Urban-rural differences in the prevalence of female pattern hair loss among secondary school girls: A cross-sectional study.

AIM: Female pattern hair loss (FPHL) is a common condition that is influenced by many external and internal factors. We aimed to identify the prevalence of FPHL among secondary school girls and identify possible associated factors. METHODS: FPHL among 3405 adolescent females was identified using detailed history, physical examination, and dermoscopy in this cross-sectional study. RESULTS: Among the 3405 included students, 2430 (71.4%) had no FPHL and 975 (28.6%) were diagnosed with FPHL (p = 0.001). The mean age of girls with FPHL was 16.43 ± 1.10 and ranged between 15 and 18 years. Among those with FPHL, 427 (43.8%) attended urban schools while 548 (56.2%) attended rural schools. No significant differences regarding paternal and maternal education, family income, or parental degree of education were observed among those with FPHL and those without (p = 0.230; p = 0.063; p = 0.276, respectively). CONCLUSION: FPHL had an overall prevalence of 28.6% among secondary school girls with a significant predominance in rural over urban areas and with a significantly associated family history. Irregular menses, history of thyroid disease, and hirsutism were significant predictors for FPHL.

Health rights knowledge among medical school students at King Abdulaziz University, Jeddah, Saudi Arabia.

BACKGROUND: Health care is a basic human right, and Saudi Arabia affirms these rights for all its citizens. OBJECTIVES: To assess the knowledge of medical students regarding health rights in Saudi Arabia. METHODS: This cross-sectional study was conducted at King Abdulaziz University (KAU) from September 2015 through November 2015. A questionnaire written in English collected demographic data and included questions about reproductive health care and health rights of women and patients with cancer, senility, or special needs. RESULTS: Of the 267 participants, 184 (68.9%) were female, and 252 (94.4%) were Saudi. Regarding consent, 87 (32.6%) and 113 (42.3%) participants believed a female patient required the consent of a male guardian to receive medical treatment or surgery, respectively, in Saudi Arabia, and only 106 (39.7%) knew that a female patient could provide consent for a caesarean section. Sixty-six (24.7%) believed that abortion is never allowed in Islam. Only 93 (34.8%) were aware that acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) patients had health rights, about half (144, 53.9%) knew that cancer patients have a right to full information, and most (181, 67.8%) believed that a patient had the right to withhold health information from his/her family. Approximately half were aware that cancer patients have the right to free medical treatment (138, 51.7%) or that health rights applied to special needs patients (137, 51.3%) and senile patients (122, 45.7%). CONCLUSIONS: The knowledge of KAU medical students regarding health rights of certain patient populations highlights the importance of health rights education in medical school.

Breast Cancer Knowledge Among Male High School Students in Saudi Arabia.

Breast cancer (BC) accounts for 24 % of all women cancer cases diagnosed in Saudi Arabia each year. Awareness is extremely important in combating this disease. This study was undertaken to assess male high school students' response to BC. This cross-sectional survey was performed on male high school students across schools in Jeddah. A questionnaire gathered data on respondent demographics, beliefs about BC, BC risk factors, early screening methods, and role of men in BC. Statistical analysis was done using SPSS 20. A total of 824 students participated, with an average age of 17.0 years. There was more than 50 % agreement that early detection of BC enhances the chances of recovery, that BC is treatable, and that clinical breast examination and breastfeeding provide protection from BC. Around half the survey population thought that BC was fatal and contagious. Fewer than 50 % thought that BC was inherited and related to smoking, consumption of contraceptive pills, repeated exposure to radiation, obesity, and wearing a bra and that breast tumors were all malignant and spread to different parts of the body. Others knew that mammograms should be performed periodically. A high percentage persuaded their relatives to have mammograms and provided them with psychological support. Knowledge of BC among male high school students in Saudi Arabia is still limited, and, therefore, programs and activities need to be established to increase awareness among high school students.

Perception of patients with cancer towards support management services and use of complementary alternative medicine--a single institution hospital-based study in Saudi Arabia.

