A cross sectional study on levels of dental anxiety, its influencing factors, and the preferred management techniques among patients in Riyadh, Saudi Arabia.

BACKGROUND: Dental anxiety is marked by intense and irrational fear of dental procedures affecting millions of individuals worldwide. The purpose of this study was to investigate the relationship between dental anxiety, its influencing factors, and the preferred management techniques among adults seeking dental care in Riyadh. METHODS: A cross-sectional questionnaire study was carried out among 1734 patients who visited dental clinics in Riyadh. A self-administered questionnaire was developed and validated, comprising 28 closed-ended questions; it demonstrated good reliability and internal consistency (Cohen's kappa coefficient = 0.90, Cronbach's alpha coefficient = 0.86), it contained pre-validated Modified Dental Anxiety Scale to quantitatively assess the level of dental anxiety. Data analysis involved descriptive analysis, Chi-square test, Pearson correlation coefficient and multiple linear regression. RESULTS: Majority (59.2%) of participants reported moderate anxiety, while 10.9% experienced high anxiety which was significantly linked to factors such as fear of pain (37.8%) and anaesthetic needles (25.8%). Topical anaesthetic gel (64.5%), pre-treatment explanations (78.9%), and conducive clinic environment (79.4%) were perceived as effective anxiety alleviators. A negative correlation existed between dental anxiety and preferred management techniques. Dental anxiety had significant association between gender (ß = 0.910) and age (ß = 0.263). CONCLUSION: This study revealed that majority of participants had moderate dental anxiety, linked significantly to influencing factors like frequency and purpose of dental visits and past dental experiences. The study also found the preferred anxiety management methods among participants which included topical anaesthetic gel, pre-treatment explanations, and a comfortable clinic environment.

Occupational Stress and Burnout Among Healthcare Workers in Saudi Arabia During the COVID-19 Pandemic.

The COVID-19 pandemic has caused a lot of stress for healthcare personnel. They are subjected to arduous and stressful working hours and may contract infection. The objectives of this study were to (i) assess the level of occupational stress and the prevalence of burnout among healthcare workers (HCWs) in the Kingdom of Saudi Arabia during the COVID-19 pandemic and (ii) to identify some sociodemographic characteristics and work-related factors that may influence the level of stress and burnout among such HCWs. An online survey was distributed on social media websites and groups of HCWs in KSA. The survey depended on the stress domain of Depression, Anxiety, and Stress Scale-21 (DASS-21) and the work-related burnout domain of Copenhagen Burnout Inventory (CBI). Data were collected using a Google form and then analyzed. Among 478 respondents, 37.7% of studied HCWs reported mild to extremely severe stress, and 47.9% of them reported work-related burnout. Occupational stress and burnout were more prevalent among front-line HCWs (43.9% and 55%) than among second-line HCWs (31.2% and 40.8%). The mean scores of occupational stress and burnout were significantly much higher among frontline physicians and nurses particularly those who are females, of younger age (≤40 years), with few years of work experience (≤15 years), being married, having chronic disease, and those previously infected by COVID-19. HCWs reported a high prevalence of occupational stress and burnout during the COVID-19 pandemic. Establishing policies and guidelines, enhancing working conditions, and providing continuous psychological support and assurance to HCWs are recommended to improve their resilience and increase their coping capacities toward pandemics.

Efficacy of Anti-Thyroid Medications in Patients with Graves' Disease.

INTRODUCTION: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use. METHOD: We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study. RESULTS: The study sample consisted of 189 patients, 72% of whom were female. The patients' median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of < 0.0001. CONCLUSION: The remission of GD was achieved in approximately half of the patients treated with ATD; however, approximately one-third of them relapsed. Lower Free T4 and TRAb levels at diagnosis were associated with remission. Longer ATD use and higher thyroid uptake upon diagnosis were associated with relapse after ATD discontinuation. Future studies are necessary to ascertain the predictors of ATD success in patients with GD.

Beyond labs: unveiling dynamics of dental students' transition from pre-clinical to clinical training in a Saudi dental school.

