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   Table of Contents - Current issue
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May-August 2020
Volume 27 | Issue 2
Page Nos. 85-153

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REVIEW ARTICLE  

What family physicians should know about interventional radiology? p. 85
Bander F Aldhafery
DOI:10.4103/jfcm.JFCM_290_19  
Interventional radiology (IR) is a rapidly evolving specialty. The minimally invasive nature of the procedures has led to a paradigm shift in treating many disease processes from conventional surgery to interventional techniques that have become the first choice and the preferred method for the treatment of peripheral vascular disease, many aortic pathologies, and venous diseases. Interventional oncology procedures have become widely available for the treatment of solid hepatic and renal tumors. This includes palliative techniques for many advanced malignancies, and fluid drainage that is exclusively performed by interventional radiologists in many hospitals all around the world. Women's health-related procedures such as uterine fibroid embolization, fallopian tube recanalization, and embolization for pelvic congestion syndrome have become attractive choices for many patients. Family physicians (FPs) are the main source of patient referral to hospitals. However, there is a notable knowledge deficiency of IR among FPs in Saudi Arabia. This may be due to poor communication between FP and IR or the lack of FP's awareness of IR procedures. This is a nonsystematic review to introduce some IR procedures to FPs pertinent to their practice to optimize patient referral and management with the use of IR services. We focused on the most commonly performed IR procedures paying special attention to their clinical indications, benefits, and alternatives.
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ORIGINAL ARTICLES Top

