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   Table of Contents - Current issue
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October-December 2021
Volume 4 | Issue 4
Page Nos. 315-378

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EDITORIAL  

Improving public health and national transformation in Saudi Arabia: Leveraging with one health entomology p. 315
Shamsudeen Faisal Fagbo, Mohammad Nafi Solaiman Al-Sabi
DOI:10.4103/jnsm.jnsm_69_21  
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ORIGINAL ARTICLES Top

Assessment of knowledge, attitudes, practices, and vaccine acceptance for coronavirus disease 2019 among the public in a MERS-CoV-endemic country p. 317
Mazin Adnan Barry, Bader A Zawawi, Moath K AlGhusoon, Abdulrahman S AlArifi, Saud K AlHothaly, Omar Abdulmohsen Fatani
DOI:10.4103/jnsm.jnsm_51_21  
Objective: The objective of the study is to identify associations between the sociodemographic characteristics and the level of knowledge, scope of attitudes, and self-reported practices among adults during the coronavirus disease 2019 (COVID-19) pandemic in Riyadh. Methods: A quantitative, cross-sectional study of adults was conducted using a multistage participatory approach between May 31 and June 7, 2020, in Riyadh, Saudi Arabia. Results: Of 1364 study participants, 73.9% knew the descriptive type of COVID-19. Females showed a statistically significant higher knowledge composite (P < 0.0001), and the majority had higher sufficient knowledge scores than males. Only 24.9% agreed that individuals could be tested positive for influenza and COVID-19 at the same time. Negative attitudes were highly prevalent among younger, unmarried, non-Saudi, male participants (P < 0.05). 72.9% reported placing masks on infants or children under 2 years. Similarly, older age groups and Saudi females were better at practicing risk-based preventive controls for COVID-19 than younger age groups and non-Saudi males (P < 0.0001). 60% expressed that if a vaccine would be available this year, they would feel it was rushed, while 56% would consider receiving it but would wait to see what happens to others. Conclusion: These findings could be helpful in guiding machine learning models in groups more affected by knowledge insufficiency, gaps in attitudes, and behavioral compliance.
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Age-adjusted survival analysis of lymphoma patients diagnosed from extranodal sites p. 324
Musa Alzahrani
DOI:10.4103/jnsm.jnsm_29_21  
Background: Lymphoma is a cancer of the lymphoid system that typically presents in nodal tissues. Involvement of extranodal sites is less common and has been shown to be associated with worst outcomes. The site of the initial diagnosis could give an idea about the accessibility of diagnostic tissue, disease presentation, behavior, and maybe associated with prognostic significance. Methodology: We retrospectively reviewed all adult lymphoma cases diagnosed with lymphoma in our center from 2008 to 2018 and studied the association between extranodal site of biopsy and overall survival (OS). Logrank method was used to calculate P value, and cox proportional hazard was used for age-adjusted survival analysis. Results: A total of 433 patients were included. Median age was 48 years, 183 (42%) were female, and 143 patients (33%) were diagnosed from extranodal sites. The most common site of extranodal involvement was gastrointestinal tract with 69 cases (16%), followed by lung 16 (4%) then central nervous system 11 (2.5%). The most common pathologic diagnosis was diffuse large B-cell lymphoma 182 (42%), followed by classical Hodgkin lymphoma 139 (32%) and then follicular lymphoma 31 (7%). Patients who were diagnosed from a biopsy obtained from extranodal site had a worst OS as compared to patients diagnosed from nodal sites with a significant P value in univariate analysis 0.049 and P = 0.05 after adjusting for age. Conclusion: Patients diagnosed with lymphoma from an extranodal site have a worst OS even after adjusting for age as compared to those diagnosed from nodal sites.
