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   Table of Contents - Current issue
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September-December 2022
Volume 11 | Issue 3
Page Nos. 159-221

Online since Wednesday, November 30, 2022

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REVIEW ARTICLES  

Focused ultrasound and deep brain stimulation for Parkinsonism – Review of literature to investigate tradeoff between safety and efficacy p. 159
Uthman Alshenqiti, Yasir Alzalabani, Khawar Siddiqui, Saud Alfaisal, Muayad Albadrani
DOI:10.4103/sjhs.sjhs_86_22  
Parkinsonism is a movement disorder, mostly caused by the neurodegenerative Parkinson's disease (PD), the second most common movement disorder. Its symptoms include rigidity, slow movement, tremor, and disruption of balance. First treatment line is dopamine replacement drugs, and surgery is due when medication fails. Surgery options include deep brain stimulation (DBS), which revolves around implanting impulse generator in the target structure, and magnetic resonance-guided focused ultrasound (MRgFUS), where transcranial sonication ablates certain structures to counter the excitotoxic circuitopathy. This review aims to compare results described in peer-reviewed publications describing DBS and MRgFUS in Parkinsonism in terms of improvement in symptoms and side effects. This study was carried out by searching prominent computerized biomedical databases (PubMed, Web of Science, Cochrane, and EMBASE) to assess and compare the safety and efficacy of MRgFUS and DBS procedures done for the treatment of PD. Most of the published results for each of the two operations are comparable, in tremor and Unified Parkinson's Disease Rating Scale scores, though minimal superiority is shown in the DBS results. The neurological adverse effects are similar between the two types, including mild-to-moderate transient instances of dysarthria and gait disturbances, which are the most common two adverse events, among others. However, DBS has a more severe or significant adverse event profile that includes hemorrhage and infection. Long-term improvement is observed more with DBS which can sustain improvement for up to 5 years. DBS, therefore, tends to better improve Parkinsonism prognosis at the cost of safety. Postoperative complications are less severe in MRgFUS, which can be a safe, efficient alternative procedure for medication-refractory Parkinsonism.
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Primary understanding of type 1 diabetes as an autoimmune disease p. 165
Mohamd A Alblihed
DOI:10.4103/sjhs.sjhs_50_22  
Type 1 diabetes (T1D) is classified as an autoimmune disease affecting a wide range of people worldwide. Beta cells in the pancreatic islets of Langerhans in the pancreases are responsible for insulin productions, which help in the exchange of blood glucose into energy. These cells were destroyed by developing particular immune mechanisms. Some newly diagnosed patients with T1D have insignificant scientific understanding of their immune system condition. Importantly, scholars found a direct relationship between hypoglycemic and innate immune response. Therefore, this review was intended to elaborate a simple scientific explanation for T1D, including T1D etiology and pathogenesis, initiation of immune response against β-cell, and immunological impact of the best therapy, in addition to the newest understanding of the cell types and immune mechanisms involved in T1D. This review included articles published from 1997 to 2022 extracted from PubMed, Medline, and Google Scholar databases.
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ORIGINAL ARTICLES Top

