Effects of exercise on sex steroid hormones (estrogen, progesterone, testosterone) in eumenorrheic females: A systematic to review and meta-analysis.

BACKGROUND: The sex steroid hormones fluctuate during the menstrual cycle, which affects the strength and postural stability of females and leads to injuries and risk of falls. These hormones may be modulated by exercise to impact the overall health of females. OBJECTIVE: To determine the effects of exercise on sex steroid hormones in eumenorrheic females. METHODS: This review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines in Lahore, Pakistan. The full-length articles were searched using these databases/search engines (PubMed, Web of Science and Google Scholar, Sci-Hub). Randomized controlled trials along with single group experimental studies were also included. All types of exercises were compared with no exercise in the control group. The Cochrane Risk of Bias assessment tool assessed and screened the articles. The data were then analyzed. The primary outcomes were the levels of estrogen, progesterone and testosterone. RESULTS: Eleven studies were included (5 randomized controlled trials and 6 quasi-experimental studies). The effects of exercise on free estradiol concentration and serum progesterone level were not significant [p = 0.37 (SMD = 0.33, 95% CI = 0.14 to 0.74, I2 = 0%) and p = 0.84 (S.D= -0.65, C.I= -6.92 to 5.62, I2 = 94%)] respectively, whereas, the effects on testosterone levels were significant [p value < 0.00001 (M.D = 0.89, 95% C.I= -2.16 to 3.95, I2 = 94%)]. CONCLUSION: A blinded randomized controlled trial should be conducted in which a structured approach should be followed by women along with warm-ups, cool down and rest intervals. TRIAL REGISTRATION NUMBER: The systematic review was registered prospectively on PROSPERO with registration number CRD42023473767.

Effects of sustained natural apophyseal glides versus rocabado 6 × 6 program in subjects with cervicogenic headache.

BACKGROUND: Cervicogenic headache is designated as the most common type of secondary headache that results from conditions affecting the neck's bony components, muscles, and intervertebral discs rather than the head itself. OBJECTIVE: The purpose was to determine the effects of Sustained Natural Apophyseal Glides (SNAGs) versus the Rocabado 6 × 6 program in subjects with cervicogenic headaches. METHODS: This study was a randomized clinical trial. The sample size was 38, and participants aged 20-60 years (mean age 40.22 ± 9.66) suffering from cervicogenic headaches were randomly allocated using the lottery method into two groups with 19 participants in each group. Assessment of subjects was done before starting treatment and by the end of the 8th week for all the variables. Outcome measures were the Neck Disability Index (NDI), 6-item Headache Impact Test (HIT-6), Flexion-Rotation test (FRT) to assess the rotation range of motion at the level of C1-C2 (goniometer) and the Numeric Pain Rating Scale (NPRS) for the intensity of pain. Data analysis was done by SPSS (IBM) 25. To check the normality of the data the Shapiro-Wilk test was used. RESULTS: In the Shapiro-Wilk test p-value of all the testing variables i.e. NDI, HIT-6 score, FRT and NPRS was > 0.05, data was normally distributed and parametric tests were used. Group A showed a considerable improvement (p < 0.05) in all variables compared to Group B, while within-group analysis of both groups shows that all outcome measures show significant results (p < 0.05). CONCLUSION: It was concluded that both SNAGs and Rocabado's 6 × 6 exercises were effective for the treatment of cervicogenic headache but the effects of headache SNAG were superior and produced more improvement in intensity of headache, disability, frequency of headache, duration of headache as compared to Rocabado 6 × 6 exercises. TRIAL REGISTRATION NUMBER: This study was registered at ClinicalTrials.gov ID: NCT05865808 on date 19/05/2023.

Comparative effects of post isometric relaxation technique and Bowen's therapy on pain, range of motion and function in patients with temporomandibular joint disorder.

