Collecting behavioral evidence from a highly mobile and seasonal population: A protocol for a survey on quad bike injuries.

BACKGROUND: Quad bikes are popular recreational, four-wheeled bikes in the Middle East. Injury prevention programs targeting quad bike crashes in the United Arab Emirates (UAE) need evidence about the risk factors and behaviours associated with these crashes in the target population. This is a protocol for a study aiming to investigate quad bike rider behaviours and to assess the risk factors associated with related injuries in the UAE. METHODS: This is a cross-sectional observational study aiming to describe a seasonal sport in a desert environment. With an estimated sample size of 451, the survey will follow a three-stage, location-based sampling strategy using the line-transect method. A sampling frame of desert locations with high injury incidences was developed, using Dubai ambulance injury records. Further expansion of the sampling frame was participatory, involving police, enthusiasts, emergency responders and gas station employees. The data collection will be limited to the winter months in fifteen high-injury desert locations across three major Emirates in the UAE. Trained researchers will observe the riders directly in the desert to note their riding habits, followed by a researcher-administered interview on riding and injury history. The interviews will be administered in Arabic and English using Qualtrics software on handheld tablets with offline and online entry mode. In addition, paper-based entry with the same format will be used as a contingency in busy quad bike locations. CONCLUSION: The objective of this study protocol is to develop a comprehensive survey that will furnish substantial evidence for the formulation of effective injury prevention strategies. To enhance the credibility of the recorded riding behaviors, field observations will be employed. The uniqueness of this study lies in its innovative sampling strategy, custom-tailored to accommodate the highly mobile and transient population of desert bikers in the UAE.

Sudden unexpected death in epilepsy: What Saudi people with epilepsy want to know-A cross-sectional study.

OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a significant cause of mortality in people with epilepsy (PWE), with an incidence of 1 per 1000 members of the population. In Saudi Arabia, no data are available that inform local clinical practitioners about the attitudes of PWE regarding SUDEP. The aim of this study was to investigate the perspectives of Saudi PWE toward SUDEP and to assess their knowledge of SUDEP. METHODS: A cross-sectional questionnaire-based study was conducted at the neurology clinics of King Abdul-Aziz Medical City, Riyadh and Prince Sultan Military Medical City, Riyadh. RESULTS: Of the 377 patients who met the inclusion criteria, 325 completed the questionnaire. The mean age of the respondents was 32.9 ± 12.6 years. Of the study subjects, 50.5% were male. Only 41 patients (12.6%) had heard about SUDEP. Most patients (94.5%) wanted to know about SUDEP, of whom 313 (96.3%) wanted to receive this information from a neurologist. A total of 148 patients (45.5%) thought that the appropriate time to receive information about SUDEP was after the second visit, whereas only 75 (23.1%) wanted to learn about SUDEP during the first visit. However, 69 patients (21.2%) thought that the appropriate time to be informed about SUDEP was when seizure control had become more difficult. Almost half (172, 52.9%) of the patients thought that SUDEP could be prevented. SIGNIFICANCE: Our findings suggest that most Saudi PWE do not know about SUDEP and want to be counseled about their risk of SUDEP by their physicians. Therefore, education of Saudi PWE about SUDEP must be improved.

Consequences of neglected traumatic spinal cord injuries.

Objectives: Spinal cord injuries cause major disabilities and are devastating events for both patients and healthcare providers. Most traumatic spinal cord injuries (TSCIs) are due to motor vehicle accidents (MVAs). Neglected injuries result in complications and poor outcomes. Here, we investigated the causes, consequences, and outcomes of neglected TSCIs. Methods: This case series study was performed at King Abdulaziz Medical City, Riyadh, KSA. Of the 750 patients treated between February 2016 and February 2021, 18 patients met our inclusion criterion of neglected high-energy TSCI with neurological deficit, necessitating surgical intervention more than 14 days after the index trauma. Results: Of the 18 patients with neglected TSCIs, 72.2% were men. The patients' mean age at the time of injury was 36.8 years, 77.8% were from outside Riyadh, and all patients had MVA-induced TSCIs, 88.9% of which were attributable to delayed referral to a tertiary center. The mean duration of neglect was 43 days, and the longest duration was 125 days. The most common site of injury was the thoracolumbar region (55.5%). The American Spinal Injury Association impairment scale score improved in two patients. Bed sores occurred in 55.5%, and deep vein thrombosis occurred in 27.8% of patients. Postoperatively, 77% of patients required intensive care unit admission. Most patients (12) did not receive specialized spinal cord injury rehabilitation postoperatively. Conclusion: Early referral of patients with TSCIs is crucial to prevent short- and long-term complications.

