The association between uncontrolled hyperglycemia (Type-2 Diabetes) and cardiovascular sequelae in patients with and without insulin.

Introduction: Despite the availability of new cardio-protective oral hypoglycemic drugs, insulin is often recommended as an add-on therapy for type-2 diabetes with hemoglobin A1C (HbA1C) ≥ 9. Introducing insulin as a choice for patients with uncontrolled hyperglycemia (HbA1C≥9) has been questionably associated with cardiovascular sequelae. This study aims to examine the association between insulin use and cardiovascular effects in type-2 diabetic patients with uncontrolled hyperglycemia. Methodology: A retrospective observational cohort study was conducted to identify cardiovascular complications between the two groups (patients with HbA1C≥9% on insulin versus those with HbA1C≥9% without insulin) at King Saud University Medical City (KSUMC). Patients with type-2 diabetes whose HbA1C was ≥ 9 during the period from 2015 to 2018 and who were followed up within the hospital for at least 5 years until the end of 2022 were included in the study. Results: A total of 366 patients were included in the study; 286 patients were on insulin, while 80 patients were not. The median baseline HbA1C levels were comparable between the two groups (10.2 versus 9.8). After 5 years of follow-up, there was no significant difference between the groups (29.4 % of insulin users versus 18.8 % of non-insulin users; p = 0.065). However, the incidence of other diabetes complications, such as retinopathy, nephropathy, and neuropathy, was significantly higher among patients who were on insulin compared to those not on insulin (50.7 % versus 27.5 %; p = 0.005). Additionally, the average of the last three HbA1C readings and the overall average HbA1C readings were significantly higher among patients who were on insulin (9.67 % versus 9.07 %; p = 0.001) compared to those not on insulin (9.64 % versus 9.11 %; p = 0.005). Conclusion: Our study did not find a significant association between the use of insulin and cardiovascular complications. The association between insulin therapy and the development of other diabetes complications warrants further investigation.

Obstetrician-gynecologists' perspectives towards medication use during pregnancy: A cross-sectional study.

A vast majority of studies evaluated pregnant women's knowledge and attitudes towards using medications during their pregnancy, with few global and lack of regional studies conducted to spot obstetrician-gynecologists practices in this regard. This study aims to assess Obstetrician-gynecologists' knowledge of medication teratogenicity potential, their frequently used resources, and their residency training contribution to medication use during pregnancy. This is a cross-sectional, survey-based study targeting licensed Obstetrician-gynecologists who are practicing in Saudi Arabia using a validated self-administered web-based questionnaire developed by the American College of Obstetricians and Gynecologists. A total of 60 obstetrician-gynecologists were included in the study. Most participants were female (72%) with median age and clinical experience of 42 and 13 years, respectively. The majority (87%) agreed that Isotretinoin is contraindicated, while around 60% of respondents were unsure about the safety of herbal remedies use. Online databases (e.g., Lexi-Comp and Micromedex) were chosen as the top utilized medication resources (45%). Around 48% strongly agreed that liability is a concern if there were adverse pregnancy outcomes following the use of medications. Regarding their training assessment, obstetrician-gynecologists who had been in practice for more than 15 years were significantly more likely to rate themselves as well qualified (P value < .05). The majority adequately and significantly rated their training on prescribed medications (58.3%), OTC medications (45%) and dietary supplements or herbal remedies (32%) (P value < .05). Obstetrician-gynecologists showed a different level of knowledge about the risks and safety of medications when used during pregnancy. More efforts are needed to optimize medication selection, herbal avoidance, and training performance.

Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia.