Objective: To assess the factors affecting the transition of dental students from pre-clinical to clinical courses in an outcome-based curriculum. Methods: This cross-sectional study surveyed dental students in the third and fourth academic years of the Bachelor of Dental and Oral Surgery (BDS) program at the College of Dentistry, Jouf University. Ethically approved and powered by the G Power software, the study employed a modified questionnaire validated through a pilot test to assess five domains. Likert scale responses were analyzed using SPSS v.25, revealing insights into clinical workload, patient interaction, and learning experiences. Multiple regression analysis was used to assess the impact of clinical skill application, workload, transition to clinics, and patient interaction on learning experience as well as CGPA. The Mann-Whitney U test compared the ranks of two independent samples, making it less sensitive to outliers and more suitable for data with non-normal distributions. Results: In this study, the response rate of the participants was 70%. A total of 44 dental students in their third and fourth years of the program completed the survey. The multiple regression analysis showed that the predictors collectively explained 36.1% of the variance in the learning experience (Adjusted R2 = 0.361). "Transition to Clinics" had a significant positive effect on learning experience (ß = 0.292, p = 0.012), "Workload" (ß = -0.203, p = 0.393) and "Patient Interaction" (ß = 0.443, p = 0.168) were not significant predictors. The Mann-Whitney U test revealed no significant gender differences in transition to clinics, workload, patient interaction, application of clinical skills, and learning experience (U = 33.09 to -40.33, p > 0.05), but a significant difference in transition to clinics between third- and fourth-year students (U = 31.56 to -43.24, p < 0.05). Conclusion: The results of this study demonstrate that the transition to clinical training can be intricate, and that multiple elements have an impact on this process. It is crucial to have support systems that facilitate the transition into the clinical learning environment.

Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study.

BACKGROUND: The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition. OBJECTIVE: This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences. METHODS: A nonrandomized cross-sectional study was conducted for older adults aged ≥60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95% CI were determined using a binary logistic regression. RESULTS: The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95% CI 0.747-0.952; P=.006). CONCLUSIONS: The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population.

Metabolic Syndrome among Patients Taking Atypical Antipsychotics: A Comparative Cross-Sectional Study at Erada and Mental Health Complex in Taif, Saudi Arabia.

Introduction: Second-Generation Antipsychotics (SGAs) are widely used for treating psychiatric disorders due to their favorable side effect profile compared to First-Generation Antipsychotics (FGAs). However, SGAs are associated with significant metabolic side effects. This study aims to explore the sociodemographic and health differences between individuals using SGAs and those not using them. Methods: A comparative cross-sectional study was conducted with 148 participants, including 102 SGA users and 46 non-users. Data were collected from patients and medical records, encompassing sociodemographic factors and health variables including diabetes mellitus, hypertension, cardiovascular disease, hyperlipidemia, waist circumference, fasting blood glucose, cholesterol, triglycerides, HDL, LDL, and BMI. Statistical analyses included chi-square and Fisher's exact tests to compare the two groups. Results: SGA users had higher rates of overweight and obesity compared to non-users (p = 0.000), with 30.4% overweight and 29.4% obese among SGA users versus 21.7% overweight and 4.3% obese among non-users. A higher prevalence of cardiovascular disease was observed in SGA users (11.8% vs. 2.2%, p = 0.076). Although not statistically significant, trends indicated higher rates of diabetes mellitus and hyperlipidemia in non-users (30.4% vs. 18.6%, p = 0.110 and 7% vs. 0%, p = 0.083, respectively). Conclusion: This study highlights significant differences in BMI and cardiovascular disease prevalence between SGA users and non-users, reinforcing the need for comprehensive metabolic monitoring in patients treated with SGAs. The findings underscore the importance of considering sociodemographic factors in managing the health risks associated with SGA use. Further research with larger sample sizes and longitudinal designs is warranted to better understand these associations and develop targeted interventions.

Evaluating the educational environment among Saudi board dental residents at King Abdulaziz Medical City in Riyadh using PHEEM tool.

