Stressors and coping strategies among secondary school male students in Abha City, Saudi Arabia.

Background: Stress is a biological process in which exposure to stressors is associated with bad health effects, decreased ability of disease management, and a higher likelihood for disease-related complications and comorbidities. Stress has been considered the main factor in the etiology of many diseases such as diabetes mellitus, cardiac diseases, and body aches for centuries. Students meet many stressful situations such as the need for success, academic demands, homesickness, and lack of social support. Coping with stress can be a leading cause in preventing psychological distress and a serious illness. Methods: A correlational cross-sectional approach was applied to the current research. The research targeted all secondary school male students in Abha city. A multistage cluster sample was applied by selecting schools and students from the Directorate of Education in Abha. Self-administered questionnaire sheets were distributed to students in their classes. The questionnaire covered students' sociodemographic data such as age, grades, parents' education and work, living conditions, and comorbidities. Stressors to which the students were exposed were also enumerated with the degree of stress for each. Stress was assessed using the Holmes-Rahe Stress Inventory for youth. Coping skills were measured using the abbreviated version of the COPE Inventory. Results: The study included 324 students whose ages ranged from 15 to 20 years old with a mean age of 17 ± 0.9 years old. Approximately 33% of the students were in first grade; 44.4% of the students had no or minimal level of stress while major stress was recorded among 26.5% of the students. In total, 77.8% of the students had moderate coping and none had high coping ability. Conclusion: The study revealed that more than half of the students had significant levels of stress and one out of each four had major stress. The most common stressors were due to the school environment and future planning. Young age, low socioeconomic status, parents' separation, and having chronic health problems were the most important determinants of stress among the students.

Elective Laparoscopic Cholecystectomy Complicated by Hemorrhagic Crisis in a Patient With Sickle Cell Disease.

Sickle cell disease (SCD) is a common genetic disorder associated with complications such as cholelithiasis. Cholecystectomy is often performed in SCD patients, but they have a higher risk of postoperative complications. Blood transfusion, while beneficial, can also have adverse effects. The optimal approach to perioperative transfusion in SCD patients is still debated. This case report presents a rare surgical presentation of gallbladder stones in an SCD patient complicated by a hemolysis crisis and bleeding after laparoscopic cholecystectomy. A 24-year-old SCD patient with symptomatic gallbladder stones underwent laparoscopic cholecystectomy. Preoperative exchange transfusions were done to optimize hemoglobin and hemoglobin S (HbS) levels. Postoperatively, the patient experienced abdominal pain, tachycardia, and hypotension, indicating a possible hemolysis versus hemorrhagic crisis. Supportive management started but patient was still not improving and persisted to be tachycardic and hypotensive and laboratory results showed a drop in hemoglobin level (4.7 g/dL) and low platelets. A massive transfusion was activated and the patient received four units of packed red blood cells, four units of platelet and four units of fresh frozen plasma, but bleeding persisted. Laparoscopic exploration was done and oozing from liver bed was controlled and shifted again to surgical intensive care unit. Unfortunately, the next day, patient again experienced rebleeding which mandating laparoscopic converted to open laparotomy, and multiple sites of ongoing bleeding were identified and controlled with liver packing. The patient required subsequent interventions, including additional transfusions and second look and abdominal closure. After several days of intensive care, the patient's condition improved, and he was discharged with follow-up arrangements. Optimal management of surgical cases in SCD patients necessitates a multidisciplinary approach and personalized perioperative care. Preoperative transfusion should be tailored based on risk factors and the procedure. Standardized protocols and guidelines are needed to enhance perioperative management and outcomes. Prioritizing perioperative care can help mitigate complications and improve results for SCD patients undergoing surgery. Further research is required in this area.

Management of Latent Tuberculosis Infection in Saudi Arabia: Knowledge and Perceptions Among Healthcare Workers.