BACKGROUND: The most common cause of mouth and facial pain is a temporomandibular joint disorder, which affects the patient's quality of life and interferes with their ability to perform daily tasks. OBJECTIVE: The purpose was to compare the effects of the Post-Isometric Relaxation Technique and Bowen's Therapy on pain, range of motion and functional activity in patients with temporomandibular joint disorders. METHODS: This study was a randomized clinical trial. A total of 24 participants were randomly allocated into two groups using the lottery method. Baseline treatment was the same (ultrasound and tapping) in both groups. Group 1 (12 participants) was treated with a post-isometric relaxation technique, and Group 2 (12 participants) with Bowen's therapy for two sessions per week (total duration of 4 weeks). Outcome measures were the Numeric Pain Rating Scale, Maximal mouth opening inter-incisal rural and jaw functional limitation scale-20. SPSS version 25 was used for statistical analysis. RESULTS: A significant improvement in pain, range of motions and functional activities in the post-isometric group showed significant results (p < 0.05) as compared to Bowen's group (independent t-test). However, within-group comparison (paired t-test), both groups showed significant results (p < 0.05). CONCLUSION: This study concluded that post-isometric relaxation was more effective in terms of pain, range of motions for mouth opening, lateral deviations and functional activity of temporomandibular joint disorder patients. However, both groups showed clinical results according to minimal clinical difference values. TRIAL REGISTRY NUMBER: The trial is registered under ClinicalTrials.govt with reference no. ID: NCT05392049 registered on 26/05/2022.

Urdu translation and validation of the international consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

INTRODUCTION AND HYPOTHESIS: The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) is a tool for the evaluation of lower urinary tract symptoms and their impact on the quality of life. The purpose of this research was the translation of ICIQ-FLUTS into the Urdu language and to determine its validity and reliability. METHODS: Two bilingual translators translated the ICIQ-FLUTS Questionnaire into the Urdu language. Three experts compared the Urdu ICIQ-FLUTS with the original version of ICIQ-FLUTS. Urdu version was translated back into English by two translators. The pre-final version was drafted after tracking the forward and backward translation differences. The final Urdu version was drafted after application to ten patients (pilot study). Final Urdu ICIQ-FLUTS was applied to 120 participants for validity and reliability. RESULTS: Urdu version was drafted after the consensus of the experts. The content validity index ranged between 0.81-0.93. The mean age of the participants was 45.2 ± 7.79 years. The test-retest reliability was analyzed through intraclass correlation coefficient (ICC) 0.972 and internal consistency by Cronbach's alpha 0.986. The concurrent validity was determined by correlating the ICIQ-FLUTS with ICIQ-UI SF (0.82) and UDI-6 (0.72). CONCLUSION: It was concluded that the Urdu version of ICIQ-FLUTS is an assessment questionnaire for the signs and symptoms of urinary incontinence. It has good content validity, concurrent validity, and test-retest reliability.

Translation and validation of the Pelvic Girdle Questionnaire in the Urdu language.

INTRODUCTION AND HYPOTHESIS: The Pelvic Girdle Questionnaire (PGQ) is designed to determine pain and limited activities in pregnant and postpartum women with pelvic girdle pain (PGP). The purpose of this study was to translate the PGQ into the Urdu language and find out the cross-cultural validity and reliability of the Urdu PGQ among pregnant and postpartum women. METHODS: A translation and cultural adaptation study was performed following international guidelines. The PGQ (the Urdu version) was drafted and a pilot study was conducted on 16 pregnant and postpartum women. A total of 125 pregnant and postpartum females participated in this study for validity and test-retest reliability. SPSS 25 was used for data analysis. RESULTS: Content validity was analyzed by the content validity index ranging from (0.92 to 1). Convergent validity was determined by correlating the Urdu version of the PGQ with the Oswestry Disability Index (ODI). Pearson rank correlation coefficient between the PGQ and the ODI (p=0.84) showed convergent validity. Internal consistency and test-retest reliability of the Urdu version of the PGQ were calculated by Cronbach's alpha (α=0.98), and intra-class correlation coefficient (ICC=0.98) respectively. CONCLUSION: The Urdu version of the PGQ showed good content and convergent validity as well as high internal consistency and test-retest reliability.

Translation and validation of Incontinence Impact Questionnaire Short Form in the Urdu language.

