Secondary Traumatic Stress Disorder Among Physiotherapists Working in High Morbidity Departments: A Cross-Sectional Study.

Purpose: This study's objective was to measure secondary traumatic stress disorder among Saudi Arabian physiotherapists employed in the critical care, neurology, cardiology, pulmonology, and mental health fields. Also, to identify the factors related to secondary traumatic stress. Methods: Between July 2021 and June 2022, a cross-sectional study involving physiotherapists from the critical care, emergency, neurology, cardiology, pulmonology, and mental health departments was carried out. Data were collected from the participants by using the validated Secondary Traumatic Stress Scale (STSS). Appropriate Statistical analysis (bivariate and multivariate) was carried using SPSS 21.0 software to analyse the data. Results: We quantified the prevalence of secondary traumatic stress, among 201 healthcare professionals (physiotherapists) in total were assessed; of them, 23.4% worked in the medical/surgical and neurosurgical departments and 5% in the critical care and emergency departments. Twenty-four percent of the participants slept less than five hours each day, and 26.4% worked more than 45 hours per week. Our study subjects had mild STS in 25.4% of cases, moderate stress in 15.9%, high STS in 15.9% and severe STS in 30.9% of cases. The intrusion score (mean = 11.65), avoidance score (mean = 5.5), arousal score (mean = 4.1) and total mean score of 42.50 of the STSS were significantly different across the age groups, marital status and years of experience of study participants. The regression analysis shows age groups and severe stress were independently related to the total STS scores. Conclusion: The study has found out higher level of STS among physiotherapists which highlights the necessity for a variety of interventional programs to be implemented in hospital settings in order to enhance communication abilities, lessen emotional discomfort, and apply relaxing techniques.

Self-awareness of HbA1c and its association with glycemic control among patients with type 2 diabetes: A multicenter study.

OBJECTIVES: To measure the self-awareness of hemoglobin A1c (HbA1c) prevalence among type 2 diabetic Saudi patients and its association with glycemic control, thereby identifying those factors that might affect their glycemic control. METHODS: This multicenter study was carried out in outpatients' diabetes clinics in tertiary hospitals in Riyadh, Qassim, and Jeddah, Saudi Arabia. The data was collected using questionnaires. The subject's self-awareness on the HbA1c test was assessed based on the combined score of 4 questions. The latest HbA1c result before the time of data collection was obtained from medical records. Data was analyzed using bivariate and multivariate statistical methods. RESULTS: The prevalence of HbA1c self-awareness was approximately 44.5%. A total of 4 participants characteristics (glycemic control, education level, monthly income and number of follow-up visits) were associated with awareness of HbA1c. Whereas for better glycemic control; type of treatment, duration of diabetes, and self-awareness of HbA1c were independently statistically significantly associated. CONCLUSION: There is a positive association between HbA1c self-awareness and glycemic control. Glycemic control was good among those who were educated on the meaning of the test, their levels, and their target goal. Awareness among health care providers regarding the role of the patient's education regarding their condition might help in providing the patient with optimal care. Further studies with different experimental designs are needed to study this association, which will contribute to the development of a structured educational program.

Prevalence of primary dysmenorrhea and its effect on the quality of life amongst female medical students at King Saud University, Riyadh, Saudi Arabia. A cross-sectional study.

