Prevalence and Awareness of Carpal Tunnel Syndrome Among Adults in Tabuk City of Saudi Arabia: A Cross-Sectional Study.

Background Carpal Tunnel Syndrome (CTS) is a condition when the median nerve is entrapped and compressed within the wrist. It significantly affects the quality of life and work productivity of the affected individuals. Aim This study aimed to assess the prevalence of CTS and the risk factors associated with this condition among the general population in Tabuk City, Saudi Arabia, and to explore their knowledge of the causes, manifestations, and treatment options. Methods This cross-sectional study included male and female adult residents of Tabuk City aged 18 years and above who agreed to participate in the study. Data were collected using an online, self-administered questionnaire that was distributed to the public using different social media platforms. Results In this study, the prevalence of CTS was 3.4%. The presence of chronic diseases was a significant risk factor for the CTS (p = 0.003). Participants having chronic diseases were 6.370 times more likely to develop CTS (AOR: 6.370, 95% CI: 2.048 to 19.817). The participants had good levels of awareness about the causes (89.3%), clinical manifestations, and treatment of CTS (92.2%). There was a significant association between the level of knowledge about the causes of CTS and gender (p=0.014). Females (74.3%) showed a higher level of knowledge than males (25.7%). As well, the young (18-25) age group (67.9%) was more significantly aware of the causes of CTS in comparison to the other age groups (p=0.023). Conclusion The prevalence of carpal tunnel syndrome among the adult population in Tabuk City, Saudi Arabia, was 3.4%, and the significant underlying risk factors were chronic diseases such as diabetes mellitus, hypothyroidism, and rheumatoid arthritis. The level of awareness of CTS was satisfactory.

Risk Factors Associated With the Development of Acute Peripancreatic Fluid Collections on Follow-Up Imaging After Acute Pancreatitis: What Physicians Need to Know.

OBJECTIVES: This study aims to identify various risk factors for acute peripancreatic fluid collections (APFCs) in patients presenting with acute pancreatitis (AP). METHODS: A blinded retrospective case-control study was conducted at a tertiary care hospital in Riyadh. Data from 327 patients who presented with AP between January 2008 and 2021 were analyzed. Following the application of inclusion/exclusion criteria, the final sample size consisted of 82 patients. Patients were divided into cases and controls based on the presence or absence of APFCs, respectively. APFCs were defined as fluid collections in the peripancreatic region that develop within four weeks of presentation without well-defined walls or solid internal components. Demographic, clinical, and laboratory variables were collected and subjected to multivariate binary regression analysis to assess the odds of developing APFCs. RESULTS: A total of 34 patients were categorized as cases, while 48 patients were controls. A significant association was found between age (P=0.022), total bilirubin (P=0.012), lipase level (P<0.001), albumin level (P=0.038), and lactate dehydrogenase (LDH) (P=0.037) on admission and the odds of developing APFCs. CONCLUSION: Older age, higher levels of bilirubin and lipase, and low levels of albumin and LDH were found to be risk factors for developing APFCs. No other variables were found to be significant. The findings of this study may provide insight into how often clinicians can expect APFCs in patients presenting with AP.

The Efficacy and Safety of Intra-articular Low Molecular Weight Fraction of Human Serum Albumin for the Management of Moderate to Moderately Severe Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Osteoarthritis is a chronic degenerative joint disease that affects weight-bearing joints. Low molecular weight fraction of 5% (LMWF-5A) human serum albumin is an intra-articular injection that emerged for the treatment of knee osteoarthritis. The aim of this review is to assess the efficacy and safety of LMWF-5A versus placebo through a systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EBSCO, and ClinicalTrials.gov registry databases were utilized to search for studies. Only randomized controlled trials (RCTs) that evaluated the efficacy of LMWF-5A versus placebo were included. Efficacy endpoints were represented by Western Ontario and McMaster Universities Arthritis Index (WOMAC) A and C scores for pain and function, respectively. Serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality rates were used to evaluate the safety of the drug. The revised Cochrane risk of bias tool was used for the risk of bias assessment. Seven RCTs (n=2939) that met the inclusion criteria were included. The meta-analysis did not find significant improvement in pain (WOMAC A) (standardized mean difference (SMD)= -0.01, 95% confidence interval (CI) -0.10 - 0.09, P=0.87, I²=30%). Additionally, no significant change in function was noted (WOMAC C) (SMD=0.01, 95% CI -0.08 - 0.10, P=0.87, I²=22%). The pooled analysis did not find a significant difference between LMWF-5A and placebo regarding the incidence of joint swelling (P=0.84), joint stiffness (P=0.53), arthralgia (P=0.53), extremity pain (P=0.45), NSAEs (P=0.21), SAEs (P=0.92), or mortality (P=1.00). However, the subgroup analysis showed a significant reduction of 42% in NSAEs upon administration of 10 mL of LMWF-5A (risk ratio (RR)=0.58, 95% CI 0.35-0.97, P=0.04). In summary, our meta-analysis did not find significant differences between LMWF-5A and placebo regarding the incidence of NSAEs, SAEs, or mortality. On the other hand, LMWF-5A did not demonstrate superiority over saline in terms of efficacy. Therefore, it is not an effective drug for managing knee osteoarthritis.

