Prevalence and factors associated with gastroesophageal reflux disease among primary health care attendants at Abha city, southwestern Saudi Arabia.

BACKGROUND: Gastroesophageal reflux disease (GERD) is an abnormal reflux of the gastric content into the esophagus. In Saudi Arabia the GERD prevalence is not recently well studied. OBJECTIVE: To investigate the prevalence of gastroesophageal reflux disease and associated factors among attendants of primary health care centers (PHCCs) at Abha city, Saudi Arabia. METHOD: A descriptive cross- sectional study was performed using GerdQ as diagnostic tool for the GERD. The GerdQ consisted of six questions. Four questions were about the positive GERD predictors. The other two questions were about the negative GERD predictors. The scoring of GerdQ relies on the frequency of GERD symptoms during the last seven days. Using stratified random sample technique a representative sample was slected from the study PHCCs taking into conmsideration the relative catchment population in each center among adult males and females attending the selected PHCCs for any reason. RESULTS: The present study included 320 persons. The study showed a prevalence of GERD of 67.8%. The prevalence of GERD with high impact on daily life (HIDL) was found to be 50%. By multiple logistic regression (enter method) only four significant independent factors associated with GERD were identified; being unmarried (aOR = 1.85, 95% CI:1.02-3.23); smoking (aOR = 2.11, 95% CI: 1.41-5.98), fast food intake (OR = 1.28, 95% CI:1.01-1.71), and subjective perception of stress (OR = 3.0, 95% CI:1.68-5.26). CONCLUSIONS: GERD is a public health problem among adults in the region. Community level awareness programs are recommended. Healthcare providers must be aware of community perceptions and practices.

Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia.

BACKGROUND: The purpose was to measure the prevalence and related risk factors of low back pain (LBP) among health care workers (HCWs) at different levels of health care in southwestern Saudi Arabia. METHODS: A cross-sectional study using a self-administered questionnaire was conducted among HCWs providing primary, secondary and tertiary health care services in the Aseer region, southwestern Saudi Arabia. The questionnaire collected data regarding having LBP in the past 12 months, socio-demographics, work conditions and history of chronic diseases, regular physical exercise and overexertional back trauma. Univariate and multivariable logistic regression analyses were performed. RESULTS: Out of 740 participants, the overall prevalence of LBP in the past 12 months amounted to73.9% (95% CI: 70.7-77.0). The prevalence of LBP with neurological symptoms reached 50.0%. The prevalence of LBP necessitating medications and or physiotherapy was 40.5%, while the prevalence of LBP requiring medical consultation was 20%. Using multivariable logistic regression, the following risk factors were identified: working in secondary and tertiary hospitals (aOR = 1.32, 95% CI:1.01-1.76), increased BMI (aOR = 1.10, 95% CI:1.01-3.65), and positive history of overexertional back trauma (aOR = 11.52, 95% CI:4.14-32.08). On the other hand, practising regular physical exercise was a significant protective factor (aOR = 0.61, 95% CI: 0.42-0.89). CONCLUSIONS: LBP is a common problem among HCWs. Many preventable risk factors have been identified, including exertional back trauma, increased BMI and lack of regular physical exercise. Occupational health and safety programmes to build ergonomically safe working conditions and encourage regular physical exercise are needed.

Burnout Syndrome among Emergency Physicians and Nurses in Abha and Khamis Mushait Cities, Aseer Region, Southwestern Saudi Arabia.

OBJECTIVES: To explore the magnitude and determinants of burnout among emergency physicians and nurses working at emergency departments of hospitals in Abha and Khamis Mushait cities. SUBJECTS AND METHODS: A cross-sectional hospital-based study was conducted in emergency departments of hospitals in Abha and Khamis Mushait cities belonging to Ministry of Health. All physicians (n=95) and nurses (n=187) currently working at these sites were invited to participate in the study by filling a validated self-administered questionnaire including two main sections: personal and professional characteristics of physicians and nurses as well as Maslach burnout inventory (MBI) to assess the three components of the burnout syndrome: emotional exhaustion, depersonalization, and reduced personal accomplishment. RESULTS: The study included 282 physicians and nurses. The age of more than half of them (54.3%) ranged between 31 and 35 years. Most of them (70.9%) were females. About two-thirds of the respondents (66.3%) were nurses while the remaining 33.7% were physicians. Majority of the emergency healthcare professionals (88.7%) had high emotional exhaustion. The prevalence of high depersonalization (cynicism) was 20.6% whereas that of low personal accomplishment was 41.1% among emergency healthcare professionals. The overall prevalence of burnout among healthcare professionals was 16.3%. Multivariate logistic regression analysis revealed that male healthcare professionals were at almost higher three-folded risk for developing burnout compared to females (aOR=2.76; 95% confidence interval (CI): 1.21-6.28, p=0.017)). Smokers were at higher significant risk for burnout compared to nonsmokers (aOR=15.37; 95% CI: 7.06-33.45, p<0.001). Healthcare professionals who reported a history of taking medications for sleep disorders expressed higher risk for burnout opposed to those with no history of sleep disorder medication (aOR=6.59; 95% CI: 2.08-20.81, p=0.001). CONCLUSION: A considerable proportion of physicians and nurses working at emergency departments of hospitals in Abha and Khamis Mushait cities had burnout syndrome, particularly high emotional exhaustion and low personal accomplishment.