Prevalence and Risk Factors of Osteoporosis in Saudi End-Stage Renal Disease Patients on Hemodialysis.

Background: Osteoporosis is characterized by a decrease in bone mineral density, thereby increasing the risk of pathological fractures. It is a common complication of chronic kidney disease. However, there is limited local data on the prevalence of osteoporosis in end-stage renal disease. Objective: The current study evaluated the epidemiology of osteoporosis in end-stage rental disease patients at a Saudi Arabian tertiary care center. Methods: This cross-sectional retrospective study was conducted using data obtained between 1 January 2016 and 31 December 2019 at the Dialysis Center at King Abdulaziz Medical City, Riyadh, Saudi Arabia. End-stage rental disease patients who were aged ≥50 years and underwent hemodialysis for at least 1 year were included, while those with documented metabolic bone disease and absence of bone mineral density data were excluded. Results: Sixty-four end-stage rental disease patients undergoing hemodialysis met the inclusion criteria. The patients underwent bone mineral density measurement at the discretion of the treating physician. The mean patients' age was 73 ± 11.5 years and 76% were women. The overall prevalence of osteoporosis was 37.5%, and it was similarly distributed among women and men (38.8% and 33.3%, respectively). Nine of the 15 male patients (60%) and 24 of the 49 female patients (49%) had fractures. Twenty-five (39%) patients used glucocorticoids. Osteoporosis was most commonly identified in the femoral neck (26.2%), followed by proximal femur (19.4%), and lumbar spine (18.8%). A high rate of osteoporosis was significantly associated with older age and being underweight. Conclusion: A high rate of low bone mineral density was demonstrated in end-stage renal disease patients. The femoral neck was the most common osteoporosis site in this patient population, and advanced age and underweight were possible risk factors for low bone mass.

Elevated level of creatine phosphokinase in newborn: Clinical significance and association with congenital muscle diseases.

OBJECTIVES: To establish the normal Creatine phosphokinase (CPK) range in newborns of all 3 modes of delivery and prove that high CPK level in neonates is not specific a indicator for muscular pathology. METHODS: This is a prospective cohort study that is conducted in King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh and included 504 term neonates who were born between March 2021 and August 2021. Two hundred and fifty three were males and 251 were females. Data and consents were managed and collected using 2 coordinators. RESULTS: Duration of the second stage of labor, age on the first CPK test and fetal gestational age were significantly correlated with CPK values (r=0.197, r=-0.234, r=0.274, respectively). The normal ranges for each delivery type were 334 U/L-2667U/L in normal spontaneous vaginal delivery, 265U/L-1182U/L in elective cesarean section, and 223U/L-3082 U/L in emergency cesarean section. CONCLUSION: The CPK was elevated in all neonates in all 3 modes of deliveries. An elevated levels of CPK in neonates is not a specific indicator for any congenital muscular pathology.

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections.