INTRODUCTION AND HYPOTHESIS: The Incontinence Impact Questionnaire Short Form (IIQ-7 SF) is a self-administered questionnaire that is used to assess the impact of urinary incontinence on the quality of life in women. It is translated into different languages; however, there is currently no official Urdu version of this tool. The main purpose of this study was to translate the IIQ-7 SF into the Urdu language and to find out its validity and reliability in women with urinary incontinence. METHODS: The IIQ-7 was translated into the Urdu language by following the standardized steps. The original version was translated into Urdu by two translators and the back translation into English was done by an independent translator. A panel of experts reviewed the translations and a final version was drafted. Fifteen women with urinary incontinence were involved in the pilot study. The validity and reliability were then assessed on 70 women with urinary incontinence. RESULTS: The content validity index (CVI) of each question ranged from 0.91 to 0.94. The convergent validity with UDI-6 was determined by using Spearman's correlation coefficient (r=0.90). Cronbach's α showed the internal consistency, which is 0.87. The test-retest reliability was calculated by the intra-class correlation coefficient, ICC=0.95. The scree plot showed the two components have eigen values greater than 1. CONCLUSIONS: The Urdu version of the IIQ-7 has shown good validity and reliability in incontinence patients, according to the findings.

Comparative effects of lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome after mastectomy.

PURPOSE: The purpose was to compare the effects of manual lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome. METHODS: This randomized clinical trial was conducted on 36 breast cancer patients with developed axillary web; participants were randomly divided into two groups. One group was treated with manual lymphatic drainage; the other group was treated with soft tissue mobilizations in addition to therapeutic exercises, i.e., stretching, strengthening and range of motion (ROM) exercises. The duration of treatment was four weeks (5 sessions/week), with therapeutic exercises as a common treatment protocol. Outcome measures were Breast-Cancer specific quality of life questionnaires, Disabilities of the Arm, Shoulder and Hand (DASH), Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS), Dynamometer and Goniometer. All outcome measure readings were recorded at baseline and the end (4th week) of the treatment. RESULTS: The compliance of the variable distribution with normal distribution was verified using the Shaphiro-Wilk test. Parametric tests were applied, and both groups showed significant effects (p < 0.05) in pairwise comparison (paired t-test). The comparison group analysis (independent t-test) showed that there was no significant difference in pain, upper limb strength, range of motions and fatigue component of quality of life questionnaire parameters (p > 0.05). Two parameters (DASH, PSFS) and one component of the quality of life questionnaire (global health) showed a significant difference (p < 0.05). CONCLUSION: Manual lymphatic drainage showed more improvement in functional movements. It was concluded that both groups, manual lymphatic drainage and soft tissue mobilization groups were clinically equally effective. TRIAL REGISTRATION NUMBER: This trial is registered at ClinicalTrial.gov PRS under trial number NCT05463185 on date 18/07/2022.

Prevalence and risk factors of non-adherence to antipsychotic medications in Saudi Arabia.

PURPOSE: To evaluate the rate and determinants of non-adherence to antipsychotic medications in Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional study that included a questionnaire, interview, and data extraction from medical records of adult patients on antipsychotic medications. The study was conducted at outpatient clinics at the psychological care department at King Fahad Medical City, Riyadh, Saudi Arabia, between October 25 and November 26, 2020. Data collection included three parts: patients' sociodemographic characteristics; antipsychotic medications used and patients' clinical characteristics; and adherence to antipsychotic medications measured by the Medication Adherence Rating Scale (MARS). RESULTS: Out of 220 patients, 122 (55.5%) were considered non-adherent (MARS scores 6 or less). The MARS items contributing most to non-adherence were "the medication makes me feel tired and sluggish" and "forget to take the medication", 55 and 40.9%, respectively. Additionally, adverse drug effect significantly increased the risk of poor adherence in regression analysis (odds ratio = 1.97, p = 0.028). The model also showed that female sex, low income, cigarette smoking, substance abuse, uncontrolled disease, comorbidity, and use of Ruqyah religious therapy were associated with increased risk of poor adherence, but were however not statistically significant (p < 0.05). CONCLUSION: This study showed high non-adherence rate to antipsychotic medications. Adverse drug effects and forgetting to take medications were the main patient-reported barriers to adherence. Likewise, sociodemographic, clinical, and spiritual factors affected medication adherence. Knowing these predictors helps in early identification of patients who are predisposed to medication non-adherence and allows personalized interventions that improve adherence and treatment outcomes.