Assessing the Ability of Non-dermatology Physicians to Recognize Urgent Skin Diseases.

Introduction Many patients present to the emergency department with skin conditions that are not true dermatologic emergencies. Urgent skin conditions are uncommon. Because these conditions are rare, they can be sometimes challenging to diagnose. Few works of literature discussed the accuracy of non-dermatologists' initial judgment on dermatologic conditions concluding that non-dermatologists misdiagnose many common and uncommon skin conditions. Because the study was never done in our region, we aim to conduct an online assessment using a questionnaire assessing the ability of non-dermatologists to recognize urgent skin diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted. Non-dermatologist physicians were contacted through their verified emails, provided by the secretaries of each department and the academic affairs unit. The questionnaire consisted of two main sections, the first section covered demographics, specialty, and academic level. The second part had eight questions, each containing a brief case scenario about an urgent dermatological condition with a picture of the condition attached. Participants were required to answer the questions and assess on a scale from one to 10 how confident they were about their answers. The responses were collected and analyzed. Results Out of all 161 responses, this study included 93 male physicians (57.8%) and 68 female physicians (42.2%). The mean age in the study was approximately 45 ± 3 years. This study showed that the percentage of accuracy by non-dermatologists in diagnosing urgent skin diseases given the typical presentation of the condition was (61.33%); nevertheless, the percentage decreased when it was recalculated in relation to the full level of confidence to (25.3%). Herpes zoster appeared to be the most recognizable urgent skin disease, and Pemphigus vulgaris was the least recognizable one. Conclusion This study shows that it is difficult for physicians to recognize some urgent skin diseases, which affects offering the optimum health care for the patients. Moreover, more dermatology-focused courses are needed to strengthen the knowledge about dermatological diseases.

Incidence of peripancreatic fluid collections in patients presenting with acute pancreatitis.

OBJECTIVES: To calculate the incidence of acute peripancreatic fluid collection (APFC) in patients with acute pancreatitis. The secondary objective is to determine the underlying etiologies of acute pancreatitis in the Saudi population. METHODS: A retrospective cohort study was carried out at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. The study analyzed data from patients who were diagnosed with acute pancreatitis between January 2008 and January 202. A total of 327 were included in the study after applying the inclusion and exclusion criteria. Their medical records were subsequently reviewed for the presence or absence of APFC on follow-up imaging studies, evidence of biliary stones, prior endoscopic retrograde cholangiopancreatography (ERCP), a history of alcohol use, and demographic variables. RESULTS: Of the 327 patients with acute pancreatitis, 158 (48.3%) developed APFC, while 169 (51.7%) did not. The majority of patients had an idiopathic etiology of acute pancreatitis (n=251; 76.8%); followed by a biliary etiology (n=51; 15.6%); post-ERCP complications (n=14; 4.3%), and other causes (n=11; 3.3%). CONCLUSION: The incidence of APFC in patients presenting with acute pancreatitis between January 2008 and January 2021 was 48.3%. The most common etiology of acute pancreatitis in this tertiary care hospital was idiopathic, followed by biliary etiologies and post-ERCP complications. More studies targeting the local complications of pancreatitis are needed to reach more definitive findings.

Abdominal X-Ray Findings of Patients With Crohn's Disease Presenting With Acute Abdominal Pain.

OBJECTIVES: The primary objective of this study is to describe the most common radiological findings found on abdominal X-rays of patients with Crohn's disease (CD) presenting with acute abdominal pain. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Riyadh. Data from CD patients who presented with acute abdominal pain between December 2016 and December 2021 was analyzed. A total of 144 abdominal X-rays met the inclusion and exclusion criteria and were included in the study. The medical records of patients who had the X-rays were subsequently reviewed for the presence or absence of follow-up imaging studies. RESULTS: Of the 144 abdominal X-ray studies, 54 (37.5%) had positive findings, while 90 (62.5%) were unremarkable. The most common category of findings was small bowel findings (32.6%), acute complications (32.6%), followed by extraintestinal findings (2.7%), and colonic findings (1.35%). About 29.2% of the abdominal X-rays had subsequent follow-up imaging done. The multivariate logistic binary regression analysis demonstrated that males had an odds ratio of 2.25 of undergoing follow-up imaging compared to females (p = 0.049). CONCLUSION:  The non-specific findings found on the majority of the abdominal X-rays may indicate that it is of limited diagnostic value in this patient population. However, they play an integral role in ruling out acute complications in CD patients presenting with abdominal pain and exhibiting disease activity.

The Journey to Diagnose Spondyloarthritis in Patients From Riyadh: A Cross-Sectional Study.

Introduction  Ankylosing spondylitis, now frequently referred to as spondyloarthritis (SpA), is a chronic inflammatory disease causing axial arthritis and inflammatory lower back pain resulting in the eventual impairment of spinal mobility. Moreover, its systemic complications include stiffness and inflexibility, restriction of lung capacity and function, eye inflammation, compression spinal fractures, and heart problems. Hence, early diagnosis and intervention play a key role in preventing acute complications and improving the quality of life. Objective  We aimed to estimate the average duration of diagnosis, the average number of doctors visited, and the association between the specialty of the first physician and the length of SpA diagnosis delay. Methods A cross-sectional retrospective study was conducted from November 2019 to April 2020 with patients from King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were 18 years and older and diagnosed with SpA. Call interviews were conducted and patients' medical charts were reviewed. The data were analyzed using the Statistical Package for Social Sciences statistical software, version 23 (IBM Corp., Armonk, NY). Result  The total sample was 101 patients: 59 (58.4%) males and 42 (41.6%) females. The average duration from the onset of symptoms until seeking medical advice (lag 1) and from seeking medical advice until the definite diagnosis (lag 2) was 24.74 ± 48.13 and 16.16 ± 34.62 months, respectively. The average number of doctors visited between the first medical encounter and the final diagnosis was 3.56 ± 5.3. Patients who consulted rheumatologists as the first medical encounter showed less delay in diagnosis compared to patients who sought non-rheumatologists, such as orthopedists, emergency physicians, and general physicians (11.81 ± 33.35 months vs. 26.63 ± 44.28, 26.96 ± 44.88, and 44.33 ± 65.75 months, respectively). Conclusion  Patients with SpA who were not seen by rheumatologists took a longer period till the final diagnosis than those who visited rheumatologists earlier in the course of the disease. Therefore, more studies are required to define the exact factors leading to the delay.

Lack of association between fat mass and obesity-associated genetic variant (rs8050136) and type 2 diabetes mellitus.

OBJECTIVES: To study the genotype and allele frequency of the fat mass and obesity-associated (FTO) rs8050136 A>C genetic variant and investigate its association with type 2 diabetes mekkitus (T2DM) parameters. METHODS: This study was carried out on 118 diabetic patients and 106 healthy individuals (control) from Prince Mohammed bin Abdulaziz Hospital, Al Madinah Al Munawarah, Saudi Arabia. The TaqMan single-nucleotide polymorphism (SNP)genotyping assay was used for rs8050136 genotyping. RESULTS: The frequency of the genotype AA was the same among T2DM and healthy control groups (21%). However, the frequency of genotype CC was 19.5% in T2DM patients and 24.5% in control individuals. There was no significant association between FTO SNP rs8050136 and an increased risk of T2DM. Furthermore, there was no association between the risk AA genotype and fasting blood glucose (p=0.092), glycated hemoglobin (p=0.177), or body mass index (p=0.561). CONCLUSION: Our findings show that the FTO rs8050136 A>C variant is not associated with T2DM in the Saudi population.

Self-Assessment of Competence in Palliative Care of Medical Doctors Working in Saudi Arabia.

BACKGROUND: The provision of palliative care (PC) for individuals with a life-threatening condition is fundamental to the role of the physician, in order to improve quality of life; however, little research has assessed the competence of the physicians in PC in Saudi Arabia. AIM: To conduct a baseline assessment of self-assessed palliative care competences among medical physicians in Saudi Arabia. DESIGN: A survey-based cross-sectional study was employed using a specifically designed questionnaire. SETTING: The participants in the study were selected from 6 specialist medical departments (Family medicine, cardiology, internal medicine, pulmonary medicine, neurology and oncology) in 4 Saudi Arabian Hospitals, based on inclusion criteria. RESULTS: The study was conducted using a validated questionnaire used in Ireland to evaluate the competence skills of physicians for the provision of palliative care. All categories showed internal reliability and normal distribution of the data. However, the score of the knowledge, attitude and practice among the physicians was higher than the expected. The clinical specialty of the physicians demonstrated greater influence on knowledge, attitude and practice related to the palliative care compared to medical education. This highlighted the importance of training in palliative care to the medical doctors working in a range of specialist area. CONCLUSION: The study provides baseline data on the level of competence of palliative care of physicians in Saudi Arabia. This study can be used as an assessment tool to further evaluate the effectiveness of palliative care in other areas as primary and secondary care settings.