Background Tuberculosis (TB) continues to pose a serious threat to public health despite great efforts. For many years, management and screening for active TB cases have been the main focus of TB control programs. Latent TB is a stage where TB can be prevented and controlled. Therefore, designing a comprehensive TB control program that includes latent tuberculosis infection (LTBI) management diseases is needed to be implemented among the healthcare workers (HCWs) who have been found to be at a higher risk for active TB compared to the general population. The objective of the study The objective of the study is to assess the knowledge and perceptions of LTBI among HCWs. In addition to estimating the prevalence of LTBI among HCWs using closed-end questions in a self-administered questionnaire. Subjects and methods Through a cross-sectional study and non-random sampling technique, 324 (84%) healthcare workers who met the inclusion criteria completed and submitted the electronic questionnaire. Results Among all participants, the study reported a good knowledge about LTBI; however, a third of HCWs had poor knowledge about the difference between LTBI and active TB. Eighteen percent of participants were diagnosed with LTBI, and two-thirds accepted the treatment. Of all participants who started the treatment, 55% completed the treatment course. The compliance rate was high among young HCWs and physicians who had a short course of LTB treatment regimen.  Conclusion The study reported a low acceptance and completion rate of LTBI therapy among HCWs. Low knowledge about some clinical facts of LTBI, the long duration of treatment, and being the treatment optional in Saudi health institutes were all barriers to accepting and completing the treatment of LTBI. All of these factors need to be addressed to increase the compliance rate to LTBI treatment.

Seasonal influenza vaccine effectiveness among health-care workers in Prince Sultan Military Medical City, Riyadh, KSA, 2018-2019.

Background: Healthcare Workers (HCWs) constitute a major group exposed to influenza. Researchers herein try to determine the influenza vaccine effectiveness (VE). Influenza VE depends on the vaccinated personal characteristics and the closeness of matching between the vaccine and the prevalent strains of the virus. The aim of our research was to identify the 2018-2019 seasonal influenza VE in HCWs. Methods: a record-based study was carried out using the test-negative design from October 2018 to September 2019 to calculate the influenza VE. HCWs with influenza like illness (ILI) were screened to detect the positive cases, and the vaccination status was determined based on vaccination database. VE was assessed from the ratio of the odds of vaccination among positive cases to the odds of vaccination among negative controls. Statistical analysis Multivariable logistic regression was used to estimate adjusted VE Results: a total of 556 HCWs presented with ILI, 65.6% were females, and 54.1% were nurses, 152 HCWs (27.3%) had laboratory-confirmed influenza, shows two peaks in January and March 2019. VE for all types was 35.0% and rose to 42.0% after adjustment for HCWs age, gender, nationality, and job position, influenza A (H3N2) VE was 78.0%. H1N1 VE was 55.0% but no significant VE for type B was found. Conclusion: Our VE estimates are in agreement with VE estimates published for that season. The use of quadrivalent vaccine with two stains of influenza B is recommended.

Renal Impairment After Cardiac Surgery: Risk Factors, Outcome and Cost Effectiveness.

Introduction Acute kidney injury (AKI) is considered one of the serious complications in the medical field. It has a large impact on patients' life medically, socially and economically. It also has a financial burden on governments and hospitals regardless of which part of the world is considered. On the other hand, AKI is a common complication of cardiac surgery, which alone has a tremendous burden and implications on patients and governments. In this study, we will discuss the various risk factors, outcomes and financial burden of renal impairment associated with cardiac surgery. Methods This is a retrospective case-control study, which included 144 adult patients who underwent open cardiac surgical procedures at King Fahad University Hospital in the Eastern Province of Saudi Arabia over a period of five years from January 2015 till the end of December 2019. We included all types of cardiac surgeries performed such as coronary artery bypass grafting (CABG), valve surgery and aortic dissection repair and excluded patients with end-stage renal disease (ESRD) requiring dialysis preoperatively and pediatric patients. Two control groups were defined, those who developed renal impairment (group A) and those who did not develop it (group B). Results The mean age of the patients was 58.59 ± 12.6 years (range: 42 to 77 years). Mean serum creatinine level in the postoperative period was 1.95 ± 1.5 mg/dL in group A compared to group B of 1.0 ± 0.32 mg/dL (P-value<0.01). Mean serum blood urea nitrogen (BUN) in group A was 26.45 ± 19.9 mg/dL compared to group B of 16.79 ± 16.2 mg/dL in group B (P-value < 0.01). Diabetic were more likely to develop renal impairment than non-diabetic (P-value = 0.049, OR 2.73; 95% CI: 0.97-7.66). Obese patients were two times more likely to develop renal impairment than non-obese (P-value = 0.056, OR 2.6; 95% CI: 0.94-7.1). The average cost for each patient with renal impairment who required dialysis was 110,000 Saudi Riyal (~ 29,000 $) compared to other patients. Conclusion Serum creatinine, BUN, diabetes and obesity are strong indicators in developing AKI in cardiac surgery. In addition, the financial burden was almost doubled in patients developing AKI.