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Demographic variability of urinary tract stones in Saudi Arabia p. 328
Khalid Abdulrahman AL-Nasser, Abdullah Fouda Neel, Fahad Ali Alyami, Khalid Manawer Al-Barraq, Muaath Mohammed Alsheheli, Mohammed Abdulaziz Alomar, Abdulaziz Mohammed Althunayan, Saleh Abdulrahman Binsaleh, Raed Mohammed Almannie
DOI:10.4103/jnsm.jnsm_106_20  
Context: Urinary tract stones are a highly prevalent problem affecting public health worldwide. Studying demographic variability in urolithiasis across different geographical areas in terms of prevalence, age, sex, stone composition, climate, and comorbidities can aid in differentiating between varieties of stone types and identifying high-risk populations. Aims: We conducted this study to identify correlations and demonstrate the demographic variability in urinary tract stone cases in Saudi Arabia. Settings and Design: We retrospectively reviewed the data of all patients who underwent stone analysis in our institution between May 2015 and June 2017. Subjects and Methods: We used Fourier transform infrared spectroscopy for stone analysis to analyze the chemical composition of each stone. We recorded the different seasons when the stones were initially analyzed and the demographics of our patients, including age, sex, general comorbidities such as hypertension, diabetes, and other patient-specific comorbidities, and stone type. Statistical Analysis Used: We analyzed our data using the statistical data analysis software IBM SPSS Statistics for Windows, version 25.0 (Armonk, NY, USA: IBM Corp). Results: We divided the ages of the patients into seven distinct age groups (0–14, 15–24, 25–34, 35–44, 45–54, 55–64, and + 65) to easily define and compare the incidence of stones within each age group and between sexes. We divided the year into hot and cold seasons according to the annual climate in Saudi Arabia. We also defined patients' coexisting comorbidities in our results. Conclusion: We found that the incidence of some types of urinary tract stones could be predicted by the presence of chronic illnesses in the middle-aged population in Saudi Arabia.
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Perception of first-year medical students of virtual video demonstration of the objective structured clinical examination at king saud university medical college in Saudi Arabia during the COVID-19 pandemic p. 333
Mona M Soliman, Maha Abdullah AlGhamdi, Abdulaziz Mustafa Shadid, Faisal Fahad Alsaif, Lamia Abdullah Alkuwaiz, Maisa Saleh Alaql, Mohammad Nezar Khdary, Ali Alaa Basfar, Fahad Alsohime, Saleh Aldhahri, Khalid Fouda Neel
DOI:10.4103/jnsm.jnsm_175_20  
Background: The coronavirus disease of 2019 (COVID-19) has challenged and disrupted medical education worldwide. Objective structured clinical examination (OSCE) is one of the types of assessment for undergraduate medical students that has been conducted for first-year medical students in the College of Medicine. Peer student training on participating in OSCE has been conducted prior to the pandemic. The aim of this study was to assess medical students' perception of online virtual peer student video training on participating in the OSCE. Methods: Medical student's council team prepared a video demonstration on the steps of participating in OSCE. In October 2020, the video was provided online for first-year medical students (n = 302) prior to their OSCE. After the completion of the OSCE exam, a 10 – item questionnaire was distributed on the students' perception on the impact of the peer student video demonstration on students' orientation about the OSCE. The questionnaire was sent by Google Forms. The results were expressed as a percentage on a Likert scale. Results: About 74.17% (n = 224) of students responded to the online questionnaire. More than half of the students (n = 126, 56%) found the steps of conduction of the OSCE well explained, provided the sufficient orientation (n = 121, 54%), and found the video stimulating (n = 122, 54%). In addition, the majority of students (n = 160, 71%) learned and understood the steps of the OSCE and 152 students (68%) found that the video helped introducing them to the concept of OSCE. Almost half the students found that the video helped lowering the stress level before the OSCE (n = 91, 41%), eased the steps of the OSCE (n = 113, 50%), and found that the materials were well prepared and explained (n = 126, 56%). Conclusions: The virtual video demonstration of the OSCE during the COVID-19 pandemic had an overall positive perception from first-year medical students. However, peer student's orientation on the OSCE will continue after the pandemic. Further supports for first-year medical students are needed during the pandemic.