OBJECTIVES: To determine the prevalence and risk factors of serious bacterial infections (SBIs) in infants 90 days and younger with a confirmed respiratory tract infection (RTI). METHODS: A retrospective cross-sectional study was carried out of infants 90 days and younger who were admitted to King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, from January 2019 to December 2020, with polymerase chain reaction (PCR)-proven RTI. Cultures from the urine, blood, and cerebrospinal fluid were reviewed with the patients' demographic information and clinical presentation. RESULTS: Of 322 patients with a viral RTI, 21 (6.5%) had a concurrent urinary tract infection (UTI), and no patients had bacteremia or bacterial meningitis. The risk of a concurrent SBI was 4 times higher in neonates (odds ratio [OR]=4.66, 95% confidence interval [CI]: [1.32-16.47]). Previously healthy infants were at lower risk to have a SBI in comparison to those with chronic diseases or renal abnormalities (OR=0.23, 95% CI: [0.09-0.61]). In addition, male gender (OR=3.49, 95% CI: [1.07-11.38]) and abnormal urinalysis (OR=4.12, 95% CI: [1.48-11.42]) were predictors of SBIs. There was no statistically significant association between the number or type of detected viruses and SBIs. CONCLUSION: No cases of invasive bacterial infections were found in infants with PCR-proven viral RTIs. There is a risk of having a concurrent UTI in this cohort of patients. Neonates had a higher risk of UTIs as compared to older infants.

Knowledge and attitude of pregnant women in the Kingdom of Saudi Arabia toward Noninvasive prenatal testing: A single center study.

BACKGROUND: Noninvasive prenatal testing (NIPT) is a screening tool for chromosomal aneuploidies. Prior knowledge of NIPT is an inherent factor in the decision-making process. We assessed the knowledge and attitude of pregnant women related to prenatal testing with a particular focus on NIPT. METHODS: A prospective cross-sectional study, using a culturally validated questionnaire, was conducted with 342 pregnant women of whom 74.9% consented for prenatal screening. Mean age and gestational weeks ± standard deviation was 31 ± 5 and 26 ± 11, respectively. RESULTS: A positive/very positive attitude was observed to ultrasound, followed by FCT, NIPT, and lastly to CVS. More than half of the participants (56.1%) had no previous knowledge of NIPT. A reaching significance association was detected between education and knowledge of NIPT. Significant association was detected between risk for aneuploidy and knowledge of NIPT. The majority (74%) indicated their willingness to perform the test. The effect and value of society on the pregnant women to make a decision regarding NIPT was negligible. CONCLUSION: The pregnant women in the current study displayed a lack of knowledge and awareness regarding prenatal screening, particularly the NIPT. We recommend that pregnant women receive adequate counseling regarding prenatal screening to increase their awareness and knowledge of prenatal testing, including NIPT.

Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study.

BACKGROUND: Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). METHODS: A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). RESULTS: A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 106/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (p = 0.02), but not with mortality. CONCLUSIONS: Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.

Prevalence of depressive symptoms and excessive daytime sleepiness in a cohort of Saudi doctors under training: A cross sectional study.

OBJECTIVES: Recent studies have highlighted an increasing prevalence of depression and sleep problems among physicians during their residency training in the medical field. The study aims to explore the prevalence of depressive symptoms and sleepiness among the residents of different medical specialties in the two regions of KSA and describe the factors that potentially cause depression and sleepiness. METHODS: A survey was distributed to the residents of King Abdulaziz Medical City in the Riyadh province, and to the residents of King Fahad Specialist Hospital Buraidah and Maternity and Children's Hospital Buraidah in the Qassim province. The Patients' Health Questionnaire-2 was used to determine the prevalence of depression and the Epworth Sleepiness Scale was used to measure sleepiness. RESULTS: One hundred and eighty-one residents completed the survey. While depressive symptoms were prevalent among 93% of the residents, 49% of the residents reported excessive daytime sleepiness. Depressive symptoms were more common in the residents of King Abdulaziz Medical City, with the prevalence being 94.5%. There was a significant association between depressive symptoms and excessive sleepiness (p = 0.046). CONCLUSION: Depressive symptoms and excessive sleepiness are highly prevalent in postgraduate trainees. Residents with depression were found to be sleepier during their work. Given the negative effect on patient safety, the high prevalence of both depressive symptoms and sleepiness is alarming. There is an urgent need to improve residents' wellness through well-structured well-being programs.

Factors and Determinants of Choosing Pathology as a Future Career: Results From a Multi-Institution Study.