Awareness of stroke among patients attending primary healthcare services in Abha, Southwestern Saudi Arabia.

OBJECTIVE: To examine the awareness about major symptoms, risk factors, and response to stroke among the population in Abha, Southwestern Kingdom of Saudi Arabia. Improving stroke-related knowledge may advance stroke prevention and reduce pretreatment delay and disabilities. METHODS: We conducted a cross-sectional study among a representative sample of primary healthcare adult patients between January-May 2016 and used a validated Arabic questionnaire to evaluate the participants` awareness about stroke. RESULTS: The study involved 1472 adults. Only 63.6% and 43.7% of participants correctly recognized thrombosis and hemorrhage as types of stroke. Commonly identified risk factors were hypertension (55.8%), dyslipidemia (45.8%), and smoking (41.9%). Sudden severe headache (54.1%), dizziness (51.0%), and difficulty in speaking (44.3%) were the most frequently recognized symptoms. The most frequently reported correct responses to stroke were contacting a doctor (73.0%), going to the hospital (67.2%), and calling an ambulance (52.4%). Improper responses to stroke (ignoring the condition or self-prescription) were noted in 18.8% of participants. Logistic regression revealed that physicians, nurses, friends and relatives as a source of knowledge were significantly associated with a lower insufficient knowledge of stroke symptoms and risk factors. On the other hand, women, persons above 40 years old, and married persons were significantly more prone to have insufficient knowledge about a proper response to stroke. CONCLUSION: Our study revealed a notable deficit of knowledge about warning symptoms, risk factors, and proper response to stroke. Health education strategies to improve stroke awareness are required and could potentially prevent and improve the outcome of stroke.

BASET scoring: A novel simple biometric score for screening and grading obstructive sleep apnea.

Background: Polysomnography (PSG) is the gold-standard diagnostic tool for Obstructive Sleep Apnea (OSA). However, the availability of PSG is limited, and OSA is widely underdiagnosed; more than 80% of most developed nations undiagnosed. There is no diagnostic validated simple tool with clear cutoff point for predicting and roll out patient with OSA in primary care clinics significantly alters clinical outcomes. Objectives: Our study aimed to assess the validity of BASET scoring as a new potential tool for screening and grading the severity of OSA patients. Methods: After institution review board approval and formal patient consent, 144 subjects for suspected OSA and their relatives were enrolled. All subjects were subjected to a full night PSG study after history taking, sleep questionnaires, and physical examination, including BASET score components: B= Body Mass Index (BMI), A= Abdominal circumference (AC), S = Snoring, E= Epworth Sleepiness Scale, and T= Tongue teeth imprint. ROC analysis that used to assess the optimal cutoff point of the BASET score and to compare its accuracy for predicting OSA with Berlin and STOP-Bang scores. Results: This study included 63 OSAS patients, 33 (52.38%) males and 30 (47.62%) females, and 81 controls; 22 (27.16%) males and 50 (72.84%) females. The Cronbach's alpha for the 5 BASET score components was 0.846, indicating the internal consistency reliability of the scale. Moreover, BASET score has a moderately strong positive significant correlation (r = 0.778, p<0.001) with AHI. By ROC analysis, the accuracy of the three measures was generally high, with BASET score predicting OSA most accurately (AUC=0.984, 95%CI: 0.956-0.999), followed by STOP-Bang (AUC=0.939, 95%CI: (0.887-0.972) and Berlin (AUC=0.901, 95%CI: 0.841-0.945). The AUC of BASET score was significantly higher compared to the Berlin score (difference= 0.0825, 95%CI: 0.039-0.125) and STOP-Bang score (difference= 0.0447, 95%CI: 0.011-0.078). On the other hand, there was no difference between the AUC of Berlin and STOP-Bang scores (difference=0.0378, 95%CI: 0.006 - 0.081 4). BASET score was significantly (p<0.001) associated with OSA grades. Conclusion: BASET score is a convenient, reliable, and valid tool for diagnosing OSA. BASET score is more accurate for predicting OSA than Berlin and STOP-Bang scores, while there is no difference between Berlin and STOP-Bang scores. BASET score indicates OSA grades. Registration of clinical trials by number: NCT05511974. Name of the registry: ClinicalTrials.gov URL: https://clinicaltrials.gov/.

