The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs.

Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.

The mid-mesial canal prevalence in mandibular molars of a Saudi population: A cone-beam computed tomography study.

INTRODUCTION: The aim was to assess the prevalence of Mid Mesial Canal (MMC) in the first and second mandibular molars in a Saudi subpopulation sample and assess its relation to side, gender, and age using Cone beam computed tomography (CBCT). METHODS: The CBCT scans at King Saud University Dental Hospital between 2016 and 2019 were reviewed and filtered. The MMC of the mandibular molars were assessed according to Pomeranz et al. classification which was: (1) independent; (2) fin; (3) confluent with the mesiobuccal canal; and (4) confluent with the mesiolingual canal. Three calibrated observers examined the MMC on all planes at both sides. Age and gender factors were used to analyze that prevalence. A chi-squared test was used and (P ≤ 0.05) was considered to be statistically significant. RESULTS: 395 patients, and 1377 teeth met the inclusion criteria. The total number of mid-mesial canals was 12 (0.9%): nine at the mandibular first molar (1.3%) and three in the mandibular second molar (0.4%). The most common type of mid-mesial canal was confluent (n = 10), of which 6 fused with the mesiobuccal canal and 4 fused with the mesiolingual canal. Two canals were of the fin type, and there was no instance of independent mid-mesial canal. There was no significant difference between all variables: tooth type, tooth side, patient gender, and patient age group (p > 0.05). CONCLUSION: In this study, the most common MMC configuration was the confluent type followed by the fin type and no independent type were found. The patient side, gender and age did not influence the prevalence of the MMC.

Perception of premarital counseling among King Khalid University students.

BACKGROUND: Genetic blood disorders are common in Arab countries which are related to many physical and mental disorders. Premarital counseling has been one of the strongest ways to prevent hereditary diseases. It can provide a capability to intervene according to identified risks, vaccinations, genetic consulting, nutrition, consulting regarding behavior and advice regarding contraception. This study aimed to assess university students' knowledge, attitude and practice of pre-marital counseling (PMC) in king Khalid University. METHODOLOGY: A cross-sectional study was conducted at King Khalid University in Abha city from May to August 2018. The students were selected using two stage stratified cluster sampling technique (medical and non-medical). A total sample of 541 students were included. A structured questionnaire with close-ended questions was designed by the authors following an extensive review of the literature on knowledge, practice, and attitude of premarital screening program. The questionnaire was developed in English and then translated to Arabic by experts at the College of Medicine. RESULTS: A total sample of 541students were involved with ages ranged from 18 years to 27 years old and 56.6% at medical colleges. Exact 73.4% of the students were aware of PMC and 95.2% reported its importance. 96.5% of the students reported their welling to do PMC on marriage and 72.1% see that it should be mandatory. CONCLUSIONS: Nearly three out of each four students had good awareness level regarding PMC. Most of the students have a positive attitude towards PMS and their readiness to adopt the counseling before marriage.

Knowledge of knee osteoarthritis among general population in Aseer region.

BACKGROUND: Osteoarthritis (OA) is the most common articular disease of the developed country and cause of chronic disability, and may cause joint failure. OA is one of the most prevalent situation that gives rise to disability, especially in elderly population. AIM: To assess the knowledge of knee OA among general population in Aseer region. MATERIALS AND METHODS: A cross-sectional survey was conducted in Aseer region including 1052 participants. The participants were included by visiting the public areas in different cities in Aseer region where many people of different social and economic level were available, and because of the the nature of Saudi community regarding home-to-home interviews. RESULTS: The research included 1052 participants from different areas in Aseer region. The ages of participants ranged from 17 to 80 years old, with a mean age of 38 ± 12 years old. Approximately 89.0% of the sampled population had good awareness regarding preventive measures of knee OA. The second highest awareness level was recorded for relieving the measures of knee OA as 84.1% of the sampled population recorded good level of knowledge. In general, 82.6% of the population had good awareness level regarding OA in total. CONCLUSIONS AND RECOMMENDATIONS: The current research revealed that the awareness of the general population in Aseer region regarding knee OA was more than satisfactory, especially for preventive measures, relieving measures, and its risk factors.