Diabetes in tuberculosis patients: An emerging public health concern and the determinants and impact on treatment outcome p. 91
Sembagamuthu Sembiah, Vivek Nagar, Devendra Gour, Dinesh K Pal, Arun Mitra, Jayeeta Burman
DOI:10.4103/jfcm.JFCM_296_19  
BACKGROUND: Tuberculosis (TB) and diabetes mellitus are still of much public health concern. Screening of TB patients for diabetes will ensure early case detection, better management of diabetes, and better TB treatment outcome. The objective of this study was to determine the prevalence and associated factors of diabetes in TB patients and their impact on treatment outcome of TB. MATERIALS AND METHODS: This was a longitudinal follow-up study of registered TB patients under the Revised National Tuberculosis Control Program in all five TB units of Bhopal district. Participants were contacted and the interview was conducted. The blood sugar of all TB patients was checked, and they were followed up to assess the treatment outcome from October 2014 to September 2017. Data were analyzed using SPSS (version 16.0. Chicago, SPSS Inc.). Logistic regression was done to find the factors for diabetes in TB patients. The Chi-square tests were used to find the difference in treatment outcomes and assess the relative risk for poor outcome in diabetic TB patients. RESULTS: Of total 662 TB patients, 82 (12.39%) were diagnosed as diabetic. Age >50 years, males, higher body mass index, pulmonary TB, patients on Category II treatment, and history of smoking were found to be predictors of diabetes in TB patients. The treatment outcome of TB was more unfavorable (defaulter, failure, and death) in diabetic TB patients (16.17%) than in nondiabetic TB patients (5.8%) (risk ratio = 2.78, 1.469–5.284 confidence interval). CONCLUSION: The high prevalence of diabetes and the unfavorable treatment outcome in diabetic TB patients make screening and management of diabetes at an early-stage crucial for a better outcome in TB patients.
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The quality of sleep and daytime sleepiness and their association with academic achievement of medical students in the eastern province of Saudi Arabia p. 97
Malak A Al Shammari, Naheel A Al Amer, Sharifah N Al Mulhim, Hussain N Al Mohammedsaleh, Reem S AlOmar
DOI:10.4103/jfcm.JFCM_160_19  
BACKGROUND: Sleep is often challenging for medical students because of the considerable amount of learning they have to do. The aim of this study was to identify the patterns of sleep quality and daytime sleepiness among medical students in Saudi Arabia and to identify the possible factors associated with poor quality of sleep and daytime sleepiness. MATERIALS AND METHODS: This cross-sectional questionnaire-based study was conducted at College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia. The questionnaire included the prevalidated Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality and the Epworth Sleepiness Scale (ESS) to measure daytime sleepiness. Covariates included sociodemographic characteristics and academic performance. Bivariate and multivariate logistic regression analyses were used to obtain adjusted and unadjusted odds ratios (ORs). RESULTS: The sampled population comprised 36.7% males and 63.30% females. The mean global PSQI score was (standard deviation (SD)=4.66), while the mean global ESS score was 8.03 (SD=4.66). Further analysis showed that 80.60% had poor sleep quality and 37.80% of the students suffered from excessive daytime sleepiness. Multivariate regression showed that poor sleep quality was significantly associated with poor academic achievement (adjusted OR = 3.33, 95% confidence interval [CI] = 1.28–8.63). Furthermore, excessive sleepiness significantly increased the odds of poor academic performance (adjusted OR = 4.58, 95% CI = 1.09–20.81). CONCLUSIONS: The results on daytime sleepiness were found to be within the ranges reported worldwide; poor sleep quality was found to be among the highest ever reported. Both sleep quality and daytime sleepiness significantly affect academic achievement.
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Prevalence and risk factors for nonalcoholic fatty liver disease in obese children in rural Punjab, India p. 103
Nishu Gupta, Gunjan Jindal, Anuradha Nadda, Saloni Bansal, Shailesh Gahukar, Ashok Kumar
DOI:10.4103/jfcm.JFCM_287_19  
BACKGROUND: Pediatric nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, hypertension, metabolic syndrome, cardiovascular problems, and increased risk of chronic liver disease and Type II diabetes mellitus. The aim of the study was to assess the metabolic profiles and associated risk factors of NAFLD in obese children. MATERIALS AND METHODS: Children with a body mass index (BMI) of >27 kg/m2 an adult equivalent cutoff (Indian Academy of Paediatrics, 2015 guidelines) aged 5–18 years presenting to the pediatric outpatient unit of PGIMER Satellite Centre, Sangrur, India, were retrospectively recruited over a 1-year period. Anthropometry, lipid profile, thyroid levels, liver function test, fasting blood sugar, and blood pressure were measured. Ultrasonography was used to diagnose NAFLD. Logistic regression was used to assess the risk factors. RESULTS: A total of 100 children participated in the study. The mean age was 10.6 ± 2.6 years and the mean BMI-Z score was 2.6 ± 0.5. The prevalence of NAFLD was 62%. Alanine transaminase (ALT) was significantly elevated in all the children with NAFLD. Lipid levels and BMI Z-score were similar in both groups. Unadjusted odds ratio shows statistically significant association of ALT (2.058 [1.11–1.01]) and waist circumference (1.089 [1.19–0.99]) with NAFLD. With adjusted odds ratio only, ALT (1.12 [1.24–1.01]) was found to be significantly associated with NAFLD. CONCLUSION: There is quite a high prevalence of nonalcoholic fatty liver in obese Indian children. All children with raised liver enzymes should undergo sonography to rule out NAFLD.
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Cherry angioma: A case–control study p. 109
Ramah I Nazer, Rahaf H Bashihab, Wedad H Al-Madani, Aamir A Omair, Mohammed I AlJasser
DOI:10.4103/jfcm.JFCM_293_19  
BACKGROUND: Cherry angiomas (CAs) are very common asymptomatic vascular skin lesions. There are only a few studies on CAs in the literature and those assessing risk factors of CAs are scarce. The aim of our study was to determine risk factors for the development of CAs. MATERIALS AND METHODS: A case–control study was conducted at a tertiary care center in Riyadh, Saudi Arabia. Patients underwent a full-body examination for CAs. Demographics and other data including medical history and medications were extracted from electronic medical records. RESULTS: A total of three hundred patients were enrolled: one hundred cases with at least five CAs and two hundred controls without CAs. Bivariate analysis identified benign prostatic hyperplasia (odds ratio [OR]: = 2.591), malignancy (OR = 2.567), tamsulosin (OR = 3.171), and clopidogrel (OR = 0.321) as statistically significant associations. After multivariate logistic regression analysis, only tamsulosin (OR = 3.475, P = 0.009) and clopidogrel (OR = 0.281, P = 0.028) were found to be independent risk factors for CAs. Malignancies tended to be more associated with CAs, but this did not reach statistical significance (P = 0.07). CONCLUSION: Tamsulosin is a possible risk factor for the development of CAs. Clopidogrel seems to have a protective role preventing the development of CAs.
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Epidemiological characteristics of fall injuries and their related outcome in Riyadh, Saudi Arabia: A descriptive study from a Level-I trauma center p. 114
Suliman Alghnam, Alaa S Alsayyari, Jawaher A Towhari, Rawabi M Alsayer, Maha Y Almohaimeed, Mohammed H Aldebasi, Ibrahim T Albabtin
DOI:10.4103/jfcm.JFCM_245_19  
