bluuebunny/crossref_metadata_2025 huggingface dataset:
The knowledge and attitude on pain management and their associated factors among nursing students at the school of nursing, Vavuniya
Authors: Wijayasundara W. M. S. K. , Karunathilake K. M. M. G. P. , Chandrakumari H. A. D. C.
Published: January 2024

Background: Pain control in patients is important as untreated pain impede their response to treatments and negatively affect their quality of life. Optimal pain management requires adequate knowledge, positive attitudes, and competent pain assessment measures. Nurses are key players and have an essential role in pain management. Applying nursing roles requires that nursing students attain adequate knowledge about pain, its management, and positive attitudes towards it.Aim/s: To assess the knowledge and attitudes on pain management and their associated factors among nursing students in the School of Nursing, Vavuniya.Methods: A descriptive cross-sectional study was conducted with the total study population of second-year (n=97) and third-year nursing students (n=43) at the School of Nursing, Vavuniya. The study was conducted using a pre-tested self-administered questionnaire that included the modified Ferrell and McCaffery (2012) Knowledge and Attitude Survey Regarding pain (KASRP). Data were described using descriptive statistics, and associations were assessed using the Mann-Whitney U and Kruskal Wallis tests. Significance was set as p<0.05. The ethical clearance was obtained from the Rajarata University of Sri Lanka.Results: The response rate was 97%. The majority belonged to the age group between 23-25 years (n=112, 80.0%). The mean age was 23.7 years (SD +1.102). Majority were female (n=135, 96%), Sinhalese (n=107, 76%) and Buddhist (n=98, 70%). Most of the students had “poor” knowledge on pain management (n=98, 70%) and had “fair” attitudes (n=98, 70%). “Good” attitudes were reported by 7% (n=10) of the students. The median of the total correct answers for knowledge was 13 (IQR=5) out of 30 questions, and the median attitude score was 8 (IQR=4) out of 15 questions. The year of study and additional study of reference materials were significantly related to knowledge and attitudes towards pain management (p<0.01).Conclusion: The overall knowledge among nursing students on pain management was “poor”, and most had fair attitudes towards pain management. Pain management education needs to be strengthened, and positive attitudes should be cultivated through curricular reforms in nursing education.
Atti Sociali
Authors: (SEI) Società Entomologica Italiana
Published: January 2024

Atti Sociali
First report of Colias croceus ab. cremonae in Italy
Authors: Raviglione Mario Carlo Battista , Boggio Fabrizio , Raviglione Marco , Zilli Alberto
Published: January 2024

We report on the first observation for Italy of ab. cremonae Verity, 1911 of Colias croceus (Fourcroy, 1785). This is an extremely rare form characterized by a lemon-yellow background color instead of the orange color typical of the nominal form of Colias croceus. This peculiarity is linked to a genetic mutation that suppresses the expression of orange/red (and pink) coloration due to erythropterin pigments, so that their absence prevents the appearance of orange color on the wings and of the pink color normally observed on the antennae, legs, fringes, and the hair vestiture of the head and thorax. The present report is based on a single male specimen recorded on 7 October 2021 near Benna (Biella, Piedmont), where Colias croceus was abundant. The presence of this aberration is relatively frequent in the Azores Islands (particularly Faial) and has also been reported for Madeira and Hasmieh (Lebanon), the site of origin of the first specimen ever collected. This aberration was previously unrecorded in Italy and is yet unknown in most of continental Europe. Another yellow aberration of Colias croceus, known as ab. erateformis, originally recorded in Romania and, later, from other West Palaearctic (mostly Mediterranean) areas, is considered a different one in which the red pigment is still present.
The catcher in the mind: validation of the brief-mentalized affectivity scale for adolescents in the Italian population
Authors: Liotti Marianna , Fiorini Bincoletto Alice , Bizzi Fabiola , Tironi Marta , Charpentier Mora Simone , Cavanna Donatella , Giovanardi Guido , Jurist Elliot , Speranza Anna Maria , Lingiardi Vittorio , Tanzilli Annalisa
Published: January 2024

The concept of mentalized affectivity (MA) encompasses the dimensions of identifying, processing, and expressing emotions and describes the process of making sense of and reevaluating one’s affects in light of autobiographical memory. This construct was developed within the theoretical framework of mentalization and, due to its interpersonal nature, added further complexity to the emotion regulation construct. This research aimed to examine the factor structure and psychometric properties of the Brief-Mentalized Affectivity Scale for adolescents (B-MAS-A) on an Italian sample of young people (aged 13-19 years). Data were collected using non-probabilistic sampling and an online survey. Participants were asked to complete a large battery of instruments, including the B-MAS-A, the Toronto Alexithymia Scale, the Reflective Functioning Questionnaire, the Epistemic Trust, Mistrust, and Credulity Questionnaire, the Strengths and Difficulties Questionnaire, and the General Self-Efficacy Scale. In study 1, factor analyses carried out on a total sample of 566 adolescents identified 3 distinct dimensions of the same components of MA found in the adult population: i) identifying; ii) processing; iii) expressing emotions. The subscales showed excellent internal consistency. Study 2 (involving a subsample of 288 participants) demonstrated good levels of construct and criterion validity. These results confirm that the B-MAS-A represents a valid and robust instrument for assessing the complex and multifaceted characteristics of MA in adolescents. The B-MAS-A can make a significant contribution to clinical practice and research and encourage systematic studies on MA in psychotherapy, taking into account the developmental stage of adolescence.
Polygenic Risk Score and Precision Medicine in Diabetes
Authors: Kwak Soo Heon
Published: January 2024