BACKGROUND: To evaluate the perception of cancer patients toward treatment services and influencing factors and to inquire about the use of complementary alternative medicine (CAM). MATERIALS AND METHODS: Information was obtained through pre-tested structured questionnaires completed by cancer patients during treatment at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Of 242 patients, 137 (64.6%) accepted to enter this study. Most were Saudi (n=93, 68%), female (n= 80, 58%), educated at university (n=71, 52%), married (n=97, 72%) and with breast cancer (n=36, 26%). One-hundred (73%) patients were satisfied with the services provided; 61% were Saudi. Ninety-four (68%) respondents were satisfied with the explanation of their cancer. Twenty-eight (21.6%) patients received CAM, of them 54.0% received herbal followed by rakia (21.0%), nutritional supplements/vitamins (7.0%) and Zamam water (18.0%), with significant differences among them (p =0.004). Seven (5%) patients believed this therapy could be used alone; 34 (25%) patients believed it could be used with other treatments, regardless of whether they themselves used this therapy. Fifty-three (53%) satisfied patients felt they received enough support; 31 (58%) patients received support from family and friends; 22 (41.6%) patients received support from the health-care team. Patients who received information about their disease from their physicians and those who felt they had enough support were more satisfied. The patients who took alternative treatment were older age, mostly female and highly educated but values did not reach significance. CONCLUSIONS: We stress enhancing the educational and supportive aspects of cancer-patient services to improve their treatment satisfaction and emphasize the need for increasing the educational and awareness programs offered to these patients.

Incidence and outcomes of antenatally detected congenital hydronephrosis.

BACKGROUND AND OBJECTIVES: Antenatally detected urinary tract abnormalities (ADUTA) are increasingly recognized. Our aims were to determine the incidence and outcomes of antenatally diagnosed congenital hydronephrosis in a large cohort. DESIGN AND SETTINGS: We recorded the number of total deliveries over 4 years at King Abdulaziz University Hospital (KAUH) between January 2008 and December 2011 from the number of nursery and neonatal intensive care unit (NICU) admissions. PATIENTS AND METHODS: We reviewed the records of 18 853 deliveries between January 2008 and December 2011 at KAUH, Saudi Arabia. ADUTA were recorded, and their postnatal medical records were reviewed for demographic and radiological data. RESULTS: ADUTA were diagnosed in 327 fetuses (1.7%). The commonest pathology was congenital hydronephrosis (n=313, 95.7%). Cystic renal anomalies were reported in 4 babies (1.2%), and 10 children (3.1%) were reported to have other renal anomalies, including duplex kidneys or a single kidney. A total of 240 babies with congenital hydronephrosis were followed up. Hydronephrosis resolved in 99 children (41.2%) within 2 months of birth. A total of 29 subjects had underlying renal anomalies (12.1%), including vesicoureteral reflux (n=12, 5%), pelvi-ureteric junction obstruction (n=14, 5.8%), and posterior urethral valve (n=3, 1.3%). The best predictor for nonresolving congenital hydronephrosis and underlying anatomical abnormalities was the anteroposterior diameter on the first postnatal scan. A cut-off point of 5 mm was found to be 83% sensitive in predicting nonresolving hydronephrosis, while 7 mm was 88% sensitive and 10 mm was 94% sensitive. CONCLUSIONS: Congenital hydronephrosis is the commonest ADUTA. A large percentage resolved within 2 months of birth, but underlying anatomical abnormalities were found in 12.1%. All babies with antenatally detected hydronephrosis should be examined by ultrasound postnatally but further radiological investigations should only be performed for persistent significant AP dilatation >=10 mm.

Human leukocyte antigen class I alleles can predict response to pegylated interferon/ribavirin therapy in chronic hepatitis C Egyptian patients.