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Pregraduation online curriculum delivery of internal medicine course during the COVID-19 pandemic: Experience of a medical college in Saudi Arabia p. 337
Salman Aljarallah, Mohammed Bedaiwi, Rashed Alrashed, Mohammed A Omair, Mona Soliman, Assim A Alfadda
DOI:10.4103/jnsm.jnsm_11_21  
Background: The COVID-19 pandemic has challenged medical education and resulted in a rapid and unexpected global shift toward online education. The study presents the experience of the College of Medicine of King Saud University in delivering a comprehensive internal medicine course for final-year medical students, which includes the implementation of novel methods of assessment. Methods: A 2-week revision of the internal medicine course was conducted for 70 pregraduation medical students. Lectures and focused case-based tutorials were conducted online. Novel assessment methods included brief written essays summarizing the tutorials, open-book short-answer question (SAQ) examination, and a virtual standardized oral examination (vSOE). A questionnaire was sent to the students (n = 70) on the contents of the course, clarity of objectives, duration, and online platform. Results: The response rate was 99.3%. Students scored higher in the SAQs compared with traditional multiple-choice tests (mean score: 92.3% vs. 69.8%). The vSOE was efficient, and grades were comparable to traditional objective structured clinical examination. The majority of students (93%) reported the scientific content as good or excellent, whereas approximately 30% found the course goals lacked a clear description. The majority (76%) found the course length appropriate, and 94% reported the online platform installation and operation easy or very easy. Conclusions: The comprehensive online internal medicine course was successfully delivered to pregraduation students. Innovative online examination methods can be a reasonable alternative in the case of lockdown. This modality of teaching and assessment was considered useful and met the expectations of students.
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Effect of preconditioning on retention of glass ionomer pit and fissure sealant: An in vivo 9-month study p. 343
Samaa A Zaghloul, Safaa R El-Sayed, Eman A R. Mohamed
DOI:10.4103/jnsm.jnsm_20_21  
Purpose: Caries prevention using fissure sealants is directly proportional to their retention. This in vivo study evaluated the effect of preconditioning on retention of glass ionomer (GI) fissure sealant, in maxillary and mandibular primary and permanent teeth. Subjects and Methods: Two hundred and forty teeth in 30 children of 6-8 years age range were involved. In all participants, the second primary and the first permanent molars in each quadrant were investigated following split-mouth design; so that, selected teeth in the right side had their pits and fissures conditioned before GI sealant application (Group A: n = 120 teeth). In the left side, however, the same sealant was applied without preconditioning (Group B: n = 120). According to Simonsen's sealant retention criteria, clinical assessment was performed at 3, 6, and 9 months. Data were gained then statistically analyzed using Chi-square test. Results: A significant difference (P ≤ 0.05) was evident between both groups at the three assessment intervals, with better sealant retention in preconditioned group. Although no significant difference appeared between primary and permanent teeth, maxillary teeth were significantly better in sealant retention than mandibular ones. Conclusions: Preconditioning enhanced GI sealant retention, more durable caries prevention can be thus provided easily with low cost.
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Smell disturbance among Saudi COVID-19 Patients p. 348
Ahmad S Alroqi, Leen Othaim Alothaim, Shoag Jaza Albugami, Noura Othaim Alothaim, Almaha A Alqabbani, Saud R Alromaih, Sama Obaid Alharbi, Fatima Saad Alangari, Danyah Khalid Saja, Sarah Saeed AlMutawa
DOI:10.4103/jnsm.jnsm_148_20  
Objectives: Recently, COVID-19 was declared a pandemic, and since then, many studies have examined its symptomatology. In this study, we aimed to focus on Saudi patients with COVID-19 who also experienced smell dysfunction. We hypothesized that there would be a high percentage of COVID-19 patients with smell dysfunction in the Saudi population. Methodology: A quantitative, observational, cross-sectional study was carried out in Riyadh, Saudi Arabia in August 2020 and was designed to assess anosmia and hyposmia in Saudi patients with a positive COVID-19 test. Only Saudi adults with confirmed COVID-19 were enrolled in the study. We distributed an electronic, self-administered questionnaire through social media platforms, and personal contact to query the patients who had a positive COVID-19 test. Results: The study included 1005 patients, of whom 63.5% were female. More than three quarters (76.7%) were between the ages of 18 and 38 years. Most of them (74.1%) were healthy, while some of them (25%) reported associated comorbidities. Overall, approximately three-quarters (72%) of the participants developed smell dysfunction during the infection period, with (17.3%) experiencing a partial loss of smell (hyposmia), and (54%) experiencing a complete loss of smell (anosmia). Conclusions: Our study revealed that approximately three-quarters (72%) of the participants with COVID-19 developed smell dysfunction during the infection period, which supports our hypothesis.
