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   Table of Contents - Current issue
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September-December 2018
Volume 25 | Issue 3
Page Nos. 143-225

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REVIEW ARTICLE  

Stroke medicine in antiquity: The Greek and Muslim contribution p. 143
Inam Khuda, Foziah Al-Shamrani
DOI:10.4103/jfcm.JFCM_8_17  PMID:30220842
The collective human effort to understand the brain and its common disease, stroke, has spanned many centuries, cultures, and societies. The ancient Greek and Muslim physicians made important contributions to the understanding and management of stroke in their time. The Muslim physicians, from 800 to 1200 AD, played an outstanding role, by conserving and refining Greco-Roman philosophies, formulating their own theories and reaching conclusions, some of which match our modern stroke models. They recognized the importance of the brain as a source of stroke symptoms, proposed the vascular nature of stroke etiology, and had some thoughts about intra-ventricular hemorrhage, and the process of atherosclerosis with the help of ancient philosophies. Their management strategies have now been discarded, but some of the herbal medicines they used, may be useful in stroke management today. Therefore, more research is required into the ancient texts to evaluate the efficacy of their management strategies.
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ORIGINAL ARTICLES Top

Gender-specific differences in the awareness and intake of vitamin D among adult population in Qassim region p. 148
Abdulmajeed A Alharbi, Mana A Alharbi, Ahmad S Aljafen, Ayed M Aljuhani, Abdullah I Almarshad, Ibrahim A Alomair, Maisa A Alfalah
DOI:10.4103/jfcm.JFCM_164_17  PMID:30220843
Background: Despite the abundance of sunshine throughout the year, Vitamin D deficiency is highly prevalent among different Saudi populations. The objective of the current study was to evaluate the awareness and intake of Vitamin D and their association among adults of both genders. Materials and Methods: A cross-sectional study was done between June and August 2016 among adult patients and their family members (>18 years) presenting at 6 Primary Care Centers in the Qassim region, Saudi Arabia. Results: A total of 500 study participants were included in the study; 54.6% of the participants were males and mostly aged most between 26–50 years. The majority of the participants had heard of Vitamin D (91.4%), believed in its importance for health (92.8%), were aware of the symptoms of Vitamin D deficiency (72.6%), and were able to identify exposure to sunlight (81.4%) and diet (70.4%) as sources. The sources of Vitamin D used by the participants were exposure to the sun (57.2%), Vitamin D-rich foods (51.2%) and supplements (18.8%). There was a significant association between overall awareness of Vitamin D and intake of at least 2 sources of Vitamin D in males (P < 0.001) but not females (P = 0.920). Although females had better awareness than males, exposure to the sun was much lower in females than males. Conclusion: As supplementation was very low in both genders, and since cultural factors that limit females' exposure to the sun are not easily modifiable, the current findings further underline the critical importance of Vitamin D supplementation, particularly in females in Saudi Arabia.
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Association between air pollutants and anthropometric measurements of boys in primary schools in Dammam, eastern Saudi Arabia p. 155
Abdulaziz M Sebiany, Ahmed S Hafez, Khalid F. A. Salama, Amr A Sabra
DOI:10.4103/jfcm.JFCM_34_18  PMID:30220844
Background: The combined action of biological, physical, and chemical agents in the environment impacts on children's health resulting in illness and disability. Body measurements provide the optimum method of evaluating the health status of children. This study was done to measure the main air pollutants that affect the physical growth of primary schoolboys and compare the growth patterns of these young boys in three different areas in the city of Dammam in the Eastern Province of Saudi Arabia. Materials and Methods: A cross-sectional survey was conducted in three different environmental areas (residential, commercial, and industrial). The total number of boys in the study was 851. Data were collected using a self-administered questionnaire with three main parts: sociodemographic, anthropometric measurements, and air pollutant measurements. Results: Less than half the children (45%) residing in the residential area belonged to Classes 4 and 5 socioeconomic groups. In addition, 56.6% of the children residing in the commercial area and 26.5% of children in the industrial area belonged to the same socioeconomic class. There was a statistically significant difference between the mean age (P < 0.01), nationality, and the number of rooms and bedrooms (P < 0.001) in the boys' homes. Furthermore, there were statistically significant differences in weight (P < 0.05), height (P < 0.001), and height for age according to international standards (P < 0.01). Moreover, arm anthropometry of boys living in the residential area was higher than in the other two studied areas. Low values of all anthropometric measurements of the studied boys were significantly associated with exposure to high levels of nitrogen dioxide (NO2) >0.35 parts per million (ppm) or carbon monoxide >35 ppm (Saudi standard) outdoors, irrespective of socioeconomic conditions. Conclusions: The most significant factors that affected anthropometric values were total suspended particulate concentration in the outdoor air of the studied areas, parental education, and/or occupation. It is recommended that steps be taken to reduce indoor and outdoor air pollution.