Dietary Habits of Students Enrolled in Faculties of Health Sciences: A Cross-sectional Study.

Introduction It is often presumed that students of health sciences are more vigilant about their diet. This study assessed the prevalence of unhealthy dietary habits and identified its associated factors among students enrolled at a large university for health sciences in the Middle East. Methods A cross-sectional study, using a set of pre-validated and anonymous dietary tools, was conducted in 2018. The self-reported students' characteristics and prevalence of 10 unhealthy dietary habits were collected. Results Males were significantly more likely have irregular meal times (ß = 0.425, adjusted [adj.] odds ratio [OR] = 1.5) and insufficient seafood consumption (ß = 0.55, adj. OR = 1.7) compared to females, adj. P = 0.046 and adj. P = 0.012, respectively. Students in their third year and above (ß = 0.857, adj. OR = 2.2) reported more insufficient water intake compared to students in the first and second years, adjusted P = 0.003. Obesity in students was a significant associated factor with fast food consumption (ß = 0.48, adj. OR = 1.8), night-eating habits (ß = 0.27, adj. OR = 1.3) and skipping meals (ß = 0.41, adj. OR = 1.5) compared to normal weight students, adjusted P = 0.002, adj. P = 0.004, and adj. P = 0.003, respectively. Conclusions Compliance with healthy dietary habits among students was less than optimal. Special consideration should be paid to gender and obesity that have been associated with insufficient water intake, irregular meal times, skipping meals, night-eating habits, and fast food consumption.

Primary mucinous adenocarcinoma of the eyelid: A case report and literature review.

Primary mucinous adenocarcinoma (PMA) of the eyelid is an exceptionally rare clinical entity. Often, it mimics with benign lesions on clinical examination and with metastatic mucinous adenocarcinoma on histological examinations. We report a case of PMA in a 60-year- old male patient who came with a slow-growing, painless swelling near the lower lid of the left eye. Excisional biopsy from the mass revealed a mucinous adenocarcinoma. To differentiate it from a metastatic mucinous adenocarcinoma, a wide range of immunohistochemistry panel was run. The tumor cells showed strong positivity for cytokeratin7, cytokeratin5/6, P63, estrogen receptor, progesterone receptor and negativity for cytokeratin20. Moreover, extensive metastatic work-up did not show any primary malignancy elsewhere, hence a final diagnosis of PMA was made. We believe that, this is the second reported case from the Middle East and the first in the Madinah region of Saudi Arabia.

Elementary school teachers' knowledge of attention deficit/hyperactivity disorder.

BACKGROUND: Teachers are often the first ones to suspect attention deficit/hyperactivity disorder (ADHD) in their students, because they are with them for most of the day and they know how normal students typically behave in classroom situations. The aim of this study is to assess the teachers' level of knowledge of ADHD and identify some factors affecting that knowledge. METHODS: It is a cross-sectional study conducted among male and female elementary governmental schools in Madina city during the year 2017/1438. A pre-validated and translated self-administered questionnaire is used in data collection. It includes demographical questionnaire and the Knowledge of Attention Deficit Disorder Scale. RESULTS: The study included 416 teachers. Their age ranged between 22 and 66 years. The average percentage of knowledge regarding ADHD general information, symptoms/diagnosis, and treatment were 41.6 ± 15.1, 41.7 ± 15, and 30.7 ± 16.6, respectively. The average percentage of overall knowledge score regarding ADHD was 38 ± 11.3. Only experience in teaching (P = 0.042) and previous experience with a child with ADHD (P < 0.001) were significantly associated with teachers' knowledge regarding ADHD general information. Special need teachers had the highest score of knowledge regarding ADHD symptoms (mean rank was 283.7), P = 0.013, and they had the highest score of knowledge regarding ADHD treatment (mean rank was 261.9), P = 0.032. Teachers who reported previous experience with a child with ADHD expressed higher level of overall knowledge regarding ADHD, P < 0.001. CONCLUSIONS: The knowledge regarding ADHD among elementary school teachers in Madina is suboptimal, particularly regarding treatment.

Metaplastic squamous cell carcinoma of breast. A pathology case report with review of literature.

Metaplastic Breast Carcinoma (MBC) is a group of rare breast cancers; squamous cell carcinoma (SCC) is its most common member. Due to rarity of the condition, frequent case reports have been published of late. In the last one year alone, there were about a dozen such reports. Here we report a case of primary squamous cell carcinomain a 62-year-old female, with a 3.5cm mass in the left breast. Biopsy and mastectomy reports confirmed Metaplastic carcinoma, with 21 benign lymph nodes.. The tumour was triple negative and cytokeratin 5/6 positive. We are reporting the first case of squamous cell carcinoma of breast from our region, and we recommended large multi centre studies.