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   2020| September-December  | Volume 27 | Issue 3  
    Online since September 25, 2020

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Current status of telehealth in Saudi Arabia during COVID-19
Saeed M Alghamdi, Jaber S Alqahtani, Abdulelah M Aldhahir
September-December 2020, 27(3):208-211
Since the beginning of the coronavirus disease (COVID-19) pandemic, the responses of countries to emerging infectious diseases have altered dramatically, increasing the demand for health-care practitioners. Telehealth (TH) applications could have an important role in supporting public health precautions and the control of the spread of the COVID-19 pandemic. This review summarizes the existing literature on the current status of TH applications used during COVID-19 in Saudi Arabia and discusses the extent to which TH can support public health measures. TH mobile applications (e.g., Seha, Mawid, Tawakklna, Tabaud, and Tetamman) have found effective tools to facilitate delivering healthcare to persons with COVID-19, and tracking of COVID-19 patients. TH has been essential in the control of the spread of COVID-19 and has helped to flatten the growth curve in Saudi Arabia. Further research is needed to explore the impact of TH applications on the progression of COVID-19 in Saudi Arabia.
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Assessment of unintentional childhood injuries and associated factors in the pediatric clinics of a tertiary care hospital in Riyadh, Saudi Arabia
Kawther N Alkhamis, Rizwan S Abdulkader
September-December 2020, 27(3):168-177
BACKGROUND: Although unintentional childhood injuries are a major cause of morbidity, there is a dearth of literature on the issue in Saudi Arabia. The aim of this study was to assess the prevalence of unintentional childhood injuries in Saudi children, safety of their home environment, and the parents' attitude toward home safety measures. MATERIALS AND METHODS: A cross-sectional survey was conducted in a consecutive sample of parents accompanying children aged ≤12 years to the pediatric outpatient clinics of a tertiary care hospital in Riyadh, Saudi Arabia. A validated self-administered questionnaire was used for data collection. Data was analysed using SPSS; Chi-square test and t-test were used to identify variables associated with injury in the preceding 12 months. Logistic regression analysis performed to identify the significant variables associated with injury after contolling for other variables. RESULTS: A total of 283 participants were enrolled. The prevalence of unintentional childhood injuries was 24.7% in the past 12 months. The majority of these injuries occurred at home (74.3%). Accidental falls were the most reported (62.9%) cause of injury followed by burns (22.9%). Being a male child, attending a nursery or kindergarten, and having parents who kept hazardous objects within the reach of children were found to be significantly associated with higher odds of injury. CONCLUSION: The prevalence of unintentional childhood injuries was high in the study population. Significant gaps were found between parents' reported knowledge and practice. Focused educational programs to improve home safety will be valuable in reducing this burden.
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Application of the Kano model to determine quality attributes of patient's care at the primary healthcare centers of the Ministry of Health in Saudi Arabia, 2019
Abdulaziz A Howsawi, Mamdouh F Althageel, Noorulzaman K Mohaideen, Mohammad S Khan, Abdulaziz S Alzahrani, Mohamed A Alkhadir, Sulaiman M Alaqeel, Moath A Alkathiri, Rayan A Hawsawi
September-December 2020, 27(3):178-185
BACKGROUND: Patient satisfaction is the ultimate goal in any healthcare system. Together with other traditional quality indicators, patient satisfaction must be addressed to improve the quality of health care. The strategic objectives of the Ministry of Health (MOH) formulated by the Saudi National Transformation Program are to improve the quality of healthcare services, expand privatization of governmental services, and create an attractive environment for both local and international investors. The objective of this study was to apply Kano model to determine quality attributes of patient care at primary healthcare centers in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted at primary healthcare centers (PHCs) under the MOH in Saudi Arabia between October 2018 and February 2019. Study included all Saudi adult patients aged 18 years or older attending the selected PHCs of MOH. Patients who had difficulty in comprehending were excluded. Data was collected by using a structured questionnaire based on the Kano model for the assessment of patients' expectations of the quality of care and provided services. Data was entered and analysed using SPSS. Chi-square test and t-test were used to test for statistical significance. RESULTS: The study included a total of 243 patients from 10 PHCs, 51% from consulting PHCs and 49% from nonconsulting PHCs. Response rate was 97.2%, and 44.9% respondents were males. Of the 18 attributes chosen for our study, 14 were one-dimensional, three belonged to the attractive type, and one was indifferent type. The top three one-dimensional attributes were “friendliness and respectfulness of the clinic receptionist,” “friendliness and respectfulness of the nurses and laboratory staff,” and “care and attention of the doctor”. CONCLUSION: The investors and policymakers need to turn their attention to assisting in the privatization of governmental services by creating a good climate for both local and international investors.
