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   Table of Contents - Current issue
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January-April 2020
Volume 27 | Issue 1
Page Nos. 1-71

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REVIEW ARTICLE  

Healthy nutrition for a healthy child: A review on infant feeding in India p. 1
Vinoth G Chellaiyan, Fasna Liaquathali, Jasmine Marudupandiyan
DOI:10.4103/jfcm.JFCM_5_19  PMID:32030072
Appropriate infant feeding is crucial for the improvement of child survival worldwide. This review aimed to explore the recommended practices, advantages of breastfeeding, and age-appropriate complementary feeding practices. Colostrum, which serves as the first immunization for the newborn, is largely ignored owing to the various myths surrounding it in developing countries. The World Health Organization recommends an early initiation of breastfeeding within one hour of birth and exclusive breastfeeding for 6 months to combat killer diseases such as diarrheal diseases, pneumonia, and obesity. On the other hand, complementary feeding is recommended with increase in the diversity, quantity, consistency and frequency as the child gets older along with continued breastfeeding for 12 months. Inappropriate complementary feeding is one of the major causes of malnutrition in children under the age of 5 years. Hence, appropriate guidance should be given to caregivers and health-care workers to help them promote the healthy growth of infants and young children.
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ORIGINAL ARTICLES Top

Association between type 2 diabetes mellitus and Helicobacter pylori infection among Saudi patients attending National Guard Primary Health Care Centers in the Western Region, 2018 p. 8
Abdullah M Alzahrani, Areej A Al Zaidi, Shahad M Alzahrani, Sultana A Binmahfouz, Fayssal M Farahat
DOI:10.4103/jfcm.JFCM_142_19  PMID:32030073
BACKGROUND: Reports on Helicobacter pylori infection in diabetics are inconsistent and contradictory. This study attempted to identify the possible association between type 2 diabetes and H. pylori infection. MATERIALS AND METHODS: Following a cross-sectional design, participants were recruited from four National Guard Primary Health Care Centers in Jeddah City, Saudi Arabia. The study was conducted from December 2017 to November 2018. All participants underwent hemoglobin A1C (HbA1c) assessment and stool antigen test for H. pylori. RESULTS: A total of 212 type 2 diabetic patients aged 40 years or more, and 209 age-matched nondiabetic subjects were included in the study. About one-quarter of the diabetics and nondiabetics were positive for H. pylori (26.9% and 26.3%, respectively). There was no significant difference. The prevalence of H. pylori did not differ significantly in the type 2 diabetics, with regard to their age groups, gender, smoking status, body mass index, chronic diseases, their HbA1c level, duration of diabetes, or received type of therapy. The prevalence of H. pylori was significantly higher in overweight and obese nondiabetic subjects (P = 0.013). Obese participants in both groups had the highest prevalence of infection (57.9% and 54.5%, respectively, P = 0.038). CONCLUSION: About one-quarter of type 2 diabetics and nondiabetics in Jeddah City have H. pylori infection. There is no association between diabetes and H. pylori infection. H. pylori was significantly higher in patients with a high body mass index.
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Effect of autism on parental quality of life in Arar city, Saudi Arabia p. 15
Dalal S Alenazi, Sabry M Hammad, Amal E Mohamed
DOI:10.4103/jfcm.JFCM_157_19  PMID:32030074
BACKGROUND: The quality of life (QOL) of the families of children with autism is lower than that of families of normal children or children with other disabilities. The study's aim was to describe the severity of effect on the domains of the QOL of caregivers of autistic children and to identify the characteristics of caregivers and children associated with impaired QOL. MATERIALS AND METHODS: This cross-sectional study included 84 parents of autistic children attending developmental abnormalities clinic in Arar city during January 1 to March 31, 2019. Parents of autistic children were interviewed using an Arabic version of the short-form 36 to assess their QOL. A mean score of <50 was considered to indicate poor QOL. Collected data were analyzed using the Statistical Package for the Social Sciences (SPSS, version 20.0). A Chi-square test was used for comparison between categorical variables. RESULTS: Of 84 caregivers, 63.1% had impaired QOL. The main domains affected were energy/fatigue and role limitations resulting from emotional problems. Female gender, unemployment, and low income of caregivers were significant factors associated with poor QOL. Autistic children of the first birth order and with long duration of the disease were more likely to be associated with poor parental QOL. Gender, income, occupation, and duration of illness were associated with poor quality of life, but this was not statstically significant. CONCLUSION: Slightly less than two-thirds of the caregivers had impaired QOL. Caregivers of autistic children need social and emotional support to help them to cope with this disability.