Effects of extracorporeal shock wave therapy on spasticity, walking and quality of life in poststroke lower limb spasticity: a systematic review and meta-analysis.

OBJECTIVE: To determine the effects of extracorporeal shock wave therapy (ESWT) on lower limb function, walking, and quality of life in patients with lower limb poststroke spasticity. DATA SOURCES: A comprehensive and systematic electronic database search of PubMed, Web of Science, ProQuest thesis Dissertation checks, Google Scholar was conducted from January 2010 to March 2022. REVIEW METHOD: Initially, the bibliography was screened to identify randomized and nonrandomized controlled trials evaluating the effects of ESWT on lower limb spasticity and functional outcomes in stroke patients. Two reviewers independently screened the title and abstract, full-text articles, extracted data, and assessed the quality of the selected studies. The primary evaluation outcome was spasticity assessed by Modified Ashworth Scale (MAS), and the secondary outcomes were walking performance and quality of life measured on different scales. DATA SYNTHESIS: Out of the total of 483 records, 15 studies (389 participants) were finally found eligible for inclusion. A meta-analysis was performed and beneficial effects of ESWT were observed in the experimental group compared with the control group on spasticity. MAS: Standard mean difference (SMD = 0.626), (95%CI = -0.133, 1.119), (p < 0.01), ROM: (SMD = 0.573), (95%CI = 0.074, 1.072), (p < 0.02). The result for before and after ESWT application on TUG: (SMD = 0.174), (95%CI=-0.151, 0.499), (p = 0.29). The results for walking performance were not significant and inconclusive which may be due to the heterogeneity of the studies included. CONCLUSION: Evidence suggests that ESWT has promising effects in reducing spasticity and improving lower limb motor function. However, uncertainty exists regarding its effectiveness in walking performance.

An overview of injury prevention for soccer players in Pakistan: A sports rehab perspective.

Soccer (football) is one of the most popular weight-bearing sports in the world, which involves activities such as jumping, running and turning. Soccer related injuries have the highest incidence in all sports and are more common in young amateur players. The most important modifiable risk factors include neuromuscular control, postural stability, hamstring strength and core dysfunction. The International Federation of Football Association introduced FIFA 11+; an injury prevention programme for reduction in the rate of injuries in amateur and young soccer players. It focusses on the training of dynamic, static and reactive neuromuscular control, proper posture, balance, agility and control of the body. This training protocol is not being used in Pakistan at amateur level who neither possess the resources, nor the knowledge or proper guidance in risk factor assessment, prevention, and subsequent sport injury management. In addition, the physicians and rehabilitation community are not much familiar with it except for those directly involved in sports rehabilitation. This review highlights the importance of including FIFA 11+ training programme in the curriculum and faculty training.

Effects of sequential approach of positional release for subscapularis and OLA Grimsby technique on shoulder external rotation in adhesive.

A sample of 34 patients was randomly assigned to two Groups A and B (17 in each group). Positional release of subscapularis technique to Group A participants and Proprioceptive Neuromuscular Facilitation (PNF) (hold-relax) and anterior mobilisation technique were simultaneously applied to Group B participants. Data was collected from Nusrat Abdul Rauf Centre for Enablement and Faisal Hospital, Faisalabad, from August 30, 2018 to November 27, 2018. The duration of the treatment was four weeks with three sessions per week. The main outcome measures were Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), and shoulder external rotation range of motion. The differences between Ola Grimsby group (Group B) and subscapularis release group (Group A) were statistically significant for pain, disability and shoulder range of motion (p-value<0.05) with higher mean values for Ola Grimsby group. This study concluded that the sequential effects of Ola Grimsby technique are better as compared to positional release of subscapularis in terms of reducing pain and improving shoulder external rotation range of motion.

Upper extremity musculoskeletal disorders and exposure to Ergonomic risk factors among handicraft workers.