Precision medicine involves tailoring medical treatment to the individual characteristics, needs, and preferences of each patient. In the realm of diabetes, genetic, environmental, and lifestyle factors must all be considered when developing personalized management strategies. Polygenic risk refers to the cumulative risk of developing a disease based on the presence of multiple genetic variants across the genome. Understanding the polygenic nature of diabetes assists in identifying various genetic factors that contribute to its onset, progression, and the development of complications. Recent studies indicate that polygenic risk scores are instrumental in distinguishing between type 1 diabetes, monogenic diabetes, and type 2 diabetes. Moreover, these scores can predict incident type 2 diabetes in women with a history of gestational diabetes and can be used to forecast diabetic complications. When polygenic risk scores are combined with other risk factors such as age, body mass index, and family history, risk stratification is enhanced, pinpointing individuals who may benefit most from early intervention strategies. Challenges related to practical use of polygenic scores include ethnicity specificity, data privacy, and generating evidence in the clinical setting. We aim to explore opportunities as well as challenges related to utilizing polygenic risk in precision medicine.
Diabetes and Non‑Nutritive Sweeteners
Authors: Lee Jisung
Published: January 2024

Non-nutritive sweeteners (NNS) can provide strong sweetness in small amounts and have fewer calories compared to sugar. However, there is much debate within the academic community regarding their long-term impact on health. For individuals with diabetes who find it challenging to reduce added sugar intake, limited short-term use of NNS may be considered as a step toward reducing sugar consumption. However, ultimately, it is important to reduce both sugar-containing beverages and those containing NNS. Diabetes educators should educate patients about the need for caution when consuming NNS and provide guidance on healthy food choices.
Unusual Localization of Eczema Herpeticum to Tinea Corporis and Cruris
Authors: Narula Soumya , Shreya K , Sahni Mukesh K , Asati Dinesh P
Published: January 2024

Eczema herpeticum (EH), known as Kaposi varicelliform eruption presents with multiple vesiculopustular lesions localized to areas of preexisting eczematous or erosive dermatoses. Most commonly seen in atopic dermatitis but colocalization with tinea cruris and corporis is atypical. In our case, multiple vesicles, pustules, and small crusted erosions associated with pain were seen confined to the areas of dermatophytosis. Tzanck smear from vesicles showed multiple multinucleated giant cells and acantholytic cells. In view of strong clinical suspicion and the presence of multinucleated giant cells, she was prescribed oral acyclovir 400 mg thrice a day for 7 days. She was reviewed after a week with complete clearance of the vesicles and crusting.
Dermatoscopic Patterns in Indian Patients with Discoid Lupus Erythematosus and Correlation to the duration of Disease and Cutaneous Lupus Erythematosus Disease Area and Severity Index
Authors: Mohanan Saritha , Bapu Nishant Ghodake
Published: January 2024

Dermatoscopic patterns of discoid lupus erythematosus (DLE) have recently been described in the literature. A temporal correlation of certain dermatoscopic features has also been proposed. There is sparse literature on dermatoscopic features seen in Indian/Asian patients with DLE and the correlation of these features with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score. A few of the patients of DLE coming to the dermatology outpatient department of our center in South India were evaluated by dermoscopy. Demographic details, duration of illness, location of plaques, and the CLASI scores were collected. A total of 26 plaques from 12 patients were evaluated by dermoscopy. Hair follicle effacement (n = 20) was the most common feature, followed by patchy pigmentation (n = 18), telangiectasia (n = 13), perifollicular pigmentation (n = 13), and perifollicular scaling (n = 10). There was a statistically significant difference in disease activity (CLASI) in patients with perifollicular scale and telangiectasia compared to patients without the above features. There was a significant difference in the duration of disease among patients with and without follicular red dots.
Dermoscopy of Cutaneous Vascular Lesions: An Observational Study
Authors: Agrawal Neha , Mehta Hita H , Lakhotia Rahul , Prakashey Arjun R.
Published: January 2024

Introduction:

Cutaneous vascular lesions (VLs) comprise of all skin diseases that originate from or affect blood or lymphatic vessels. VLs are expected to show predominant vascular structures (VS) in dermoscope and adequate interpretation of the shapes and distribution of VS lead the observer to the right diagnosis.

Objectives:

The aim is to study and evaluate the dermoscopic patterns of different types of VLs using polarized white and orange light.

Methodology:

Patients presenting with VLs including vascular tumours, vascular malformations, purpura, and other miscellaneous conditions were enrolled in this study conducted in dermatology outpatient department. After relevant history and examination, dermoscopic images were captured and stored for the analysis.