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School absenteeism during menstruation amongst adolescent girls in Delhi, India Highly accessed article p. 163
Aditi Vashisht, Rambha Pathak, Rashmi Agarwalla, Bilkish N Patavegar, Meely Panda
DOI:10.4103/jfcm.JFCM_161_17  PMID:30220845
Background: Girls' health and education form the cornerstone of development and the gateway to full participation as women in political, economic, and cultural life of a country. Poor menstrual hygiene management has been shown to result in a sense of shame, anxiety, and embarrassment that contributes to absenteeism and poor performance at school. The objectives of this study were to determine the percentage of girls absent from school during menstruation, to evaluate the various factors associated with school absenteeism during menstruation, and to assess the practices regarding menstrual hygiene. Materials and Methods: A mixed method research of combined cross-sectional study and qualitative research was conducted in six government schools of Delhi by means of a questionnaire survey and focus group discussions. The sample size was 600 adolescent girls. Results: Out of 600, 245 (40%) girls remained absent from school during their menstruation. School absenteeism was significantly associated with the type of absorbent used, lack of privacy at school, restrictions imposed on girls during menstruation, mother's education, and source of information on menstruation. Nearly 65% reported that it affected their daily activities at school and that they had to miss their class tests and classes as a result of pain, anxiety, shame, anxiety about leakage, and staining of their uniform. Conclusion: Since mothers are the primary source of information, they should be counseled to dispose of their taboos about discussing issues related to menstruation. They should be taught about the ill effects of adhering to taboos related to menstruation. The curriculum on general biology should have more detail on menstruation.
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Consumption of vitamin and mineral supplements and its correlates among medical students in Eastern Province, Saudi Arabia Highly accessed article p. 169
Wejdan M Al-Johani, Kasim M Al-Dawood, Moataza M Abdel Wahab, Haneen A Yousef
DOI:10.4103/jfcm.JFCM_156_17  PMID:30220846
Background: Although vitamin and mineral supplements are popular in many countries, few studies have documented their use among college students. Moreover, there is not much national data on the use of supplements by Saudi medical students. The aim of this study was to determine the prevalence of the use of vitamin and mineral supplements by female medical students at Imam Abdulrahman Bin Faisal University (IAU) in Dammam, Saudi Arabia, and to identify characteristics associated with the use of supplements in this population. Materials and Methods: For this cross-sectional study, all female medical students at IAU in Dammam, Saudi Arabia, were approached during September to November 2016. Results were presented as frequency distribution. Chi-square test and logistic regression analysis were performed to determine factors associated with supplement use; P < 0.05 was considered statistically significant. Results: Completed questionnaires were returned by 474 students (response rate of 77%). The prevalence of the use of vitamin and mineral supplements was 44.6%; Vitamin D was the most commonly used supplement. Association of supplement use with a higher family income and the habit of regular exercise was statistically significant. However, this use of supplements was not significantly associated with smoking or marital status. Conclusion: The use of supplements, particularly Vitamin D, by female medical students was 44.6%. The highest percentage of users belonged to families with higher incomes and had the habit of exercising regularly.