OBJECTIVES: To quantify the prevalence of primary dysmenorrhea, study its associated factors, and to assess its effect on the quality of life of female medical students. METHODS: A cross-sectional study was conducted among 376 female medical students at King Saud University student campus and King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, between September 2017 and May 2018. The study was conducted using a consecutive, non-random sampling technique. RESULTS: The prevalence of primary dysmenorrhea among female medical students was 80.1%; most of the participants (n=134) reported moderate pain (49.8%). Primary dysmenorrhea was significantly associated with caffeine consumption (p less than 0.05) and did not show an association with factors,  body mass index, diet, lack of physical activity, and smoking. Among the SF-36 domains, the 4 domains physical health (p less than 0.001) and emotional health (p=0.01) including health changes (p=0.033) and pain (p less than 0.001) were statistically significantly affected by dysmenorrhea. Primary dysmenorrhea also had a significant impact on the students' academic performance where a higher proportion of students suffering from primary dysmenorrhea showed negative effects on their attendance, concentration, study time, and participation in class. CONCLUSION: Most female medical students suffer from primary dysmenorrhea, which adversely affects their quality of life and academic performance. Caffeine consumption demonstrated a significant association with primary dysmenorrhea. Periodical awareness programs to minimize the consequences of primary dysmenorrhea should be introduced.

Community's compliance with measures for the prevention of respiratory infections in Riyadh, Saudi Arabia.

BACKGROUND: Acute respiratory tract infections are the most common causes of both morbidity and mortality worldwid, and the management and prevention of acute respiratory infections is a global problem, especially in developing countries. This study sought to assess the community's compliance and practice of measures for the prevention of respiratory infections and discover their source of health information. MATERIALS AND METHODS: A cross-sectional study was carried out in the five biggest shopping malls in Riyadh city in July 2014. The required sample size was 980 persons aged 15 or older, with 196 from each of the five biggest shopping malls from each of the five geographic areas of Riyadh. Data was collected by face-to-face interview using standardised questionnaire, and analyzed using SPSS. RESULTS: Overall, 48.3% of the participants thought that they were susceptible to any of the respiratory infections of pandemic influenza; 59.7% always washed their hands with water and soap and 34.8% used antibacterial soap. About 29% reported avoiding touching their eyes, noses, and mouths directly with their hands; 63.5% covered their noses and mouths with tissue paper when sneezing or coughing. A substantial number said they "never" shared their personal stuff, including towels (70.5%) and utensils (49.0%) with others. Only 21.2% avoided crowded places or wore a mask (9.1%) in such a situation. A high proportion (62.8%) did not take the seasonal flu vaccine. The most common sources of health information included television/radio (47.9%), social media (29.4%), and friends/family (28.1%). CONCLUSIONS: Health authorities should seize every opportunity to prevent respiratory infections by adopting all evidence-based infection control measures to improve public awareness, attitude, and practice.

Can computed tomography and carbon monoxide transfer coefficient diagnose an asthma-like phenotype in COPD?

BACKGROUND AND OBJECTIVE: Post-mortem and computed tomography (CT) studies indicated that emphysema is a feature of COPD even in the 'blue bloater/chronic bronchitis' type. We aim to test the hypothesis that the non-emphysematous patients are distinct from the main body of COPD and are more akin to asthmatic patients. METHODS: We studied 54 patients with COPD. Emphysema was measured by Goddard's visual scoring of CT scan and the carbon monoxide transfer coefficient (KCO). Bronchial biopsy was offered for thickness of basement membrane (BM) (≥7 µm) as a marker of remodelling in irreversible asthma. Spirometry was repeated after therapy with Budesonide/Formoterol for 1 year. RESULTS: The non-emphysematous phenotype were 24 of 54 patients (44%) by CT scan and 23 of 54 patients (43%) by KCO, showing agreement in 53 out of 54 patients. The non-emphysematous patients were younger, had higher forced expiratory volume in 1 s (FEV1 ) (median 61% vs 49.7%), greater prevalence of hypertrophy of nasal turbinates and higher serum IgE. The emphysematous phenotype had lower BMI and greater dyspnoea score. The BM was thickened in 11 of 14 and 0 of 10 patients in the non-emphysematous and emphysematous groups, respectively. Three patients without emphysema and a normal BM normalized their FEV1 upon receiving inhaled corticosteroid (ICS)/long-acting ß2 agonist (LABA). All the non-emphysematous improved their FEV1 after ICS/LABA (median = 215 mL). The median decline in the emphysematous was -65 mL. CONCLUSION: The non-emphysematous phenotype of COPD displays important features of asthma: clinical picture, histology and response to ICS. CT and KCO can predict spirometric response to ICS/LABA.

