah validated the survey. Primarily we evaluated the level of participation in public health volunteering. Secondary endpoints were perception of the importance of volunteering determinants among participants, correlation between volunteering and independent socio-demographic variables, and any attribute of volunteering determinants. STATISTICAL ANALYSIS USED: Descriptive analyses using the Statistical Package for Social Sciences, version 24. RESULTS: 231 consenting participants filled the survey. Most of the participants were Saudi citizens, predominantly female, bachelor or higher degree holders, and married. Out of 227 respondents, 98 (43%) declared volunteering in the previous year. Only the age was positively correlated to volunteering significantly. Respondents significantly perceived the 33 attributes of the questionnaire as "extremely, very, or somewhat important." Determinants like values, enhancement, and social were significant predictors of volunteering but not career development or protection. CONCLUSIONS: Volunteering complements healthcare resources in coping with emergent situations like COVID-19 pandemic. More efforts are required to bring awareness toward volunteering opportunities in Saudi healthcare sector.

Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey.

BACKGROUND: Patients' non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from their prescribed medication, which can lead to worsening of medical condition, development of comorbidities, reduced quality of life, elevated health care costs, and increased mortality. OBJECTIVE: This study aimed to assess medication adherence among patients with diabetes and associated factors in Bisha primary health care centers (PHCCs) in Saudi Arabia. PATIENTS AND METHODS: A cross-sectional study was conducted with a sample of 375 type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of the Bisha governorate. The participants were aged 18 years and above, and had been taking diabetes medications for at least 3 months. Pregnant women, patients with mental illnesses, and those who were not willing to participate were excluded. Adherence to diabetes medications was measured using the four-item Morisky Green Levine Medication Adherence Scale (MGLS). All participants completed a self-report questionnaire including sociodemographic and clinical variables. Univariate and multivariate analyses were carried out using SPSS version 22. RESULTS: Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%), patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low adherence (MGLS score ≥3), respectively. Factors associated with the level of adherence in univariate analysis were occupational status (P=0.037), current medication (P<0.001), glycated hemoglobin (A1c) (P<0.001), and number of associated comorbidities (P<0.001). In multivariable analyses, A1c <7 (P<0.001) and no associated comorbidities (P<0.003) variables remained significantly associated with adherence. CONCLUSION: The level of adherence to medication in diabetes mellitus patients in the Bisha PHCCs was found to be suboptimal. The findings point toward the need for better management of primary health care providers' approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients' level of adherence remains essential for successful diabetes treatment.

Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis.

Clinical tests to diagnose lumbar segmental instability: a systematic review.

STUDY DESIGN: Systematic literature review. OBJECTIVES: To evaluate the diagnostic accuracy of clinical tests used to diagnose patients with structural lumbar segmental instability (LSI). BACKGROUND: Patients with structural LSI represent an important, identifiable subgrouping of individuals with low back pain. Numerous clinical tests have been proposed to diagnose structural LSI; however, data on the diagnostic accuracy of these tests have not yet been evaluated through a systematic review of the literature. METHODS: A systematic review was conducted in 6 electronic databases for diagnostic accuracy studies, published between January 1950 and March 2010, that evaluated clinical tests against radiological diagnosis of structural LSI. The diagnostic accuracy of the clinical tests from the retrieved articles was independently evaluated, reviewed, and quality scored using the QUADAS tool. RESULTS: Four articles and a total of 11 clinical tests used in the diagnosis of structural LSI met the study inclusion criteria. The majority of tests had high specificity but low sensitivity, with positive likelihood ratios ranging from very small to moderate. QUADAS scores ranged from 16 to 25 out of a possible 26. The passive lumbar extension test was the most accurate clinical test, with high sensitivity (84%), specificity (90%), and a positive likelihood ratio of 8.8 (95% CI: 4.5, 17.3), indicating that this clinical test may be useful in the differential diagnosis of structural LSI. CONCLUSION: This systematic review found that the majority of clinical tests routinely employed to diagnose structural LSI demonstrated only limited ability to do so. The results do, however, indicate that the passive lumbar extension test may be useful in orthopaedic clinical practice to diagnose structural LSI. Additional research is required to further validate its use for diagnosing structural LSI in all populations of those with low back pain. LEVEL OF EVIDENCE: Diagnosis, level 2a.