Objective: To evaluate paramedic ability in recognizing 12-lead Electrocardiogram (ECG) with ST-segment Elevation myocardial infarction (STEMI) in Saudi Arabia. Methods: This is a quantitative exploratory cross-sectional study using an electronic survey of paramedics was conducted between June and September 2021. The survey included demographics, educational and clinical experiences, and multiple 12-lead ECG strip questions to assess participants' ability to recognize STEMI. We reported the overall sensitivity, specificity, and correct proportions with 95% Confidence Intervals (CI). Results: Eighty-four paramedics completed the survey, and 65% of them were between 24 and 29 years old, with a median, of three years of field experience. Overall sensitivity and specificity were 58.39% (95% CI, 50.4% to 66.1%) and 29.01% (95% CI, 25.15% to 33.1%), respectively. In total, 67.1% correctly identified inferior STEMI, whereas only 50% correctly identified lateral STEMI. Both STEMIs were correctly identified by 41%, and the majority misinterpreted STEMI mimics (ECG rhythms with similar ECG morphology to STEMI). The proportion who correctly recognized left bundle branch block was 14.8%, pericarditis was 10.9%, and ventricular pacing was 1.4%. However, almost third of participants correctly identified right bundle branch block (32.9%) and left ventricle hypertrophy (30.7%). Overall, there was no correlation between the correct ECG interpretation of STEMIs and educational and clinical experiences. Conclusion: Paramedics were able to identify STEMI events in prehospital settings with moderate sensitivity and low specificity with limited ability to differentiate between STEMI and STEMI mimics. Therefore, additional training in ECG interpretation could improve their clinical decision-making, and to ensure that proper care and treatment is provided. Further research on a large, representative sample of paramedics across the country could provide more definitive evidence to establish a greater degree of accuracy in detecting STEMI in prehospital settings.

Aspirin Use among Saudi Adults: The Prevalence and Users' Characteristics.

Introduction: Despite the public routine use of aspirin as cardio-prophylaxis agent, its use is only recommended in particular situations, and not as usual primary prevention. Only few local studies investigate the use of aspirin in patients with certain diseases, but not within the public population. The purpose of this study was to evaluate the prevalence of aspirin use and identify the demographic and clinical characteristics among Saudi users. Methodology: A cross-sectional study targeting Saudi adults in Saudi Arabia was conducted over a period of four months in 2021 using online Google forms. The study collected data to assess the prevalence of use, use of aspirin according to prevention type, users' characteristics and comorbidities. Additionally, a self-assessment of knowledge, perception, reasons and attitude towards aspirin use among Saudi adults was conducted. A chi-square test was used to determine the association between the variables. A P-value ≤ 0.05 was considered statistically significant. Results: The prevalence of aspirin use was 47%. Regarding the self-assessed aspirin knowledge, the majority of the respondents (n = 481; 62.4 %) found to have good knowledge. Less than half of the participants (n = 341; 44%) use aspirin as primary prevention agent while only 23 participants (2.9%) use aspirin as secondary prevention agent. There was a significant difference between gender and user type (p = 0.001). With regards to comorbidities, hypertension, hyperlipidemia, diabetes, and obesity were common among the primary users of aspirin. Significant associations were found (p = 0.001) between participant's user type and the following characteristics such as smoking status, past medical history, presence of comorbidities. Conclusion: Aspirin use is commonly prevalent Saudi population with good level of knowledge of the therapy; however, its popular use as primary preventive agent for CVD may necessitate medical advice based on the level of cardiovascular risk.

Prevalence and Factors of Anxiety During the Coronavirus-2019 Pandemic Among Teachers in Saudi Arabia.

Background: Teachers play a central role in successful education. Due to the COVID-19 pandemic, regular in-person attendance in classes at all levels of education has been disrupted for more than 1 year in many countries. These lockdowns, which include the discontinuation of in person learning at schools and universities has presented a significant challenge for teachers to adapt to online teaching. Given this rapid format change, occupational anxiety levels among educators has increased. Objective: The primary objective of this study was to assess the prevalence of anxiety among teachers in Saudi Arabia. A secondary objective was to explore characteristics of teachers associated with the level of anxiety level during the period of lockdown. Methods: An anonymous, online cross-sectional study was carried for 3 months (February 2021 through April 2021). The questionnaire consisted of four sections and included the Generalized Anxiety Disorder instrument (GAD-7). Chi-square tests were completed for categorical comparisons while binary logistic regressions were used for associative relationship exploration. The IRB at King Saudi University Medical City, Saudi Arabia approved this study. Results: A total of 742 respondents completed the survey yielding an anxiety prevalence of 58.2 % among teachers. Medium degree of statistically significant differences identified as marital status (p = 0.046). women had higher anxiety (65.3%) than men (34.7%) but gender with anxiety was low degree of statistical significance compared with non-anxiety status (p = 0.697). The odds of anxiety among middle teachers was twice (OR = 2.01) as high as the odds of anxiety among other levels of teacher (p = 0.01, 95% CI 0.94-4.26). Conclusions: This study identified that many teachers experienced anxiety during the lockdown, especially women and middle school teachers. Future studies should identify contributing factors to estimate the magnitude of the exposure to anxiety between different types of teachers to help establish better preventive measures based on the workplace environment.