BACKGROUND: Falls are the leading cause of admissions for trauma emergency in Saudi Arabia. However, the scarcity of evidence of what the burden of falls is locally limits the understanding of the underlying risk factors and hinders planning of effective prevention. The objective of this study was to describe patients' characteristics and health outcomes after hospital admissions as a result of a fall injury. MATERIALS AND METHODS: A retrospective analysis was conducted using a trauma registry from a level-I trauma center in Riyadh. All patients admitted as a result of a fall between 2001 and 2018 were included (n = 4825). Variables included were demographics, mechanism of fall, length of hospital stay, surgery, intensive care unit admission, intubation rate, and severity of the injury. For continuous variables, means and standard deviations were calculated, whereas, frequencies and proportions were used to describe categorical variables. Chi-squared tests were used to compare variables across age groups, and F test was used to compare the means of continuous variables. RESULTS: Majority of the patients (63.6%) were male and about 39% of the sample were children. The most common mechanism of falls was standing (52.6%) followed by slipping (23.0%). Overall, limb fractures were the most common injury (73.3%). While upper limb fractures were more common in children (44.5%; P < 0.01), lower limb fractures were more prevalent among the older patients (70.2%; P < 0.01). Fall injuries in the elderly were significantly associated with higher mortality (3.5%; P < 0.01). CONCLUSION: This study highlights the significant burden fall injuries impose on population health. Prevention programs may use these findings to guide and tailor interventions for specific age groups. Furthermore, this study underlines the need for a national recording system for injuries to guide policymakers in evidence-based decisions.
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Complementary and alternative medicine practice and perceptions of attendees of primary care centers in Eastern Saudi Arabia p. 120
Shaher D AlShehri, Reemaz M AbdulHameed, Atteha Z Taha, Ahmed M Almusalmi, Mohammed S Almulaify, Fatimah L Alkhabbaz
DOI:10.4103/jfcm.JFCM_218_19  
BACKGROUND: Complementary and alternative medicine (CAM) refers to the use of nonconventional medical practices together with standard medical care. Specific forms of CAM included in this study are the use of honey, dry and wet Hijama, Quran, Zamzam water, Nigella sativa (black seed), and others. The objective was to determine the prevalence of the use of different CAM modalities by the attendees of primary health-care centers (PHCCs) and assess the reasons behind their use. MATERIALS AND METHODS: A cross-sectional study was conducted at PHCCs in the cities of Dammam and Al Khobar, over a period of 12 months. The study population was patients and their accompanying relatives attending the PHCCs, aged 18 years and above. Data were collected using a self-administered questionnaire in Arabic designed by the investigators after a review of the literature on the use of CAM. Questionnaire was modified after pilot testing among 200 medical students, and was validated by two expert consultants of the family and community medicine department at the university. The questionnaire was administered and supervised by the 3rd and 4th year medical students. Data were entered and analyzed using the SPSS version 16 (SPSS Inc., Chicago, IL, USA) statistical software. Descriptive statistics were computed, and odds ratios were calculated for associations between CAM use and various independent factors. Logistic regression analysis was used to determine the factors which predict the use of CAM by attendees. All the analyses were performed at α =0.05. RESULTS: The total number of attendees interviewed was 2114; 52.5% of whom reported using CAM. The types of CAM varied in their popularity of use, the majority of users favoring honey and Quran, 24.6% and 20.5%, respectively. Recommendations by relatives and friends were reported as the most common reason in this sample for using CAM (56.1%). Age, awareness of CAM, perceptions that use of CAM is better, use of CAM helps, herbs had no side effects, CAM was easy to obtain, and the attendee currently suffers from a disease were significantly associated with higher CAM use. CONCLUSION: More than 50% of the participants reported using CAM; honey and Quran were the most widely used modalities. For people to make informed decisions on the use of complementary medicine, physicians should impress on their patients to inform their doctors of their use of complementary medicine modalities so that encouragement could be given where appropriate.
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Prevalence of sleep deprivation and its effect on the performance of family medicine residents in Riyadh, Saudi Arabia p. 125
Mohammed A Alrishan, Sulaiman A Alshammari
DOI:10.4103/jfcm.JFCM_9_20  
BACKGROUND: A good night sleep is essential for good health since it supports proper brain functions and its ability to make decisions and to learn and remember new information. The objectives of this study were to assess the prevalence of sleep deprivation (SD) and its effects on the performance of family medicine residents in Riyadh. MATERIALS AND METHODS: A cross-sectional study design was based on an informative-validated self-assessment questionnaire, especially designed by the Medical Council of Canada, to assess the performance of family medicine physicians. Ethical approval was obtained from the institutional review board. Data was analysed using SPSS; initial analysis included computating frequencies and percentages. Odds ratios were calculated for association between. RESULTS: Of the total 258 respondents, 32% had low performance, and 41.5% of the sample suffered from SD, with a male/female ratio of 1:1. There were no significant differences between residency level (R1, R2, R3, and R4) and the average number of sleeping hours. However, 45.5% of R1, 47.8% of R2, 32.4% of R3, and 41.5% of R4 suffered from SD. The data showed a significant difference between the performance and the average number of hours of sleep of the respondents on a typical day. SD was associated with the low performance of 48.6% of subjects compared to 18.3% in those who slept for 7–9 h (aOR=3.96). CONCLUSION: SD negatively affects the performance of family medicine residents. There was no statistically significant difference between males and females in performance. The center for residents' training should consider adequate sleep as essential for the promotion of health and performance.
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Effect of modified physiology laboratory sessions on the awareness and knowledge of obesity of health-related university students p. 131
Talay Yar, Basil A Alshaikh, Nazish Rafique, Ahmed A Alsunni
DOI:10.4103/jfcm.JFCM_301_19  
BACKGROUND: Obesity is a global health problem of immense magnitude. Increased awareness and knowledge about obesity in health-care providers are essential to addressing this global issue. The aim of the present study was to assess the baseline knowledge on obesity of university students in health-related programs and evaluate the effectiveness of modified physiology laboratory (MPL) sessions in enhancing the awareness of obesity of these students by repeated exposure to physiological differences between normal weight (NW) and overweight or obese (OW/OB) individuals. MATERIALS AND METHODS: It was a quasi-experimental study in which three regular physiology laboratory exercises were modified (MPL) to address different aspects of obesity. A total of 319 students (181 male and 138 female) from health-related colleges taking the physiology course during academic session 2011–2012 were included in the study. A questionnaire on obesity served as a measure of prior knowledge and improvement of evolution of student knowledge. The questionnaire was administered thrice: Beginning of the first MPL session (pretest), at the end of the second session of the first MPL (posttest-1), and the end of second session of the final MPL (posttest-2). Correct knowledge (CK), perceived knowledge (PK), and accuracy of knowledge (KA) were evaluated. Students gathered and analyzed physiological data in these sessions to explore the differences between NW and OW/OB subjects. RESULTS: The students' level of PK on obesity was high, but KA was low in pretest. The three knowledge indices improved significantly (P <0.001) from pretest (PK = 77.2%; KA = 52.8%; CK = 40.5%) to posttest 1 (PK = 93.5%; KA = 70.1%; CK = 65.9%). However, from posttest 1 to posttest 2, only small but significant increments were observed in CK (10.5%) and KA (8.7%). CONCLUSION: The awareness and knowledge on obesity of health-related undergraduate university students at baseline were low, but significantly improved after MPLs. The students' knowledge did not only increase but also improved in accuracy. This increase in awareness and knowledge of obesity is expected to directly impact on the students' lifestyles and boost their confidence to counsel others on obesity.
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CASE REPORT Top