BACKGROUND: The quality of education and the learning environment significantly influence dental trainees' success and experiences. However, the impact of the educational environment on dental residents in Saudi Arabia remains unexplored. This study aimed to assess the educational environment among dental residents at King Abdulaziz Medical City (KAMC) using the Postgraduate Hospital Educational Environment Measure (PHEEM) instrument, shedding light on its influence and providing insights for improvement. METHODS: A cross-sectional survey was conducted among 85 dental residents from various specialties at King Abdulaziz Medical City in Riyadh, Saudi Arabia, using the PHEEM instrument to evaluate the educational environment. Data analysis involved descriptive statistics, the Shapiro-Wilk test for score normality, and comparative analyses to explore the relationships between PHEEM scores and sociodemographic characteristics, specialties, residency years, and health habits. RESULTS: A total of 85 dental residents completed the survey. The majority of participants were aged 25 years and older (96.5%), female (56.5%), and single (78.8%). Most of the participating dental residents were Saudi board orthodontic residents (18.8%), and they were at the R2 level of training (32.9%). 88.2% were non-smokers, and 78.8% of them practiced physical activity. The PHEEM assessment revealed an overall score of 117.12 out of 160, with subscale scores of 41.54 out of 56 for role autonomy, 44.66 out of 60 for teaching, and 30.92 out of 44 for social support. Factors like age, marital status, and smoking were associated with lower scores, while being female and physically active were linked to higher scores. Notably, R3 residents had significantly lower scores than R1 residents (p < 0.05). CONCLUSION: This study evaluated the educational environment in Saudi board dental programs at KAMC, revealing an overall positive atmosphere but highlighting the need for improvement in certain areas. Despite some limitations, this research represents a significant step toward assessing and enhancing the educational environment for dental residents in Saudi Arabia, ultimately ensuring a better learning environment for future dental professionals.

Secondhand smoke exposure among adolescents in the gulf cooperation council countries: analysis of global youth tobacco surveys.

This study aimed to analyze patterns and predictors of secondhand smoke (SHS) exposure among adolescents (12-16 years old) in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Nationally representative data from the most recent Global Youth Tobacco Survey in each country were analyzed (N = 17,220). SHS exposure at home, in public places, and at school was assessed. Descriptive statistics summarized exposure prevalence overall and by sex. Multivariable logistic regression examined factors associated with each SHS exposure's outcome. The results showed that SHS exposure was high overall, with exposure at home and school ranging from 12.7 to 20.7%, respectively, in Oman to 39.4% and 36.7%, respectively, in Kuwait. Almost half of the adolescents reported exposure to SHS in public places, with a prevalence of 40.8% in Saudi Arabia to 65.9% in Kuwait. The prevalence of exposure varied between countries, with the highest rates occurring in Kuwait. Girls had higher exposure at home, while boys had higher exposure in public and at school. Factors associated with higher exposure included parental smoking, friend smoking, and tobacco advertising. The belief that SHS is harmful was associated with lower home exposure. In conclusion, adolescents in the Gulf Cooperation Council countries are exposed to concerning levels of SHS, especially in public places. These findings underscore the urgent need for stronger tobacco control policies, including comprehensive smoke-free laws covering all public venues, to protect youth from SHS exposure. Additionally, the results support the development of targeted interventions promoting smoke-free homes and social norms against smoking.

Clinical training and practice of using digital health solutions among healthcare workers in clinical settings during Hajj season.

Digital health solutions are widely used in Saudi Arabia, but training, clinical practice and challenges related to using digital health applications have not been evaluated from the perspective of healthcare workers during the Haj season in Makkah. The current study was planned to explore clinical training, practices and challenges related to the use of digital health among healthcare workers during the Haj season from June to August 2023. Of the 470 subjects, 347(73.8%) were males and 123(26.2%) were females. The overall median age was 40 years (interquartile range: 27-56 years). In the clinical practice of using digital health, 185(39.4%) of the subjects strongly agreed that digital health was useful and beneficial during transportation difficulties, and 167(35.5%) strongly agreed that digital health applications had changed their working routine during the Haj season. Negative outcome expectations were the challenge least reported by 72(15.3%) respondents.