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The relationship between sleep quality, stress, and academic performance among medical students p. 23
Abdullah D Alotaibi, Faris M Alosaimi, Abdullah A Alajlan, Khalid A Bin Abdulrahman
DOI:10.4103/jfcm.JFCM_132_19  PMID:32030075
BACKGROUND: Sleep is essential for the body, mind, memory, and learning. However, the relationship between sleep quality, stress, and academic performance has not been sufficiently addressed in the literature. The aim of this study was to assess the quality of sleep and psychological stress among medical students and investigate the relationship between sleep quality, stress, and academic performance. MATERIALS AND METHODS: This cross-sectional study targeted all medical students in their preclinical years at a Saudi medical college in 2019. All students were asked to complete an electronic self-administered questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), the Kessler Psychological Distress Scale (K10), questions on the students' current overall grade point average, and other demographic and lifestyle factors. The associations between categorical variables were analyzed using Pearson's Chi-squared test at 0.05 significance level. RESULTS: The mean PSQI score was 8.13 ± 3.46; 77% of the participants reported poor quality of sleep and 63.5% reported some level of psychological stress (mean K10 score: 23.72 ± 8.55). Poor quality of sleep was significantly associated with elevated mental stress levels (P < 0.001) and daytime naps (P = 0.035). Stepwise logistic regression model showed that stress and daytime nap were associated with poor sleep quality. Whereas, poor sleep or stress did not show any significant association with academic performance. CONCLUSION: Poor sleep quality was significantly associated with elevated levels of strees. However, they did not show any statistically significant relationship with academic performance.
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The status of zinc in type 2 diabetic patients and its association with glycemic control p. 29
Dhedhi M Farooq, Ali F Alamri, Basmah K Alwhahabi, Ashraf M Metwally, Khalid A Kareem
DOI:10.4103/jfcm.JFCM_113_19  PMID:32030076
BACKGROUND: Zinc (Zn) is a trace element that carries antioxidant properties. Deficiency of Zn increases oxidative stress, especially in diabetes. The objective of this study was to assess the relationship between the level of Zn and glycemic control in type 2 diabetes. MATERIALS AND METHODS: A cross-sectional study was carried out in the Department of Medicine at King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia, from March 2018 to September 2018. A total of 440 participants were included in the study; 252 of these had type 2 diabetes and 188 were controls. All participants had laboratory investigations including fasting blood sugar (FBS), glycosylated hemoglobin, and lipid profile and Zn levels. These two groups (diabetics and controls) were further divided into Zn deficient group and normal Zn group according to their Zn levels. Data were analyzed by using SPSS software. RESULTS: The mean Zn level was 11.7 + 1.5 in the control group, whereas it was significantly low (9.3 + 1.6) in the diabetic group (P = 0.001). Zn deficiency in the control group was only 6.4%, while in the diabetic group, it was 67.9%, (P ≤ 0.001). The mean ages for the low Zn group and normal Zn group were 40.9 + 12.5 and 37.5 + 10.1, respectively, and the Zn deficient group was higher in age (P < 0.003). There was no significant statistical difference between genders regarding Zn deficiency. Obesity was associated with significantly low Zn levels (P = 0.016). The serum Zn level was significantly negatively associated with FBS and glycated hemoglobin in diabetic participants (P < 0.001). CONCLUSION: Diabetic patients have Zn deficiency compared to normal individuals and poor glycemic control is associated with low Zn levels.