BACKGROUND: Racial differences and broad spectrum response to anti-hepatitis C (anti-HCV) therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen (HLA) class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon (Peg-IFN) plus ribavirin therapy in chronic hepatitis C (HCV) genotype 4 patients in Egypt.  METHODS: This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response (SVR) and 88 non-responders (NR)]. Serological testing of HLA class I antigens (HLA-A and HLA-B alleles) were performed by standard complement-dependent microlymphocytotoxicity assay.  RESULTS: The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 (P = 0.011), B40 (P < 0.001) and B41 (P < 0.001) was significantly higher in NR cases (OR/95% CI: 7.05/(1.39-18.01), 10.31/3.14-36.1 . On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR  (OR: 0.50; 95% CI: 0.28-0.89; P = 0.02) and HLA-B38 can predict non response to therapy (OR: 7.92; 95% CI: 1.67-37.54; P = 0.009) with an overall accuracy of 60%.Severe fibrosis (OR: 3.035; 95% CI: 1.521-6.091; P = 0.002), high viremia (OR: 2.69; 95% CI: 1.11-6.53; P = 0.005) and steatosis (OR: 2.1; 95% CI: 1.002-3.90; P = 0.041) predicted no response with an overall accuracy of 81.8%.  CONCLUSION: HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection.

Impact of medical curriculum on conceptualization of professionalism by residents at a University Hospital, Jeddah, Saudi Arabia.

BACKGROUND: The quality of healthcare outcomes and patient satisfaction are affected by communication skills and professionalism of the physician. Medical curricula have substantial influence on physicians' perception of professionalism. OBJECTIVES: The aim of this study was to determine the impact of medical curriculum on the values of the residents at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and their opinions on professionalism and to identify the sources that they describe as most influential in shaping their views. METHODS: This cross sectional study was conducted in 2010/2011. A modified version of the questionnaire designed by Blue and colleagues was distributed among the target group (n=201). Psychometric analysis of the survey tool showed that it was precise and had construct validity. RESULTS: The return rate was 76.6%. The overall means of the attitudes of both male and female residents toward the attributes of professionalism were low. Attitude toward professionalism showed an insignificant difference between male and female residents. Self-reflection ranked first among all studied attributes. Most male (80%) and female (76.7%) residents believed that working with consultants, specialists, and senior residents in the hospital was the main source of their opinions on professionalism. They considered basic science studies and the other extracurricular courses they attended to be the least helpful in developing their opinions. CONCLUSION AND RECOMMENDATIONS: Residents at King Abdulaziz University Hospital feel underserved in the area of developing their values toward professionalism during the preclinical years, relying to some extent on their experiences during their clinical years and mainly on their interactions with consultants, colleagues, and hospital staff to develop their sense of professionalism. Given the recent changes in the curriculum adopted by the university, it is recommended to assess the attitudes of the students under the new curriculum toward professionalism and to compare them with those of students under the traditional curriculum.

Research practices and publication obstacles among interns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2011-2012.

BACKGROUND: Medical students can play a vital role in health research at any institute. Moreover, scientific publication by medical students is a strong indicator of students' knowledge, skills and attitudes towards scientific research. Very little information exists, however, on this matter in Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional study was conducted to assess the publication practices of medical interns who graduated from King Abdulaziz University Faculty of Medicine and to investigate barriers to conducting and publishing research during their medical studies. A questionnaire was distributed to 394 interns and 249 (63.2%) responded. RESULTS: About 31% of the responding interns started research during their undergraduate study years. About 12% discontinued their research, whereas only 7% submitted their research for publication. Only 3.2% of the interns had their research papers published and 3.2% had their research paper accepted for publication; 2% had research papers under revision. Interns had positive attitudes towards research, although only a few of them had submitted their papers for publication. Furthermore, interns expressed the need for training in research design, scientific paper writing and publication practice. They recommended devoting slots in medical school curriculum, in addition to other extracurricular training workshops, to teach and train students on such practices and also to provide more convenient opportunities for student participation in conferences. CONCLUSION AND RECOMMENDATIONS: Interns in King Abdulaziz University Faculty of Medicine have a positive attitude towards research; however, few students submit papers for publication. Lack of time and training in research methods were the main obstacles cited by the interns for conducting and publishing research. Interns welcome training in research, scientific writing and publication practice. These requirements will be issued to the main curriculum committee at the faculty of medicine and recommendations on possible actions will be discussed with the administration.

Interdisciplinary integration of the CVS module and its effect on faculty and student satisfaction as well as student performance.