Acute encephalopathy in a 6-year-old child with concurrent COVID-19 infection: a case report from Saudi Arabia.

COVID-19 is a global health crisis that has impacted the world with heavy economic and social losses. In the early days of the pandemic, pediatric COVID-19 was well-known for its low infectivity and mortality rates as well as its benign clinical outcomes. Herein, we report the case of a 6-year-old girl with COVID-19-associated encephalopathy without respiratory symptoms. To the best of our knowledge, this is the first child reported from Saudi Arabia with COVID-19-induced encephalopathy. A 6-year-old patient with COVID-19 was presented to the Abha Maternity and Child Hospital in southeastern Saudi Arabia. Routine clinical and laboratory examinations revealed normal findings. Despite the absence of COVID-19 respiratory manifestations, the patient manifested COVID-19-related encephalopathy. The patient responded well to pulse steroid, favipiravir, and symptomatic seizure therapies. The patient recovered completely without any neurologic morbidities. A COVID-19-related encephalopathy was observed for the first time in Saudi Arabia among pediatric patients. Clinicians should be alert to potential neurologic complications associated with COVID-19. It should be considered in the differential diagnosis of children presenting with acute encephalopathy, even in the absence of respiratory symptoms. To avoid long-term neurologic sequelae, prompt seizure and immunosuppressive therapies are essential.

Specific aeroallergen sensitization associated with current rhinitis among adults in southwestern Saudi Arabia.

Data about allergic sensitization to rhinitis among adults are limited. The objectives were to explore the prevalence of current rhinitis (CR) and associated specific allergen sensitizations in southwestern Saudi Arabia. A cross-sectional study was conducted on 969 adults in southwestern regions of Saudi Arabia, namely Aseer, Jazan, and Al Baha. From each region, 5 primary health care centers were chosen. The validated Arabic Version of the International Study of Asthma and Allergies in Childhood questionnaire was used. Total immunoglobulin E (IgE) enzyme-linked immunosorbent assay, cytokine enzyme-linked immunosorbent assay (interleukin [IL]-4, IL-10, IL-13, and interferon-γ), aeroallergen-specific IgE immunoassay (a panel of 30 common aeroallergens; 9 indoor and 21 outdoors), and eosinophilic count were assessed. A prevalence of CR of 35.8% (95% confidence interval: 32.8%-38.9%) was found. Regarding outdoor aeroallergens, Mesquite-positive IgE antibodies were higher among CR adults (odds ratio = 1.52, 95% confidence interval: 1.02-2.21) compared to those without CR. The same significant pattern was found with Chenopodium, Ragweed, Pigweed, Russian thistle, Bermuda grass, Timothy grass, and Rye. All indoor aeroallergens were not significantly associated with CR. Total IgE and eosinophil count were significantly higher among adults with CR. In conclusion, CR in southwestern regions of Saudi Arabia is common and of significant public health importance. Aeroallergens that associate with adult sensitization to CR tend to be of the outdoor variety particularly the herbaceous grass and their pollens. The magnitude of CR and its association with exposure to outdoor aeroallergens should be taken into account by health policy decision makers, clinicians, and medical practitioners when diagnosing and treating related conditions.

Increased mental stress among undergraduate medical students in south-western Saudi Arabia during the COVID-19 pandemic.