Public awareness of colorectal cancer in Saudi Arabia: A survey of 1070 participants in Riyadh.

BACKGROUND/AIMS: The aim of this study was to investigate colorectal cancer (CRC) awareness in healthy individuals in Saudi Arabia in order to identify segments of the population that would most benefit from targeted education programs. SETTING AND DESIGN: Survey/questionnaire. PATIENTS AND METHODS: Random, healthy individuals from Riyadh, Saudi Arabia, were approached to participate in a 10-question multiple choice survey about CRC. Data were analyzed by demographic criteria, including age, gender, marital status, and level of education, to determine if members of these groups displayed differential knowledge. STATISTICAL ANALYSIS: Differences in responses by demographic data were analyzed using Pearson's Chi-square test. A P < 0.05 was considered statistically significant. RESULTS: In total, 1070 participants completed the survey. Most respondents believe that screening for colon cancer should begin at symptom onset (42.9%). Less than 20% of all respondents believe that polyps are a risk factor for CRC, which varied significantly according to level of education; however, even the most educated answered correctly less than 50% of the time. Similarly, only 34.8% of all respondents knew that a family history of CRC imparted a personal risk for CRC. CONCLUSIONS: Although older individuals and those with higher education tended to answer questions correctly more often, there were some misconceptions regarding universally accepted screening protocols, symptoms, and general understanding of CRC in Saudi Arabia. A national education/screening program in Saudi Arabia is recommended to improve CRC knowledge.

Length of MRI signal may predict outcome in advanced cervical spondylotic myelopathy.

OBJECTIVE: To study clinical and radiological factors that may correlate with independent walking (IW) following advanced cervical spondylotic myelopathy (CSM) surgery. METHODS: A retrospective case series including all advanced CSM patients (Nurick 4 and 5) who underwent surgery from 2003-2010 in the Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia. Only patients with 6 months or more follow-up were included. A neuroradiologist who was blinded to the clinical data reviewed all MRI studies. RESULTS: Forty-three patients were included (83% males, mean follow-up 29 months). A better preoperative neurological status was a positive predictor of IW after surgery (85.7% Nurick 4 versus 36.4% Nurick 5, p=0.001). Independent walking was less likely in patients with the following MRI features: longer T2-weighted image (T2WI) signal changes (p=0.001), well-circumscribed T2WI signal changes (p=0.028), T1WI hypointensity (p=0.001), and narrow spinal canal diameter (p=0.048). Multivariate regression revealed that both an increased T2WI signal change length and T1WI hypointensity were independent predictors. The risk of dependent walking increased by 1.35 times as the T2WI signal intensity length increased by one mm, and by 14-times with T1WI hypointensity. CONCLUSION: Regaining IW after surgery in patients with advanced CSM was less likely for cases showing MRI features of longer T2WI signal changes and T1WI hypointensity. Better baseline walking, less defined T2WI signal change, and a wider spinal canal were good prognostic factors.

Comparison of three groups of patients with usual interstitial pneumonia.