Association of Perception, Interest, and Barriers of Learning and Practicing Yoga with Levels of Stress in Life among Residents Living in Saudi Arabia.

BACKGROUND: Yoga as a mind-body activity and clinical studies on yoga's effects on physical and mental health have produced encouraging results. However, there is little research done on the population's perception and interest toward practicing yoga in KSA. Thus, the current study was undertaken to evaluate the perception, interest, and barriers of learning and practicing yoga with levels of stress in life among residents of Saudi Arabia. METHODOLOGY: This is an observational, cross-sectional study in which people were polled using questionnaires. The study included people of both genders aged 18-70, and Google Forms were distributed through various online platforms. The collected data were statistically analyzed. RESULTS: The study included 906 subjects in total. Participants were mostly female (64%) and non-Saudi residents (70.9%) between the ages of 31 and 51 years, with moderate levels of stress in life. About 58.6% of the study participants were aware of the benefits of yoga. The Chi-square analysis shows low-stress subjects (67.5%) knew more about yoga and meditation, whereas no-stress subjects (35.7%) practiced yoga. About 14.9% of high-stressed people consulted a yoga therapist. The majority of high (15.3%), medium (12%), and no-stressed (19.6%) did yoga for mental health and focus, whereas the low-stressed (19.3%) did it for physical health. C. ONCLUSION: Most of the study population knew yoga's physical, psychological, and spiritual benefits. The study found a relationship between the everyday stress levels of Saudi Arabian citizens and their opinions about, interest in, and obstacles to taking up yoga. More experimental and longitudinal studies are needed to confirm this hypothesis.

Résumé Contexte:Le yoga en tant qu'activité corps-esprit et les études cliniques sur les effets du yoga sur la santé physique et mentale ont produit des résultats encourageants. Mais peu de recherches ont été réalisées sur la perception et l'intérêt de la population envers la pratique du yoga en Arabie Saoudite. Ainsi, la présente étude a été entreprise pour évaluer la perception, l'intérêt et les obstacles à l'apprentissage et à la pratique du yoga avec les niveaux de stress dans la vie parmi les résidents d'Arabie Saoudite.Méthodes:Il s'agit d'une étude observationnelle transversale dans laquelle les personnes ont été interrogées à l'aide de questionnaires. L'étude a porté sur des personnes des deux sexes âgées de 18 à 70 ans et les formulaires Google ont été distribués sur diverses plateformes en ligne. Les données collectées ont été analysées statistiquement.Résultats:L'étude a inclus 906 sujets au total. Les participants étaient pour la plupart des femmes (64 %) et des non-résidents saoudiens (70,9 %) âgés de 31 à 51 ans, avec des niveaux de stress modérés dans la vie. Environ 58,6 % des participants à l'étude connaissaient les bienfaits du yoga. L'analyse du chi carré montre que les sujets peu stressés (67,5 %) en savaient davantage sur le yoga et la méditation, tandis que les sujets non stressés (35,7 %) pratiquaient le yoga. 14,9% des personnes très stressées ont consulté un yoga thérapeute. La majorité des personnes très (15,3 %), moyennement (12 %) et non stressées (19,6 %) ont fait du yoga pour leur santé mentale et leur concentration, tandis que les personnes peu stressées (19,3 %) l'ont fait pour leur santé physique.Conclusion:La plupart de la population étudiée connaissait les bienfaits physiques, psychologiques et spirituels du yoga. L'étude a découvert une relation entre les niveaux de stress quotidiens des résidents saoudiens et leurs perceptions, leur intérêt et les obstacles à l'apprentissage et à la pratique du yoga. Des études expérimentales et longitudinales supplémentaires sont nécessaires pour confirmer cette hypothèse.

Utility of Various Activation Procedures in Provoking Ictal and Interictal Patterns, during Routine Electroencephalogram (rEEG) Recording.