Background: The COVID-19 pandemic has disrupted the daily life and academic trajectory of many students. The objectives of this study were to evaluate the effect of the pandemic on perceived stress levels among medical students. Methods: Comparative pre-pandemic and pandemic surveys were conducted among samples of undergraduate medical students. Students responded to a questionnaire including personal and academic data, and Cohen's Perceived Stress Scale (PSS). Results: Overall, the prevalence of high perceived stress during the pandemic (20.6%) was significantly higher (p = 0.001) than pre-pandemic (11.6%). A multivariable analysis revealed that the independent factors associated with high perceived stress were: participation in the study during the pandemic (aOR = 1.79, 95% CI: 1.22-2.63), female sex (aOR = 1.74, 95% CI: 1.23-2.47), younger age (aOR = 1.62, 95% CI: 1.04-2.55) and lower family income (aOR = 1.50, 95% CI: 1.12-2.03). PSS score was negatively correlated with increasing age, family income, and academic level. PSS score was positively correlated with: worries about the possible disruption of education or exams, excessive news exposure, worries about the possibility of COVID-19 infection, and the effects of mandatory isolation and social distancing. Conclusion: The COVID-19 pandemic increased the level of stress among medical students. Female students, younger students, and those in lower academic grades are the most at risk of having high stress. Worries about possible academic disruptions due to the pandemic are significant stressors. The implementation of online stress management programs is recommended.

Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough.

BACKGROUND: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. METHODS: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. RESULTS: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae) was significantly higher (p = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65-96%) and 48% (95% CI: 31-66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47-65%) and 80% (95% CI: 60-91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies.

Risk Factors of the First-Time Stroke in the Southwest of Saudi Arabia: A Case-Control Study.

Worldwide, stroke is the second leading cause of death and a frequent cause of permanent disability. The objective was to identify the first-time stroke modifiable risk factors in the Aseer region, southwest Saudi Arabia. In a multicenter hospital-based case-control study design, all first stroke patients admitted to hospitals in the Aseer region were included consecutively over one year. Age, sex, and geographical residence-matched controls were selected and included in a ratio of 1:1. Data collected included altitude (low or high), nationality, marital status, educational level, family history of stroke, history of diabetes mellitus, history of systemic hypertension, high cholesterol level, current smoking, obesity, and regular exercise practice. The study included 1249 first-time stroke patients and 1249 age, sex, and residence-matched controls. Hypertension, diabetes mellitus, obesity, and high cholesterol were significantly highly prevalent among cases (57.7%, 49.4%, 42.0%, 29.4%, respectively) compared to controls (31.8%, 25.9%, 30.8%, 12.1%, respectively). Practicing regular exercise was significantly highly prevalent among controls (29.9%) compared to cases (13.1%). Multivariable logistic regression analysis revealed that systemic hypertension (adjusted odds ratio (aOR) = 2.12, 95%CI: 1.74-2.57), diabetes mellitus (aOR = 1.73, 95%CI: 1.41-2.21), obesity (aOR = 1.95, 95%CI: 1.61-2.28) and high cholesterol (aOR = 1.64, 95%CI: 1.28-2.10) were significant risk factors, while regular exercise practice was a significant protective factor (aOR = 0.12, 95%CI: 0.05-0.26) for stroke. Hypertension, diabetes mellitus, obesity, and high cholesterol are major risk factors for stroke in the Aseer region of southwest Saudi Arabia. The protective role of regular physical activity in reducing the risk of stroke is evident. The observed higher prevalence of potentially modifiable risk factors among stroke cases encourages an urgent need to develop and implement a national program to control these factors.

Prevalence and correlates of university students' perceived stress in southwestern Saudi Arabia.

ABSTRACT: The university period can be stressful for most students. It may be due to exposure to various stressors. Objectives: To establish the prevalence and factors associated with high perceived stress among university undergraduates in south-western Saudi Arabia.A self-administered survey was conducted among a representative sample of King Khalid University students through a cross-sectional study. Data obtained included socio-economic, academic characteristics, and grade point average (GPA) scores. Stress was assessed using the Perceived Stress Scale.This study included 2467 students. The average Perceived Stress Scale score was 19.13 ±â€Š6.56, which was notably higher (P = .02) among health care undergraduates (19.45 ±â€Š6.49) compared to others (18.85 ±â€Š6.61). High perceived stress prevalence rate was 12.7% (13.6% in health care institutions and 12.0% in non-healthcare institutions). Multivariable analysis revealed that high perceived stress was considerably greater among females (adjusted odds ratio [aOR] = 2.35, 95% confidence interval:167-3.30), smokers (aOR = 1.65), those with an unsatisfactory income (aOR = 3.10), and healthcare students (aOR=1.33). In contrast, it was negatively associated with the GPA score (aOR= 0.77).High perceived stress is a substantial problem among university students. Female students and healthcare students are at a greater risk. High stress is correlated with smoking, lower GPA scores, and perceived insufficient family income.

Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia: Clinical perspective from a case series.

ABSTRACT: Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C).The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described.All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions.Pediatric patients with SARS-CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.

Toxocara Awareness Among Medical Practitioners in Saudi Arabia.

Human toxocariasis is a zoonotic infection with global and regional impacts. Worldwide it is underestimated and clinically overlooked. Medical practitioners are generally unaware of the extent of the resulting disease spectrum. The objective of the study was to assess knowledge and disease awareness among medical practitioners in Aseer, south-western Saudi Arabia. A questionnaire addressing knowledge about the parasite, its visceral larva migrans and the disease spectrum generated was used to interview participants. The study included 285 participants. In answer to the question what is toxocara, only 27%, answered correctly that it is a nematode, paediatricians being the majority. With regard to years of experience among participants, 56.8% of those who answered correctly had less than 5-year experience, as opposed to 35.4% for those with more than 10-year experience. The cumulative awareness about the disease manifestations and spectrum, i.e. those who knew, was less than 30% across specialties and years of experiences. Lack of awareness regarding Toxocara infection and the disease spectrum it can generate is evident. The consequence for such lack of knowledge within our practising medical community is simply unacceptable as it might translate into misdiagnosis and consequently misguided treatment.

Iodine Deficiency Disorders as a Predictor of Stunting among Primary School Children in the Aseer Region, Southwestern Saudi Arabia.

OBJECTIVES: To investigate the present occurrence of stunting and explore the role of iodine deficiency disorders (IDDs) as a predictor of stunting among primary school children in the Aseer Region. METHODS: In a cross-sectional investigation on school children in the Aseer region, thyroid enlargement was evaluated clinically. Urine was collected to evaluate iodine content. RESULTS: The present study involved 3046 school-age pupils. The study disclosed a total goiter rate of 24.0% (95% CI: 22.5-25.5%). The median urinary iodine content (UIC) was 17.0 µg/L. A prevalence of stunting (height for age z score of less than -2) of 7.8% (95% CI: 6.9-8.8%) was found. In a logistic regression model, pupils having clinical goiter (aOR = 1.739; 95% CI: 1.222-2.475) and students having UIC of less than 17 µg/L (aOR = 1.934; 95% CI: 1.457-2.571) were considerably related with stunting. In the receiver operating characteristic (ROC) curve, urinary iodine content to forecast stunting was good (AUC = 0.611, 95% CI: 0.594-0.629). The curve recognized the optimum cutoff point of urinary iodine content to be ≤19.0 µg/L. The sensitivity was 59.66% (95% CI: 53.1-66.0) and the specificity was 57.62% (95% CI: 55.8-59.5). Conclusion: The present study showed that stunting among school-aged children presents a mild public health problem. On the other hand, a severe iodine deficiency situation was revealed among school children in the Aseer region. Continuous monitoring of iodine status among school children is therefore necessary. Concerted interventions that blend nutrition-sensitive with nutrition-specific approaches are expected to influence decreasing stunting significantly.

Experience of Basic Life Support among King Khalid University Health Profession Students, Southwestern Saudi Arabia.

BACKGROUND: Satisfactory experience about basic life support (BLS) is crucial to ensure rapid and efficient delivery of essential life-saving care during emergency situations. OBJECTIVES: To assess BLS experience among health profession students at King Khalid University (KKU), Southwestern Saudi Arabia. METHODS: A cross-sectional study was conducted on a representative sample of male and female health profession students, during the academic year 2019-2020. A self-reported questionnaire was utilized to collect data about BLS experiences, which included receiving BLS training, reasons for not having BLS training, suggestions to improve BLS training, encountering a situation that required the use of BLS, practicing BLS when needed and reasons for not practicing BLS when needed. RESULTS: Out of 1261 health profession students, 590 received formal BLS training with a prevalence rate of 46.8% (95% CI: 44.0-49.6), and 46.0% of them trained at the university. Important obstacles for non-attendance included busy academic schedule (54.7%) and high cost of the training course (18%). Overall, 84.1% supported integration of BLS training into their college curricula. Almost 26% encountered a situation that required BLS; however, only 32.4% responded. Through multivariate regression, the significant determinant of response was having formal BLS training (aOR = 4.24, 95% CI: 2.38-7.54). The frequent reasons for non-response were lack of adequate BLS knowledge (35.0%), nervousness (22.8%), and that the victim was of opposite sex (9.0%). CONCLUSION: It is recommended that more emphasis should be given to BLS training among undergraduates of health profession colleges in Southwestern Saudi Arabia. It is recommended that BLS training be integrated into health profession college curricula. Including BLS training as a graduation requirement for health profession students might motivate students to attain BLS training courses.