[Sutureless scleral intraocular lens fixation: report of nine cases and literature review]. / Implants à fixation sclérale sans suture : série de neuf cas et revue de la littérature.

PURPOSE: To report the results of a technique of sutureless intrascleral fixation of a three-piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature. MATERIALS AND METHODS: We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric(®) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications. RESULTS: We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 ± 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3-month postoperative visual acuity was 0.42 ± 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 ± 0.78 diopters. Complications included IOL decentration of 1.5mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases. DISCUSSION: Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to the iris by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub-2.8mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning. CONCLUSIONS: Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support.

Evaluation of capillary blood glucose versus a high-risk questionnaire for screening for undiagnosed diabetes mellitus in Eastern province, Saudi Arabia.

This study compared 2 screening tests for detecting undiagnosed diabetes mellitus when applied in a mass-screening campaign in the Eastern province of Saudi Arabia in 2004-05. Of 15 082 individuals screened, 65.8% were positive by the American Diabetes Association risk-score questionnaire and 71.3% by determination of capillary blood glucose (CBG) using a portable glucometer. Type 2 diabetes mellitus was confirmed in 20.3% of participants and pre-diabetes in 33.9% using fasting venous blood testing. The risk-score questionnaire did not perform well versus fasting and random CBG. Optimal cut-offs for fasting and random CBG were 120 mg/dL and 160 mg/dL respectively. Fasting CBG had higher sensitivity, specificity and discriminating ability than random CBG for detection of diabetes and pre-diabetes in this population.

Control of diabetes mellitus in the Eastern Province of Saudi Arabia: results of screening campaign.

To assess the status of diabetes mellitus (DM) control in the Eastern province of Saudi Arabia, all Saudi Arabian residents aged 30 years and above were invited to participate in a screening campaign. Of 197 681 participants screened 15.7% had a previous diagnosis of DM. Sociodemographic and clinical data were collected from these patients. Only 33.8% of patients were achieving their glycaemic control target (fasting or random capillary blood glucose < 130 mg/dL or < 180 mg/dL respectively). Multiple logistic regression analysis showed that higher age, current smoking and lower level of physical activity were significantly associated with uncontrolled DM. Hypertension was positively associated with glycaemic control. The overall rate of diabetes control is unacceptably low in the general population of this province.

Prevalence of current smoking in Eastern province, Saudi Arabia.

All Saudi Arabian residents of the Eastern province of Saudi Arabia aged 30+ years completed a structured interview questionnaire about smoking. The prevalence of current smoking (smoked > 100 cigarettes or any tobacco products including waterpipe in lifetime and still smoking daily or occasionally for 1 month or more) among 196 268 respondents was 16.9% (28.7% among men and 4.5% among women). There was a significantly higher prevalence of smoking at younger ages in men and older ages in women. Multiple logistic regression analysis showed that factors independently associated with smoking were lower socioeconomic tatus, lower education, being divorced and occupations such as the military and self-employed.

Prevalence of diabetes mellitus and impaired fasting glucose levels in the Eastern Province of Saudi Arabia: results of a screening campaign.