OBJECTIVE: To determine the association of Upper extremity musculoskeletal disorders and Exposure to Ergonomic risk factors among handicraft workers. METHODS: This cross-sectional survey was conducted in a 12 weeks' duration i.e. from November 2018 till January 2019. Nordic musculoskeletal questionnaire was used to determine the frequency of upper limb musculoskeletal disorders. Postural analysis was done using Rapid Upper Limb Assessment (RULA). Data was collected from 100 Handicraft workers and the type of work included Art work (n=18), Ada Work (n=7), botanical arrangement (n=11), Textile, fashion designing and stitching (n=38), Fine arts (n=20), embroidery and knitting (n=6). RESULTS: The frequency distribution of Rapid upper limb assessment (RULA) score for exposure to risk factors showed that 47 participants were at a high risk and required implementation of change. Most of the participants (n=35) reported pain in neck and shoulder (n=29). The chi square test for association between pain in upper extremity and exposure to risk factors showed that only wrist pain had statistically significant association with overall RULA score (p-value<0.05). CONCLUSION: The study concluded that neck and shoulder are more frequently affected among handicraft workers. The frequency of workers who were at high ergonomic risk and required implementation of change in working conditions was high.

Pattern of changes in latissimus dorsi, gluteus maximus, internal oblique and transverse abdominus muscle thickness among individuals with sacroiliac joint dysfunction.

BACKGROUND AND OBJECTIVE: Altered Pattern of the Global Muscle system is presented in literature among individuals with sacroiliac Joint Dysfunctions. However, the pattern of changes in the Latissimus dorsi (LD) and gluteal maximus (GM) among sacroiliac joint dysfunctions (SIJD) is not reported. This study aimed to investigate the changes in the resting muscle thickness of the Latissimusdorsi and gluteal maximus in SIJD. METHOD: A total of 88 subjects (44 individuals with SIJD and 44 healthy individuals as matched control) was included in this study. The resting thickness of the Latissimusdorsi and gluteal maximus was measured using real time musculoskeletal ultrasonography and data was compared between the ipsilateral side and contra lateral side among subjects with SIJD as well as healthy subjects. Independent sample t test was used to analyze the data by using SPSS version-25. RESULTS: The results showed that contralateral LD were reduced significantly among subjects with SIJD when compared with the other side and with control. It also showed that ipsilateral IO, TrA and GM were reduced significantly among subjects with SIJD when compared with the controls and with contralateral side. CONCLUSION: The reduced resting muscle thickness showed an altered motor pattern of Deep Muscles of local system and Gross muscles of global system among patients with sacroiliac joint dysfunction.

Comparison of conservative exercise therapy with and without Maitland Thoracic Manipulative therapy in patients with subacromial pain: Clinical trial.

OBJECTIVE: To determine the effect of conservative exercise therapy with and without Maitland thoracic manipulation in patients with subacromial pain. METHODS: The randomised controlled trial study was conducted at the Mayo Hospital, Lahore, Pakistan, from June 2015 to February 2016, and comprised patients with subacromial pain (group 1) and controls (group 2).Pre-assessment was done by using numeric pain rating scale and shoulder pain and disability index as subjective measurements, while range of motion was taken as objective measurement. SPSS version 21 was used for data analysis. RESULTS: Of the 40 participants, there were 20(50%) in each group. The baseline pain intensity on numeric pain rating scale for group 1 was 5.05±1.538 and for group 2 was 5.35±1.137; the values later changed to 0.70±0.923 and 2.30±0.979, respectively. The baseline functional status score according to shoulder pain and disability index for group 1 and 2 was 40.25±12.354 and 43.15±7.343 that changed to 12.30±4.714 and 22.55±5.577, respectively. CONCLUSIONS: Maitland thoracic spinal manipulation with conservative exercise therapy was more effective than conservative exercise therapy alone.

A comparative study of dynamic soft tissue mobilization vs. passive stretching technique to improve the flexibility of hamstrings in cricket players.

Different therapies are available for correcting the tightness of hamstring muscles. Objective of this study was to compare the effectiveness of Dynamic Soft Tissue Mobilization DSTM technique and Passive Stretching PS to improve the flexibility of tight hamstrings in cricket players. A total of 120 cricket players having tightness of hamstrings were enrolled and randomized into two groups A and B using lottery method. Group-A was treated with DSTM and group-B with PS to improve the flexibility of hamstrings. Active Knee Extension Angle AKEA test was used to measure the hamstring tightness as it is a gold standard test for this purpose. The mean value of AKEA, pre-treatment score deficient to 180 degrees for DSTM was 25.66 ± 6.90, and that of PS was 25.46 ± 6.89, while the post-treatment score was 10.81 ± 4.30, and 18.63 ± 7.06 respectively. Post-treatment score for DSTM was statistically lower than PS. (p-value < 0.05). So it was concluded that it is better to use DSTM for acquiring better results.