OBJECTIVE: To determine the clinical characteristics and outcomes of patients with lungdominant connective tissue disease (LD-CTD) with a usual interstitial pneumonia (UIP) who do not meet the criteria for any form of CTD, and to compare these parameters with those of patients with idiopathic pulmonary fibrosis (IPF/UIP) and CTD-associated-UIP. METHODS: We conducted a prospective study on 118 patients diagnosed with UIP [LD-CTD, n = 28; CTDUIP, n = 29; and IPF/UIP, n = 61]. We compared the clinical characteristics, physiological findings, serum albumin concentrations, high-resolution computed tomography (HRCT) imaging data, and outcomes among the three groups and used Cox's proportional hazards regression analysis to identify variables associated with an increased risk of death. RESULTS: The LD-CTD and CTD-UIP patients were younger, more often female, and predominantly nonsmokers, compared with the IPF/UIP group. A significant difference in survival was evident between patients in the CTD-UIP and IPF/UIP groups (p = 0.028), but not between LD-CTD and IPF/UIP (p = 0.164) or between LD-CTD and CTD-UIP (p = 0.254). The variables associated with poorer survival in all UIP patients were (reduced) initial SpO2 level (hazard ratio [HR], 2.89; 95% confidence interval [CI] 2.1-3.7; p = 0.009) and lower serum albumin concentration (HR 2.16; 95% CI 1.6-2.7; p = 0.008). CONCLUSIONS: LD-CTD has distinct clinical characteristics that suggest an autoimmune background resembling that of CTD-UIP but differing from that of IPF/UIP. However, LD-CTD with a UIP pattern was not associated with improved survival. The resting oxygen saturation level and serum albumin concentration were independent predictors of mortality in all of the studied UIP patients, regardless of UIP type.

Bowel function and its associated variables in Saudi adults. A population based study.

OBJECTIVE: To study bowel patterns (function/habits) and its associated variables in an adult Saudi population. METHODS: In a cross sectional study, a 21-item questionnaire on bowel function (habits and frequency) was distributed to 10,000 high school students from all 5 regions of Riyadh City, Saudi Arabia, between February and April 2011. The randomly selected students, and 2 of their household or family members completed the questionnaire. Socio-demographic characteristics, eating habits, chronic diseases, and medications used were studied. RESULTS: Sixty-one percent (N=4918) were above the age of 16 years, of which 51.5% were males, and 88.1% were Saudis. It was observed that 18.1% of respondents perceived their bowel movements as being irregular and abnormal. There was no association between gender and abnormal/irregular bowel movement (OR: 0.89; p=0.13). Individuals over 60 years suffered from bowel pattern abnormalities (OR=1.8; p=0.01). Educational status (secondary), occupation (teacher and unemployed), diet habits, and chronic diseases of study subjects were also statistically significantly associated with their bowel movements. Respondents consuming more vegetables, fruits, meats, dairy products, and rice had significantly more normal bowel movements. Females tended to defecate less frequently as compared with males (p<0.0001). Approximately 40% of both genders have bowel movements at least once a day. CONCLUSION: Our results may serve as a baseline for appropriate intervention strategies, and also for future studies to substantiate, negate, or add more observations/conclusions.

Prediction of pulmonary hypertension in patients with or without interstitial lung disease: reliability of CT findings.

PURPOSE: To study the reliability of pulmonary vascular measurements based on computed tomography (CT) in the prediction of pulmonary hypertension (PH) in patients with advanced interstitial lung disease (ILD) compared with those without ILD. MATERIALS AND METHODS: The study was approved by the Institutional Review Board. All patients gave written informed consent. A prospective study of 134 patients who underwent right-sided heart catheterization and chest CT scanning within 72 hours of admission was conducted. Patients were divided into two groups-one with ILD (group A, n = 100) and one without ILD (group B, n = 34). CT measurements of the main pulmonary artery diameter (PAD), the ratio of PAD to the ascending aorta diameter (AAD), right pulmonary artery diameter (RPAD), and left pulmonary artery diameter (LPAD) were obtained. Univariate logistic regression analysis was performed, and receiver operating characteristic curves were constructed to assess the predictive ability of vascular measurements obtained by using CT in the identification of PH. RESULTS: Main PAD was significantly greater in patients with PH than in those without PH in both groups (group A, P = .008; group B, P = .02). A PAD greater than 25 mm in patients with ILD was predictive of PH, with a sensitivity of 86.4% (32 of 37), a specificity of 41.2% (26 of 63), a positive predictive value of 46.3% (32 of 69), and a negative predictive value of 83.8% (26 of 31). In patients without ILD, a PAD greater than 31.6 mm and an LPAD greater than 21.4 mm were predictive of PH (sensitivity, 47.3% [nine of 19]; specificity, 93.3% [14 of 15]; positive predictive value, 90.0% [nine of 10]; and negative predictive value, 58.3% [14 of 24]). CONCLUSION: CT-derived vascular measurements were of limited utility in the prediction of PH in patients with ILD compared with those without ILD.

