Knowledge, attitude, and practices on exercise among pregnant females attending Al-Wazarat Health Center, Riyadh, Saudi Arabia.

BACKGROUND: The consequences of physical inactivity during pregnancy are one of the major problems among pregnant women in Saudi. To explore the pattern of exercise and to know the beliefs and reasons for not doing physical activity (PA) emphasized the need for conducting this study. This study aimed to improve the level of knowledge and practice of PA among women during pregnancy. METHODS: A cross-sectional study was performed using quota sampling. RESULTS: 41.62% of pregnant women had high level of physical activity (PA) awareness and practice and 58.37% had a low level of awareness and practice. Statistical difference was found between the two groups in terms of parity, education level, work status, and family income. Pregnant women preferred walking as exercise. They are aware about PA benefits during pregnancy, but perceived that tiredness was the greatest barrier for physical activity. CONCLUSION: This study recommends conducting well-designed intervention sessions to promote PA awareness and practice among pregnant women, especially those with low education, low income, and low number of children.

Measles, Mumps, Rubella, and Varicella Immunity among Nursing Staff in a Major Hospital, Riyadh, Saudi Arabia.

INTRODUCTION: Measles, mumps, rubella, and varicella (MMRV) represent risk to HCWs. Checking on antibodies against MMRV is an important part of infection control among nursing staff for their own health, their colleagues and for the health of patients. Screening for immunity against MMRV is an initial step before vaccination of nursing staff. This study is to describe immunity status against MMRV by screening nursing staff in a tertiary care hospital in Riyadh. METHODS: A cross sectional survey among nursing staff was conducted from July to August 2019 at Prince Sultan Military Medical City. A convenience sampling was used to screen 1534 nursing staff working at several high-risk departments. Record for their immune status and antibody titer for MMRV were reviewed using a data collection form. RESULTS: Screening for immunity among nursing staff found that; 79.3% were immune against measles; 75.5% to be immune against mumps; 95.8% were immune against rubella; and 67% were immune against varicella. The highest proportion of immune nursing staff against measles (96.3%) and varicella (93.5%) was found in Intensive care department while the highest proportion of immune staff against mumps (89.4%) was found in Long Stay department, and against rubella (97.5%) in Hemodialysis department. On the other hand, It was found that Hemodialysis Department had the Highest proportion of non-immune staff against measles (35.6%), mumps (39%), and varicella (56.3%), while Emergency Department had the lowest proportion of immune staff (6%) against rubella. CONCLUSION: Despite that immunity among nurses screened was good on some departments; however, such results need improvement in these critical areas. These finding emphasize the importance of the currently mandatory screening for MMRV before employment. We suggest conducting comprehensive programs to increase awareness and vaccination coverage in areas with low rates of immunity.

Acute Leg Ischaemia in a Child due to a Thrombosed Popliteal Aneurysm.

INTRODUCTION: The case of an idiopathic thrombosed popliteal aneurysm is described in an otherwise healthy 6 year old child. This is the fourth reported case and the second youngest patient to present with an idiopathic isolated popliteal aneurysm. REPORT: A 6 year old boy presented with an acutely ischaemic right foot. Computed tomography angiography confirmed a thrombosed popliteal aneurysm. A femoropopliteal bypass was performed with reversed long saphenous vein and ligation of the aneurysm. Yearly follow up is ongoing with ultrasound surveillance; the child's growth and development is unaffected, and the graft is patent. There was a readmission over six years later with claudication on the right side. There was evidence of thrombus in the graft with associated distal embolisation, which was managed conservatively with anticoagulation. DISCUSSION: Given the rarity of such presentations in the paediatric population, there is minimal good quality data to guide treatment. There have been three previous cases of idiopathic popliteal aneurysms all managed with a reversed long saphenous vein femoropopliteal bypass with resection of the aneurysm. Management should be guided based on the clinical picture and should be undertaken in specialised tertiary centres if possible. Surgical intervention is the treatment of choice in patients with an ischaemic limb.

Impact of an integrated care program on glycemic control and cardiovascular risk factors in patients with type 2 diabetes in Saudi Arabia: an interventional parallel-group controlled study.

BACKGROUND: Long intervals between patient visits and limited time with patients can result in clinical inertia and suboptimal achievement of treatment goals. These obstacles can be improved with a multidisciplinary care program. The present study aimed to assess the impact of such a program on glycemic control and cardiovascular risk factors. METHODS: In a randomized, parallel-group trial, we assigned 263 patients with poorly controlled type 2 diabetes mellitus (T2DM) to either a control group, standard care program, or a multidisciplinary care program involving a senior family physician, clinical pharmacy specialist, dietician, diabetic educator, health educator, and social worker. The participants were followed for a median of 10 months, between September 2013 and September 2014. Glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profiles, and blood pressure (BP) were measured. The assignment was blinded for the assessors of the study outcomes. The study registry number is. RESULTS: In the intervention group, there were statistically significant (p < 0.05) post-intervention (relative) reductions in the levels of HbA1c (-27.1%, 95% CI = -28.9%, -25.3%), FBG (-17.10%, 95% CI = -23.3%, -10.9%), total cholesterol (-9.93%, 95% CI = -12.7%, -7.9%), LDL cholesterol (-11.4%, 95% CI = -19.4%, -3.5%), systolic BP (-1.5%, 95% CI = -2.9%, -0.03%), and diastolic BP (-3.4%, 95% CI = -5.2%, -1.7%). There was a significant decrease in the number of patients with a HbA1c ≥10 (86 mmol/mol) from 167 patients at enrollment to 11 patients after intervention (p < 0.001). However, the intervention group experienced a statistically significant increase in body weight (3.7%, 95% CI = 2.9%, 4.5%). In the control group, no statistically significant changes were noticed in different outcomes with the exception of total cholesterol (-4.10%, p = 0.07). In the linear regression model, the intervention and the total number of clinic visits predicted HbA1c improvement. CONCLUSIONS: Implementation of a patient-specific integrated care program involving a multidisciplinary team approach, frequent clinic visits, and intensified insulin treatment was associated with marked improvement in glycemic control and cardiovascular risk factors of poorly controlled T2DM patients in a safe and reproducible manner. TRIAL REGISTRATION: ISRCTN Identifier: ISRCTN83437562 September 19, 2016 Retrospectively registered.

Determinants of family medicine physicians' knowledge and application of asthma management guidelines at primary healthcare centers in Riyadh, Saudi Arabia.

BACKGROUND: The level of uncontrolled asthma is still high despite the availability of effective treatments and evidence-based guidelines for controlling asthma. Knowledge and adherence to evidence-based guidelines among care providers are crucial to the treatment. OBJECTIVE: To investigate the determinants of family physicians' knowledge and application of asthma management guidelines at primary healthcare setting in Saudi Arabia. METHODS: This is a cross-sectional study, conducted at 18 primary healthcare centers in Riyadh, Saudi Arabia. The sample consisted of 246 physicians. A self-administrated questionnaire was distributed among the physicians. The questionnaire included demographic, job characteristics, knowledge of asthma guidelines, and application of asthma guidelines' questions about the essential items related to diagnosis and management of asthma according to the international/local guidelines. The minimum acceptable level for each knowledge and application of guidelines was defined as scoring 70% correct answers. RESULTS: The results show very low level of knowledge of guidelines among physicians with 94.6% scoring below the acceptable knowledge level. The guidelines are applied below the acceptable level with 55.6% scoring below the cut-off point. Higher level of knowledge is associated with higher position of the physician (P = 0.006), qualification held by the physician, namely, MRCGP qualification vs. MBBS (P < 0.001), and the physician's experience, namely, 10-15 years of experience vs. less than 5 years (P = 0.01). The application of guidelines is associated with position of the physician (P = 0.041). Physicians with registrar position scored higher application for guidelines than general practitioners and senior house officers. CONCLUSION: Recognition of the low level of knowledge and application of guidelines among care providers and working toward minimizing this problem can be through education, training, and monitoring of application; this can potentially improve asthma control among patients.

Treatment of subclavian artery stenosis: A case series.

INTRODUCTION: In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. PRESENTATION: Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. DISCUSSION AND CONCLUSION: This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities.

Popliteal Artery Pseudoaneurysm with Secondary Chronic Common Peroneal Nerve Neuropathy and Foot Drop after Total Knee Replacement.

Total knee replacements (TKRs) are performed to treat debilitating arthritis and are one of the most routinely performed surgical procedures in the United Kingdom. Complications of infection and deep vein thrombosis are well recognized and managed, whereas neurovascular injuries are rarely reported although should not be disregarded. We report on the case of a 72-year-old man who presented 5 weeks after a TKR with symptoms of a progressively worsening ipsilateral foot drop. A diagnosis of common peroneal nerve neuropathy secondary to the compressive effects of a popliteal pseudoaneurysm was made, and he underwent uneventful patch repair of the pseudoaneurysm. Unique to the literature is the chronicity of the foot drop, which still persisted at follow-up 6 weeks later.