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Association of shisha smoking with acute otitis media in men: A case-control study p. 352
Khalifa Binkhamis, Abdulelah Hamad Alsaeed, Sultan Nasser Alfehaid, Rakan J Almetary, Abdulaziz Saeed Alshahrani, Abdulrahman H Alduhayyim, Waleed Suliman Alanazi
DOI:10.4103/jnsm.jnsm_173_20  
Objectives: The objective of this study is to determine the possible associations between acute otitis media (AOM) and shisha smoking, cigarette smoking, and vaping in adults. Materials and Methods: The study was carried out from August 2019 to April 2020 using a case-control design. The sample consisted of 144 male participants from King Saud University Medical City aged 18–55 years, of whom 72 were cases, i. e., diagnosed by a physician with AOM, and 72 were controls, i.e. diagnosed with a physical injury with no history of AOM. The participants were interviewed over the phone based on a validated questionnaire by the WHO and were evaluated for shisha smoking, cigarettes smoking, and vaping status. Results: Of the 144 patients originally contacted, 136 (67 cases and 69 controls) were included in the analysis. The total number of participants who smoked any type of tobacco was 51 (37.5%). Among the 51 general smokers, 54.9% had a history of AOM with odds ratio of 1.436 (confidence interval [CI] 0.715–2.884, P = 0.308). Among shisha smokers, 70% developed AOM with odds ratio of 2.774 (CI 0.996–7.721, P = 0.045). Among cigarette smokers, 53.6% had a history of AOM with odds ratio of 1.287 (CI 0.617–2.681, P = 0.501). The number of vape users was too low to produce any significant results. Conclusion: The study found a significant association between shisha smoking and AOM among adult men in Riyadh. This finding correlates with what previous studies found about the dangers of tobacco consumption.
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Knowledge, awareness, and attitude of medical students concerning genetics and premarital screening p. 356
Syed Sameer Aga, Yara Abdulaziz Alghamdi, Amal Abdullah Alghamdi, Muhammad Anwar Khan
DOI:10.4103/jnsm.jnsm_47_21  
Objectives: The objectives of the study are to evaluate the medical students' knowledge, awareness, and attitude of genetics and genetic testing in general and premarital screening (PMS) in particular. Materials and Methods: An online predesigned, validated, and self-administered questionnaire was dispensed to all medical students of our university. This included questions regarding sociodemographic data, genetics, genetic testing, and PMS. Results: A total of 302 students responded to the survey with a mean age of 21.68 ± 2.32 (standard deviation) of which 38.7% were males and 61.3% were females. 51 (16.9%) students were from Phase I, 124 (41.1%) from Phase II, 127 (42.1%) from Phase III of College of Medicine KSAU-HS, Jeddah Campus. 224 (74.2%) of the participants had no direct relationship between the parents and 23 (7.6%) had personal history of hereditary disease. About 86.1% of students knew that genetic counseling is available in the Kingdom and 83.4% were familiar with PMS. Majority of students (female = 83.2%; male = 84.6%) did perceive that consanguinity can increase the chance of hereditary diseases. Overwhelming majority (female = 94.1%; male = 85.4%) agreed to make PMS obligatory before marriage, 87.4% of which were Phase III students. However, only a minority of students disagreed with marriage to be allowed even if the result of PMS came incompatible and most agreed to carrying out PMS which contrasts what others have reported. Conclusions: Majority of students had a positive attitude toward PMS, much higher than previously reported, thereby reflecting upon the importance of medical education as a lynchpin between the knowledge and practice.