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Quality of life of migraine patients followed in neurology clinics in Riyadh, Saudi Arabia p. 37
Fatima G AlHarbi, Mohammed A AlAteeq
DOI:10.4103/jfcm.JFCM_185_19  PMID:32030077
BACKGROUND: Migraine is a chronic disorder that negatively affects a patient's quality of life (QOL). As little is known about the QOL of migraine sufferers in Saudi Arabia, our aim was to investigate the QOL and the level of migraine-associated disability of migraine patients. MATERIALS AND METHODS: This cross-sectional study was conducted in neurology clinics at King Abdulaziz Medical City for National Guard and Prince Sultan Military Medical City in Riyadh, Saudi Arabia, from August to December 2018. The migraine-specific QOL questionnaire (MSQ), version 2.1, was used to measure restrictive, preventive, and emotional domains. The sum of the item responses ranged between 0 and 100, with higher scores indicating better QOL. A descriptive analysis of numerical variables was reported in terms of means and standard deviation, while categorical variables were described using frequencies and percentages. RESULTS: A total of 300 migraine patients completed the questionnaire; 67% were females. Age of participants ranged from 20 to 53 years, with mean age of 34.21 (SD=7.26). The mean score in the QOL restrictive domain was 51.8 ± 19, whereas the mean scores for preventive and emotional domains were 54 ± 18 and 46.3 ± 23.4, respectively. Low QOL scores were associated with young ages, long disease duration, frequent migraine attacks, and presence of chronic diseases. CONCLUSION: Chronic migraine has a negative impact on QOL, predominantly in young patients, patients with frequent attacks, those not using preventive medications, and those suffering from chronic diseases.
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Saudi mothers' perception of their children with attention-deficit hyperactivity disorder in Dammam, Al-Qatif, and Al-Khobar cities, Saudi Arabia p. 46
Zainab J Al-Mohsin, Heba A Al-Saffar, Shaher Z Al-Shehri, Marwa M Shafey
DOI:10.4103/jfcm.JFCM_149_19  PMID:32030078
BACKGROUND: Mothers' perceptions about attention-deficit hyperactivity disorder (ADHD) are central to the management of the disorder. The aim of the study was to assess the knowledge, experiences, and attitudes of mothers with ADHD children toward ADHD and identify their common sources of information and service barriers from the perspectives of these mothers in the Dammam, AI-Khobar, and Al-Qatif areas. MATERIALS AND METHODS: This cross-sectional study comprised mothers of 132 children with ADHD who attended private and government sector special education schools and day-care centers in the Al-Khobar, Dammam, and Al-Qatif cities of Saudi Arabia. All the mothers completed self-administered structured questionnaires. RESULTS: About 47% mothers of children with ADHD had poor knowledge of ADHD, 74.2% had a positive attitude toward the condition, and 51.5% had a neutral perception of their children. Most of the children received combined therapy, with 69.5% exhibiting improved behavior. The most common concern of mothers was fear of the side effects of medication (39.4%). The mothers were the first family members to seek advice; the most common reason for first visit to clinic were poor social skills (45.5%), and attention hyperactive aggressive behavior (45.5%). The most common reason for the delay in diagnosis was failure to recognize the child's aberrant behavior (67.4%), whereas the most common source of information was internet (63.6%). CONCLUSION: It is important for clinicians to address the mothers' perceptions of ADHD as part of the treatment for ADHD to improve the children's quality of life. It is also important to develop educational materials and awareness campaigns that target mothers and facilitate good communication between the services through the social media.