INTRODUCTION: This study aimed to estimate the prevalence of diagnosed and undiagnosed diabetes mellitus (DM) in the Eastern Province of Saudi Arabia, and to study its relationship with socioeconomic factors. METHODS: The study targeted all Saudi subjects aged 30 years and above who resided in the Eastern Province in 2004. DM screening was conducted by taking the capillary fasting blood glucose (CFBG) after eight hours or more of fasting, or the casual capillary blood glucose (CCBG). A positive screening test for hyperglycaemia was defined as CFBG more than or equal to 100 mg/dl (5.6 mmol/l), or CCBG more than or equal to 140 mg/dl (7.8 mmol/l). A positive result was confirmed on another day through the measurement of fasting plasma glucose (FPG) levels from a venous sample. A diagnosis of DM was considered if FPG was more than or equal to 126 mg/dl (7.0 mmol/l), or when there was a history of a previous diagnosis. RESULTS: Out of 197,681 participants, 35,929 (18.2 percent) had a positive history of DM or a positive screening test for hyperglycaemia. After confirmation by venous blood testing, the prevalence of DM dropped to 17.2 percent while the prevalence of newly diagnosed DM was 1.8 percent. The prevalence increased with age and was higher in women, widows, divorcees, those who had a low education level and the unemployed. CONCLUSION: The prevalence of DM in Saudi Arabia is one of the highest reported in the world, and its yield of screening is high.

Evaluation of capillary blood glucose versus a high-risk questionnaire for screening for undiagnosed diabetes mellitus in Eastern province, Saudi Arabia

This study compared 2 screening tests for detecting undiagnosed diabetes mellitus when applied in a mass-screening campaign in the Eastern province of Saudi Arabia in 2004-05. Of 15 082 individuals screened, 65.8% were positive by the American Diabetes Association risk-score questionnaire and 71.3% by determination of capillary blood glucose [CBG] using a portable glucometer. Type 2 diabetes mellitus was confirmed in 20.3% of participants and pre-diabetes in 33.9% using fasting venous blood testing. The risk-score questionnaire did not perform well versus fasting and random CBG. Optimal cut-offs for fasting and random CBG were 120 mg/dL and 160 mg/dL respectively. Fasting CBG had higher sensitivity, specificity and discriminating ability than random CBG for detection of diabetes and pre-diabetes in this population

Prevalence of current smoking in Eastern province, Saudi Arabia

All Saudi Arabian residents of the Eastern province of Saudi Arabia aged 30+ years completed a structured interview questionnaire about smoking. The prevalence of current smoking [smoked > 100 cigarettes or any tobacco products including waterpipe in lifetime and still smoking daily or occasionally for 1 month or more] among 196 268 respondents was 16.9% [28.7% among men and 4.5% among women]. There was a significantly higher prevalence of smoking at younger ages in men and older ages in women. Multiple logistic regression analysis showed that factors independently associated with smoking were lower socioeconomic status, lower education, being divorced and occupations such as the military and self-employed

Control of diabetes mellitus in the Eastern province of Saudi Arabia: results of screening campaign

To assess the status of diabetes mellitus [DM] control in the Eastern province of Saudi Arabia, all Saudi Arabian residents aged 30 years and above were invited to participate in a screening campaign. Of 197 681 participants screened 15.7% had a previous diagnosis of DM. Sociodemographic and clinical data were collected from these patients. Only 33.8% of patients were achieving their glycaemic control target [fasting or random capillary blood glucose < 130 mg/dL or < 180 mg/dL respectively]. Multiple logistic regression analysis showed that higher age, current smoking and lower level of physical activity were significantly associated with uncontrolled DM. Hypertension was positively associated with glycaemic control. The overall rate of diabetes control is unacceptably low in the general population of this province

[Use of silicone oil in vitreal hemorrhage complicating proliferated diabetic retinopathy]. / Intérêt de l'huile de silicone dans la rétinopathie diabétique proliférante compliquée d'hémorragie intravitréenne.