Results:

A total of 170 patients of 20 VLs were studied including 118 males and 52 females. For evaluating dermoscopic features, we described the findings under two headings, key features, and other nonspecific features. In key features, we included lacunae and vascular patterns, whereas in other features, homogenous area, white collarette, white rail lines, peripheral erythema, increased pigment network, brown area, veil, dot, globule, patch, lines and changes in background color, etc., were included. Interestingly, dermoscopy revealed some new features such as half and half lacunae and pattern 4 in angiokeratoma, arciform structures in angioma serpiginosum, silvery globules in subungual hematoma, and many more.

Conclusion:

Dermsocope can be used as a handy tool to quickly diagnose innocent VLs based on established dermsocopic features and to easily differentiate them from each other and from the malignant lesions.
Pyoderma Gangrenosum Associated with Ulcerative Colitis and Tuberculosis Brain Abscess Successfully Treated with Intravenous Immunoglobulin
Authors: Nayanathara G S , Pai Varadraj Vasant , Ghodge Rakhi
Published: January 2024

Pyoderma gangrenosum (PG) is a rare noninfectious autoinflammatory neutrophilic dermatoses occurring in 5%–12% of patients with ulcerative colitis (UC). Clinically, it is classified into ulcerative, pustular, bullous, and vegetative types. A few atypical and rare variants have also been described. The disease is characterized by painful cutaneous ulcers and is often associated with systemic diseases. Inflammatory bowel disease may precede it, follow it or occur simultaneously with PG. In some patients, control of bowel disease also leads to control of PG, but this does not occur in all patients. The mainstay of treatment is long-term immunosuppression with corticosteroids or ciclosporin. Herein, we present a case of PG associated with UC in whom immunosuppressants are contraindicated, was treated successfully with IV immunoglobulins.
Kikuchi–Fujimoto Disease followed by Systemic Lupus Erythematosus in a Male Child: A Diagnostic Challenge
Authors: Kodali Sruthi , Arakkal Geeta Kiran , Kodali Sandeep , Vaishnavi Kolluri Siva Bala
Published: January 2024

Kikuchi–Fujimoto disease (KFD) is a benign self-limiting condition characterized by fever and necrotizing lymphadenitis commonly reported in adults, especially females, and rarely in males and children. The disease can be mistaken for lymphoma or systemic lupus erythematosus (SLE) clinically and histologically. KFD may be associated with SLE. Recurrences of KFD are common and hemophagocytic lymphohistiocytosis is the most common complication. Herein, we report the case of KFD in a 5-year-old boy who presented with fever and cervical lymphadenopathy following which he developed SLE. The diagnosis was confirmed by lymph node biopsy and antinuclear antibodies profile. His condition met 7 out of 17 systemic lupus international collaborating clinics (SLICC) criteria for SLE.
Subretinal hyporeflective globule: A novel OCT finding in central serous chorioretinopathy
Authors: Goel Sugandha , Mishra Samarth , Bhattacharya Sampurna , Majumdar Bristi , Sen Ahana , Mukherjee Riya , Ramandhane Raghul Nandan , Goel Nikita , Saurabh Kumar , Roy Rupak
Published: January 2024

Purpose:

To describe the subretinal hyporeflective globule in cases of central serous chorioretinopathy (CSC).

Methods:

A retrospective analysis of consecutive cases of CSC presenting to a tertiary eye care center in eastern India was conducted. Subretinal hyporeflective globules were identified as small globular lesions below the external limiting membrane/ellipsoid zone, but above the RPE layer. They had a hyperreflective border with a hyporeflective core and a clear posterior tail of hyper-transmission.

Results:

The present study analyzed 137 eyes of 137 patients. Eighty (58.4%) eyes had acute disease at presentation, 48 (35%) eyes had chronic disease, and eight (5.8%) eyes had resolved CSC. Subretinal hyporeflective globules were seen in 27 (21.8%) eyes, of which choroidal caverns were seen in seven (5.1%) eyes. Twenty-five eyes with chronic CSC and only two eyes with acute CSC had subretinal hyporeflective globules. Three eyes with resolved CSC had subretinal hyporeflective globules.

Conclusion:

We describe subretinal hyporeflective globule as a novel optical coherence tomography (OCT) finding in cases of CSC and describe its clinical correlates.
Anterior plaque brachytherapy placement for treatment of iris and iridociliary melanomas – Surgical procedure and institutional experience
Authors: Pike Sarah , Engelhard Stephanie B , Greig Luciano Custo , Woods Kaley , Jennelle Richard L , Berry Jesse L
Published: January 2024

Surgical placement of eye plaque brachytherapy (EPB) is the standard of care for the treatment of uveal melanomas, including iris/iridociliary melanomas. However, unique challenges exist in anterior EPB placement. Here, we describe a surgical technique for anterior EPB placement when placement requires plaque positioning onto the cornea. Blunt conjunctival peritomy exposes the sclera overlying the tumor. A “dummy” plaque is placed, with positioning confirmed by direct visualization. The amniotic membrane is draped across the cornea and anchored with the eyelet sutures, the plaque is placed overlying the membrane, the conjunctiva is closed over the plaque, and a temporary tarsorrhaphy is performed. One week later, the conjunctival incision is reopened for plaque/amniotic membrane removal. This technique was employed in the treatment of 12 iris/iridociliary melanomas at our institution, with no instances of corneal damage. In placing an anterior plaque, employing this technique allows appropriate cancer treatment while optimizing patient comfort and corneal integrity.
A Rare Case of Lyell Syndrome Secondary to Ofloxacin Eye Drops
Authors: Sreedharan Anusree Vellot , Naveen Kikkeri N. , Krishna Sowmyashree , Prabhu Sweta R.
Published: January 2024