BACKGROUND: Activation procedures (APs) are adopted during routine electroencephalography (rEEG) to provoke interictal epileptiform abnormalities (EAs). This study aimed to observe interictal and ictal (EAs) of different EEG patterns, provoked by various APs. METHODOLOGY: This cross-sectional study was performed in the neurology department of King Fahd hospital of university, Saudi Arabia. The EEGs and medical records of patients who presented for EEG recordings were screened initially, then 146 EEGs provoked EAs due to utilization of APs, were included for analysis. RESULTS: Among all EEGs with provoked EAs, Non-rapid eye movement sleep (NREM) provoked EAs in 93 (63.7%) patients with following patterns, focal spike wave discharges (FSWDs) 45 (P= 0.01), focal spike wave discharges with bilateral synchrony (FSWDBS) 27 (P=0.03) and generalized spike wave discharges (GSWDs) 46 (P=0.01). Intermittent photic stimulation (IPS) most significantly provoked FSWDs in 07 patient (P =0.01) and GSWDs in 30 patients (P=<0.001) 7 patients (P = 0.01) and GSWDs in 30 patients (P < 0.001). Hyperventilation (HV) was associated with a higher occurrence of GSWDs in 37 patients (P =0.01). Female sex 7 (P = 0.02), provoked GSWDs 3 (P = 0.03), NREM sleep 8 (P = 0.04), prolonged EEG record 3 (P = 0.02), clinical events during recording 5 (P ≤ 0.01), diagnosis of genetic 05 (P = 0.03), and immune-mediated epilepsies 2 (P = 0.001) were associated with the provocation of ictal EAs; however, in multiple logistic regression analysis, no statistically significant association of these variables (P ≥ 0.05 each) was noted. CONCLUSION: The provocation of EAs in rEEG with different APs varies according to circumstances, including seizure types, epilepsy etiology, and the type of AP applied. These clinical and procedural parameters affect the diagnostic yield of rEEG and need careful consideration during rEEG recordings. APs adopted during rEEG recording can induce FSWDs, FSWDBS, and GSWDs in the form of either interictal or ictal EAs in various etiologies of epilepsy. Ictal EAs may appear in the form of GSWDs, during NREM sleep, in prolonged EEG records; however, their independent association needs to be evaluated in larger sample studies. Further, prospective cohort studies with adequate sample sizes are warranted.

Résumé Contexte:Des procédures d'activation (AP) sont adoptées lors d'une électroencéphalographie de routine (rEEG) pour provoquer des anomalies épileptiformes (EA) intercritiques. Cette étude visait à observer les inter-critiques et critiques (EA) de différents modèles EEG, provoqués par divers PA.Méthodes:Cette étude transversale a été réalisée dans le département de neurologie de l'hôpital universitaire King Fahd de Khobar, en Arabie Saoudite. Les EEG et les dossiers médicaux des patients qui se sont présentés pour des enregistrements EEG ont été initialement examinés, puis 146 EEG avec des EA provoqués lors de l'utilisation des AP ont été inclus pour analyse.Résultats:Parmi tous les EEG avec des AE provoqués, le sommeil à mouvements oculaires non rapides (NREM) a provoqué des EA chez 93 (63,7 %) patients avec les schémas suivants : décharges d'ondes de pointe focales (FSWD) 45 (P = 0,01), onde de pointe focale avec bilatéral synchronisation (FSWBS) 27 (P = 0,03) et décharges d'ondes de pointe généralisées (GSWD) 46 (P = 0,01). La stimulation photique intermittente (IPS) a provoqué de manière plus significative des FSWD chez 07 patients (P = 0,01) et des GSWD chez 30 patients (P = < 0,001) 7 patients (P = 0,01) et des GSWD chez 30 patients (P < 0,001). L'hyperventilation (HV) était associée à une fréquence plus élevée de GSWD chez 37 patients (P = 0,01). Sexe féminin 07 (P = 0,02), GSWD provoqués 03 (P = 0,03), sommeil NREM 08 (P = 0,04), enregistrement EEG prolongé 03 (P = 0,02), événements cliniques lors de l'enregistrement 05 (P = < 0,01), diagnostic des épilepsies génétiques 05 (P = 0,03) et des épilepsies à médiation immunitaire 02 (P = 0,001) étaient associées à la provocation d'EA critiques, cependant, dans l'analyse de régression logistique multiple, aucune association statistiquement significative de ces variables (P = > 0,05 chacune) était noté.Conclusion:La provocation d'EA dans l'EEGr avec différents AP varie en fonction des circonstances, notamment des types de crises, de l'étiologie de l'épilepsie et du type d'AP appliqué. Ces paramètres cliniques et procéduraux affectent le rendement diagnostique du rEEG et doivent être soigneusement pris en compte lors des enregistrements rEEG. Les AP adoptés lors de l'enregistrement rEEG peuvent induire des FSWD, des FSWBS et des GSWD sous la forme d'EA inter-critiques ou critiques dans diverses étiologies de l'épilepsie. Les EA critiques peuvent apparaître sous forme de GSWD, pendant le sommeil NREM, dans les enregistrements EEG prolongés; cependant, leur association indépendante doit être évaluée dans des études sur un échantillon plus large. De plus, des études de cohortes prospectives avec des échantillons de taille adéquate sont justifiées.