BACKGROUND: Beyond the adoption of the principles of horizontal and vertical integration, significant planning and implementation of curriculum reform is needed. This study aimed to assess the effect of the interdisciplinary integrated Cardiovascular System (CVS) module on both student satisfaction and performance and comparing them to those of the temporally coordinated CVS module that was implemented in the previous year at the faculty of Medicine of the King Abdulaziz University, Saudi Arabia. METHODS: This interventional study used mixed method research design to assess student and faculty satisfaction with the level of integration within the CVS module. A team from the medical education department was assembled in 2010/2011 to design a plan to improve the CVS module integration level. After delivering the developed module, both student and faculty satisfaction as well as students performance were assessed and compared to those of the previous year to provide an idea about module effectiveness. RESULTS: Many challenges faced the medical education team during design and implementation of the developed CVS module e.g. resistance of faculty members to change, increasing the percentage of students directed learning hours from the total contact hour allotted to the module and shifting to integrated item writing in students assessment, spite of that the module achieved a significant increase in both teaching faculty and student satisfaction as well as in the module scores. CONCLUSION: The fully integrated CVS has yielded encouraging results that individual teachers or other medical schools who attempt to reformulate their curriculum may find valuable.

Sensitivity of standardised musculoskeletal examination of the hand and wrist joints in detecting arthritis in comparison to ultrasound findings in patients attending rheumatology clinics.

The aim of this study is to standardise the muscuoloskeletal (MSK) examination of the hand and wrist joints and to determine the sensitivity of this standard exam to diagnose arthritis in comparison to ultrasound (US) findings. A standardised approach to MSK examination of the hand and wrist joints was formulated. It consists of inspection, followed by screening exam based on active range of motion testing, and then using specific techniques to detect clinical swelling and tenderness. The scissor and squeeze techniques for metacarpophalangeal (MCP) joints, 4-finger technique for the proximal interphalangeal (PIP) joints and 2-thumb technique for the wrist joints. Patients aged 18-75 years with symptoms suggestive of inflammatory arthritis for more than 3 months were included in the study from two centres. Two rheumatologists conducted MSK examination, while a grayscale with power Doppler US was performed by two ultrasonographers recording signs of arthritis (effusion, proliferation and hyperaemia) on the same day of visit. Statistical analysis was carried out to compare MSK examination findings in detecting swelling and tenderness to US examination findings. A total of 2,112 joints were assessed both clinically and with US. Using a standard MSK examination by a rheumatologist to detect clinical swelling showed the following sensitivities as compared to US findings: 4-finger technique of 69 % in third PIP, the scissor technique of 74 % in second MCP and 70 % in third MCP, and the 2-thumb technique of 80 % at the wrist joint. The MCP squeeze technique showed sensitivity of 66 % for tenderness. A standard MSK examination with its described techniques is a sensitive tool if used appropriately to diagnose clinical arthritis as compared to US.

A model of horizontal and vertical integration of teaching on the cadaveric heart.

This work was performed in a trial to organize the learning process by focusing on the integration of medical education particularly between the three main subjects: gross anatomy, histology and pathology. It was a theoretical teaching draft designed to be implemented with second year students of the Medical school of the King Abdul Aziz University, Jeddah, KSA, in order to overcome disadvantages in traditional teaching. The objectives of this work were to make medical students, at the pre-clinical stage of their medical carrier, alert to diagnosis and handling of clinical problems and to develop their ability to integrate pre-clinical and clinical subjects. Fifty human cadaveric hearts were anatomically and histopathologically examined. This examination revealed six different clinical problems such as pericarditis, myocarditis, cardiac hypertrophy, parasitic infestation, rheumatic heart disease and fatty infiltration. The medical students of the second year will be first introduced to the normal anatomical and histological structure of the heart, then allowed to visualize and examine the specimens of the cadaveric heart both macroscopically and microscopically. They will be introduced to a set of clinical problems through some clinical scenarios and asked to search for the possible etiological factors causing these changes, associated signs and symptoms. Finally they will be asked to present their findings and interpretations. This paper demonstrated a pathway of self-directed learning in an integrated teaching setting in the medical curriculum using available cadaveric material at a preparatory stage before developing the system-based curriculum.