Lyell syndrome or toxic epidermal necrolysis (TEN) is a severe mucocutaneous adverse drug reaction characterized by generalized erythema and widespread epidermal necrosis resulting in its detachment. If not appropriately intervened, it may result in sepsis, multiorgan failure, and death. TEN secondary to topical drugs is very rare and only a few cases have been documented so far. Here, we report a case of a 10-year-old child who presented with features of TEN following administration of ofloxacin eye drops, which is commonly prescribed in ophthalmic practice for conjunctival inflammation. She was treated in the pediatric intensive care unit with systemic corticosteroids, cyclosporine, intravenous immunoglobulin, and other supportive therapy including collagen dressing, and showed complete recovery. This case report highlights the need for awareness among physicians regarding serious adverse events caused by topical drugs and a multidisciplinary approach which paves the road for recovery.
A Rare Case of Incontinentia Pigmenti in a Male Child with Dermoscopic and Histopathological Correlation
Authors: Arora Raina , Kaur Karamjot , Chopra Dimple , Goel Seema
Published: January 2024

Incontinentia pigmenti (IP) is a rare X-linked genodermatosis mostly occurring in females with the condition being fatal in males but certain mechanisms may allow survival of male subjects. We report a rare case of IP in a 19-day-old male patient with no history of similar lesions in the family adding to its rarity. The histopathological correlation of the lesions with dermatoscopy showed yellow oil drop-like globular structures correlating with spongiosis in the vesicular stage and verrucous lesions showed brown blotches in a circular pattern with overlying gray-brown dots correlating with hyperkeratosis and dyskeratosis.
A Study of Viral Causes of Fever with Rash in Children
Authors: Yadav Anukriti , Sarkar Rashmi , Mendiratta Vibhu , Jais Manoj , Basu Srikanta , Sonker Sneha
Published: January 2024

Background:

Fever with rash is common among children and is seen by both dermatologists and pediatricians. The various causes of fever with rash in children include viral infections, bacterial infections, rickettsial species, collagen vascular diseases, and drug hypersensitivity rash. Viral exanthems are by far the most common cause of fever with rash in children. Common viral etiologies are measles, rubella, varicella, adenovirus, herpes simplex virus (HSV) 1 and 2, human herpes virus 6, human herpes virus 7, Epstein–Barr virus, coxsackie, dengue, chikungunya, influenza A and B, and hepatitis B.

Aims:

The study aimed to study the magnitude of various viral causes of fever with rash in children and to study the various morphological patterns of rash.

Materials and Methods:

This was a hospital-based observational study which included 90 children presenting to the dermatology and pediatrics outpatient department with fever and rash. Immunoglobulin M antibody testing for measles, rubella, varicella, HSV, chikungunya virus, dengue virus, and hepatitis B virus was done. Reverse transcription-polymerase chain reaction for COVID-19 virus was done when suspected.

Results:

The most common etiology of fever with rash was viral (51.1%). Out of all viruses isolated, measles was the most common (15.55%), followed by Chikungunya (14.44%). Maculopapular rash was the most common morphology of rash (40%) found in patients. Among the patients having maculopapular rash, measles was the most common virus isolated.

Conclusion:

Viral exanthems should be considered a strong differential in all children presenting with fever and rash.
A Study of Sleep Quality and Quality of Life in Children with Atopic Dermatitis between 6 and 12 Years of Age
Authors: Kallan Febin , Pillai Rathish T. , Hijaz P. T. , Simi P. S. , Nair Rakhee V.
Published: January 2024

Introduction:

Atopic dermatitis (AD) is a common, chronic, relapsing dermatitis, affecting mainly children. It is associated with intense pruritus which can disrupt the sleep and quality of life (QOL), thereby impairing the neurocognitive development. An understanding of the link between severity of AD and sleep quality in children may help in better treatment of this condition.

Materials and Methods:

A hospital-based cross-sectional study was conducted to correlate severity of AD with sleep quality and QOL. Sixty-six children with AD were enrolled for the study. In addition to basic demographic details, all patients were analyzed for disease severity using SCORing AD (SCORAD) score. The QOL and sleep quality were evaluated using Children’s Dermatology Life Quality Index (CDLQI) questionnaire and Children’s Sleep Habits Questionnaire (CSHQ), respectively.

Results:

The mean age of the study group was 8.94 ± 1.94 years and mean body mass index was 19.97 ± 2.69 kg/m2. The median SCORAD score was 32 ± 50. Mean CSHQ score was 43.17 ± 7.15, and it showed a positive correlation with SCORAD score (R
2 = 0.655; P = 0.000). Similarly, median score of CDLQI was 14 ± 18, which also showed a positive correlation with SCORAD score (R
2 = 0.822; P = 0.000). All the domains of CDLQI questionnaire were affected by the disease. In the CSHQ questionnaire, all parameters were affected except parasomnias and sleep-disordered breathing.