Prevalence of laser refractive surgery among ophthalmologists in Saudi Arabia.

PURPOSE: The primary aims of this study are to assess the prevalence of excimer laser refractive surgery among ophthalmologists in Saudi Arabia, evaluates the satisfaction rates among ophthalmologists who have undergone laser refractive surgery and whether they would recommend the procedure to their immediate family members. METHODS: A cross-sectional study surveyed ophthalmologist irrespective of specialty or subspecialty in Saudi Arabia. A self-reported survey tool has been used for data collection. Candidates were contacted by email and WhatsApp messages that introduced the nature of the study and an online link to a survey was included. For those who did not respond to the digital contact, direct survey interviews were conducted at an Ophthalmology conference in Riyadh, Saudi Arabia, 2018. RESULTS: The final study sample was comprised of 183 ophthalmologists. Most of them 107 (58%) reported that they currently are performing laser refractive surgery.There were 73 (39.89%) ophthalmologist who self-reported that they are emmetropic, 110 (60.11%) self-reported themselves as ametropic, not including presbyopia.Of the 110 ophthalmologists with refractive errors, 52 (47.27%) were candidate for laser refractive surgery for myopia, hyperopia or astigmatism. Most of non- candidates attributed the non-candidacy to non- specific reasons and dry eye. Of the 52 participants who reported themselves as candidates for laser refractive surgery, 20 (38.46%) reported that they had undergone laser refractive surgery, and 32 (61.54%) had not. Most of them (50%) reported that they "like to wear glasses or contact lenses. In general, 14 (70%) reported complete satisfaction with the postoperative outcome.Of all ophthalmologists participated in the study, 94% would advise laser refractive surgery to their first-degree relatives. CONCLUSION: Excimer laser vision correction among ophthalmologists in Saudi is much higher than the market penetration in the general population reported in other countries. Most of the ophthalmologists who underwent the procedure were satisfied with the outcome.

Schoolteachers' Knowledge of Attention-Deficit/Hyperactivity Disorder-Current Status and Effectiveness of Knowledge Improvement Program: A Randomized Controlled Trial.

BACKGROUND: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school. OBJECTIVES: To assess the schoolteachers' knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program. METHODS: A randomized controlled trial study design was followed on 100 primary school teachers from Abha City, Saudi Arabia. Teachers were randomly selected and allocated into trial and control groups. A self-administered questionnaire was used to evaluate teachers' knowledge about ADHD. After the baseline assessment, participants in the trial group received a two-day ADHD knowledge improvement program. Teachers' knowledge about ADHD was reassessed using the same questionnaire immediately after finishing the intervention program and after three months in both groups. RESULTS: Only 16% and 22% of trial and control groups, respectively, showed adequate baseline knowledge about ADHD. Teachers' main sources of information about ADHD were the internet (67%), friends (47%), TV (34%), and reading books (23%). Knowledge of teachers in the trial group significantly improved immediately after the intervention. After three months, these knowledge benefits slightly declined but remained more adequate than those of teachers in the control group. The logistic regression model revealed that being a participant in the trial group and of higher qualification were associated with significant improvement in teachers' retained knowledge on ADHD (p < 0.001 and p = 0.050, respectively). CONCLUSIONS: The majority of male primary school teachers in Abha City, Saudi Arabia, have inadequate knowledge about ADHD. Applying a knowledge improvement program can substantially improve their knowledge of ADHD. Consideration should be given to the integration of ADHD knowledge improvement program into teachers' educational programs.

Current Practices and Existing Gaps of Continuing Medical Education among Resident Physicians in Abha City, Saudi Arabia.