INTRODUCTION: Vitreous hemorrhage is a frequent complication of proliferated diabetic retinopathy. Vitrectomy has vastly improved its prognosis. The purpose of this study was to evaluate the use of silicone oil in vitreal surgery in this indication. METHODS: We present a retrospective study of 15 eyes that underwent vitrectomy and silicone oil injection for vitreal hemorrhage complicating proliferative diabetic retinopathy. For each patient, we noted the clinical and echographic features, the surgical procedure, and the postoperative outcome after a mean period of 20 months. RESULTS: The indications for silicone injection were recurrent vitreal hemorrhage (seven eyes), aggressive fibrovascular proliferations (five eyes), and iatrogenic retinal breaks (three eyes). Anatomic success was noted in ten cases. Four patients had a hemorrhage reoccurrence after silicone oil removal and one patient developed neovascular glaucoma. Silicone cataract (seven eyes) and emulsification of silicone (one eye) were noted. DISCUSSION: The use of silicone oil in vitreal surgery for complicated proliferated diabetic retinopathy contributes a hemostatic and plugging effect, but it still has a number of disadvantages such as the need to remove it and its own side effects. It can be beneficial in cases of rubeosis or recurrent hemorrhage. However, it is essentially indicated in recurrent hemorrhage in monophthalmos patients.

[Keratoplasy for Peters anomaly (clinical case)]. / La Kératoplastie dans l'anomalie de Peters (cas clinique).

INTRODUCTION: Peters anomaly is a primitive congenital glaucoma characterised by a central corneal leukoma. Therefore, keratoplasty is essential in addition to the specific treatment of the glaucoma. We aim to study the particularities and the evolutional ways of penetrating keratoplasty in Peters anomaly by presenting a clinical case treated in our service. CLINICAL CASE: Female baby aged 1 month, addressed for bilateral corneal leukoma. On examination he presented no ocular pursuit, a nystagmus and a megalocornea. Clinical features concluded to congenital glaucoma associated to Peters anomaly. The patient underwent trabeculectomy with Mitomycine C application. At the age of 2 1/2 years, and with an equilibrated eye pressure, she underwent penetrating keratoplasty using a 8,5mm diameter corneal graft. After 2 months the nystagmus decreased, and the vision improved, permitting an easier walk for the child. CONCLUSION: Peters anomaly is a frequent cause of congenital glaucoma, where penetrating keratoplasty is essential for corneal transparency. It necessitates a good eye pressure control.

Localization of a novel autosomal recessive non-syndromic hearing impairment locus DFNB63 to chromosome 11q13.3-q13.4.

Hereditary hearing impairment is the most genetically heterogeneous trait known in humans. So far, 50 published autosomal recessive non-syndromic hearing impairment (ARNSHI) loci have been mapped, and 23 ARNSHI genes have been identified. Here, we report the mapping of a novel ARNSHI locus, DFNB63, to chromosome 11q13.3-q13.4 in a large consanguineous Tunisian family. A maximum LOD score of 5.33 was obtained with microsatellite markers D11S916 and D11S4207. Haplotype analysis defined a 5.55 Mb critical region between microsatellite markers D11S4136 and D11S4081. DFNB63 represents the sixth ARNSHI locus mapped to chromosome 11. We positionally excluded MYO7A from being the DFNB63-causative gene. In addition, the screening of two candidate genes, SHANK2 and KCNE3, failed to reveal any disease-causing mutations.

Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern Province, Saudi Arabia.

This study was conducted to provide some epidemiological aspects of needle stick injuries among health care workers in the eastern province in Saudi Arabia. Data about 282 injuries reported from the hospitals of the Eastern Province of Saudi Arabia were collected through specially designed questionnaire retrospectively from 1995 to 1997. Results showed that 50% of injuries occurred in the first 3 years of employment. Workers in medical and surgical specialties suffered an equal degree of reported exposure. The highest percentage (46.8%) of injuries occurred during syringe related actions. Patients' wards were the major location of incidents (48.5%) followed by ICUs and dialysis units (17.7%), theatres (15.6%) and accidents and emergency departments (13.8%). There was no significant association between injuries and type of shifts. The middle hours of the shifts showed a significant association with injuries. The pattern of injuries was significantly associated with over loaded periods of medical practices. Deficiencies in implementing the standard recommendations for prevention and control of needle stick injuries were noted in the studied hospitals.

Standardized national growth chart of 0-5-year-old Saudi children.