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Smoking cessation counseling: Knowledge, attitude and practices of primary healthcare providers at National Guard Primary Healthcare Centers, Western Region, Saudi Arabia p. 175
Sarah Al-Jdani, Samar Mashabi, Basim Alsaywid, Abdullah Zahrani
DOI:10.4103/jfcm.JFCM_142_17  PMID:30220847
Background: Tobacco use is the most modifiable risk factor that increases mortality rates worldwide. The World Health Organization stated in 2015 that around six million people die each year as a result of tobacco use. Most of these deaths are diagnosed as premature. This study assessed the level of knowledge, attitude and practices of smoking cessation counseling (SCC) of primary healthcare providers (PHCPs) in Saudi Arabia. Materials and Methods: A cross-sectional study conducted from June 10, 2016 to March 31, 2017 in five Primary Healthcare Centers (PHC) of the Ministry of National Guard-Health Affairs, Jeddah, Western Region (WR). The study subjects were the staff physicians, family medicine doctors and dentists. Their selection was based on convenience sampling (N = 167, n = 130). Results: More than half of the study participants (53.2%) were middle-aged. Most were family medicine residents (25.4%) and staff physicians (24.6). Fourteen physicians were smokers, only 8 (57.1%) of whom had tried to quit. The Internet was the main source of information on SSC (21.3%), followed by postgraduate studies (19.4%). The overall level of knowledge of SCC was poor with a mean score of 35.25 ± 18.40; the overall level of attitude was good with a mean score of 76.81 ± 8.63 and the overall level of practice was average, with a mean score of 55.23 ± 21.54. There was a significant association between position (consultant) and knowledge (P < 0.001), attitude (P < 0.001) and practice (P < 0.001). Conclusion: PHCPs' have poor knowledge of counseling on the cessation of smoking and their practices are unsatisfactory despite their positive attitude to this role. This affects the delivery of SCC to the patients. Postgraduate studies, workshops and training are indeed necessary to help PHCPs' to understand the significance of the role they play in implementing SCC for patients, individuals, family and the community effectively.
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Pediatric sickle cell disease and obstructive sleep apnea: A cross-sectional study in a tertiary pediatric center in Saudi Arabia p. 183
Wadha Alotaibi, Safa Eltahir, Mohmmed Rayis, Khalid Al-Mobaireek, Ayah Alsarheed, Gawahir Mukhtar, Jumageldi Jumayev, Suhail Al-Saleh
DOI:10.4103/jfcm.JFCM_153_17  PMID:30220848
Objective: The aim of the study was to evaluate snoring and obstructive sleep apnea (OSA) in Saudi children with sickle cell disease (SCD). Materials and Methods: This cross-sectional study was conducted among children with SCD attending a hematology clinic were recruited. Demographics, clinical data, and sleep questionnaires were collected and overnight polysomnographies performed. Results: Seventy children (31 of whom were females) with SCD were included in the study. Their median (interquartile) age was 9 (6.5, 11) years and their body mass index z-score was −1.2 (−2.0, −0.4). Seventy-four percent of SCD patients snored and 32 (46%) had evidence of OSA (obstructive apnea-hypopnea index [OAHI] ≥2 events per hour of sleep), 13 of whom had moderate OSA (OAHI ≥5 and <10 events per hour of sleep) and 10 had severe OSA (OAHI ≥10 events per hour of sleep). Conclusion: Snoring and the proportion of OSA were high in children with SCD. This underlines the importance of screening for OSA in all children with SCD.
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Violence towards healthcare workers: A study conducted in Abha City, Saudi Arabia p. 188
Safar A Alsaleem, Abdullah Alsabaani, Reem S Alamri, Rawan A Hadi, Mona H Alkhayri, Kholoud K Badawi, Almozn G Badawi, Abdulaziz A Alshehri, Abdulrahman M Al-Bishi
DOI:10.4103/jfcm.JFCM_170_17  PMID:30220849
Background: Workplace violence in healthcare settings is a common, but an underreported problem that has been largely ignored. Violence against healthcare workers can have an adverse effect on their performance outcomes and thus influence patients' health and satisfaction. The aim of this study was to determine the frequency and types of violence against healthcare workers in a Saudi Arabian city. It was also to identify the risk factors of violence against healthcare workers and to investigate the possible consequences of such behavior. Materials and Methods: In Abha city, there are two government hospitals and ten primary healthcare centers. All healthcare workers in these healthcare institutions including physicians, nurses, dentists, pharmacists, laboratory technicians or specialists, radiologists, social workers, and psychologists were eligible to participate in this cross-sectional study. Data were collected using a structured self-administered questionnaire. Results: A total of 738 healthcare workers responded (92% response rate). The mean age was 31 ± 7.7 years (range 21–60) and the majority (64.9%) were females and 69.4% were Saudis. More than half (57.5%) had experienced some workplace violence at least once. Verbal assaults and slaps were the most common form of workplace-related violence (58%). Conclusions: Violence against healthcare workers in Abha city is more common, especially against nurses. The reasons need to be explored in order to set and develop policies, regulations and interventions to prevent violence against workers.