Prognosis of stroke in children after three months of regular physical therapy in Lahore.

OBJECTIVE: To evaluate the effects and significance of Proprioceptive Neuromuscular Facilitation exercises on stroke patients. METHODS: The prospective follow-up study was conducted from January, 2012, to June, 2012, and comprised randomly-selected patients at the Department of Neurology, Children Hospital and Institute of Child Health, Lahore, Using systematic sampling the patients were divided into two groups. Patients in group I were subjected to Proprioceptive Neuromuscular Facilitation therapy, while those in group II were treated by passive range of motion exercises only. All patients were followed up at months 1, 2 and 3. Data was collected through a questionnaire, while muscle strength was evaluated through Medical Research Council scale. All date was analysed using SPSS 20. RESULTS: There were 50 patients in the study who were all below 15 years of age. Muscle strength of affected side at baseline in the experimental group I was 2.36±0.49 and in the control group II it was 2.60±0.50. At the end of the three-month follow-up, it had considerably increased to 4.76±0.43 in group I while it was 3.80±0.50 in grgup II (p<0.0001) CONCLUSION: Proprioceptive Neuromuscular Facilitation technique was an effective method in terms of pain relief, stiffness reduction and functional improvement.

Effects of kinesio taping with and without active release technique in carpal tunnel syndrome.

BACKGROUND: Kinesio taping is used as a conservative treatment for carpal tunnel syndrome and the active release technique is also effective. OBJECTIVE: The purpose of the present study was to compare the effects of kinesio taping with and without the active release technique on pain, grip strength, functional disability and range of motion in patients with carpal tunnel syndrome. METHODS: It was a randomized controlled trial. Thirty-two patients with carpal tunnel syndrome were randomly allocated to two groups: Group A received kinesio taping with the active release technique for 4 weeks (3 days/week); Group B received kinesio taping alone for 4 weeks (5 days/week). Outcome measures were the Boston Carpal Tunnel Syndrome Questionnaire, a numeric pain rating scale, goniometry and hand-held dynamometry. SPSS software, version 25, was used for data analysis. RESULTS: Normal distribution was assessed on the Shapiro-Wilk test and parametric tests were applied. Independent t-test results showed that patients who received kinesio taping with the active release technique showed significantly greater improvement (p < 0.05) in pain, functional status and range of motion than the group that received kinesio taping alone. Within-group analysis (paired t-test) showed that both groups significantly improved (p < 0.05) in all outcome measures. CONCLUSION: Kinesio taping with the active release technique procured significantly greater improvement in pain, range of motion and functional disability than kinesio taping alone. CLINICALTRIALS: gov registration number: 789.

Short and long-term reproductive outcomes after hysteroscopic adhesiolysis for infertile women.

OBJECTIVE: To evaluate reproductive outcomes after hysteroscopic adhesiolysis for patients with Asherman syndrome (AS) who presented with infertility and/or subfertility. METHODS: A retrospective study was conducted in the Women's Specialized Hospital, King Fahad Medical City, from December 2010 to December 2018. The medical records were reviewed for all infertile women who had hysteroscopic adhesiolysis. The specific study's main reproductive outcomes included: [1] the overall rate of conception, [2] the overall rate of conception according to the severity degree of intrauterine adhesions (IUAs), [3] the reproductive methods for achieving conception, and [4] pregnancy outcomes. Reproductive methods for conception included spontaneous conception, ovulation induction (OI), intrauterine insemination (IUI), and in-vitro fertilization (IVF) with/without intracytoplasmic sperm injection (ICSI). Outcomes of pregnancy included ectopic pregnancy, miscarriage, and live birth events. RESULTS: Forty-one patients (n=41) were analyzed. Their mean age was 32.2±4.6 years. The most common menstrual pattern amongst these patients was hypomenorrhea 46.4%. All patients resumed regular menstrual cycles after the adhesiolysis procedure. The overall conception rate during the 24 months follow up was 53.6%, and the overall live birth rate was 34.2%. Of the 22 patients who conceived, 12 patients (29.2%) conceived spontaneously, 2 (4.9%) with IUI, and 8 (19.5%) with IVF-ICSI. The patients with minimal IUAs had a significantly higher pregnancy rate (71.4%) when compared to those with moderate (47%) and severe (40%) IUA (two-tailed log-rank test, p=0.041). CONCLUSIONS: The spontaneous cumulative conception rate following hysteroscopic adhesiolysis was higher in patients with minimal IUAs than those with moderate and severe IUAs.

