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   Table of Contents - Current issue
Coverpage
January-March 2023
Volume 6 | Issue 1
Page Nos. 1-57

Online since Tuesday, January 3, 2023

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LETTER TO EDITOR  

A pathophysiological mechanism for valproate-induced hyperammonemia p. 1
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/jnsm.jnsm_19_22  
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REVIEW ARTICLE Top

Long COVID: The long-term consequences of COVID-19 and the proposed pathophysiological mechanisms Highly accessed article p. 3
Mohammed Masood, Sai Sundeep Chodisetti, Ahmed S BaHammam
DOI:10.4103/jnsm.jnsm_133_22  
The new devastating pandemic coronavirus disease 2019 (COVID-19) caused by the novel coronavirus severe acute respiratory syndrome (SARS-CoV-2) has been related to approximately 600 million cases and more than six million deaths till now. After recovery from COVID-19, some patients develop long-term sequelae called long COVID (LC). LC cases have been reported with multi-system involvement, with the most common being neuro-psychiatric, cardiorespiratory, hematological, and gastrointestinal systems highlighting the need for multidisciplinary team involvement and treatment. Since we are more than two and half years into this pandemic, we have more understanding of the pathophysiology and successful treatment of acute COVID-19, and we see more survivors and, subsequently, individuals with LC. However, the pathogenic mechanisms leading to LC are not clear till now. This review describes the potential pathogenic mechanisms leading to LC and common clinical manifestations reported from current evidence.
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ORIGINAL ARTICLES Top