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Knowledge, attitude, and performance of primary healthcare physicians in Aseer Region, Saudi Arabia about attention deficit hyperactivity disorder p. 194
Ayedh A Al-Ahmari, Rishi K Bharti, Mohammad S Al-Shahrani, Muffarah H Alharthi, Hassan M Alqarni, Hassan M Alshehri
DOI:10.4103/jfcm.JFCM_120_17  PMID:30220850
Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders. This study aimed to assess the knowledge, attitude, and practice of primary health-care (PHC) physicians on diagnosis and management of ADHD. Materials and Methods: This was a cross-sectional study included 340 PHC physicians in Aseer Region, Saudi Arabia. A self-administered questionnaire was used to collect data on personal characteristics, knowledge, attitude, and practice of the diagnosis and management of ADHD. Results: Nearly 47.6% of the PHC physicians were aged <30 years, 60.3% were male, 79.1% were Saudi nationals, and 84.1% had completed MBBS. Only 13.2% had attended continuing medical education courses on ADHD, 63.2% had read about ADHD; Internet was the main source of information (30.7%). Participants' attitude toward ADHD was mainly positive, while 32.1% had poor knowledge and 17.6% had diagnosed ADHD cases in the last year, but 73.3% had referred the diagnosed cases to specialists. Participants' knowledge differed significantly according to their age, gender, and nationality. Conclusions: PHC physicians' knowledge about ADHD was suboptimal, but they had a positive attitude toward their role with regard to ADHD. PHC physicians should focus on the clinical and diagnostic aspects of ADHD. Awareness and interest of undergraduate medical students and newly graduated physicians in ADHD should be raised. The Ministry of Health should encourage attendance at extracurricular courses and workshops.
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Correlates of physical disability in the elderly population of Rural North India (Haryana) p. 199
Zahid A Khan, Chanpreet Singh, Tazeen Khan
DOI:10.4103/jfcm.JFCM_160_17  PMID:30220851
Background: With the increase in life expectancy, the number of older persons is constantly rising. Disability rates for elderly people are also on the rise with an increase in the burden of chronic diseases depriving them of independence and the performance of activities of daily living. The study aimed to estimate the prevalence of physical disability and determine its correlates among elderly population of rural Haryana. Materials and Methods: A community-based cross-sectional study was conducted among 322 elderly participants aged 60 years and above in the rural area of Haryana, India. Data pertaining to sociodemographic profile, self-reported chronic diseases/ailments, and disability assessment by means of Barthel and Katz index of activities of daily living was collected and analyzed. Results: Overall, 21.4% and 18% elderly people had some form of disability according to the Barthel index and Katz index, respectively. With aging, disability increased and 52.5% of the elderly aged 75 years and above were found to have disability according to the Barthel's index. Females (P = 0.014), those who were currently not married (P = 0.001), currently unemployed (P = 0.001), and those with chronic diseases/ailments (P = 0.002), had significantly higher disability rates. Binary logistic regression analysis revealed age 75 years and above, current unemployment, and the presence of three or more chronic diseases/ailments as significant factors related to physical disability. Conclusion: Disability is associated with increasing age and an increase in the burden of chronic health ailments in the elderly. Consequently, there is the need to prioritize preventive, promotive, curative, and rehabilitative services for the geriatric population.