Cyst of Montgomery: An uncommon adolescent breast lump p. 138
Afnan F Almuhanna, Asma F Almuhanna, Reem S Alzuabi, Reem A Alshamlan, Fatimah H Almarhoon
DOI:10.4103/jfcm.JFCM_288_19  
Reports of the incidence of the cyst of Montgomery, a rare condition of the breast, affecting mainly adolescent female, are scarce in the literature. This cyst develops from an obstruction of the small papular projections at the edge of the areola called Montgomery tubercles. It could be a simple asymptomatic mass or an inflamed symptomatic mass. We report two cases encountered this year. The first case was a 15-year-old female who complained of bilateral breast pain and a right breast mass. Laboratory tests were unremarkable. A diagnosis of noninflamed Montgomery cyst based on clinical and sonographic examination was made. An antibiotic was recommended. The second case was a 13-year-old female who complained of pain and swelling with redness in the right breast. Laboratory tests were unremarkable. Sonographic examination revealed a right retroareolar cyst containing turbid echogenicity with surrounded hyperemia. A diagnosis of inflamed Montgomery's cyst was made. Medical treatment was successful without any surgical intervention. Both patients had favorable outcomes at follow-up visits. This stresses the importance of a proper recognition of the pathology, incidence, diagnosis and management of the cyst of Montgomery in the pediatric age group.
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LETTER TO EDITOR Top

Anxiety in secondary school students in Al-Khobar, Saudi Arabia, 2018–2019 p. 142
Nalakath A Uvais
DOI:10.4103/jfcm.JFCM_81_20  
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Author's Reply p. 143
Zaenb H Al Salman, Fatimah A Al Debel, Fatimah M Al Zakaria, Marwa M Shafey, Magdy A Darwish
DOI:10.4103/2230-8229.285820  
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ABSTRACTS Top

Arabic Abstracts p. 144

DOI:10.4103/2230-8229.285823  
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010