Conclusion:

The study demonstrated a significant association between severity of AD with sleep quality and QOL. It highlights the need for interventions to diminish sleep problems and to improve QOL in children with AD.
Motivators for the public to receive the seasonal influenza vaccination and the effect of coronavirus disease 2019 pandemic on the uptake of the seasonal influenza vaccination
Authors: AlAmer Naheel A. , Al-Shammari Malak A. , Al-Johani Wejdan M. , Al-Mansour Abdulelah H. , AlShamlan Nouf A. , AlQarni Amani M. , Aldhawyan Adam F. , Alkaltham Shikha M. , Al-Muhaidib Hala R. , Darwish Magdy A.
Published: January 2024

BACKGROUND:

The coverage of the seasonal influenza vaccine has always been sub-par. Understanding the motivators of receiving vaccines, especially during pandemics, could enhance and increase the coverage rates. The Saudi Ministry of Health launched its annual influenza vaccination campaign during the 2021 influenza season and provided vaccinations in primary healthcare settings. This study aims to explore public motivators to receive influenza vaccination, particularly during the coronavirus disease 2019 global pandemic.

MATERIALS AND METHODS:

This cross-sectional study enrolled 783 participants who attended the influenza vaccination campaign. All persons who received the influenza vaccine in the influenza vaccination campaign held in Dammam, Saudi Arabia, from October to November 2021, were interviewed and completed a self-administered questionnaire. Odds ratio with a 95% confidence interval were estimated using the full model fit. The significance level was set as α = 0.05.

RESULTS:

The majority of the participants had more than high school education (81%), were males (66.2%), and married (59.6%), and 50.6% were below 35 years of age. Participants with higher education, health-care workers, and those who had been previously counseled on influenza vaccination were less likely to have started taking the influenza vaccination, whereas smokers and persons who do not have routine checkups were more likely to start influenza vaccination. The main motivator to take the influenza vaccine was the establishment of a vaccination campaign near the participant’s workplace (62.2%), followed by advice from their physician (30.3%), and fear of having influenza disease (29.6%).

CONCLUSION:

Accessibility to the vaccination campaigns was the main motivator for receiving the vaccine followed by the advice from physician. Advice from physician and increasing mobile vaccination campaigns and mobile clinics would substantially increase influenza vaccine uptake.
Prevalence of menstrual irregularities after coronavirus disease 2019 vaccination: A cross-sectional study in the Eastern Province, Saudi Arabia
Authors: Latif Rabia , Aldossary Deena A. , Aljabari Najla A. , Alowaied Saja S. , Aljabari Latifah A. , Albash Noor J. , Alabdulhadi Aseel S. , Rafique Nazish , Al-Asoom Lubna I. , Salem Ayad M.
Published: January 2024

BACKGROUND:

Reports indicate that there are menstrual cycle disturbances following coronavirus disease 2019 (COVID-19) vaccination. The present study explored the prevalence of menstrual irregularities after COVID-19 vaccination and the association of menstrual irregularities with vaccine type, doses, immediate adverse effects, history of COVID-19 infection, and its severity.

MATERIALS AND METHODS:

For this cross-sectional study, 406 women of reproductive age completed an online survey about the postvaccine changes in their menstruation (cycle duration, bleeding days, and bleeding amount), COVID-19 vaccine history (doses, type of vaccine, and immediate adverse effects), history of COVID-19 infection, and its severity. Data was analyzed using SPSS; descriptive statistics were computed and Chi-square test, and binary logistic regression analysis were performed.

RESULTS:

Of the total 406 women, 45% reported postvaccine changes in their menstrual cycle. The most common menstrual change was increased dysmenorrhea (68%), followed by an increase in the length of the cycle (52%). There was a significant association between postvaccine menstrual changes and the age, marital status, and family history of menstrual irregularities. No association was observed between postvaccine menstrual changes and COVID-19 vaccine-and COVID-19 infection-related variables. As per the best-fit model of our predictors, the odds of having postvaccine menstrual changes were 0.41 times less in “single” women (confidence interval [CI] = 0.26–0.27; P < 0.001) and 1.714 times greater in women who had a “family history of menstrual irregularities” (CI = 1.092–2.690; P = 0.02), respectively.

CONCLUSION:

A substantial number of women complained of postvaccine menstrual changes regardless of their age, type of COVID-19 vaccine, doses, immediate adverse effects, and COVID-19 infection history/severity. Being “single” decreased the probability, whereas having a family history of menstrual irregularities increased the probability significantly of having postvaccine menstrual changes.
The prevalence and predictors of diabetes in a private health insurance scheme: An analysis of three million beneficiaries in Saudi Arabia
Authors: Aljehani Nasser , Alghnam Suliman , Alqunaibet Ada , Alwahabi Shehana , Reka Husein , Almohammed Rimah , Almaghrabi Abdullah , Alghamdi Shabab
Published: January 2024

BACKGROUND:

Noncommunicable diseases (NCDs) are a leading threat to population health in Saudi Arabia. Addressing NCDs is a priority for health-care transformation, and understanding the current disease prevalence is crucial. The prevalence in other settings is unknown because studies have relied on data from households or public health-care institutions. This study aims to investigate the prevalence and predictors of diabetes in the privately insured population.