BACKGROUND: Continuing medical education (CME) is an everlasting process throughout the physician's working life. It helps to deliver better services for the patients. OBJECTIVES: To explore CME among resident physicians in Abha City; their current practices, their opinions, and barriers faced. METHODS: A cross-sectional study was conducted among resident physicians at the Ministry of Health hospitals in Abha City using a validated self-administered questionnaire. It included personal characteristics, current CME practices, satisfaction with CME, and barriers to attendance. RESULTS: The present study included 300 residents from 15 training specialties. Their reported CME activities during the previous year were lectures and seminars (79.7%) followed by conferences (43.7%), case presentations (39.7%), workshops (34.0%), group discussion (29/7%), and journal clubs (27.3%). Astonishingly enough, very few (8%) attended online electronic CME activities. There were significant differences in CME satisfaction scores by different training specialties. Regarding residents' perceptions of the effectiveness of different CME activities (conferences/symposia, workshops/courses, and interdepartmental activities) the results showed that workshops and courses were significantly the most effective method compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in improving practice behaviors. Barriers reported were being busy, lack of interest, high cost, and lack of suitable providers. CONCLUSION: Based on the findings of this study, it is recommended that online learning be promoted as a CME format for trainees. There should be support of residents and clinicians through the provision of protected time for their CME activities outside their daily clinical commitments.

Clinical and Biochemical Predictors of Nonalcoholic Fatty Liver Disease among Type 2 Diabetes Mellitus Patients at Primary Health Care Level in South Western Saudi Arabia.

OBJECTIVES: To predict the role of different clinical and biochemical parameters in identifying nonalcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) in Abha city, southwestern Saudi Arabia. METHODS: A stratified random sample was selected. A detailed clinical and biochemical examinations were performed. Using portable abdominal ultrasound examination, NAFLD was identified. The study used receiver operating characteristic (ROC) analysis. RESULTS: The study covered 237 T2DM patients. NAFLD was detected among 174 patients. Area under the curve (AUC) calculations showed that the ability of age, duration of DM in years, and body mass index to predict NAFLD was poor (AUC < 0.6). Similarly, biochemical factors like HbA1c%, AST, cholesterol, triglycerides, HDL, LDL, and VLDL were poor in discriminating between those with and without NAFLD among T2DM. On the other hand, the ability of ALT to predict NAFLD among T2DM was good (AUC = 0.701, 95% CI: 0.637-0.761). The analysis identified the optimal cutoff point of ALT to be ≤22.1 nmol/L. The corresponding sensitivity was 60.7% (95% CI: 53.0-68.0) and specificity was 62.5% (95% CI: 49.5-74.3). CONCLUSIONS: Early identification of NAFLD among T2DM is important. A threshold cutoff value of 22.1 nmol/L of ALT has been identified to predict NAFLD. They should be referred for ultrasound examination for NAFLD.

Coronavirus disease 2019 pandemic stress and its effects on irritable bowel syndrome patients in Saudi Arabia.

ABSTRACT: Coronavirus disease 2019 (COVID-19 pandemic has affected the psychological health of people, causing a higher level of stress. Stress can exaggerate the symptoms of irritable bowel syndrome (IBS).To assess the effect of the COVID-19 pandemic stress on patients with IBS in Saudi Arabia.A descriptive cross-sectional approach was used, which targeted accessible subjects with IBS from different regions of Saudi Arabia. Data were collected from participants using a structured electronic questionnaire, which captured the participants' socio-demographic data, medical history, IBS clinical data, self-reported stress due to COVID-19, and its effect on IBS symptoms.A total of 1255 IBS patients completed the questionnaire. About 63.4% of them reported stress due to the pandemic. The most frequently reported causes of stress were fear of infection occurring in the family, followed by fear of self-infection (43.5%), and death due to COVID-19 infection (17.2%). Most of the stressed participants (56.6%) reported that stress usually exaggerated IBS symptoms. Almost 22% of them consulted a physician for stress aggravation of the symptoms, 18.1% used sedatives due to stress, 9.2% modified IBS medications due to the stress, and 75.5% of the participants reported impaired daily activities due to symptoms exacerbation. Coexisting chronic morbidities and inability to differentiate between COVID-19 gastrointestinal symptoms and IBS symptoms were significantly associated with COVID-19 related stress (P = .039 and .001, respectively).Two-thirds of IBS patients were stressed during the first few months of COVID-19 pandemic. Patients unable to differentiate between COVID-19 gastrointestinal tract symptoms and IBS symptoms, and patients suffering from chronic morbidities were more vulnerable. Pandemic stress exacerbated patients' symptoms and impacted their activities of daily life.