The impact of emergency antibiotic administration time on patients with sepsis.

OBJECTIVES: To assess the mortality benefits of timely antibiotic treatment of adults present at the emergency department with sepsis and compare one-hour administration and 3-hour administration starting from the time of triage. METHODS: In this retrospective study, we used secondary data analysis to investigate the utility of the National Early Warning Score as a predictor of mortality in sepsis patients between July 2018 and June 2019, at the Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia. The patients were grouped into 2 based on the time interval from triage to the first antibiotic administration: the immediate group received antibiotics within the first hour, and the early group received antibiotics between one and 3 hours. The primary outcome of interest was in-hospital mortality. RESULTS: Out of 495 septic patients, only 292 patients (mean age of 56.3 ± 23.6 years) met the inclusion criteria. Two hundred fifty (85.6%) patients received antibiotics within one hour of triage (immediate), while 42 (14.4%) patients received antibiotics between one and 3 hours (early). Overall, in-hospital mortality was 31.8%. The mortality rates among patients who received early antibiotic was 31.6% and who received immediate antibiotic was 33.3%, with a p-value of 0.823. CONCLUSION: Our findings did not support immediate antibiotic administration over early administration in patients with sepsis. However, further studies are recommended to investigate the effects of antibiotic timing on the outcome of severe sepsis patients.

Interprofessional Education Competition During the COVID-19 Pandemic at King Saud University: Benefits and Challenges.

BACKGROUND: The objective of this qualitative study was to explore the value of virtual IPE competition that involved a COVID-19 case among healthcare students and the lessons that can be learned to improve this experience in the future. METHODS: The 27 senior students from the colleges of medicine, pharmacy, nursing, and paramedics were invited to two focus groups that followed the IPE competition and lasted 60 minutes each. A semi-structured focus group discussion guide was used in the focus group discussion to explore the benefits and limitations of the virtual IPE experience. Verbatim transcription of the two video-recorded sessions was conducted, and inductive thematic analysis was performed to uncover different emerging themes. RESULTS: The number of students who consented to participate was 16 (59.26%). The IPE virtual competition was perceived favorably by all students; however, multiple organization and communication barriers were reported. Although the participants liked the IPE virtual competition, they clearly stated their preference for an in-person IPE competition over the virtual one. Managing a COVID-19 case was not perceived favorably by some participants due to the absence of evidence-based clinical guidelines supporting certain treatment protocols over others. Thus, some participants preferred a non-COVID-19 case where clear and evidence-based guidelines exist. CONCLUSION: The use of different IPE strategies to enhance healthcare students' collaboration and understanding of their roles in the multidisciplinary healthcare team, especially during pandemic times, such as COVID-19, is possible. Future studies should examine new and innovative IPE strategies that address the identified limitations of virtual IPE.

Comparison of the Effectiveness and Comfort Level of Two Commonly Used Mask Ventilation Techniques in a Model.

BACKGROUND: Mask ventilation is an important rescue airway skill for providing oxygenation and ventilation. Maintaining a good face mask seal is a fundamental factor for successful ventilation. Therefore, the aim of this study was to compare the effectiveness and comfortability of 2 commonly used mask ventilation techniques. METHODS: A randomized crossover study was performed to compare the 2-handed C-E and 2-handed V-E techniques on a simulation model. Respiratory therapists were recruited by convenience sampling to hold the mask during mechanical ventilation with a fixed tidal volume (VT) of 500 mL, a rate of 12 breaths/min and a PEEP of zero were provided. Each participant performed a 2-min ventilation session, with a total of 24 breaths for each technique. For each technique, we recorded the median VT and the number of successful breaths (≥300 mL). Provider comfort was assessed by using a 5-point Likert scale at the end of the 2 techniques. Subgroup analyses were conducted for sex, experience, and height of the participants. RESULTS: Of the 75 respiratory therapists recruited, 74 participants were included in the analysis. There was no statistically significant difference in the median VT between the V-E (417 mL [interquartile range, 396-427] mL) and C-E techniques (410 [interquartile range, 391-423] mL) (P = .82). Approximately 74% of breaths delivered by the C-E technique were effective, whereas only 68% of those delivered by the V-E technique were effective (P < .001). Most of the participants reported that using the 2-handed C-E technique was more comfortable. CONCLUSIONS: In our study, the median VT did not differ significantly between the 2 techniques. However, the C-E technique seemed to be superior to the V-E technique in terms of the number of effectively delivered breaths and comfortability. Further studies are recommended for basic airway management techniques.