MATERIALS AND METHODS:

This retrospective study explored the prevalence and predictors of diabetes in beneficiaries aged 15 years or older who sought medical care in 2022. Data were sourced from the National Platform for Health and Insurance Exchange Services, a unified health insurance claim platform. We used the International Classification of Disease-10 to capture the condition. To identify predictors of diabetes, we employed a backward selection approach for logistic regression.

RESULTS:

Over 3.3 million beneficiaries sought medical care during the study. The population was relatively young aged 26–39 years, (47.5%) and two-thirds of males. The prevalence of diabetes was 11.0% and varied across regions, with the highest in Bahah (18.4%) and the lowest in Jizan (9.5%). Age, gender, nationality, insurance company size, body mass index, region, hypertension, and coronary heart disease were significant predictors of diabetes. Hypertensive patients were over five times more likely to have diabetes than those without hypertension (odds ratio OR = 5.08; 95% confidence interval CI = 5.02–5.24). Saudis were 30% more likely to have diabetes than other nationalities (OR = 1.3; 95% CI = 1.28–1.31).

CONCLUSION:

We found a higher prevalence of diabetes in privately insured beneficiaries than the recent national estimate. This necessitates population health management strategies at all levels (primary, secondary, and tertiary) to mitigate the burden of diabetes in privately insured individuals. This study provides valuable baseline data for the prevalence of diabetes in this population and emphasizes the urgent need for targeted interventions, especially in regions with a higher prevalence.
Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia
Authors: Al-Awad Feras A. , Almutairi Hussien A. , Almutairi Saad A. , Alessa Othman S. , Alanazi Salman F. , Alzain Nasser M. , Albakr Dalal M. , Alzahrani Safa I.
Published: January 2024

BACKGROUND:

Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring.

MATERIALS AND METHODS:

This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable.

RESULTS:

The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity.

CONCLUSION:

Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices.
Knowledge and practice of preparticipation physical evaluation of Saudi primary care physicians in the Eastern Province of Saudi Arabia
Authors: Bahamdan Ahmed S. , Amghais Sadiq A. , Shafey Marwa M. , Althunyan Abdullatif K.
Published: January 2024

BACKGROUND:

The preparticipation physical evaluation (PPE) monograph is a vital resource for medical providers aimed at ensuring the safety and well-being of athletes during sports participation by screening for injuries and disease risk factors. However, the concept of PPE is relatively new in Saudi Arabia, where primary care physicians (PCPs) often lack the proper training for it. This study’s aim was to assess PCPs’ knowledge and practice of PPE and identify associated factors.

MATERIALS AND METHODS:

A self-administrated web-based questionnaire was distributed to PCPs in the Eastern Province of Saudi Arabia. The questionnaire covered the various aspects of PPE knowledge (including general principles, components, contraindications of sports participation, concerning history and physical findings, electrocardiography interpretations, and ethical considerations) as well as PPE practice. Initial treatment of data included descriptive statistics.; Chi-square tes or Fisher's exact test as, as appropriate, were used to determine association of knowledge and practices with various independent variables.

RESULTS:

Of the 240 contacted PCPs, 192 responded yielding a response rate of 80%; 50.5% had no prior PPE training. About 43% of the PCPs had not encountered PPE during their examination, but the remainder performed monthly PPE. Notably, 82.8% demonstrated a poor level of knowledge regarding PPE and only 43% had a satisfactory level of practice.

CONCLUSION:

This study revealed that a significant proportion of PCPs displayed poor knowledge of PPE and <½ of our sample showed satisfactory practice levels. Recommendations to establish the local guidelines regarding PPE for PCPs to follow should be emphasized and PPE training integrated into both undergraduate and postgraduate family medicine curricula. These measures are crucial for the enhancement of the safety of athletes in Saudi Arabia.
Health coaching for hypertension control in primary care patients with uncontrolled hypertension in Egypt
Authors: Abbas Samar M. , Salama Hend M. , Nour-Eldein Hebatallah , Ahmed Hazem A. Sayed
Published: January 2024

BACKGROUND:

Health coaching effectively improves hypertension self-care activities and the control of blood pressure (BP) in hypertensive patients. Studies on the effects of health coaching on patients in primary care with uncontrolled hypertension in developing countries are limited. In this study, the effectiveness of health coaching on hypertension self-care and BP control was assessed in patients who have uncontrolled hypertension compared to standard care in Egypt.

MATERIALS AND METHODS:

Our quasi-experimental study included control and intervention groups. The intervention group included 70 participants who received health coaching sessions (face-to-face and by telephone) besides the standard care, whereas the control group included 71 participants who only received the standard care. The study was conducted between July 2020 and November 2021. The participants were recruited from three primary healthcare settings in the Port Said Governorate. Personal and medical history, BP measurements, and hypertension self-care activity level effects (H-SCALE) were obtained. Paired-t-test was used to assess the changes in BP measurement, and H-SCALE score before and after receiving the health coaching. McNemar’s test was used to assess changes in controlled BP and optimal hypertension self-care activities between control and health coached groups. Multiple logistic regression analysis assessed the predictors of better BP control.