Chromosome 16p11.2 microdeletion syndrome with microcephaly and Dandy-Walker malformation spectrum: expanding the known phenotype.

BACKGROUND: Chromosome 16p11.2 deletions and duplications were found to be the second most common copy number variation (CNV) reported in cases with clinical presentation suggestive of chromosomal syndromes. Chromosome 16p11.2 deletion syndrome shows remarkable phenotypic heterogeneity with a wide variability of presentation extending from normal development and cognition to severe phenotypes. The clinical spectrum ranges from neurocognitive and global developmental delay (GDD), intellectual disability, and language defects (dysarthria /apraxia) to neuropsychiatric and autism spectrum disorders. Other presentations include dysmorphic features, congenital malformations, insulin resistance, and a tendency for obesity. Our study aims to narrow the gap of knowledge in Saudi Arabia and the Middle Eastern and Northern African (MENA) region about genetic disorders, particularly CNV-associated disorders. Despite their rarity, genetic studies in the MENA region revealed high potential with remarkable genetic and phenotypic novelty. RESULTS: We identified a heterozygous de novo recurrent proximal chromosome 16p11.2 microdeletion by microarray (arr[GRCh38]16p11.2(29555974_30166595)x1) [(arr[GRCh37]16p11.2(29567295_30177916)x1)] and confirmed by whole exome sequencing (arr[GRCh37]16p11.2(29635211_30199850)x1). We report a Saudi girl with severe motor and cognitive disability, myoclonic epilepsy, deafness, and visual impairment carrying the above-described deletion. Our study broadens the known phenotypic spectrum associated with recurrent proximal 16p11.2 microdeletion syndrome to include developmental dysplasia of the hip, optic atrophy, and a flat retina. Notably, the patient exhibited a rare combination of microcephaly, features consistent with the Dandy-Walker spectrum, and a thin corpus callosum (TCC), which are extremely infrequent presentations in patients with the 16p11.2 microdeletion. Additionally, the patient displayed areas of skin and hair hypopigmentation, attributed to a homozygous hypomorphic allele in the TYR gene. CONCLUSION: This report expands on the clinical phenotype associated with proximal 16p11.2 microdeletion syndrome, highlighting the potential of genetic research in Saudi Arabia and the MENA region. It underscores the importance of similar future studies.

Factors associated with diet quality of adolescents in Saudi Arabia.