Needs assessment to incorporate Saudi human genome project and personalized medicine into saudi undergraduate medical curriculum p. 12
Marwa Ahmed El Naggar
DOI:10.4103/jnsm.jnsm_10_21  
Introduction: The Saudi Human Genome Program (SHGP) is one of the groundbreaking national programs and the largest genome initiative in the Middle East. His Royal Highness has put the growth of the health-care sector at the top of government priorities to ensure and increase the welfare of the Saudi nation. There are a few studies about needs assessment to incorporate the Saudi Human Genome and personalized medicine in Saudi Arabia's medical curricula until now. Aim: This study aimed to assess the need to incorporate Saudi Human Genome theme and personalized medicine into the Saudi undergraduate medical curriculum. Methodology: A cross-sectional descriptive study was implemented and a simple random sample of 28 faculty members and medical educationists working inside KSA was taken. The study followed Kern's six-step approach to curriculum development designed by Kern et al. 2005, by the application of its first four steps: (i) problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation, and (vi) evaluation and feedback. A self-administered questionnaire was designed on Google Forms and distributed electronically by E-mail and WhatsApp groups to assess faculty members' needs determine course objectives and teaching methods, and level, and determine the departments that will manage it, and students' assessment tools. Results: Twenty-eight medical educationists and faculty members from different specialties participated in the study. 26 (92.9%) and 16 (57.10%) of the study population stated that their undergraduate medical curriculum did not address the topics of the Saudi Human Genome and personalized medicine, respectively. Twenty-two (78.60%) agreed that there is a need to incorporate both topics in the curriculum. Twenty-four (85.70%) agreed that incorporating SHGP will familiarize students with the importance of genetic counseling in reducing and preventing hereditary and genetic diseases. Conclusion: There is a lack of incorporation of the Saudi Human Genome Project and personalized medicine into the Saudi medical curriculum, and there is a need to incorporate both topics into it to gauge its effectiveness and identify areas for its implementation improvement.
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The psychometric properties of the Arabic version of the fear of COVID-19 scale p. 18
Reem Al Khalifah, Afnan Younis, Hessah I Al Suwaidan, Noor AlAnazi, Leena R Baghdadi
DOI:10.4103/jnsm.jnsm_130_21  
Aim: We aimed to translate and perform transcultural adaptation of the English version of the Fear of COVID-19 Scale (FCV-19S) to Arabic, and assess predictors of COVID-19 fear. Methods: We translated the original seven-item English FCV-19S to Arabic, then back-translated the scale to English. The scale was evaluated by a group of medical experts and participants from the general population to test for content and face validity. The final version of the scale was assessed in a cross-sectional study that included adults residing in Saudi Arabia, who participated in a study to assess the impact of COVID-19 fear on children's vaccination during the COVID-19 pandemic curfew March 24–July 6, 2020. Results: Overall, 577 participants responded to the survey. The mean age was 32.6 ± 5.7 years, and the majority had bachelor's or postgraduate university degrees. COVID-19 was diagnosed in 1.4% of the participants. The mean total score for the COVID-19 fear scale was 20 ± 5.4. The COVID-19 fear scale had excellent internal consistency and Cronbach's alpha 0.85 (95% confidence interval 0.93–0.96). Conclusions: The modified Arabic version of the FCV-19S is a valid and reliable tool to measure fear levels during the pandemic of COVID-19. Using an appropriate psychometric tool to measure the level of fear can help in monitoring changes in population fear levels, and implementing population-level measures to limit unwarranted fear.
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The factors affecting the response of 2019 pilgrims toward preventive measures against SARS and other Respiratory Infectious Diseases in Hajj p. 24
Osama A Samarkandi, Yasser A Alharbi, Anas A Khan, Hamoud S Alqarni
DOI:10.4103/jnsm.jnsm_110_21  
Purpose: This study aims to evaluate the response of pilgrims at Almadinah Almunawwarah Airport toward knowledge of preventive measures on respiratory infectious diseases, and to study the factors affecting the response of pilgrims to prevent infectious diseases such as SARS. Materials and Methods: This study was conducted at Almadinah Almunawwarah airport in the Kingdom of Saudi Arabia. Pilgrims who arrived at the city airport of Almadinah Almunawwarah (during the pilgrimage season in 2019) were invited to participate in this study. The tool used to collect data was a paper-based questionnaire. Results: The respondents' mean age was 39.8 years with a range of 18 to >50 years and a median age of 35–50 years. The findings indicated that 82.8% of the study participants reported overcrowding could increase the risk of infections. In addition, 67.4% of them agreed that cardiovascular and heat-related illnesses are major causes of death in travelers to the Hajj. With regards to attitudes about 70% agreed that visiting a physician before travel is essential whereas 73.7% of them agreed that personal hygiene protects them from many diseases. Conclusion: The current study shows that knowledge, attitudes, and practices toward preventive measures against respiratory infectious diseases, such as SARS, among pilgrims, are generally less acceptable if contrasted with their ways toward preventive procedures.
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The relationship between coronavirus disease-2019-positive patients and plasma interleukins and transforming growth factor-β levels p. 32
H Seda Vatansever, Murat Sayan, Melike Ozgul-Onal, Sila Akhan, Selcan Ozel, Tamer Sanlidag
DOI:10.4103/jnsm.jnsm_37_22  
Objective: The aim of this study is to reveal the relationship between the cytokine plasma levels and symptoms of coronavirus disease-2019 (COVID-19)-positive patients, which is characterized by serious respiratory syndromes. Materials and Methods: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-positive patients were evaluated in four groups. Group 1 patients had no symptoms. Group 2 patients were mildly symptomatic. Group 3 patients had multiple symptoms. Group 4 patients had all symptoms of acute respiratory distress syndrome. Analysis of interleukin (IL)-17A, transforming growth factor-β1 (TGF-β1), and IL-6 concentrations in plasma samples taken from patients were examined by enzyme-linked immunosorbent assay method. Results: IL-17A levels were increased in parallel with the clinical condition in all patients. TGF-β1 was only observed in patients in Groups 3 and 4, and IL-6 was only observed in Group 4 patients. Conclusion: It is known that many cytokines are involved in the development of different viral infections and viral invasion always triggers an inflammatory response. The profile of inflammatory markers may be used to classify COVID-19 patients. In conclusion of this study, it is suggested that the level of cytokines which is changed according to the patient's clinical status should be used to evaluate the response of SARS-CoV-2 treatment. IL-17A, TGF-β1, and IL-6 concentrations in plasma levels could be good prognostic indicators of COVID-19.