RESULTS:

Health coaching resulted in more controlled BP (51.4%, P < 0.001) compared to the delivery of only usual care (11.3%, P = 0.008). The intervention showed a significant promotion in hypertension self-care activities, including medication usage (P < 0.001), low-salt diet (P < 0.001), and weight management (P < 0.001). The H-SCALE score mean change was the only predictor for BP control (odds ratio 1.057, P = 0.048) in the intervention group after 6 months.

CONCLUSION:

Intervention including traditional health coaching and phone calls is a beneficial modality for the promotion of hypertension self-care and improvement of BP control in primary care patients with uncontrolled hypertension.
Serotonin syndrome: An often-neglected medical emergency
Authors: Badar Ahmed
Published: January 2024

Optimum serotonin level in the serotonergic synapses of the central nervous system (CNS) is related to mood, behavior, and sleep. Serotonin syndrome (SS) is a rare yet very dangerous adverse effect resulting from increased serotonin in CNS. The diagnosis of SS is based on the presence of clinical symptoms, which can include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, sweating, and diarrhea. SS is invariably caused by inadvertent use of serotonergic medicines. There is an ever-growing list of medicines that are associated with the risk of SS. Some of the common classes of drugs that can contribute to the development of SS include selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, stimulants (e.g., amphetamines and cocaine), lithium, opioids, drugs used for recreational purposes like ecstasy Methylenedioxymethamphetamine (MDMA), and some herbal supplements (e.g., St. John’s Wort). SS can occur when these medications are taken alone or in combination, especially when a new medication is added, or the dose of an existing medication is changed. The management of SS typically involves discontinuing the use of the substance that caused the excess serotonin levels and providing supportive care, such as intravenous fluids and electrolytes. In severe cases, benzodiazepines may be used to control agitation and muscle rigidity, while serotonin antagonists, such as cyproheptadine, may be used to reduce serotonin levels. The literature review points to a general unawareness among physicians about the condition or drugs associated with it. Consequently, this potentially fatal condition is overlooked. There is a need for regular information updates and reminders to all those who prescribe medications to the patients.
Knowledge and barriers to screening for colorectal cancer among individuals aged 40 years or older visiting primary healthcare clinics in Al-Khobar, Eastern Province
Authors: Alabdulkader Assim M. , Mustafa Tajammal , Almutailiq Danah A. , Al-Maghrabi Razan A. , Alzanadi Rabab H. , Almohsen Danyah S. , Alkaltham Nourah K.
Published: January 2024

BACKGROUND:

Colorectal cancer (CRC) ranks third as the most common cancer in the world and the 4th most common cause of deaths from cancer. In Saudi Arabia, CRC is the most common cancer in males and the third most common in females. Early screening reduces the risk of CRC and death. However, there is a lack of awareness of CRC screening in Saudi Arabia. The objective of this study was to determine the knowledge, practices, and barriers to CRC screening using the Health Belief Model (HBM).

MATERIALS AND METHODS:

This study enrolled Saudis aged 40 years or older visiting PHCCs in Al-Khobar. Data were collected using a self-administered questionnaire or a direct interview of the selected participants. Information sought included sociodemographics, past CRC screening, CRC knowledge, and HBM items. Data analysis was done using SPSS; the Chi-squared test and ANOVA were used to determine statistical significance.

RESULTS:

A total of 206 of the individuals approached completed the questionnaire. The average age was 51.1 years, and 51% were males. Only 10% reported that a physician had provided information on CRC prevention or discussed/recommended screening for CRC, and 10% had undergone screening for CRC. Seventy-five percent of respondents had heard of CRC, and 74% said that CRC was preventable. Regarding the HBM, no significant difference in the mean scores for perceived susceptibility, perceived severity, self-efficacy, and benefits of CRC screening was found by age groups. The mean score for perceived severity was higher for females than males. About 60% of participants were extremely likely to have a screening test for CRC done on the day if recommended by the doctor.

CONCLUSION:

The knowledge and awareness of CRC screening of the targeted sample is inadequate. Individuals with higher perceived susceptibility, severity of CRC, and perceived benefit of the screening tests were more willing to undergo the test. The highest perceived barrier was having no symptoms, and the lowest was “getting a stool test is too much of a hassle.” These findings underline the importance of having a national screening program and campaigns to deal with the concerns of people and raise awareness of CRC.
Neuromorphological and Biochemical Effects of Co-exposure to Bisphenol A and Cadmium in Insulin-resistant Rats
Authors: Lawal Abdulwasiu Taiwo , Sharafadeen Ahmed Olamilekan , Akinola Oluwole Busayo
Published: January 2024

Background:

Cadmium (Cd) and bisphenol A (BPA) are known industrial additives and environmental toxicants that have been extensively reported for their various deleterious effects on biological systems, particularly endocrine disruption and neurotoxicity. In high-fat diet-induced insulin-resistant model rats, we studied the neurotoxicity and oxidative stress effects of co-exposure to Cd and BPA.