Introduction: Research exploring factors that may influence the diet quality of adolescents in the Middle East are very limited. We aimed to investigate factors associated with diet quality and the weight status of adolescents in Saudi Arabia. Methods: A cross-sectional study that included 638 healthy adolescents aged between 11 and 18 years who were randomly recruited from 16 private and public middle- and high-schools located in two Saudi cities (Jeddah and Madinah). All participants were given an envelope for parents to collect socioeconomic data. Diet quality and anthropometric data of adolescents were evaluated at school. Results: Median diet quality score was higher among males compared to female adolescents (10.00 (8.00-11.00) vs. 9.00 (8.00-10.0), respectively, p = 0.018). Median diet quality score was significantly higher among adolescents residing in Jeddah compared to adolescents residing in Madinah (10.00 (9.00-11.0) vs. 9.00 (8.00-10.0), respectively, p = 0.002). Stepwise linear regression analysis indicated that city of residence (B = -0.53, SE = 0.16 [95% CI: -0.83 to -0.22]), and child's sex (B = -0.34, SE = 0.15 [95% CI: -0.64 to -0.05]) were associated with diet quality scores of adolescents in Saudi Arabia. Discussion: Future longitudinal research should be directed to further investigate other possible factors influencing the diet quality of adolescents and individuals from other age groups in Saudi Arabia.

Assessing Saudi women's awareness about human papillomavirus (HPV) and their susceptibility to receive the vaccine.

Cervical cancer is a significant health concern for women worldwide, with human papillomavirus (HPV) being the primary cause. This study aimed to assess Saudi women's awareness and knowledge of HPV, determine their information sources, and evaluate their intention to receive the HPV vaccine. A questionnaire-based survey was conducted among 654 Saudi females aged 18 to 60 years from January to May 2023. The results revealed that 60.85% of the participants had heard about HPV, but only 8.25% had received the HPV vaccination. Despite the low vaccination rate, 71.11% of the respondents expressed willingness to receive the vaccine. Educational level was the significant predictor of the vaccine awareness and acceptance. The internet and social media were the most prevalent sources of information about HPV. The study highlights the need for additional education about HPV-related diseases and vaccination among Saudi women. Although there is a high level of HPV vaccine acceptance, the lack of knowledge suggests that targeted educational interventions are necessary to increase awareness and promote vaccination uptake. These findings can inform public health strategies to reduce the burden of cervical cancer in Saudi Arabia through improved HPV vaccination coverage and education.

Factors influencing the choice of pediatric resident: program directors perspective in Saudi Arabia: a cross-sectional study.

BACKGROUND: Pediatrics is one of the most important medical specialties in the Kingdom of Saudi Arabia) KSA) since it serves a large population. Therefore, the pediatrics residency program is considered one of the most important and competitive programs. Obtaining acceptance in Saudi programs depends mainly on the Saudi Commission for Health Specialties (SCFHS) score, then the applicant enrolls to do the interviews with the training centers in the accepted region. This study aimed to evaluate the factors used by pediatric program directors (PD) in accepting applicants in their pediatric residency program in KSA. METHODS: In this cross-sectional study, an online questionnaire consisting of 49 items was distributed among 76 current and former pediatric PDs in KSA. Participants were selected via non-probability convenience sampling. Data were collected and analyzed using the Social Sciences Statistical Package (SPSS version 26). RESULTS: Of the sample of PD studied, males represented 77.6%, while females represented 22.4%. Most of the PDs were over 50 years old. Most of them were former pediatric PDs (71.1%). The current study found that the Saudi Medical Licensing Exam was the most important factor [3.87 (0.89)] followed by services and electives [3.86 (0.65)], research [3.84 (0.83)], interview [3.77 (0.89)], GPA [3.50 (0.62)], and letter of recommendation [3.39 (0.76)]. CONCLUSIONS: For those interested in pediatrics residency programs in KSA, this study recommends that seeking a high Saudi Medical Licensing Exam (SMLE) score, taking pediatric elective rotations during internship, and acquiring excellent basic knowledge in research were the most important aspects of pediatrics residency selection from the pediatrics PD's perspective.

Newborn hearing screening in Eastern Saudi Arabia: A tertiary hospital experience.