Background Globally, less than 10% of graduating medical students select pathology as a future career. Many factors were reported from different settings to influence the choice of pathology. The aim of this study was to investigate the factors that determine medical students' preferences in choosing pathology as a future career. Methods This cross-sectional study surveyed students from three governmental medical schools in Riyadh, Saudi Arabia. A self-administered questionnaire that contained demographic questions and items that addressed perceived factors that affect the choice of pathology was distributed to medical students. Collected data were analyzed using Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 25.0 (Armonk, NY: IBM Corp). A chi-square test was used to determine the association between independent variables and interest in pathology. Results Out of the 400 questionnaires distributed, 338 students completed the survey with a response rate of 84.5%. Overall, surgery (24%) and internal medicine (20%) were the most favored, specialties with only 5% of the students selecting pathology as their first choice. Patient-doctor interaction (72.2%) was perceived as the most important factor in not choosing pathology as a future career. Taking an elective course, younger age groups, and year in medical school were all significantly associated (p<0.001) with an interest in pathology. Conclusion In this study, most of the students indicated surgery and internal medicine as their first specialty choices. Only 5% of the students chose pathology as their first choice. Two-thirds of medical students perceived pathologists do not interact with patients. A significant association was found between younger age groups, enrolling for a pathology course, and having an interest in pathology.

Clinical Presentation of Asymptomatic and Mild SARS-CoV-2 Infection in Riyadh, Saudi Arabia.

BACKGROUND: There is substantial evidence that most SARS-CoV-2 infections are mild or even asymptomatic, yet they can transmit the virus to others. The current study described the clinical presentation of mild COVID-19 cases isolated in the ministry of health (MOH) quarantines in Riyadh, Saudi Arabia. METHODS: A cross-sectional study targeted the SARS-CoV-2 PCR +ve asymptomatic and mild COVID-19 patients isolated in the Saudi MOH quarantines in Riyadh city between July and December 2020. The confirmed COVID-19 patients were enrolled and interviewed by telephones after obtaining the informed consent. RESULTS: The study included 223 patients with a mean age of 32.5±10.7 years old. The majority were male 156 (70%). Only 27 [12.1%; 95% CI = (8.1-17.1%)] were asymptomatic. General fatigue was the most common reported symptom, 43.5%, followed by headache with 42.6%, and cough by 38.1%. Anosmia and ageusia were reported by 33.2% and 31.4%, respectively. The least common reported symptoms were vomiting, earache, and nausea with 1.8%, 4.0%, and 7.6%, respectively. CONCLUSION: The top five clinical manifestations of mild COVID-19 cases were general fatigue, headache, cough, anosmia, and ageusia. Only 12% of confirmed COVID-19 cases were asymptomatic.

Flipping a biochemistry class within a medical curriculum: Impacts on perception, engagement, and attainment.

The flipped classroom has gained prominence in higher education, but little has been written about its application in the Middle East. This study aimed to assess the feasibility, acceptability, and impact of flipping biochemistry classes in comparison to the traditional didactic program. The study was conducted on first-year medical students taking biochemistry at a private University in Saudi Arabia. A series of short, pre-recorded videos were used to replace traditional lectures. The scheduled lecture time was used for problem solving and discussion sessions. To gather their evaluation of the learning approach, participants completed an online survey. To study the effect of the learning approach on exam performance, the scores of the participants were compared in questions taught using the flipped classroom versus the traditional didactic method. Participants noted that the effort needed for the course was similar regardless of the learning approach. Moreover, examination performance measured using single best answer multiple-choice questions showed no difference between the two teaching methods. However, the participants did report a significantly better perception of the flipped classroom compared to the traditional approach. Although no significant improvement in examination results was noted, the participants significantly favored the flipped classroom over traditional lectures. This study has demonstrated that the flipped classroom can be used in the teaching of the biosciences within a Middle Eastern setting, resulting in an improvement in student satisfaction and engagement in the course materials.

Work-related musculoskeletal disorders among clinical laboratory workers.