A national survey was carried out to achieve the following objectives: (1) construction of national standards for Saudi children, 0-5 years old, with regard to weight, height and head circumference for males and females; (2) construction of a growth chart for weight, height and head circumference for 0-5-year-old Saudi children that can be used at hospitals and health centres in the Kingdom for routine follow-up of the growth of these children. To achieve these objectives, the WHO recommendations were applied. A total of 24,000 Saudi children, 12,000 males and 12,000 females, were selected randomly representing the five regions of the Kingdom with 200 children in each monthly age group. Demographic data as well as the anthropometric measurements were recorded by well-trained personnel using a pretested questionnaire and new, well calibrated equipment. The current study showed that Saudi boys (0-5 years old) were heavier and taller than Saudi girls in the same age group, and that the median weights and heights of Saudi boys and girls (0-5 years old) were more than those of the Harvard standards. A growth chart was constructed which was suitable for growth monitoring programmes all over the Kingdom.

Seasonal, nontoxigenic Vibrio cholerae O1 Ogawa infections in the Eastern Region of Saudi Arabia.

BACKGROUND: Surveillance for Vibrio cholerae in the Eastern Region of Saudi Arabia has been ongoing since 1985 to detect and prevent local proliferation of imported cholera. In 1996 and 1997 the authors performed additional microbiologic and epidemiologic assessment of V. cholerae surveillance to better characterize a recurrent summertime pattern of V. cholerae infections in the Eastern Region of Saudi Arabia. METHODS: All health facilities routinely submitted stool or rectal swab specimens for isolation of V. cholerae from patients with gastroenteritis. In addition, specimens were taken from expatriate workers and household contacts of persons with confirmed V. cholerae infection. Forty-two isolates were evaluated for cholera enterotoxin by enzyme-linked immunosorbent assay, cholera toxin polymerase chain reaction, and Y1 adrenal cell assay; 12 isolates also were characterized by pulsed-field gel electrophoresis (PFGE). Interviews about potential exposures were done for all V. cholerae infections. RESULTS: Vibrio cholerae O1 serotype Ogawa biotype El Tor was identified in 113 gastroenteritis patients (6.0 per 100,000 population per year), 28 asymptomatic expatriate workers, and 16 of 982 household contacts of index patients. All symptomatic infected persons had mild illness that was not typical of cholera, and all 42 isolates evaluated were nontoxigenic. All 12 isolates evaluated by PFGE had an indistinguishable pattern (pattern 81). Infections appeared in late May, decreased in mid-July through August, increased again in September, and disappeared from December through April. Infections had a uniform geographic distribution and affected all ages. No linkage was identified between affected households, or between community cases and food-handlers or domestic servants. DISCUSSION: Surveillance in the Eastern Region of Saudi Arabia has identified a novel strain of nontoxigenic V. cholerae O1 Ogawa. This strain probably has a local environmental reservoir. Since cholera toxin is the primary virulence factor involved in the cause of cholera, assays for cholera toxin should be included in cholera surveillance.

Frequency of and prevention measures for needle-stick injuries among hospital healthcare workers in Saudi Arabia.

This study was undertaken to determine the frequency of needle-stick injuries among healthcare workers in hospitals in the Eastern Province of Saudi Arabia from 1995 to 1997, and to gather information about the measures these hospitals are taking to protect their employees against these injuries. Precautionary measures taken to protect healthcare workers from injury and the follow-up after injuries were surveyed. The total overall prevalence rate of needle-stick injuries was significantly lower among healthcare workers in governmental hospitals than among those in private hospitals. The extremely low prevalence rate of needle-stick injuries indicated that there were serious defects in the reporting systems of the hospitals studied. All hospitals should have a mandatory, clear, and unified policy to help reduce the number of needle-stick injuries. Hospitals must adopt a policy to ensure that precautions are taken to reduce healthcare workers' accidental exposures to potentially infected blood.