Prevalence of depression in postmyocardial infarction patients in a tertiary care center in Riyadh.

BACKGROUND: The coexistence of coronary artery disease (CAD) and depression is a growing concern, as both conditions lead to disability. Although depression is more prevalent in CAD patients than in the general population and has been associated with adverse cardiac outcomes, the underlying mechanisms linking depression and CAD are not yet fully understood. This study aims to assess the prevalence of depression in postmyocardial infarction (MI) patients as baseline data in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted at King Saud Medical City, Riyadh. The study population included male and female patients who had survived MI from January 2022 to June 2022. A sample size of 323 patients was initially planned, but only 249 patients could be included on account of exclusions. The patients underwent screening for depression using Patient Health Questionnaire-2 (PHQ-2), and those who were positive on screening were further assessed using the PHQ-9 according to DSM-5 criteria. Sociodemographic data, comorbidities, and previous cardiac interventions were collected from medical records. RESULTS: The mean age of the study participants was 57.15 years, and majority (76.6%) were males. The prevalence of previously diagnosed depression was 9.2%, and 5.2% of patients reported using antidepressant medication. According to the PHQ-9 scores, 33.33% had depression, 9% had moderate depression, and 2.4% had severe depression. There were significant associations between the severity of depression and previous CAD (P < 0.05), previous coronary artery bypass graft surgery (P < 0.05), and heart failure (P < 0.05). CONCLUSION: This study reveals a high prevalence of depression in post-MI patients at King Saud Medical City. The findings highlight the need for comprehensive management of depression in this population to improve outcomes. Further research into the underlying mechanisms linking depression and CAD to develop effective interventions is required.

COVID-19 Vaccine During Pregnancy and Perinatal Outcomes.

Introduction When COVID-19 vaccination started, there was little data on the safety of immunization against COVID-19 infection in pregnant women. Previous studies revealed no safety concerns for pregnant women or newborns who received a messenger ribonucleic acid (mRNA) COVID-19 vaccine during pregnancy. This study aimed to investigate the effects of COVID-19 vaccination on pregnant women and on perinatal outcomes. Methods This cross-sectional study was conducted in a maternity hospital in King Saud Medical City. It started in January 2022 and ended in June 2022. The questionnaire was developed and validated by experts. This study included all women admitted to the postpartum ward who were more than 18 years old and had received the COVID-19 vaccine. The study excluded women who had no proof of their vaccination status or who could not complete the questionnaire. The primary outcome was the effect of COVID-19 vaccination on gestational age and birth weight. The secondary outcomes included the development of polyhydramnios, oligohydramnios, mode of delivery, Apgar score, postpartum hemorrhage, and neonatal intensive care unit admission. Results A total of 365 pregnant women participated in this study. The mean gestational age of the unvaccinated women was 38.83 ± 1.62 weeks, which was significantly (p < 0.001) higher than that of vaccinated women (37.69 ± 2.9 weeks). In addition, the average birth weight for the unvaccinated women was 2.96 ± 0.4 kg, which did not differ significantly (p = 0.89) from that of vaccinated women (2.97 ± 0.66 kg). Conclusion COVID-19 vaccination, regardless of the type of vaccine received before, during, or after pregnancy, is not associated with any unfavorable perinatal outcomes for pregnant women or neonates.

Psychological Impact of COVID-19 Pandemic on Healthcare Workers in Riyadh, Saudi Arabia: Perceived Stress Scale Measures.

BACKGROUND: The COVID-19 pandemic has been stressful and of considerable concern among health care workers (HCWs). Being particularly at increased risk for exposure, HCWs worry about becoming infected as well as infecting co-workers, patients and family members. Such distress and panic may have destructive effects on individuals and may last long after the pandemic situation leading to depression or post-traumatic stress disorder. Therefore, the aim of the current study is to measure and investigate the prevalence of the factors affecting psychological stress during the COVID-19 pandemic among HCWs. METHODS: A self-administered online survey-including perceived stress scale (PSS) questions-was disseminated among HCWs in Riyadh, Saudi Arabia (SA) between1st June and 30th July 2020. RESULTS: A total of 469 HCWs responded to the survey for a high response rate (93.8%). The PSS revealed that 15.8% of the respondents were suffering from high stress levels, 77.2% were suffering from moderate stress levels and 7% with low stress levels. Females and junior frontline staff reported more severe stress levels. Participation on the pandemic team shows significant impact on stress levels. CONCLUSION: COVID-19 pandemic has increased stress levels among HCWs and affects their psychological wellbeing. Designing programs promoting HCWs mental health are crucial and emotional and psychological support strategies should be part of every public health crisis management plan.

The utilization of hydroxychloroquine to reduce the main signs and symptoms of COVID-19 patients, a cross-sectional study.

Hydroxychloroquine (HCQ) and chloroquine were found to have positive results in some non-randomized clinical trials with more benefit in decreasing the viral load of COVID-19. HCQ is a lysosomotropic and lipophilic drug that can penetrate cell membranes, and accumulates in the acidic lysosomes. The high concentration of alkaline HCQ increases the pH in lysosomes from the normal levels of 4.7-4.8 to 6 which leads to inhibition of lysosomes functions and thus, prevents the entry of coronavirus into cells. OBJECTIVES: The main aim of this study is to find out the appropriateness of using HCQ in asymptomatic/mildly symptomatic COVID-19 positive patients in an attempt to reduce the development of signs and symptoms of COVID-19 and severe disease. METHODOLOGY: Randomized selection, open-label trial to evaluate the efficacy of HCQ for patients presenting with asymptomatic COVID-19 upon diagnosis. Cases that met the inclusion criteria were divided into two arms [102 subjects to take HCQ (a loading dose of 400 mg twice daily given orally, followed by a maintenance dose of 200 mg twice daily for 4 days), and 100 subjects were used as a control group]. A follow-up for all the participants on daily basis for 14 days for any signs and symptoms (fever, cough, and shortness of breath). The main variables are action profile (represented by Area under the curve (AUC) for fever, cough, and shortness of breath statistically analyzed to differentiate between the two groups. RESULTS: Data in this study showed that HCQ was effective in reducing body temperature from the first day to the fifth day; this positive effect was significant with (p < 0.001) compared with subjects who didn't receive HCQ. While there was no significant effect on cough or Shortness of breath. CONCLUSION: The recommendation of this study is to utilize HCQ to all subjects with asymptomatic COVID-19 infection providing that these subjects are within the inclusion criteria of this study. There was no adverse drug reaction observed for HCQ on daily follow-up.