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Smokers' perception, attitudes towards smoking cessation when visiting a smoker physician p. 366
Abdulaziz A Alodhayani, Abdulelah I Alhussain, Fahad M Alshughaithry, Saad A Aloqile, Saad A Alowaimer, Khaled A Showail, Salem Mohammed Basalem
DOI:10.4103/jnsm.jnsm_170_20  
Background: Smoking is one of the leading risk factors that raised mortalities and morbidities significantly. Smoking cessations programs were implemented to reduce the number of smokers. Many factors may influence the smoking cessation including factors related to the treating physician. Objective: To determine smokers' perception and attitude towards smoking cessation when knowing the physician is a smoker. Methods: This was an observational cross-sectional survey study that has been conducted among smokers' patients at King Khalid University Hospital in Riyadh, the estimated sample size was 200 participants. Results: The participants who saw a smoking physician were 90% and 8.8% of them were supported by physicians to quit smoking. The remaining 10% participants reported that they did not see a smoking physician and 15.8% of them were supported by physicians to quit smoking. There was significant correlation between attitude toward smoking cessation and the smoking status and the highest score was found among current smokers and lowest score among ex-smokers (P-value= 0.012). Moreover, the score was highest among those who have history of failed attempt to quit smoking. Lastly, there was no statistically significant difference in scores based on perception and attitude towards smoking cessations when knowing the physician is a smoker. Conclusion: The present study assessed the level of perception and attitude among smokers and the results suggest a different impact of smoker physicians and compared it according to characteristics of smoking. Also, this study showed variations in the behaviors of smoking and cessation, smoking-related barriers that prevent patients from stopping smoking based on physician smoking status.
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Histopathological spectrum and clinicopathological concordance of nonneoplastic skin lesions at a teaching hospital in South-Eastern Nigeria: A 16-year retrospective study p. 373
Chinedu O Ndukwe, Michael Emeka Chiemeka, Uchechukwu Brian Eziagu, Chinwe Chioma Ndukwe, Joseph Chukwuma Uzoigwe
DOI:10.4103/jnsm.jnsm_6_21  
Background: Only a few clinicopathological epidemiological studies detailing histopathologically diagnosed skin diseases have been carried out in Nigeria. Thus, the aim of this study was to retrospectively survey the histopathological spectrum and clinicopathological concordance of histopathologically diagnosed skin diseases in Nigeria over a 16-year period. Materials and Methods: This study involved the assessment of all skin biopsy specimens received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2004 to December 2019. Histopathological diagnoses based on these skin biopsies were made by consultant anatomical pathologists using routine hematoxylin and eosin-stained slides. All relevant demographic data and provisional clinical diagnoses were obtained from the histopathology laboratory requisition forms provided with the specimens. The skin lesions were then classified according to the International Classification of Diseases, Tenth revision (2019). Results: A total of 347 skin lesion biopsy specimens were included in this study. Most of the patients were aged 20–39 years old, with a mean age of 34.2 years. One hundred and forty-eight (42.7%) of the patients were males, whereas 199 (57.3%) were females. The most common 1CD-10 categories were disorders of skin appendages (105/347 [30.3%] cases) and papulo squamous disorders (81/347 [23.3%] cases), whereas the least common category was radiation-related disorders of the skin (2/347 [0.6%] cases). The most common disorder of the skin appendage was epidermal inclusion cyst (71/105 [71.4%] cases). Lichen planus was the most common papulosquamous disorder observed (26/81 [32.1%] cases). Only 202 cases included records of the biopsy site. The lower extremities were the most common sites of involvement (48/202 [23.8%] cases). The clinical diagnosis was concordant with the histopathological diagnosis in 55.3% of the cases, whereas it was discordant in the remaining cases. Conclusion: The most common skin diseases observed in this study were disorders of skin appendages and papulosquamous lesions. Our study provides baseline data for future population-targeted studies of nonneoplastic skin diseases.
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