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Comparative study of the efficacy and safety of intranasal azelastine hydrochloride and fluticasone furoate in the treatment of allergic rhinitis
Nandish Chennakeshavaraju, Sarala Narayana, Azeem S M. Mohiyuddin
September-December 2020, 27(3):186-191
BACKGROUND: Allergic rhinitis (AR) is characterized by nasal itch, sneezing, watery or mucous rhinorrhea, nasal obstruction, and nasal or pharyngeal irritation. If untreated, AR can impair patients' quality of life (QOL). Azelastine hydrochloride (AH), histamine receptor antagonists, has anti-inflammatory and mast cell stabilizing properties. Fluticasone furoate (FF) is an anti-inflammatory agent with action on mast cells, eosinophils, neutrophils, macrophages, and lymphocytes. This study compares the efficacy and safety of these medications in AR. MATERIALS AND METHODS: Patients in the study had been clinically diagnosed with AR. In each group, there were 75 randomized patients who were to receive either FF (27.5 μg/spray) or AH (0.10%) intranasally twice daily. Assessment in terms of symptoms (total nasal symptom score), signs (endoscopic staging), QOL, eosinophil count, and sensory attributes was done at baseline, day 7, and day 15. Adverse effects were recorded, and the cost incurred was analyzed. Paired and umpaired t-test were used to compare symptom scores, QOL scores, and absolute eosinophil count within and between the groups, respectively. RESULTS: The total number of patients was 150 (76 males and 74 females); the mean age for FF group was 26.23 ± 5.2 years, and 26.96 ± 4.8 years for AH group. By day 7, there was a reduction of all scores in both medications, but the reduction in reduction was highly significant with FF (P = 0.001). There was a significant reduction (P = 0.001) in absolute eosinophil count both in blood and nasal smears by day 15 in both the groups; the reduction was significant (P = 0.001) with fluticasone. Adverse reactions were reported by 33.3% of patients receiving FF and 28% patients receiving AH. CONCLUSION: Fluticasone furoate produced sustained relief of symptoms, signs, and sensory attributes with a greater reduction in eosinophil count in comparison with AH in patients with allergic rhinitis.
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Incidence and risk factors associated with hypoglycemia among patients with chronic kidney disease: A systematic review
Mohammed S ALEissa, Ibrahim A AlGhofaili, Haifa F Alotaibe, Maram T Yaslam, Mohammed S AlMujil, Maha M Arnous, Sultan K Al Dalbhi
September-December 2020, 27(3):157-162
Hypoglycemia is a common complication in patients with chronic kidney disease (CKD), more so if they have diabetes as well. The occurrence of hypoglycemia in CKD is associated with considerable morbidity and mortality, both of which are treatable and preventable. This review summarizes the incidence and risk factors associated with hypoglycemia among patients with CKD. The meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A search was done on PubMed, EMBASE, SCOPUS, Cochrane Library, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature for cohort studies in English published between January 2000 and August 2019 using search terms related to hypoglycemia (low blood sugar), chronic kidney disease (chronic renal failure OR renal failure), and incidence (risk OR epidemiology OR risk factors). Summary measures were calculated using random-effects model. A total of 5 studies involving 311,817 persons were included in the meta-analysis. The pooled incidence of hypoglycemia in patients with CKD was 0.188 (confidence interval [CI] = 0.097–0.287). The incidence of hypoglycemia was significantly higher in patients with CKD than in patients without CKD (Relative risk [RR] = 1.89, 95% CI = 1.86–1.92,P < 0.0001). No heterogeneity was reported between the studies (I2 = 0%, P > 0.05), and publication bias was also found. Females, patients who had diabetes mellitus of long duration, and those on antidiabetic drugs such as insulin and sulfonylureas were at risk of developing hypoglycemia in CKD as per narrative review. The incidence of hypoglycemia in patients with CKD is high. Therefore, there is need to closely monitor affected individuals so that appropriate management protocols could be set up. Further probing of various risk factors for hypoglycemia in CKD patients is necessary for early detection and initiation of timely preventive and curative measures.
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Mean glycosylated hemoglobin in children with type 1 diabetes at King Fahad Medical City, Riyadh, Saudi Arabia
Abdulhameed Y Alsaheel, Sulaiman I Alayed, Yazzan M Alotaibi, Aseel A Alfahhad, Othman M Alothman, Hissah F Alnefaie
September-December 2020, 27(3):163-167
BACKGROUND: Type 1 diabetes is the third most common chronic disease among teenagers. In Saudi Arabia, there is a gap of knowledge regarding hemoglobin A1C (HbA1c) concentration levels, and adherence to regular follow-up visits by patients. The aim of this study was to determine the mean glycosylated hemoglobin (HbA1c) levels in diabetic children who have been diagnosed with type 1 diabetes and were being followed up at a tertiary care center in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted among all diabetic children treated at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. Data were retrieved and analysed during the period from September to December 2018. Diabetic patients of <18 years and who were being followed up at KFMC were included in the study. Data on age, sex, duration of illness, associated comorbidities, antidiabetic regimen, and HbA1c levels were obtained. Student t-test was used to compare quantitative parameters between two groups, and Chi-square employed to test for associations between categorical variables at 5% significance level. RESULTS: A total of 510 patients of were included in the study; about 53% were females. The mean HbA1c level was 10.6% and females showed higher HbA1c levels. Data showed a strong correlation between age and HbA1c levels (P < 0.001), with older patients showing higher HbA1c levels. The HbA1c levels also increased as the duration of disease increased. The median number of patient visits to KFMC was two per year. No statistically significant differences were observeed for type of treatment for diabetes. Celiac disease, the most frequent comorbidity, was seen in 50% of patients. CONCLUSION: Diabetic children who were followed up at KFMC had high HbA1C level (10.6%), and lower than recommended follow-up visits per year. The treating physicians should educate patients and their legal guardians on the importance of follow-up visits and their role in controlling HbA1C levels, and following healthier lifestyle.