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Anxiety and depression and their relation to the use of electronic devices among secondary school students in Al-Khobar, Saudi Arabia, 2018–2019 p. 53
Zaenb H Al Salman, Fatimah A Al Debel, Fatimah M Al Zakaria, Marwa M Shafey, Magdy A Darwish
DOI:10.4103/jfcm.JFCM_140_19  PMID:32030079
BACKGROUND: Adolescence is a critical transitional period for the development of mental illnesses such as depression or anxiety, and these days, adolescents spend less time playing outside than they do using electronic devices. The aim of this study was to examine the relationship between the use of electronic devices and anxiety and depression in female secondary school students in Al-Khobar City, KSA. MATERIALS AND METHODS: This cross-sectional study included 903 female students selected from the four educational districs (Al-Khobar, Al-Thuqbah, Al-Dhahran and Al-Rakah). Data was collected using a self-administered anonymous questionnaire that included questions related sociodemographics and the use of electronic devices, the Beck Depression Inventory, and the Generalized Anxiety Disorder 7-item scale. Data analysis included descriptive statistics frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Chi-square test was performed to test for significance for association between categorical variable. Odds ratios were calculated for association of anxiety and depression with various independent variables including the use of electronic devices. A binary logistic regression model was used to determine factors associated with anxiety and depression. All test were performed at 5% significance level. RESULTS: The mean age of the participants was 16.29 years (SD=0.84). About 98% reported using electronic devices; 67.3% used electronic devices 2 or more hours daily, and 81.5% used them at bedtime. About 66% students had moderate-to-severe anxiey and 70/5% had mild-to-severe depression. The logistic regression model showed that users of electronic devices at bedtime were 1.524 more likely to have anxiety (P=0.026), while spending more than 2 hours on the devices at bedtime were significantly associated with depression. CONCLUSION: The high prevalence of anxiety and depression among female students is worrisome. Finding suggests that adolescents might benefit from a restricted use of electronic devices. It is necessary to develop age-specific guidelines regarding duration of the use of electronic devices and to integrate the development of psychosocial skills into the school curriculum.
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SHORT COMMUNICATION Top

Evaluation of health-care providers' knowledge in the science of aerosol drug delivery: Educational sessions are necessary p. 62
Hajed M Al-Otaibi
DOI:10.4103/jfcm.JFCM_138_19  PMID:32030080
BACKGROUND: Aerosolized drugs are widely used to treat and control a variety of pulmonary diseases. However, there is increasing evidence that patients are unable to use their drug delivery device correctly. The failure of aerosolized treatment is usually the result of poorly communicated instructions. The aim of this investigation was to evaluate the knowledge of health-care providers in the science of aerosol drug delivery (ADD) and assess the impact of further education on their knowledge. MATERIALS AND METHODS: One hundred and seventeen health-care providers attended a 4-hour educational course on ADD science. The course was conducted from June to August 2018 in Jeddah, Riyadh, and Dammam. Pre-course assessment done with a 12-item multiple-choice questionnaire. Post-course assessment was conducted after the end of course in which participants were asked to rate their knowledge of ADD on a scale of 1–10 (before and after the course). RESULTS: Sixty-six health-care providers (physicians, pharmacists, respiratory therapists, and health educators) completed the course. The participants' clinical experience, on average (±standard deviation), was 7.6 ± 7.3 years. Clinical experience favored physicians over other groups. The precourse score for all participants was 3.2 ± 1.9 out of 12 and the postcourse score was 6.97 ± 2.7. There was a significant statistical difference between pre- and postcourse assessment scores (P < 0.05). Differences between the four specialties were insignificant (P = 0.216), without a correlation between clinical experience and preassessment scores (P = 0.202). CONCLUSION: The present data indicate that health-care providers' knowledge of ADD is completely inadequate. There is an urgent need to introduce an ADD educational package in the curricula. An annual competency-based evaluation for health-care providers is critical as well.
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CASE REPORT Top

Cardiac arrest and stroke due to unsupervised use of herbal preparation p. 67
Malak A Alshammari, Ali Hassan, Amna S Alsaihati, Faisal H Aldera, Haitham S Alaithan
DOI:10.4103/jfcm.JFCM_83_19  PMID:32030081
Despite the widespread use of herbal preparations and ongoing studies on their therapeutic potential, there are no safety standards on their usage. We report a case of a 36-year-old male patient who presented with severe muscle weakness and generalized fatigue. He had no significant medical history. Initial laboratory investigations revealed hypokalemia, hypomagnesemia, and hypophosphatemia. His condition suddenly deteriorated, and he went into cardiac arrest. He was resuscitated in accordance with advanced life support guidelines. On recovery, he had left-sided weakness and dysarthria. He underwent head computed tomography, which revealed an acute infarct in the right middle cerebral artery territory. We determined that he had developed electrolyte deficiency as a result of a recent intake of a mixture of herbs consisting of khella, barley, and frankincense for kidney stones.
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LETTER TO EDITOR Top

Rivaroxaban treatment failure: Adding a new case to the list p. 70
Fahmi Y Khan
DOI:10.4103/jfcm.JFCM_285_19  PMID:32030082
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010