Aims:

This study aims to look at prefrontal microarchitecture and antioxidant profiles in insulin-resistant rats.

Materials and Methods:

Twenty-five adult Wistar rats were randomly assigned into five groups (A– E; n = 5). With A receiving normal saline; B: 40 mg/kg. bw CdCl2 + high-fat diet (HFD) + Suc; C: 40 mg/kg. bw BPA + HFD + Suc; D: 40 mg/kg. bw BPA + 40 mg/kg. bw CdCl2 + HFD + Suc; and E: HFD + Suc orally for 56 days. Finally, brains were excised from each group and the medial prefrontal cortex was dissected from both hemispheres with right hemisphere samples processed for hematoxylin and eosin histology and left hemisphere samples homogenized for biochemical evaluation of oxidative stress markers. One-way analysis of variance and Tukey’s post hoc test were used for data analysis with P < 0.05 considered statistically significant.

Results:

From our findings, prefrontal glutathione levels were significantly lower (P < 0.05) in the insulin-resistant rats (Cd + BPA + HFD + Suc: 120.9 ± 21.89, HFD + Suc: 93.27 ± 17.29) compared with control rats (244.0 ± 11.57), while prefrontal glutathione reductase activity was significantly elevated (Cd + BPA + HFD + Suc: 41.02 ± 5.5, HFD + Suc: 41.09 ± 1.68, P < 0.05) compared to the control rats (20.17 ± 3.27). Prefrontal neurons showed nuclear condensation, cytoplasmic vacuolations, and clumping of cells.

Conclusion:

Morphological and biochemical evidence from the present study suggests that environmental and metabolic factors do combine to induce profound adverse effects on prefrontal microanatomy and antioxidant system.
Femoral neck system as a safe alternative to cannulated compression screw and dynamic hip screw in femoral neck fractures: an early comparative study
Authors: Lim Zhe Zheng Clyde , Tan Cheryl Marise Peilin , Antony Xavier Rex Premchand , Yam Michael Gui Jie , Chua Ivan Tjun Huat
Published: January 2024

Introduction:

The femoral neck system (FNS) is a safe alternative to cannulated compression screw (CCS) and dynamic hip screw (DHS) in femoral neck fractures.

Methods:

A dual-centre retrospective cohort study was performed on femoral neck fractures (AO type 31-B) treated with closed reduction and internal fixation using FNS, DHS or CCS between April 2016 and April 2020. Exclusion criteria were as follows: patients aged below 16 years; chronic fractures beyond 7 days; pathological fractures; fracture extension to the intertrochanteric region or ipsilateral neck and shaft fractures; and open fractures. A total of 85 patients were identified: FNS (n = 28), DHS (n = 29) and CCS (n = 28).

Results:

The FNS and CCS groups had a lower Garden and Pauwels classification compared to the DHS group (both P < 0.001). Both FNS and CCS groups were comparable in postoperative orthopaedic complications (10.7% [n = 3] vs. 3.6% [n = 1], adjusted P = 0.321). The DHS group had more postoperative orthopaedic complications than the FNS group, but this was not statistically significant (27.6% [n = 8] vs. 10.7% [n = 3], adjusted P = 0.321). There were no significant differences in median time to radiological union or median femoral neck shortening at union (both P > 0.05) among the three groups.

Conclusion:

The new DePuy Synthes FNS is a safe alternative to CCS with comparable complication rates for femoral neck fractures that are less displaced and more stable. The FNS also appears to be a safe alternative to DHS in the fixation of femoral neck fractures for the few cases of high-energy femoral neck fractures.
Safety and efficacy of dupilumab in adult atopic dermatitis in Singapore
Authors: Yew Yik Weng , Zhao Xiahong , Yong Adeline Mei Yan
Published: January 2024

Introduction:

Dupilumab, a biologic approved for treatment of moderate-to-severe atopic dermatitis (AD), has been reported to be largely effective with minimal adverse effects. However, being a targeted therapy, its effectiveness and side effects are expected to be varied in a heterogeneous ethnic population. Currently, the majority of studies on dupilumab are based on Western populations.

Methods:

A retrospective cohort of 51 patients with moderate-to-severe AD treated with dupilumab at a tertiary skin institute from January 2018 to February 2020 was included. Outcome measures such as Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Quality of Life Index (DLQI) were analysed at baseline and after 16 weeks of treatment. Laboratory tests at the respective time points were also measured.

Results:

Patients treated with dupilumab showed consistent reduction in body surface area (BSA) involved, SCORAD, EASI and DLQI scores. Concurrently, serum immunoglobulin E (IgE) and absolute eosinophil count showed a downward trend at 4 months of treatment. There was a transient increase in mean serum IgE at 1 month of dupilumab treatment. Also, 42.0% and 35.3% of patients developed eye symptoms, and head and neck dermatitis, respectively, but there were no major adverse events reported. Childhood-onset AD was more likely to have improved BSA scores compared to adult-onset AD.

Conclusions:

Our study confirms the efficacy of dupilumab with real-world data in an adult Asian population. Higher proportions of eye symptoms, and head and neck dermatitis were observed in our cohort compared to other Asian clinical cohort studies. Further studies are needed to evaluate these differences.