AIMS AND OBJECTIVES: The aim of this study was to estimate the prevalence and risk factors of work-related musculoskeletal disorders (WMSDs) among clinical laboratory workers. MATERIALS AND METHODS: This questionnaire-based cross-sectional study included the clinical laboratory departments of six governmental tertiary and secondary hospitals in Riyadh, Saudi Arabia. The selected instrument was a self-administered adapted standardized questionnaire. The sample comprised 306 laboratory workers, and the selected sampling technique was a non-random convenient method. RESULTS: The overall prevalence of WMSDs in any body region was 82% in the last 12 months; it was mainly linked to lower back pain (61%). In the logistic regression, age <30 years, working in specific laboratories and working in hematology/flow-cytometry laboratory divisions were all found to be significant risk factors (P < 0.05). CONCLUSION: Clinical laboratory workers are at a high risk for WMSDs; it is essential that we take preventative action to address this.

Cervical spine clearance in unconscious pediatric trauma patients: a level l trauma center experience.

PURPOSE: To radiographically assess cervical spine clearance in unconscious pediatric trauma patients. METHODS: A retrospective cohort study was conducted to review pediatric patients with suspected cervical spinal injuries between 2005 and 2018 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All pediatric patients aged 15 years and less, who sustained trauma (motor vehicle accident, pedestrian, fall, all-terrain vehicle accident, and sports injures) and were intubated at the scene or in the emergency department, were included. RESULTS: A total of 62 patients were included. The average age for children was 8 ± 3.9 years. The average Glasgow coma scale (GCS) for children at initial trauma was 7.6 + 3.7. The average injury severity score (ISS) was 24.1 + 17.7. The most frequent abnormal finding identified on CT scan was cervical spine straightening (N = 8; 13.1%). A total of 13 children had abnormal MRI findings, with the most common injury being ligamentous in nature (N = 13; 46.42%). The sensitivity and specificity of CT scan in cervical spine clearance in unconscious children are 84.8% and 100%, respectively. CONCLUSION: Utilizing CT scans in clearing the cervical spine is of paramount importance to promptly detect possible injuries. The role of MRI in cervical spine clearance still cannot be undervalued, especially when the clinical suspicion for injury is high.

Future ophthalmology practice pattern: A survey of Saudi Board of Ophthalmology residents.

PURPOSE: The main purpose of the study was to examine and identify factors that influence the future practice pattern of Saudi Board of Ophthalmology residents as well as their academic goals. This study also aimed to compare the plans and career goals of the current Saudi ophthalmology residents with a former cohort of Saudi ophthalmology residents. METHODS: All current residents of Saudi Board of Ophthalmology were invited to complete an anonymous online survey in March 2017. Residents were contacted by email. The survey contained questions on demographics, plans and factors influencing career choice of the residents in their future. Data were categorized by gender. Chi-square was used to assess the effect of gender on outcomes where appropriate. RESULTS: Of 150 residents surveyed, 91 (61%) responded to the survey. Having the ability to combine medicine and surgery was the most motivating factor for pursuing an ophthalmology residency training program (81% of respondents). Most residents expressed an interest in providing refractive surgery (62%), being involved in research activities (85%) and working part-time in the private sector (73%). The majority (81%) expressed a desire to practice in an urban setting as well as pursuing fellowship training (81%). Anterior segment (31%) and surgical retina (15%) were the most popular choices for fellowship training. CONCLUSION: Increasing interest in joining fellowship training programs (mostly in surgical subspecialties) and being involved in research activities among current generation of ophthalmology residents have been observed compared to a previous cohort study in the same country.

Kidney cancer in Saudi Arabia. A 25-year analysis of epidemiology and risk factors in a tertiary center.

OBJECTIVES: To evaluate available epidemiological data and risk factors for kidney cancer in a tertiary care center in Riyadh, Saudi Arabia, over a period of 25 years. METHODS: This retrospective study conducted in a tertiary care center included all adult patients with primary kidney cancer who presented and were managed between 1990 and 2015. Based on this information, we forecast the incidence of the disease in our center over the next 5 years (2016 to 2020). RESULTS: In total, 371 patients were included in the study. The mean age of the patients was 56.3 years and the majority were male (61%). Among the patients, 55.8% were diagnosed incidentally. At the time of diagnosis, 53.2% were hypertensive, 46.2% were diabetic, 39.1% had dyslipidemia, and 25% were smokers. In addition, most patients were obese (42.3%) or overweight (30%). The most frequent histopathological variants were clear cell and chromophobe. Most patients presented with Stage 1. Minimally invasive surgery (laparoscopic, robotic) was performed in 55% of cases. Based on these data, we predicted that 172 new cases will present at our tertiary care center in 5 years from 2016 to 2020. CONCLUSION: The incidence in kidney cancer is increasing and is associated with an alarming increase in the prevalence of associated risk factors.