OBJECTIVES: To analyze the performance of a leading institution in implementing newborn hearing screening and address two key areas: the knowledge gap in screening practice and the prevalence of permanent sensorineural hearing loss in Saudi Arabia. METHODS: We analyzed the prevalence of hearing impairment in all live births at King Fahad Hospital of the University, Al Khobar, Saudi Arabia, from September 2018 to June 2022. Automated auditory brainstem response was used for both initial screening and rescreening. Newborns who failed the rescreening underwent a diagnostic evaluation. We assessed the coverage of initial screening, the rate of lost follow-up, referrals for rescreening and diagnostic evaluation, and the prevalence of hearing impairment. RESULTS: A total of 5,986 newborns were born. Of these, 96.5% were screened. The passing rate for the initial screening and rescreening was 71.8%. However, 27.5% of newborns were lost to follow-up. Only 0.7% required referral for a diagnostic evaluation. The overall prevalence of hearing impairment was 2.6 per 1,000 newborns. CONCLUSION: Early identification of hearing loss through newborn screening improves the lives of affected individuals. Our program currently meets the World Health Organization's 1-3-6 benchmark goals. However, the underestimation of permanent hearing loss due to the 30% lost-to-follow-up rate is a limitation. Emphasizing the importance of the screening program is crucial to raising awareness and improving the accuracy of prevalence rates.

What do you do with a normal appearing appendix? A national study of Pediatric Surgeons.

OBJECTIVES: Surgeons may encounter a grossly normal appearing appendix in a patient with clinically suspected appendicitis. The purpose of this study is to determine the practice of pediatric surgeons in Saudi Arabia when this is encountered, and determine the reasons behind their decision making. METHODS: An electronic survey was sent to all pediatric surgeons in Saudi Arabia. Data points collected included demographics, peri-operative imaging preference, and personal practice when managing an intra-operative grossly normal appendix in symptomatic children. RESULTS: A total of 105 responses were obtained yielding a response rate of 33.8% The majority of respondents, 88 (87.1%) would remove the appendix while 13 (12.9%) would leave it in situ. The most common reason for removing the appendix was the possibility of microscopic/Endo appendicitis 71 (34.8%) while the most common reason for leaving the appendix in situ was the possible usage of the appendix for reconstructive benefits in the future 11 (50%). The overwhelming majority 87 (86.1%) felt that there were no sufficient guidelines on removal of the normal appearing appendix at the time of surgery for suspected acute appendicitis. CONCLUSION: The majority of pediatric surgeons in Saudi Arabia would proceed with an appendectomy when an intra-operative grossly normal appendix is seen in patients suspected to have acute appendicitis. There is a clear lack of published pediatric guidelines and large studies to guide the correct course of action.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons.

OBJECTIVES: To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. METHODS: This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. RESULTS: For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. CONCLUSION: Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.

Comparative analysis of nutritional quality and microbial contamination in camel milk: Evaluating safety and public health risks between camel milk obtained from street vendors and farms in Saudi Arabia.

OBJECTIVES: To evaluate the nutritional quality and microbial contamination of raw camel milk sourced from street vendors and compare it with milk obtained from farms, with a particular emphasis on pathogenic organisms. METHODS: Twenty samples were systematically collected from street vendors and farms between July 2022 and February 2023 and analyzed at King Fahad Medical Research Centre and the Pharmacy College, King Abdulaziz University, Jeddah, Saudi Arabia. The microbial analysis employed culture-dependent techniques for colony-forming unit analysis and isolation of microbial colonies from milk samples. Microbial identification utilized advanced methods, including VITEK-MS equipment and the MALDI-TOF technique. The chemical composition was analysed through enzyme-linked immunosorbent assays. RESULTS: The findings revealed significant differences in microbial loads, with milk sourced from street vendors exhibiting considerably higher microbial counts than farm-sourced milk, including pathogenic species like Staphylococcus aureus and Escherichia coli. The results indicated that camel milk from street vendors possessed a higher level of microbial contamination, suggesting potential health risks associated with its purchase and consumption from these sources. CONCLUSION: This study highlights the urgent need for stringent food safety practices in handling, selling, and distributing camel milk to reduce microbial risks to safe levels, thereby mitigating potential health hazards.