Assessing knowledge about hypertension and identifying predictors of inadequate knowledge in Saudi Arabia: A cross-sectional study.

BACKGROUND: Globally, hypertension is among the leading causes of premature mortality. It is a noncommunicable disease characterized by a persistent state of raised blood pressure that increases the risk of cardiovascular diseases and medical conditions affecting the brain and kidneys. There is a paucity of thorough hypertension knowledge assessment among hypertensive patients in the Jazan region of Saudi Arabia. Thus, this study aimed to assess overall and specific knowledge about hypertension and to identify predictors of inadequate knowledge. METHODS: A cross-sectional study was conducted in the Jazan region of Saudi Arabia between February and April 2023. Data were collected using an online, self-administered questionnaire divided into two sections. In the first section, the characteristics of the participants were collected. In the second section, the Hypertension Knowledge-Level Scale was used to measure overall and specific knowledge areas (subdimensions). The overall and subdimensional means were tested using Mann-Whitney U and Kruskal-Wallis H tests. Furthermore, the binary logistic regression was conducted to determine inadequate knowledge predictors. RESULTS: In all 253 hypertensive patients were eligible for participation; almost 70% of whom were male. The mean age of the participants was 45 years (±14.7), and their mean overall knowledge score was 17.60 (±5.09), which was equivalent to 67.7% of the maximum score. In addition, 40.7% of participants had an adequate level of hypertension knowledge. The complications subdimension level of knowledge was borderline optimal. At the same time, an adequate knowledge level was detected only in the lifestyle subdimension. CONCLUSION: Most patients showed inadequate levels of knowledge related to hypertension management. Diet, medical treatment, disease definition, drug compliance, and complications were subsequently the least knowledgeable subdimensions among the study population. Therefore, these subdimensions should be prioritized when planning hypertension educational interventions and during follow-up sessions, especially for patients of younger age groups and those with lower educational levels.

Living with Fibrodysplasia Ossificans Progressiva: Radiological Images of a Patient with Extensive Heterotopic Ossification.

Fibrodysplasia ossificans progressiva (FOP) is an exceptionally rare genetic disorder characterized by the progressive formation of heterotopic bone in soft tissues. Here, we present the radiological findings of an 18-year-old female diagnosed with FOP who had severe spinal and right-upper-limb abnormalities. Her SF-36 scores suggested significant impairment in physical function, affecting work and other regular daily activities. Radiographic evaluation with X-rays and CT scans revealed scoliosis and total fusion of almost all levels of the spine, with only a few disc spaces spared. A large mass of heterotopic bone was observed, corresponding to the location of the paraspinal muscles in the lumbar region, branching upwards and fusing with the scapulae on both sides. On the right side, this exuberant heterotopic bone mass fused with the humerus, resulting in a fixed right shoulder, while the rest of the upper and lower limbs are spared and have a range of motion. Our report highlights the extensive ossification that can manifest in patients with FOP, resulting in restricted mobility and a poor quality of life. While there is no definite treatment that can reverse the effects of the disease, preventing injuries and minimizing iatrogenic harm is of critical importance in this patient as inflammation is known to play a key role in triggering heterotopic bone. Meanwhile, ongoing research into therapeutic strategies holds the key to unlocking a potential cure for FOP in the future.

Long-Term Outcome of Phrenic Nerve Transfer in Brachial Plexus Avulsion Injuries.

INTRODUCTION: In brachial plexus injuries, useful recovery of arm function has been documented in most patients after phrenic nerve transfer after variable follow-up durations, but there is not much information about long-term functional outcomes. In addition, there is still some concern that respiratory complications might become manifest with aging. The aim of this study was to report the outcome of phrenic nerve transfer after a minimum follow-up of 5 years. PATIENTS AND METHODS: Twenty-six patients were reviewed and evaluated clinically. Age at surgery averaged 25.2 years and follow-up averaged 9.15 years. RESULTS: Shoulder abduction and external rotation achieved by transfer of phrenic to axillary nerve (or posterior division of upper trunk), combined with spinal accessory to suprascapular nerve transfer, were better than that achieved by transfer of phrenic to suprascapular nerve, combined with grafting the posterior division of upper trunk from C5, 52.3 and 45.5 degrees versus 47.5 and 39.4 degrees, respectively. There was no difference in abduction when the phrenic nerve was transferred directly to the posterior division of upper trunk or to the axillary nerve using nerve graft. Elbow flexion (≥M3 MRC) was achieved in 5 (83.3%) of 6 cases. Elbow extension M4 MRC or greater was achieved in 4 (66.6%) of 6 cases. All patients, including those who exceeded the age of 45 years and those who had concomitant intercostal nerve transfer, continued to have no respiratory symptoms. CONCLUSIONS: The long-term follow-up confirms the safety and effectiveness and of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries.

Effect of Health Education Programme on the Knowledge of and Attitude about Sickle Cell Anaemia among Male Secondary School Students in the Jazan Region of Saudi Arabia: Health Policy Implications.

This study was conducted to develop an instructional programme on sickle cell anaemia (SCA) and test the effect of the programme on the secondary school students' knowledge of and attitude towards sickle cell anaemia in the Jazan region of Saudi Arabia. A pretest/posttest one-arm interventional study was conducted at the Faculty of Public Health and Tropical Medicine, Jazan University, with a convenience sample of 120 male students. The intervention consisted of two interactive sessions about sickle cell anaemia and premarital screening. The mean student knowledge score was 6.04 ± 3.02 on the pretest, which improved to 10.73 ± 3.47 on the posttest, with a statistically significant difference (t = 15.2, p < 0.001). There was no significant difference in the responses pertaining to attitude before and after the health education intervention. The policy implications of these findings are discussed to improve the performance of the Saudi healthcare system in dealing with this costly inherited disease.

Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex.

BACKGROUND: There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. METHODS: In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. RESULTS: After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). CONCLUSION: Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.

Women in Cairo, Egypt and their risk factors for unmet contraceptive need: a community-based study.

BACKGROUND AND METHODOLOGY: Although modern family planning methods are readily available in Egypt at low cost, a considerable proportion of women still have an unmet contraceptive need. The aim of this study was to detect the risk factors of unmet contraceptive need among married women in the childbearing period in an underprivileged area in Cairo with high population density. A survey of 2340 women in the Marg district of Eastern Cairo was conducted by means of home interviews. For every woman identified as having an unmet contraceptive need (n=174), the next two women identified with met contraceptive need were selected as controls (n=348). RESULTS: The prevalence of unmet need was 7.4%. Risk factors identified were: belief that contraception is religiously prohibited (OR 2.08, 95% CI 1.06-4.09); poor interspousal communication about the desired number of children (OR 2.59, 95% CI 1.40-4.79); husband opposition to contraceptive use (OR 2.96, 95% CI 1.47-5.97); a previous history of unwanted pregnancy (OR 2.98, 95% CI 1.73-5.14); and experiencing side effects from previous contraceptive use (OR 5.69, 95% CI 3.46-9.37). CONCLUSIONS: The authors propose training physicians to identify and counsel women who experience contraceptive side effects and/or a previous unwanted pregnancy, as well as the transmission of clear media messages on the religious acceptability of contraceptive use.

Tendon transfer around the shoulder in obstetric brachial plexus paralysis: clinical and computed tomographic study.

One hundred nine obstetrical palsy patients with defective shoulder abduction and external rotation had subscapularis release and transfer of teres major to infraspinatus with or without pedicle transfer of the clavicular head of pectoralis major to deltoid. The age at surgery averaged 67 months (11-192) and follow-up averaged 36 months (12-80). Thirty-nine cases had follow-up CT scan of both shoulders. Improvement of abduction averaged 64 degrees and that of external rotation 50 degrees, 100% and 290% gain, respectively. Both negatively correlated with the age at surgery (P < 0.001), and were significantly higher in patients operated younger than 4 years. On computed tomographic scans, the degree of glenoid retroversion positively correlated (P < 0.001) with the age at surgery, and was significantly higher in patients operated older than 4 years. The degree of posterior subluxation showed no significant difference between different ages. There was no significant difference between the operated and normal sides in patients operated younger than 4years with regard to glenoid retroversion and in those operated younger than 2 years with regard to posterior subluxation. The operation is useful for correction of defective shoulder abduction and external rotation in obstetric palsy. It is best performed before the age of 2 to get maximal improvement in motion and prevent secondary bone changes. Between the ages of 2 and 4, it also resulted in significant improvement in motion and prevented glenoid retroversion, but not posterior subluxation. After the age of 4, the improvement in motion was not significant and secondary bone changes were not prevented.

Telescoping vascularized fibular graft: a new method for treatment of congenital tibial pseudarthrosis with severe shortening.

Vascularized fibular grafts have proved reliable in the treatment of congenital pseudarthrosis of the tibia with a high success rate. However, severe shortening cannot be primarily corrected by this technique and requires a second-stage lengthening procedure. Ilizarov's method allows correction of shortening and axial malalignment together with the non-union. However, in the dysplastic type with severe shortening, corticotomy of the affected bone may result in delayed consolidation or recurrence of disease. In addition, the large distraction distance (equal to the amount of shortening plus the resulting defect after excision of the pseudorthrosis site) requires prolonged frame application, which may not be tolerated by the patient. We present a new technique combining vascularized fibular graft and Ilizarov distraction that allows simultaneous correction of shortening while treating the non-union in a single-stage operation. This method avoids corticotomy in the congenitally affected bone and markedly shortens the time of frame application.

Reconstruction of lower limb bone defects after sarcoma resection in children and adolescents using free vascularized fibular transfer.

This study included 11 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap and their surgery performed at least 24 months before the end of the study. The average age at operation was 14.4 years. All tumors, except one, were high-grade sarcomas (stage IIA, IIB, and Ewing's sarcoma). The tumor volume averaged 200.6 cm3 (range 41.5-400). The resulting defect after tumor resection averaged 14.8 cm (range 9-20). The fibula was inserted as a single strut in eight patients and as a double-barrel construct in three patients. Fixation was augmented by interlocking nail in four cases, bridge plate in five cases and external fixator in two cases. All flaps survived. All grafts united in an average period of 3.9 months (range 3-8) after transfer. Full weightbearing was possible after an average period of 6 months (range 6-10). Significant hypertrophy (>/=30% of the original fibular diameter) occurred in all patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean 38 months), the degree of hypertrophy averaged 96.6% (range 30-200%). Graft fracture occurred in one patient after plate removal and healed conservatively. Shortening averaged 1 cm (range 0-3). The Musculoskeletal Tumor Society rating score averaged 21 points at the end of the first postoperative year and 23 at the end of the study.

Surgical treatment of brachial plexus traction injuries in children, excluding obstetric palsy.

Traumatic brachial plexus injuries in children, excluding birth palsy, are seldom reported. In this study, we report on 11 cases operated upon between 1995-1998, and followed for at least 30 months. All patients were males with an average age of 11 years (range, 3-16 years). The denervation time averaged 3.8 months (range, 1-8 months). Eight patients had two or more root avulsions; two had additional severe infraclavicular injuries. In total, 6 grafting and 25 extraplexal neurotization procedures were used. Donor nerves included the intercostal nerves, phrenic nerve, spinal accessory nerve, and contralateral C7 root. Elbow flexion was restored in all but 2 cases. Shoulder abduction varied from 30-90 degrees, according to the method of reconstruction. Triceps recovered in 2 cases and finger and wrist extensors in 1 case. Wrist and finger flexion was obtained in 1 case. Sensory recovery in the palm reached S2/S2+. Harvesting the phrenic nerve and the contralateral C7 root resulted in no residual morbidity. Compared to adults, children have a higher incidence of root avulsion, no deafferentiation pain, a higher incidence of associated skeletal injuries, and the same recovery rate of elbow and shoulder functions following plexus reconstruction, but recovery is faster. Given the frequency of root avulsions, neurotization is often required.

Hypertrophy after free vascularized fibular transfer to the lower limb.

This study included 25 patients with lower limb tumors who had reconstruction by vascularized fibula osteoseptocutaneous flap performed at least 24 months before the end of the study. Hypertrophy of the transplanted fibula was estimated on serial radiographs by a modification of the formula of De Boer and Wood (J Bone Joint Surg [Br] 71:374-378, 1989). A significant graft was observed in 90% of the patients at an average follow-up of 27 months (range, 30-200%). The time to graft union (start of partial weight-bearing) positively correlated with the time to significant graft hypertrophy (r = 0.9, P < 0.01). The final amount of graft hypertrophy was affected by the age of the patient (P < 0.01) and the length of follow-up (P < 0.05). Graft hypertrophy progressed at an average rate of 3.3% per month (range, 2.3-4.9%) until the end of the 30th month; thereafter, little or no increase in graft hypertrophy was observed. The rate of graft hypertrophy showed two significant peaks at 6-12 months (P < 0.001) and at 18-24 months (P < 0.05). Patients younger than age 20 years showed faster hypertrophy, with a peak at the 12th month. Hypertrophy progressed faster in patients who received chemotherapy until the 12th month, and then declined sharply compared to those who did not receive chemotherapy.

Shoulder fusion and free-functioning gracilis transplantation in patients with elbow and shoulder paralysis caused by poliomyelitis.

Six children between 7-16 years of age presented with flail shoulder and elbow caused by poliomyelitis. Shoulder fusion was followed by free-functioning gracilis transplantation to replace the atrophied biceps muscle. The transplanted muscle was reinnervated by either the spinal accessory or phrenic nerve. Follow-up averaged 44 months (range, 56-23 months). All cases developed at least grade 3 power of elbow flexion and were able to place their hands to their mouths. Five out of 6 cases were able to flex their elbow against resistance. One case required tension readjustment, and elbow flexion contracture of 45 degrees developed in another case. On average, the transplanted gracilis started to contract 3 months after transplantation, and muscle power reached grade 2 at 5-6 months and grade 3 at 9-12 months. Muscles supplied by the spinal accessory nerve were earlier to contract and ultimately attained more power than those supplied by the phrenic nerve, probably because of easier rehabilitation. Shoulder fusion and free-functioning gracilis transplantation for biceps replacement provide a solution for restoration of function in children with flail shoulder and elbow, as caused by poliomyelitis. The procedure can be useful in other neuromuscular conditions, such as late-presenting Erb's palsy, especially when no other muscles are available for local transfer.

Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap.

This study included 25 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap, and who had their surgery performed at least 24 months before the end of the study. The average age at operation was 23.5 years. Twenty-three tumors were malignant;16 were staged as high-grade sarcomas (stage IIA, stage IIB, and Ewing's sarcoma). Tumor volume averaged 293.2 cc (range, 41.4-860). The resulting defect after tumor resection averaged 16 cm (range, 9-20 cm). The fibula was inserted as a single strut in 21 patients, and as a double-barrel construct in 4 patients. Fixation was augmented by interlocking nail in 11 cases, bridge plate in 9 cases, and external fixator in 5 cases. Twenty-four (96%) flaps survived. All grafts united in an average period of 4.5 months (range, 3-8 months) after transfer. Two secondary procedures were necessary to achieve graft union. Full weight bearing was possible after an average period of 7.5 months (range, 5-14 months). Significant hypertrophy (> or =30% of original fibular diameter) occurred in 85% of patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean, 32 months), the degree of hypertrophy averaged 90% (range, 30-200%). Graft fracture occurred in three patients, and all healed conservatively. The Musculoskeletal Tumor Society rating score (MTSRS) averaged 21.2 points at the end of the first postoperative year, and 23.6 at the end of the study.