Period prevalence, risk factors and consequent injuries of falling among the Saudi elderly living in Riyadh, Saudi Arabia: a cross-sectional study.

OBJECTIVES: Approximately 28% to 35% of people aged 65 and over fall each year. The consequent injuries of falls are considered a major public health problem. Falls account for more than half of injury-related hospitalisations among old people. The aim of this study was to measure a 1-year period prevalence of falling among old people in Riyadh, Saudi Arabia. In addition, this study described the most common risk factors and consequent injuries of falls. SETTING AND PARTICIPANTS: A cross-sectional survey was carried out in Riyadh, using a convenient sampling. The targeted population were Saudi citizens who were 60 years or above. Over a 6-month period, 1182 individuals were sampled (545 men and 637 women). RESULTS: The 1-year prevalence of falling among old Saudis (>=60 years) was 49.9%. Our results show that 74% of the participants who experienced falls had postfall injuries. Old participants who were uneducated and those with middle school certification were associated with falls (adjusted OR (aOR) 1.72; 95% CI 1.15 to 2.56, aOR 1.81; 95% CI 1.15 to 2.85, respectively). Those who live in rented houses had a higher risk of falls. Interestingly, having a caregiver was significantly associated with more falls (aOR 1.39; 95% CI 1.08 to 1.79). However, not using any medications was significantly related to fewer falls. In addition, old individuals using walking aids were more likely to fall than those who did not. Participants who mentioned 'not having stressors were associated with less frequent falls (aOR 0.62; 95% CI 0.39 to 0.97). Cerebrovascular accidents were strongly associated with falls with an estimated OR of 2.75 (95% CI 1.18 to 6.43). Moreover, osteoporosis, poor vision and back pain were found to be predictors for falls among the elderly. CONCLUSION: 49.9% of elderly Saudis had experienced one or more falls during a 12-month period. Several preventable risk factors could be addressed by routine geriatric assessment. Research on the impact of these risk factors is needed.

Knowledge and attitude towards total knee arthroplasty among the public in Saudi Arabia: a nationwide population-based study.

PURPOSE: Studies on total knee arthroplasty (TKA) in Saudi Arabia are scarce, and none have reported the knowledge and attitude of the procedure in Saudi Arabia. Our study aims to measure the knowledge and attitude of TKA among the adult Saudi population. METHODS: To encompass a representative sample of this cross-sectional survey, all 13 administrative areas were used as ready-made geographical clusters. For each cluster, stratified random sampling was performed to maximize participation in the study. In each area, random samples of mobile phone numbers were selected with a probability proportional to the administrative area population size. Sample size calculation was based on the assumption that 50% of the participants would have some level of knowledge, with a 2% margin of error and 95% confidence level. To reach our intended sample size of 1540, we contacted 1722 participants with a response rate of 89.4%. RESULTS: The expected percentage of public knowledge was 50%; however, the actual percentage revealed by this study was much lower (29.7%). A stepwise multiple logistic regression was used to assess the factors that positively affected the knowledge score regarding TKA. Age [P = 0.016 with OR of 0.47], higher income [P = 0.001 with OR of 0.52] and participants with a positive history of TKA or that have known someone who underwent the surgery [P < 0.001 with OR of 0.15] had a positive impact on the total knowledge score. CONCLUSIONS: There are still misconceptions among the public in Saudi Arabia concerning TKA, its indications and results. We recommend that doctors use the results of our survey to assess their conversations with their patients, and to determine whether the results of the procedure are adequately clarified.

The prevalence and association of stress with sleep quality among medical students.

INTRODUCTION: Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. METHODS: This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. RESULTS: A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p<0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, p<0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). CONCLUSION: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment.