Saudi Journal of Medicine & Medical Sciences最新文献

Background: Physicians in Saudi Arabia encounter significant occupational stressors that elevate their risk of mental health challenges.

Objective: This review maps research on the mental health of physicians in Saudi Arabia, identifies key themes and gaps, and contributes to understanding physician well-being. It aims to inform future research and targeted interventions to improve both physician well-being and healthcare quality.

Methods: This scoping review mapped literature (2000-2024) on the mental health of physicians in Saudi Arabia. Inclusion criteria were primary research studies (quantitative or mixed methods) on the mental health of physician (interns to consultants) in Saudi Arabia. PubMed, Scopus, Web of Science, and Google Scholar were searched. Thematic synthesis was performed.

Results: Eighty-eight cross-sectional studies (sample size range: 55-1205; N ~11,000) revealed significant mental health challenges. Workplace bullying (70%, 95% CI: 65.2%-74.6%) and harassment (83.6%, 95% CI: 79.7%-87.0%) were prevalent. Psychiatric issues included high stress (>50%, 95% CI: varied according to study), depression (up to 75.8%, 95% CI: 70.2%-80.8% in residents), anxiety (up to 50%, 95% CI: 43.0%-57.0%), and sleep disturbances (up to 87%, 95% CI: 82.0%-91.1% in residents). Substance use (smoking 16%-47.7%) and self-prescription of psychotropics were observed. Adaptive coping (e.g., religion and planning) was common, while maladaptive coping (e.g., self-blame) was associated with higher stress, particularly in females. Job satisfaction varied, with lower satisfaction in intensive care and plastic surgery.

Conclusions: This review highlights significant, interconnected mental health challenges among physicians in Saudi Arabia, particularly in high-stress specialties and among female physicians. Targeted interventions and future research are needed to address work-related stress, improve coping, enhance institutional support, and promote physician well-being and healthcare quality.

Background: The rising prevalence of obesity is associated with significant health risks, underscoring the need for effective prevention and treatment. The use of anti-obesity medications (AOMs) remains limited due to several barriers.

Objectives: To physicians' perspectives and clinical practices regarding AOMs in Saudi Arabia.

Methods: We conducted a national cross-sectional survey between May and August 2024 targeting family physicians, endocrinologists, and bariatric surgeons in Saudi Arabia. We distributed the survey using convenience sampling through department heads at hospitals across five regions and relevant professional societies. We collected data on clinician demographics, clinical practices, and perceptions related to AOMs. We compared responses across specialties and identified predictors of prescribing AOMs.

Results: A total of 92 clinicians completed the survey: 71 family physicians, 20 endocrinologists, and 1 bariatric surgeon. Overall, 15.3% of the respondents had received formal obesity-focused training. While 92.4% reported counseling patients on obesity-related complications, 57.6% routinely referred patients to dietitians. Endocrinologists preferred international guidelines and prescribed AOMs more frequently than family physicians (90.0% vs. 60.5%; P < 0.001). Glucagon-like peptide-1 receptor agonists were the most commonly prescribed first-line agents. Key predictors of prescribing AOMs included medical specialty, guidelines preference, and prior obesity training.

Conclusions: Physician specialty, clinical experience, and adherence to guidelines influence the prescription of anti-obesity medications in Saudi Arabia. Limited training and a more conservative approach among family physicians highlight the need for targeted educational interventions to improve obesity management. Initiatives should focus on harmonizing clinical guidelines and expanding access to evidence-based treatments.

Aims: We aimed to determine the prevalence, nature, and identification methods of the adverse drug events (ADEs) as well as explore if standard definitions were utilized while assessing ADEs in Saudi Arabia.

Methods: We systematically searched MEDLINE via PubMed and Embase from their inceptions to April 2022. We investigated experimental and observational studies conducted in Saudi Arabia.

Results: We screened 14,398 records and included 12 studies. This review indicated that the incidence of ADEs ranged from 0.58% to 74.2%, while three cross-sectional study reports highlighted that the proportion of subjects experiencing ADEs ranged from 28% to 98.5%. This wide variation can be attributed to factors such as diverse study designs, measurement variability, and heterogeneous populations. ADR was the most frequently reported type of ADE in all studies. Chart review (58%) was the commonly utilized ADE detection method, followed by patient interviews (25%), and trigger tools (17%). Five studies (42%) used their own ADE definition, and only one study (8%) reported the standard ADE definition; however, half of the studies (n = 6) did not report any ADE definition.

Conclusions: This systematic review suggests that ADE prevalence varied between studies, with chart review being the most used approach for ADE identification in Saudi Arabia, followed by patient interviews. ADR was the most common type of ADE among all studies. Further, most studies did not use the standard ADE definitions. To improve medication safety and patient care outcomes, our review highlights the crucial need for standardized ADE detection and reporting practices in Saudi Arabia. Future research should prioritize prospective studies with standardized methodologies to accurately assess ADE prevalence rates and evaluate the impact of interventions on reducing ADEs in Saudi Arabia.

Background: Students worldwide have increasingly been reported to be strongly preoccupied with body image dissatisfaction (BID).

Objective: To explore the prevalence of BID among female tertiary education students in Oman as well as to examine the relationship between sociodemographic variables, social media use, and BID expression.

Materials and methods: This cross-sectional survey study was conducted between January 1, 2022, and March 31, 2022, and included female undergraduate students from Sultan Qaboos University, Oman. The Arabic-validated self-administered questionnaires of Body Shape Questionnaire-34 and the Social Media Addiction Scale were used to elicit data.

Results: A total of 463 students were included (mean age: 21.5 ± 3 years; single: 90.9% unmarried). Of these, 17.9% reported BID (95% CI: 14.54-21.73%). In the multivariate analysis, significant correlations were observed between BID and the subscales of social media addiction: time displacement (OR: 1.353; P = 0.001), compulsive tendencies (OR: 1.424; P = 0.001), and social consequences (OR: 1.200; P = 0.013). In addition, compared with respondents who had a normal BMI, the risk of BID was eight-fold higher among those who were overweight (OR = 8.514, 95% CI= 4.059-17.858; P <0.001) and 25 times higher among those who were obese (OR = 25.697, 95% CI = 8.266-79.886; P <0.001).

Conclusions: This study found that about one-fifth of undergraduate female students from Oman experienced body image dissatisfaction, with higher prevalence among those who are overweight or obese. Significant associations were found between BID and social media use. These findings highlight the need for targeted interventions and awareness programs to address body image concerns and mitigate the impact of social media on student mental health.

Objectives: Most people in Saudi Arabia reside in population-dense cities and may be predisposed to poor sleep quality. This study aimed to determine the self-reported sleep and napping patterns in a convenient cross-sectional sample of adults living in Saudi Arabia.

Materials and methods: In this cross-sectional study, information related to sleep quantity and quality during workdays and weekends were collected from adults living in four major cities of Saudi Arabia: Makkah, Jeddah, Riyadh and Taif. Demographic, anthropometric, behavioral, socioeconomic, and comorbidity status were also collected. Standardized tools for screening common sleep complaints (i.e., the Epworth Sleepiness Scale, the Insomnia Severity Index, and the STOP-BANG questionnaire) were included.

Results: Participants (N = 1200; 40% males) had an average age of 35 ± 14 years. The most common sleep onset-time during workdays and weekends was 12 am. The most common wakeup times during workdays and weekends were 6 am and 12 pm, respectively. There was a significant difference between workdays and weekends in nighttime sleep duration (7.1 ± 2.3 hours vs. 8.5 ± 2.2 hours, P <0.001) and total sleep duration over 24 hours (8.7 ± 2.2 hours vs. 9.7 ± 2.5 hours, P <0.001). There was a greater proportion of participants who took regular daily naps during workdays compared with weekends (51% vs. 33%, respectively, Chi-square test P <0.001). Nap duration during workdays and weekends was similar (2.1 ± 1.1 hours vs. 2.0 ± 1.0 hours, dependent t-test P = 1.0).

Conclusion: People living in Saudi Arabia tend to sleep late and have a short nighttime sleep duration and regular long daytime napping. On weekends, these variables change toward the recommended range (i.e., increased nighttime sleep duration and decreased napping count and duration).

Background: Exocrine pancreatic insufficiency (EPI) is an underdiagnosed entity among patients with new-onset chronic diarrhea (CD). The aim of this study is to investigate the prevalence of EPI in patients with CD.

Materials and methods: Patients with new-onset CD (≥4 weeks) from 2018 to 2021 were enrolled in this single-center prospective study. If stool fecal elastase (FE) was <200 μg/g, patients were offered a confirmatory 72-hour fecal fat test.

Results: FE testing was completed by 97 patients, of which 9 had low FE (9.3%). Average weight was significantly higher in patients with low FE (98.5 ± 29.3 kg vs 82.2 ± 22.2 kg; P = 0.045). There was no significant difference in gender, age, race, presence of diabetes mellitus, and history of tobacco or alcohol use between the two groups. After controlling for other factors, patients with low FE had a statistically higher weight in comparison to those with normal FE. Nine patients in the entire cohort were started on pancreatic enzymes (three based on low FE and six empirically based on high pretest probability for EPI). Six of the nine patients had complete resolution of symptoms (including two of three patients with low FE).

Conclusion: Considering the 9.3% prevalence of EPI among patients with CD, we propose screening for EPI with stool FE as part of the initial workup for these patients.Trial Registration: Clinicaltrial.gov number NCT03407534.

We report a rare case of hyperimmunoglobulinemia D syndrome (HIDS) in a young man who was initially diagnosed with familial Mediterranean fever, hidradenitis suppurativa, and, eventually, with Crohn's disease. The final diagnosis of HIDS was based on whole-exome sequencing. The unique concurrence of these three conditions has not been reported previously. The multiple diagnoses and overlapping presentations of these conditions should raise awareness about alternative diagnoses that mimic inflammatory and autoimmune conditions, including HIDS, a rare but clinically relevant condition. Exploring patients' family histories to understand the genetic contribution to HIDS is also important. This is evidenced by the fact that whole-exome sequencing for our patient was performed because the patient's brother was diagnosed with HIDS, and the sequencing led to the final diagnosis.

Background: Smoking may increase levels of pro-inflammatory cytokines, which is an important contributor to rheumatoid arthritis (RA) pathogenesis.

Objectives: The aim of this study was to describe the characteristics of RA patients who were smokers compared with non-smokers.

Methods: A total of 849 RA patients who were smokers out of a large RA cohort of 10,364 patients (8.2%) were compared to 924 age-, sex-, and body mass index-matched RA patients who were non-smokers. Patients were subjected to full history-taking and clinical examination. Laboratory tests such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) were measured. The disease activity score 28 (DAS28) and the health assessment questionnaire (HAQ) score were assessed.

Results: The mean age among smokers was 46.4 ± 11.3 years, the male-female ratio was 3:1, and the mean disease duration was 6.4 ± 6.2 years. There was a significantly higher frequency of diabetes mellitus, hypertension, and metabolic syndrome in smokers compared to non-smokers (13.7%, 17.1%, and 9.2% vs. 8.4%, 12.9%, and 3.5%; P < 0.0001, P = 0.01, P < 0.0001, respectively), while hypothyroidism was more common in non-smokers (P = 0.03). Rheumatoid nodules (P = 0.03), oral ulcers (P = 0.002), keratoconjunctivitis sicca (P = 0.043), and neurological manifestations (P = 0.002) were significantly more common in smokers, but the DAS28 was lower (4.2 ± 1.5 vs. 4.8 ± 2.5; P < 0.0001). RA-related changes were significantly more common in female smokers than in males. On regression analysis, none of the differences found in the comparison between smokers and non-smokers remained significant.

Conclusions: Smoking in RA patients was found to be associated with a higher frequency of traditional comorbidities, rheumatoid nodules, oral ulcers, sicca complex, and neurological manifestations, but a lower disease activity. There is an obvious sex-driven pattern, with clinical alterations occurring more frequently in female smokers. Higher RF, anti-CCP, and double seropositivity are more observable in males and positive antinuclear antibody in females.

Background: Infectious gastroenteritis is one of the most prevalent diseases worldwide. Multiplex molecular assays enable simultaneous and rapid detection of various gastrointestinal pathogens, but it has not been used to report the prevalence of such infections from Saudi Arabia.

Objectives: To determine the viral, bacterial, and parasitic pathogens implicated in infectious diarrhea among children and adults and describe their seasonality in Al-Ahsa, Saudi Arabia.

Materials and methods: This is a retrospective study that included all documented results of syndromic PCR-based gastrointestinal pathogen panels between November 1, 2021, and March 31, 2023, from a private, tertiary healthcare hospital in Al-Ahsa, Saudi Arabia. Patients' demographics, detected pathogens, recorded temperature, and date of testing were retrieved from the hospital's electronic medical records.

Results: A total of 606 non-duplicate samples were included. Viral, bacterial, and parasitic pathogens were detected in 24.8%, 50.5%, and 3.8% of samples, respectively. Of the total tested samples, norovirus (13.2%), and sapovirus (4.5%) were the two most commonly detected viruses. Enteropathogenic E. coli (21.6%) and enteroaggregative E. coli (9.7%) were the most commonly identified bacterial targets. The only parasitic pathogen detected was Crytposporidium spp. (3.8%). Children aged ≤5 years tested positive for most pathogens, while elderly patients were mainly positive for diarrheagenic E. coli, C. difficile, norovirus, and sapovirus. Most pathogens peaked during summer, while norovirus, Campylobacter spp., and Cryptosporidium spp. were predominantly seen in winter or spring. Bacterial pathogens were commonly co-detected with gastroenteritis viruses.

Conclusion: We describe variable distributions of viral, bacterial, and parasitic causes of diarrhea across age groups and seasons in Saudi Arabia. Viral and bacterial pathogens (specifically, norovirus and diarrheagenic E. coli) are the predominant pathogens in infectious gastroenteritis.

Background: Cleft lip and palate (CLP) can have an impact on the physical development of children; however, data from such studies is currently limited.

Objectives: To compare growth parameters between children with non-syndromic CLP and healthy controls in Saudi Arabia.

Materials and methods: This case-control retrospective cohort study included Saudi children with CLP and age- and gender-matched healthy children (1:1) who attended a tertiary care center in Riyadh, Saudi Arabia. Growth measurements (weight, length, and head circumference) were taken at the ages of 1 year and 2 years, and the Saudi Growth Chart was used as a reference data.

Results: The study included 86 children in each group (N = 172), with 31.4% females and 68.6% males. The mean current age was 3.2 ± 1.7 years. Most patients had a unilateral CLP (96.5%). Multivariable analysis demonstrated that at the age of 1 year, compared with controls, patients with CLP had significantly lower weight (OR: 1.7, P = 0.026), weight standard deviation score (SDS) (OR: 0.4, P = 0.001), and head circumference SDS (OR: 0.8, P <0.001); however, these did not remain significant at the age of 2 years. In the early repair (age <1 year) and late repair (age ≥1 year) groups, 76.1% and 63.2% of the patients achieved catch-up growth.

Conclusion: This study found that Saudi children with cleft lip and palate had significantly lower weight and head circumference compared with healthy children in the first year of life, but catch-up growth in the second year of life, largely following surgical repair, rendered these differences to be insignificant.