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Hoarseness among school teachers: A cross-sectional study from Dammam p. 205
Ahmed A Alrahim, Rawan A Alanazi, Mohammad H Al-Bar
DOI:10.4103/jfcm.JFCM_152_17  PMID:30220852
Background: Voice disorders are known to be a serious occupational hazard for teachers. Compared to the general population, teachers have a greater risk of developing hoarseness of voice. The prevalence of voice disorders in teachers is 20%–50%. To the best of our knowledge, there has been no study in Saudi Arabia (SA) on the prevalence of hoarseness in teachers. Materials and Methods: A cross-sectional survey was conducted in 13 randomly selected schools at different levels of education in Khobar, SA, between February 2016 and March 2016. Data collected included demographic data, comorbidity, smoking, school type, laryngopharyngeal reflux, hearing problems, common cold, family history, number of students, and stress. The study included teachers who were actively teaching. Teachers with laryngeal cancer and those who were not actively teaching as well as those who were on sick leave were all excluded from the study. Data were analyzed using SPSS version 20. Results: Out of 400 surveys distributed, 187 teachers responded; mean age of teachers was 42.5 years and 55.1% were females. The percentage of teachers who subjectively complained of hoarseness was 27%; teachers in public schools had a higher prevalence of hoarseness than teachers in private schools. The greater the number of students per class, the more likely it was for the teacher to develop hoarseness (P = 0.038). The factors statistically significantly associated with hoarseness included smoking, acid reflux, family history of hoarseness, and work-related stress. Conclusion: Prevalence of hoarseness in teachers is high owing to a combination of multiple associated factors, many of which can be controlled
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MEDICAL EDUCATION Top

Bullying among medical and nonmedical students at a university in Eastern Saudi Arabia p. 211
Abdullah A AlMulhim, Mukhtar Nasir, Abdulrahman AlThukair, Maryam AlNasser, Jennifer Pikard, Syed Ahmer, Muhammad Ayub, Alya Elmadih, Farooq Naeem
DOI:10.4103/jfcm.JFCM_92_17  PMID:30220853
Background: Many medical students, junior doctors, and other health-care professionals have been affected by the negative experience of bullying. Research is scarce on bullying experienced by medical and nonmedical students in Saudi Arabia unlike what is found in Western countries. It is unclear whether being a nonmedical student modifies the risk of being bullied. Materials and Methods: A cross-sectional study included 400 university students using convenient sampling. The sample comprised 295 students who responded and were stratified into medical (n = 176) and nonmedical (n = 119) groups. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze our data. Normality was measured using the Kolmogorov–Smirnov test. Statistical significance was tested using chi-square test for categorical variables, and t-test for continuous variables. Results: Almost half of the respondents were found to have experienced some bullying, victimization, or other harassment during their medical education. The most common forms of bullying were verbal abuse and undue pressure to produce work (43.8%; n = 77). Nonmedical students experienced more bullying than medical students and were more likely to be female, single, and younger in age. The number of medical students subjected to sexual harassment (1.7%; n = 3) was higher than nonmedical students (0.8%; n = 1). Physical violence was more towards nonmedical (4.2%; n = 5) than medical students (1.1%, n = 2). The rates of bullying continue to be associated with anxiety and depression. Conclusions: Our data suggest similar bullying rates in the developed world but higher than previously reported in a Saudi study. Bullying or harassment affects both medical and nonmedical students and is associated with high levels of anxiety and depression.
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CASE REPORT Top

Recurrent extensive plunging ranula: A rare case p. 217
Ali R AlHayek, Manahel A Almulhem, Mohammed A Alhashim, Nasser A Aljazan
DOI:10.4103/jfcm.JFCM_24_18  PMID:30220854
Plunging ranula (PR) is a cystic mass presenting on the lateral side of the neck with or without a history of the usual presentation of an intraoral lesion. “PR” is recognized as an uncommon lesion that has been found predominantly in the third decade of life mostly in males. However, the exact prevalence of “PR” is not yet known. We report a rare case of an extensive PR that reached the parapharyngeal space in a 17-year-old Saudi female. The diagnosis was made when she presented to the ENT clinic with swellings in the right submandibular and right floor of the mouth. The diagnosis of “PR” with the absence of an oral lesion is very challenging and requires a detailed history, clinical examination, and radiological imaging. Different modalities of treatment have been discussed. However, the excision of ranula and the sublingual gland is the most effective way of management.
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LETTERS TO EDITOR Top

A comment on a study by Yazdanpanahi et al. (2018) p. 220
Sabira A Dkhar
DOI:10.4103/jfcm.JFCM_82_18  PMID:30220855
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Author's reply p. 221
Zahra Yazdanpanahi, Marzieh Nikkholgh, Marzieh Akbarzadeh, Saeedh Pourahmad
DOI:10.4103/2230-8229.240165  PMID:30220856
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Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh p. 222
Prabha Thangaraj
DOI:10.4103/jfcm.JFCM_56_18  PMID:30220857
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ERRATUM Top

Erratum: Mobile phone use while driving and the risk of collision: A study among preparatory year students at King Saud University, Riyadh, Saudi Arabia p. 224

DOI:10.4103/2230-8229.240167  PMID:30220858
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