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Prevalence of potentially inappropriate medication and its correlates in elderly hospitalized patients: A cross-sectional study based on Beers criteria
Rishabh Sharma, Parveen Bansal, Ravinder Garg, Ravi Ranjan, Rakesh Kumar, Malika Arora
September-December 2020, 27(3):200-207
BACKGROUND: The increase in the prescription of potentially inappropriate medication (PIM) in older adults with significant health consequences is a global concern. This study aimed to determine the prevalence of PIM prescription in older adults as identified by Beers criteria 2015 and 2019. MATERIALS AND METHODS: A cross-sectional study was carried out in older adults aged >65 years at a tertiary care postgraduate teaching hospital. All patients aged ≥65 years irrespective of their gender, admitted in the medical ward of the hospital with single/multiple comorbidities, and prescribed at least one daily medication, were included in the study. Data of patient history, patient case sheet, medication charts, laboratory reports, as well as radiological examinations test reports were retrieved from their files and were captured in a prevalidated data collection form. SPSS used for data analysis; multivariate logistic regression was used to determine the predictors of PIM prescribing and odds ratios (ORs) and 95% confidence intervals for ORs were computed. RESULTS: Study included 323 patients; 61.3% were male, 74% patients were 65–70 years of age, and 78% patients were illiterate. The overall prevalence of PIM uses according to the Beers criteria 2015 and 2019 was 60.1% and 61.9%, respectively. No association found between PIMs prescribes and diagnosis category. Male gender, age 76–80 years, and education 10–12th class were found to be significantly related to PIM prescription. CONCLUSION: This study reflects a critical view of noncompliance of Beers criteria for geriatric healthcare even in tertiary care hospitals in India. Creatinine clearance rate should be kept in view when prescribing medicines for elderly inpatients.
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Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia
Asmaa M Alomran, Duaa A Almubarak, Batool A Alrashed, Abdul S Khan
September-December 2020, 27(3):192-199
BACKGROUND: Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor–patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS: Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age (P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of “mostly appropriate” and “very appropriate” to questions on patient–doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION: The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor–patient relationship and the establishment of a therapeutic education program.
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Non-COVID area of a tertiary care hospital: A major source of nosocomial COVID-19 transmission
Mahendra K Meena, Mahendra Singh, Prasan K Panda, Mukesh K Bairwa
September-December 2020, 27(3):212-215
COVID-19 pandemic has spread to all corners of the world where infection control measures are being implemented. There is now a resurgence of the disease in health care facilities with documented in-hospital transmission and cases becoming positive in areas designated to cater for COVID-19 negative patients. We encountered such an event at our institution where fourteen patients (including health care workers) in the non-COVID zone were found to be COVID-19 positive. This highlights the loopholes in the system and the need for better and systematic infection control measures in hospitals that deal with infectious diseases with high infectivity. Findings also suggests the failure of government's criteria for suspected COVID-19 cases, and therefore needs a rethinking. Keywords:
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A rare case of intraductal papilloma with atypical ductal hyperplasia in a male breast: A pathological diagnosis
Sushma Bharti, Jyotsna Naresh Bharti, Jeewan Ram Vishnoi, Arsha B Soudamini
September-December 2020, 27(3):216-218
Male breast cancer is itself a very rare condition and represents 0.5%–1% of all breast cancers diagnosed. Atypical ductal hyperplasia (ADH), intraductal papilloma (IP), and ductal carcinoma in situ are also very rare in a male breast. Only a few cases of ADH with gynecomastia have been reported in English literature until now. Here, we report a rare case of an IP with ADH associated with gynecomastia in an elderly male, who complained of right nipple pain, discharge, and tiny retroareolar mass. Mammography showed a subareolar nodule graded as the Breast Imaging-Reporting and Data System 4B. It is difficult to differentiate, both clinically and radiologically, between benign and malignant papillary lesions and invasive carcinoma, because of the similarity of findings. Hence, any male with palpable unilateral hard fixed lesions in the retroareolar region with complaints of nipple discharge, skin changes, or axillary lymphadenopathy should have a histopathological evaluation.
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Erratum: Effect of modified physiology laboratory sessions on the awareness and knowledge of obesity of health-related university students

September-December 2020, 27(3):219-219
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Arabic Abstracts

September-December 2020, 27(3):220-232
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010