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Awareness of the causes and management of endodontic mishaps among dental students at King Saud University and Riyadh Al-Elm: A cross-sectional study p. 38
Mazen Alkahtany, Khalid Almadi, Abdulaziz Ghassab Alotaibi, Yazeed Alzahrani, Bader Fatani, Almaha Alabdullatif, Haifa Alaiban
DOI:10.4103/jnsm.jnsm_77_22  
Background: Nonsurgical root canal treatment is an inseparable and essential element of thorough dental health care. Any errors that occur through any phase of endodontic treatment can affect the success of treatment. Objective: The aim of this study is to evaluate and assess dental Student's knowledge, awareness, and practice regarding the endodontic mishap. Materials and Methods: This study was carried out in Saudi Arabia, Riyadh, King Saud University, Dental hospital, and Riyadh Al-elm dental hospital. A well-structured questionnaire consisting of 24 questions were sent to 465 dental students from both colleges male and female from 3rd, 4th, and 5th academic year using Google form. Results: In general, 260 students (55.9%) reported at least one endodontic procedural error. Access cavity errors were reported by 158 students (34%). The total number of instrumentation errors was 243, which were performed by 187 students (40.2%). A total of 284 obturation errors were reported by 220 students (47.3%), and among the whole sample, the average knowledge of the student regarding endodontic mishaps was only 34%, which mean that 66% of the student does not know the causes and management of the endodontic procedural errors. Conclusion: As health-care providers, it is our responsibility to treat our patient with highest quality, and update our knowledge constantly, and according to our results, the average knowledge of the student regarding endodontic mishaps was only 34%, this shows that dental students have inferior knowledge about the causes and management of the endodontic errors, thus measures should be taken by the educational program and the student them self to improve their knowledge regarding endodontic mishaps.
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Prevalence of depression and depressive symptoms among patients using beta-blockers in King Khalid University Hospital, Riyadh Saudi Arabia: A cross-sectional study p. 46
Mohammed A Al-Jaffer, Ibrahim Bader Al-Shaqrawi, Omar H Al-Omar, Abdullah A Al-Jammaz, Meshaal K Al-Ghanim, Albaraa M Al-Saif, Mohammed N Al-Shunayf
DOI:10.4103/jnsm.jnsm_59_22  
Background: The relationship between depression and beta-blockers (BBs) use is a controversial topic for many decades. Due to the interference with adrenergic and serotonin receptors, BB use has been linked to depression in many early cross-sectional and case studies. Others have investigated the indirect relationship between BB use and novice antidepressant use. However, larger trials have yielded inconsistent findings. The objective of this study is to identify the presence of depression and depressive symptoms among patients using BBs in the internal medicine, cardiology, and psychiatry Departments in King Khalid University Hospital (KKUH) and to measure its prevalence. Research Design and Methods: A cross-sectional study included patients visiting Internal Medicine, Cardiology, and Psychiatry clinics at the KKUH in Riyadh, Saudi Arabia, who is known using BBs for any indication and excluded patients previously diagnosed with depression before taking BBs. This study was carried out from December 2018 to October 2019. Either physically or over the phone, patients were requested to complete the Patient Health Questionnaire-9 questionnaire. Drug names and pictures were provided for ease of drug identification. The sample size was 291, with a confidence interval of 95% and 5% margin of error. Written consent was acquired from all participants. Results: Two hundred and ninety-one surveys were collected, among 151 (52%) were females and 140 (48%) were males. Females were more likely to report depressive symptoms and had higher scores of symptom severity on average (P < 0.016). Only 17 patients (5.8%) were found to report no depressive symptoms, while most patients reported mild depressive symptoms (35%). We have not found a statistically significant relationship between BB type and the magnitude of depressive symptoms severity. Conclusions: Although the usage of BBs and the prevalence of depressive symptoms were not directly correlated in our study, compared to the local prevalence, our patients demonstrated a higher prevalence trend of depressed symptoms. In addition, our observations did reveal fascinating information on the gender disparity in depression.
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Knowledge about attention deficit hyperactivity disorder among primary school teachers in Riyadh, Saudi Arabia p. 51
Noura Abouammoh, Afnan Younis, Layan Alwatban, Marwah Alkhalil, Rawan Alharbi, Reham AlHalabi, Shahad Alzahrani, Shikah Alrwais
DOI:10.4103/jnsm.jnsm_22_22  
Context: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders affecting children. As ADHD symptoms affect the learning process of children at schools, teachers have an important role in identifying children who may have ADHD. Aim: This study aims to estimate knowledge level of primary school teachers in Riyadh about ADHD and to correlate the level of knowledge to demographic characteristics. Settings and Design: A cross-sectional study including 448 male and female teachers from 20 primary schools. Materials and Methods: Schools were sampled using multistage random sampling technique. The Knowledge of Attention Deficit Disorder Scale questionnaire was used for data collection. Data collection continued for 1 month starting from January 30, 2020. Statistical Analysis Used: Association between main outcome and different demographic variables was tested using analysis of variance test for more than two groups, categorical variables and t-test for nominal binary variables using SPSS. Results: The mean of the overall knowledge about ADHD was 43.1%. The mean of ADHD general knowledge, diagnosis, and treatment was 32.3%, 61%, and 36%, respectively. Regarding general knowledge about ADHD, teachers between 22 and 30 years of age and males scored significantly higher than the other groups. Regarding teachers' knowledge about ADHD treatment, statistically significant higher scores were found male teachers. Previous experience with ADHD child had significantly higher scores than those who did not have experience in all three knowledge categories. Conclusions: Knowledge about ADHD has a positive correlation to previous experience with ADHD which proves the importance of implementing a training program to help the teachers identify students with ADHD leading to earlier diagnosis and better outcomes.
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