Amphibians distribution and habitats in the southwestern region of Saudi Arabia.

This study surveyed 205 wetland sites in the Southwestern Saudi Arabia. We found seven species of amphibians (Anura), which belong to four families: Bufonidae; which includes four species, Sclerophrys tihamica; S. Arabica, Duttaphrynus dhufarensis, and Bufotes viridis; Hylidae, represented by only one species, the tree frog Hyla savignyi; Ranidae, which represented by one species, Pelophylax ridibundus and finally the Dicroglossidae, represented by one species, Euphlyctis ehrenbergii. The reasonable amount of rain received in southwest Arabia, and habitat diversity contribute to the relative abundance of amphibians in the region. Five types of wetland habitats were found in the study area. Valley streams, irrigated farms, seasonal ponds, dam reservoir and lagoons of treated sewage water. The current study revealed the wide spread of amphibians in southwestern Saudi Arabia than what had been reported earlier and confirmed the presence of the Bufotes viridis at three new sites in Asir Heights. It also showed the wide spread of S. arabica in all types of habitats in the southwestern region of Saudi Arabia. Habitat degradation was evident in the region, which might lead to species loss.

Effectiveness of transnasal endoscopic powered adenoidectomy in patients with choanal adenoids.

OBJECTIVES: To demonstrate the technique and efficacy of powered assisted adenoidectomy using nasal endoscopy. PATIENTS AND METHODS: Between 2002 and 2003, forty children (age ranged from 3 to 17 years) with symptoms and signs suggestive of snoring and/or obstructive sleep apnea and choanal adenoids were randomly selected and distributed in two groups. Group A underwent transnasal endoscopic powered adenoidectomy (TEPA) and group B underwent curettage adenoidectomy (CA). Both groups underwent pre- and postoperative nasal endoscopy. Direct comparisons between the two groups were made with regards to operative time, amount of blood loss, postoperative morbidity, complications, and resolution of symptoms. RESULTS: Male to female distribution was equal 1:1. The mean age of both groups was 8 years. In group A, the mean blood loss was 8.2 ml compared to 22.1 ml in group B (p<0.05). The operative time in group A was 6.1 min vs 12.3 min in group B (p<0.05). There were no operative or postoperative complications in both groups. Postoperative follow up and nasal endoscopy showed no recurrence of symptoms or adenoid remnants. CONCLUSION: Using TEPA for removing choanal adenoids is an adequate and safe method. The TEPA technique can be added to the armamentarium of techniques used by pediatric otolaryngologists.

Characteristics of immunization providers in riyadh and their self-perception of competency.

OBJECTIVE: To study the demographic characteristics of immunization providers in Riyadh City and their self-perception of competency. METHODS: A cross-sectional study was conducted among immunization providers in Riyadh City from August 2003 to March 2004. This study covered 71 institutions: (25 primary health care centers, 30 private clinics and dispensaries, 8 government hospitals and 8 private hospitals). Immunization providers were selected by stratified random process. One hundred and one physicians participated in the study and the data were obtained by self-administered questionnaires, tabulated and analyzed using appropriate statistics. RESULTS: The participating physicians were mostly pediatricians (50.5%) and general practitioners (38.6%). About 47% of them had had no training in immunization during the preceding 10 years. Self-evaluation revealed that 30.7% of them ranked themselves as excellent, 67.3% as average and 2.0% as poor immunization providers. Self-confidence was associated with specialty, qualification, place of work, years of experience and training on immunization (p<0.05). Most of participating doctors (83.7%) used books as their references. The doctors were least confident in vaccinating pregnant and lactating women and the vaccination of travelers to endemic areas. CONCLUSION: To improve immunization services, doctors should be trained before being involved in this practice. There should be frequent distribution of national and international protocols with the auditing of the practice to improve and sustain a highly effective service.