Health care professionals' knowledge and attitudes toward telemedicine.

Background: The utilization of modern communication technology in the healthcare field is known as telemedicine, and it represents an advancement in the healthcare industry. For effective implementation of these technologies, healthcare professionals must possess the appropriate knowledge and hold a positive perspective toward the implementation of telemedicine. The current study aims to evaluate the knowledge and perspective of healthcare professionals in King Fahad Medical City, Saudi Arabia toward telemedicine. Methods: This study was carried out in a diverse hospital, King Fahad Medical City, Saudi Arabia and it was a cross-sectional study. The study took place from June 2019 until February 2020, during which 370 healthcare professionals, including physicians, nurses, and other healthcare professionals participated. The data was gathered by using a structured self-administered questionnaire. Results: The analysis of the data revealed that the majority of the healthcare professionals who participated in the study, 237 (63.7%), had limited knowledge of telemedicine. About 41 (11%) participants had a good understanding of the technology, and 94 participants (25.3%) had extensive knowledge. The overall attitude of the participants toward telemedicine was positive, with a mean score of 3.26. The mean attitude scores varied significantly (P < 0.001) among the different professions, with physicians scoring 3.69, allied healthcare professionals scoring 3.31, and nurses scoring 3.07. The coefficient of determination (R2) was used to evaluate the variation in attitude toward telemedicine and it was found that education (12.4%) and nationality (4.7%) had the least impact on the attitude toward telemedicine. Conclusion: Healthcare professionals are crucial to the successful implementation and continuity of telemedicine. However, despite their positive attitude toward telemedicine, most of the healthcare professionals who participated in the study had limited knowledge of it. There were differences in attitude among different groups of healthcare professionals. As a result, it is necessary to create specialized educational programs for healthcare professionals to guarantee the proper implementation and continuation of telemedicine.

What motivated residents of Saudi Arabia to receive the COVID-19 vaccine?

Background: Acceptance of vaccination is a multifactorial issue. The unprecedented speed at which the COVID-19 disease spread globally has meant that people have had to face the idea of receiving novel vaccines for a novel disease. Purpose: Studies conducted earlier in the pandemic had shown high vaccine hesitancy in Saudi Arabia, therefore we wanted to understand the motivating factors for people living in Saudi Arabia with regards to accepting the COVID-19 vaccine, our survey was conducted when the government had already mandated vaccination to enter public spaces. Saudi society is not particularly outspoken and therefore it was of special importance to the authors to explore the motivation behind COVID-19 vaccines. Methods: This is a cross-sectional survey of 802 participants living in Saudi Arabia. The questionnaire was distributed to staff, visitors, and patients in a hospital in Saudi Arabia and via electronic means to the general population. Results: A total of 521 (65%) of the respondents were women, and 281 (35%) were men. A total of 710 (88.5%) were Saudi, and 55 (6.9%) were non-Saudi. The majority of participants (496, 65.7%) stated that they registered for the vaccine as soon as it was available, with 185 (24.5%) stating that they registered when they were mandated to do so and 74 (9.8%) registered only when they felt cases were increasing. Most participants (316, 41%) stated that the main reason for taking the vaccine was one of a self-protective nature, followed by indirect vaccination (240, 31.1%), paternalistic reasons (157, 20.4%) and altruistic reasons (58, 7.5%). Conclusions: With the increased burden on healthcare that is being faced by COVID-19, other resources need to be carefully allocated. This paper may aid the Saudi government in understanding the motivation for the population to take the vaccine and therefore facilitate any future vaccination campaigns to ensure the best utilization of resources.