Gastroprotective effect of an aqueous suspension of black cumin Nigella sativa on necrotizing agents-induced gastric injury in experimental animals.

BACKGROUND/AIM: Previous studies on "Black seed" or "Black Cumin" Nigella sativa (NS) have reported a large number of pharmacological activities including its anti-ulcer potential. These studies employed either fixed oil, volatile oil components or different solvent extracts. In folkloric practices, NS seeds are taken as such, in the form of coarse dry powder or the powdered seeds are mixed with water. This study examines the effect of NS aqueous suspension on experimentally induced gastric ulcers and basal gastric secretion in rats to rationalize its use by herbal and Unani medicine practitioners. MATERIALS AND METHODS: The study was conducted at the Medicinal, Aromatic and Poisonous Plants Research Center, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Acute gastric ulceration was produced by various noxious chemicals (80% ethanol, 0.2 M NaOH, 25% NaCl and indomethacin) in Wistar albino rats. Anti-secretory studies were undertaken in a separate group of rats. Gastric wall mucus contents and non-protein sulfhydryl concentration were estimated, and gastric tissue was examined histopathologically. RESULTS: An aqueous suspension of Black seed significantly prevented gastric ulcer formation induced by necrotizing agents. It also significantly ameliorated the ulcer severity and basal gastric acid secretion in pylorus-ligated Shay rats. Moreover, the suspension significantly replenished the ethanol-induced depleted gastric wall mucus content levels and gastric mucosal non-protein sulfhydryl concentration. The anti-ulcer effect was further confirmed histopathologically. CONCLUSION: These findings validate the use of Black seed in gastropathies induced by necrotizing agents. The anti-ulcer effect of NS is possibly prostaglandin-mediated and/or through its antioxidant and anti-secretory activities.

Survival of bronchiectatic patients with respiratory failure in ICU.

BACKGROUND: The outcome of patients with bronchiectasis during and after their stay in the intensive care unit (ICU) has seldom been reported in the literature. Managing these patients in the ICU can be challenging because of the complex nature of their disease. This study aims to identify the in-hospital and long-term outcome of patients with bronchiectasis and respiratory failure (RF) in ICU. METHODS: A retrospective study was carried out by studying all bronchiectatic patients admitted to the medical ICU for RF over a 10-year period (1995-2004). RESULTS: The mean (+/- standard deviation) age of 35 patients was 63.5 +/- 11.7 years and APACHE score was 22.3 +/- 7.3. The 4-year mortality was 60%. Among the variables observed, age > 65 years (hazard ratio (HR): 4.15; 95% confidence interval (CI): 3.2-5.1), APACHE II score > 24 (2.6, 95% CI 1.7-3.5), intubation (2.81, 95 %CI 1.9-3.7), inotropic support (2.9, 95% CI 2.0-3.7), Home-O2 (4.0, 95% CI 2.7-5.2) and activity index (4.0, 95% CI 2.8-5.3) were associated with diminished survival in univariate analysis by Cox regression. By long rank test, survival probabilities were significantly low at these strata. Multivariate analysis of Cox proportional hazard model showed that age > 65 years (HR: 5.4, 95% CI 1.9-15.7); activity index (HR: 4.8, 95% CI 1.4-16.6); and inotropic support (HR: 3.8, 95% CI 1.5-10.1) were independently associated with reduced survival. CONCLUSION: The decreased survival of ICU patients was associated with age > 65 years, activity index (bedridden or wheelchair-bound) and use of inotropic support.