Glycemic Control and Management in Pharmacist-Led Diabetic Clinic vs. Physician-Led Diabetic Clinic.

Background and Objectives: Globally, diabetes Mellitus (DM) is a life-threatening disease that, if it remains uncontrolled, can lead to mortality or serious complications. Despite the noticeable benefits of clinical pharmacist in managing diabetes, some institutions in Saudi Arabia are reluctant to establish a pharmacist-led diabetic clinic for monitoring and follow-up. The objective of this study is to assess the glycemic control by comparing the reduction in hemoglobin A1c (HbA1c) percentage between patients followed in the pharmacist-led diabetic clinics vs. those followed in physician-led diabetic clinics. Materials and Methods: A retrospective observational study with a 12-month follow-up were used to detect the difference in the glycemic control by comparing the reduction in HbA1c percentage from the baseline, and average changes in HbA1c, fasting blood glucose (FBG), blood pressure (BP), and lipid panel between the two groups. The level of self-care was assessed by Summary of Diabetes Self-Care Activities (SDSCA) Questionnaire. Results: The study involved 52 patients who visited the diabetic clinic at a community teaching hospital. Exactly 24 patients were followed by the pharmacist-led diabetic clinics, while 28 were followed by physician-led diabetic clinics. HbA1c baseline was 8.7% and 8.4% for pharmacist and physician, respectively. The average difference in HbA1c for the pharmacist-led diabetic clinics vs. the physician-led diabetic clinics was not statistically significant (8.67 vs. 8.56; p = 0.77). Moreover, no difference in the glucose profile, lipid panel, and blood pressure were seen between the two groups. However, the median HbA1c change from baseline between the two groups significantly favored the pharmacist-led clinic (0.7 vs. 0.003; p = 0.04).The average of responses in all four aspects of the SDSCA (diet, exercise, blood sugar testing, and foot care) was also higher among patients in the pharmacist-led diabetic clinic. Conclusions: Pharmacist-led diabetic clinics for glycemic control and follow-up showed efficient results that encourage the comprehensive and integral inter-professional patient care.

Using gel for difficult mask ventilation on the bearded patients: a simulation-based study.

The beard is a well-known cause of difficult mask ventilation due to excessive air leaks. Various techniques have been proposed to overcome this difficulty, such as applying a gel on the mask edge. Our objective was to determine whether the gel technique will improve ventilation and to assess the comfort of the provider. A randomized crossover design was conducted to assess the efficacy of gel in a bearded simulation model. Respiratory therapists (RT) were recruited by convenience sampling to hold the mask using a two-handed technique for a two-minute ventilation session. During the session, the ventilator provided a fixed Tidal Volume (TV) of 550 mL and a respiratory rate of 12 per minute, and the simulated model measured the received volumes. We compared the median TV and number of failed ventilation attempts with or without the gel. The comfort level while using the gel was assessed with constructed questions. We recruited 74 respiratory therapists working in Riyadh city. More than half of the participants had more than 5 years experience. The median tidal volume for standard mask ventilation without the gel was 283 mL [interquartile range (IQR) 224, 327], whereas that with the gel was 467 mL [451, 478], respectively (p < 0.01). The number of successful ventilations was recorded out of 24 breaths during the 2-min ventilation period for each technique; the proportion of successful ventilations increased significantly by 65% (95% CI 51-75%, p < 0.01) with the gel. In addition, only nine participants believed the technique was not comfortable, while the remaining individuals found it comfortable or natural. In our bearded simulation model, applying the gel significantly improved ventilation without negatively affecting comfort. Further studies and education are encouraged in the field of basic airway management.