Awareness of isotretinoin use and Saudi FDA pregnancy prevention program in Riyadh, Saudi Arabia: A cross-sectional study among female patients.

INTRODUCTION: Oral isotretinoin is an effective agent for the treatment of severe cystic acne. Isotretinoin is a teratogen; there is an increased risk of congenital defects in infants exposed to the drug in the uterus. The Saudi Food and Drug Authority (SFDA) has implemented a pregnancy prevention program (PPP) to protect females from those teratogenic effects. OBJECTIVES: To investigate the awareness of women, of reproductive age who were using Isotretinoin or used it previously, about isotretinoin use and the SFDA-approved PPP in Riyadh, Saudi Arabia. METHODS: This cross-sectional study was conducted during the period from June to October 2019. A questionnaire was developed based on the published literature and the PPP recommendations. The study was carried out online among female patients who were on Isotretinoin therapy or have used it previously in Riyadh city. The Statistical Package for Social Sciences (SPSS for Windows, version 24) was used to analyze the study data. RESULTS: During the study period, 483 patients participated in the study. Among them, 97.3% reported that they used the drug based on a doctor's prescription, 94.6% were aware of Isotretinoin's teratogenic effect, and 30.6% confirmed their awareness of the PPP. Amongst the participants, 9.1% (n = 44) used Isotretinoin while being married or planning to get married within a one-month period after using it. Concerning the use of two contraceptive methods according to the PPP guidelines, of the participants, 43.2% reported that they have been informed by their healthcare providers to use two contraceptive methods before starting the medication. Also 43.2% reported that they have been informed to use two contraceptive methods while using the medication, and 50% reported that they have been informed to use two contraceptive methods for one month after stopping the medication. Regardless of the information they had, participants' actual practice, was as follow: 15.9% used two contraceptive methods before starting the medication, 15.9% used two contraceptive methods during the treatment, and 13.6% used two contraceptive methods for one month after stopping the medication. CONCLUSIONS: Although this study revealed that the vast majority of participants were aware of isotretinoin's teratogenic effect, still a considerable number of them had no idea about the PPP. This issue needs to greatly be addressed to minimize the risk of teratogenicity.

A Comprehensive Overview of Polypharmacy in Elderly Patients in Saudi Arabia.

Background/Objectives: Saudi Arabia has a great percentage of geriatric patients associated with multiple chronic diseases who require close attention and monitoring for their medications. The purpose of this study is to develop a full-framed picture about the utilization of medications for geriatric patients and how to provide better health-care management. Methodology: A retrospective cross-sectional study targeting patients 65 years of age and older, who are taking multiple chronic medications for different indications. Descriptive analysis and frequency of the main variables were used as appropriate. Only qualified and professional candidates were chosen for data entry to present the quality and accuracy of data. Results: A total of 3009 patient profiles were analyzed, with the patients' average age in years being 73.26 ± 6.6 (SD). It was found that 55% of the patients have polypharmacy. An average of 6.4 medications were prescribed for patients aged between 65 and 70 years compared with a significant difference for patients aged 71 years and above, while a linear correlation between age and comorbidity diseases associated with all elderly patients. Hypertension, hyperlipidemia, and diabetes mellitus are the most common comorbidity diseases for elderly patients aged 65 years and older. Conclusion: Polypharmacy in geriatrics is defined as a patient aged 65 years and older receiving five or more appropriate medications. It is the responsibility of health-care professionals to reduce the number of medications in elderly patients. Awareness of geriatric medications and diagnosed diseases will improve managing adverse drug reaction and other risk factors. Awareness of geriatric medications should elaborate on how to avoid adverse drug reaction and other risk factors. It is the responsibility of physicians and pharmacists to reduce the number of medications in elderly patients. We also prove that the number of medications will not necessarily increase with age. The main impact of this study is to follow the main recommendations to improve health care management in geriatrics.

Diabetic neuropathy. Correlation with other diabetic microvascular complications.

OBJECTIVE: We studied the frequency of neuropathy in Saudi patients with definite diabetic microvascular complications and compared it to patients without complications. A high frequency of neuropathy in patients with definite microvascular complications would suggest a vascular etiology. METHODS: The study group consisted of 201 type-2 diabetic patients followed in the diabetic clinic of King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. These patients were screened for microvascular disease. Only symmetrical distal sensory and motor neuropathy cases were included in the study. Screening for retinopathy was carried out according to Klien`s criteria and nephropathy was diagnosed if albuminuria, microalbuminuria, abnormal blood urea nitrogen or creatinine was present. RESULTS: There was a strong correlation between the prevalence of diabetic peripheral neuropathy, retinopathy (P<0.001) and nephropathy (P<0.01), in patients with type 2 diabetes mellitus. This strong correlation suggests a common underlying pathogenesis. CONCLUSION: We conclude that microangiopathy may be a major factor in the pathogenesis of diabetic neuropathy. Major risk factors for microangiopathy are the degree of glycemic control and duration of diabetes.