The risk factors for self-monitoring of blood glucose among individuals diagnosed with type 2 diabetes in Saudi Arabia p. 170
Mohammed Abdulrahman Alsuliman, Qi Zhang, Shelley Mishoe, Praveen K Durgampudi
DOI:10.4103/sjhs.sjhs_95_22  
Background: Lack of self-monitoring of blood glucose (SMBG) is a known risk factor for controlling type 2 diabetes mellitus (T2DM). Nevertheless, little research has been conducted on SMBG among Saudis with T2DM. Aim: The study aimed to investigate personal and cognitive-perceptual factors for SMBG among Saudis with T2DM guided by Health Promotion Model. Methods: A cross-sectional study was conducted with a sample size of 808 Saudi adults with T2DM utilizing secondary data from the Saudi Health Interview Survey for 2013. Statistical Analysis: Bivariate and multivariate logistic regressions were applied to examine the risk factors for SMBG among Saudis with T2DM. Results: The prevalence of SMBG was 55.5% in Saudi adults with T2DM. In the multivariate analysis, obesity (adjusted prevalence ratio [APR] = 1.20), middle (APR = 1.30) and higher (APR = 1.49) education where predictors of SMBG, whereas shorter diabetes duration (APR = 0.78 for <5 years and 0.78 for 5–9 years) and Eastern region (APR = 0.66) were inversely associated with SMBG. Conclusions: The study suggested the future design of interventional programs related to self-care practices should focus on diabetic individuals with low education, obesity, and longer duration of diabetes, and regional differences, specifically when considering limited access to health care during the COVID-19 pandemic. In addition, longitudinal studies with a large sample size at national and regional levels are needed to further examine the personal and psychological risk factors in Saudis with T2DM.
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Hormonal, metabolic, and Vitamin D status variabilities among Saudi women with polycystic ovarian syndrome versus nonpolycystic ovarian syndrome controls: A retrospective study p. 179
Ramya Ahmad Sindi
DOI:10.4103/sjhs.sjhs_91_22  
Background: Vitamin D deficiency in Saudi Arabia is alarmingly high and can affect all human ages. However, the characteristic hormonal and metabolic features, and the systemic Vitamin D levels, among Saudi women with polycystic ovarian syndrome (PCOS) remain largely unknown. Aims: This retrospective study aimed to identify the hormonal, metabolic, and Vitamin D status variabilities among infertile Saudi women with PCOS versus those of non-PCOS fertile women as controls. Materials and Methods: The medical records of a total of 99 women (49 PCOS and 50 controls), with matched age and body mass index, were analyzed in this study. For each woman who met the study inclusion criteria, the analyzed parameters included the serum levels of 25-hydroxyvitamin D (25(OH) D), sex hormone-binding globulin (SHBG), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), androgen, total testosterone (TT), estradiol, progesterone, thyroid hormones, the fasting plasma glucose (FPG), and lipid profile concentrations. Results: Compared to the controls, women with PCOS had significantly lower levels of 25(OH) D, SHBG, FSH, and estradiol, but they had significantly higher levels of LH, androgen, TT, FPG, total cholesterol, and low-density lipoprotein cholesterol. There were no differences between the two groups regarding the other parameters. Conclusions: The present findings highlight the prevalence of sex hormones, metabolic, and Vitamin D status disturbances among Saudi women with PCOS. Large-scale retrospective and prospective studies are therefore essential to realize these findings.
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The effect of integrating a nursing licensure examination preparation course into a nursing program curriculum: A quasi-experimental study p. 184
Abdulaziz Mofdy Almarwani
DOI:10.4103/sjhs.sjhs_87_22  
Background: Nursing licensure examinations (NLEs) are used worldwide to determine nursing students' levels of competence and preparedness to practice nursing. However, despite students' knowledge of nursing concepts, some students struggle with anxiety, pressure, and NLE question style. Preparation courses embedded within nursing students' curriculum may be effective in preparing students to take the NLE. Aim: The aim is to determine the effectiveness of implementing a Saudi Nursing Licensure Examination (SNLE) preparation course into nursing students' curriculum. Setting and Design: A quasi-experimental, repeated measures design was used with 109 undergraduate nursing students in three-branch college of nursing in the western region of Saudi Arabia. Methods: Students completed a 3-month SNLE preparation course integrated into the current curriculum. The course involved practice question preparation, case studies, and online learning videos. Students took an SNLE-style pretest before the course and a posttest one month after the course was completed. Results: Most students were female (70.6%) and 34.9% reported studying 1–2 h per week studying for the course. There was a significant, positive, and strong correlation between the number of hours spent studying and SNLE posttest scores (r = 0.729, n = 109, P < 0.001). Students performed significantly better after taking the SNLE preparation course. Female students scored higher in all domains compared to male students, especially within the maternity and pediatric nursing domain. Conclusions: An NLE preparation course integrated into the nursing curriculum was shown to be effective within this sample of Saudi nursing students. Further research with larger samples may be needed to corroborate these findings.
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Dental pattern diversity in a Saudi Arabian population: An orthopantomogram-based study p. 190
Nabeel Almotairy, Abdulrahman Althunayyan, Dina Alkhuzayyim, Lina Aloufi, Rola Alhusayni
DOI:10.4103/sjhs.sjhs_93_22  
Background: Dental pattern diversity was investigated in different populations, but none have focused on Saudi Arabia. Aim: The aim of this study was to investigate the dental pattern diversity in Saudi Arabia. Setting and Design: This was a retrospective study. Materials and Methods: Five thousand two hundred and twenty-five orthopantomograms of healthy dentate adults were divided into four age groups: Group 1, 18–30 years; Group 2, 31–45 years; Group 3, 46–55 years; and Group 4, >55 years. The conditions of the 32 teeth in each individual were assigned to 10 characteristics to form a dental pattern, and the diversity of patterns was estimated using the Simpson's Diversity Index. Statistical Analysis: The diversity, proportions, and frequency of unique dental patterns were descriptively compared between age groups and sexes. Results: The dental pattern diversity for full dentition was >0.99, with 5024 unique dental patterns. The diversity and frequency of dental patterns were lower in the maxillary and mandibular anterior segments compared to those in posterior segments. All virgin teeth were the most frequently observed dental pattern for full dentition (1.24%). The dental pattern diversity for full dentition was similar across the age groups, but the frequency of unique dental patterns was 68.23%, 91.47%, 90.39%, and 88.89% for Groups 1, 2, 3, and 4, respectively. Further, the frequency of unique dental patterns was 10%–20% higher in females than in males. Conclusions: The dental pattern diversity was high in the studied Saudi Arabian sample and was affected by individuals' age and sex, where older individuals and females have higher diversity than younger individuals and males.
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Validation of the health-related quality of life questionnaire for adult strabismus AS-20 in the Arabic language p. 197
Reem Saleh Alamri, Mayar Abdulkarim Alyousef, Noha Omar Bamardouf, Badr Ali Alharbi, Lina H Raffa
DOI:10.4103/sjhs.sjhs_113_22  
Background: The impact of strabismus to the quality of life (QoL) in adult patients has not been assessed and explored in Arab countries. Aims: This study aims to assess the validity and reliability of the Arabic-translated adult strabismus-20 (AS-20) questionnaire in determining the impact of strabismus on health-related QoL (HRQoL) of patients. Settings and Design: A cross-sectional study on the psychosocial and functional scores collected from 161 adult patients with strabismus, diagnosed from 2011 to 2021 in King Abdulaziz University Hospital, Jeddah City. Population with no strabismus manifestation was used as the control group. Subjects and Methods: One hundred and sixty-one adult patients, with a minimum age of 18 years with manifest strabismus, were contacted via phone calls to answer the QoL questionnaire list using Arabic-translated AS-20 questionnaire. Statistical Analysis Used: A model of Alpha (Cronbach) was used to determine the reliability test of the Arabic-translated AS-20 questionnaire. A comparison of two mean scores was performed using an independent t-test or Welsch's t-test, which was only significant at < 0.05 level. Results: The overall AS-20 mean scores for male and female adults were 66.79 ± 28.2, with a total psychosocial and functional mean score of 65.70 ± 30.9 and 67.88 ± 30.8, respectively. In general, female patients have a higher mean score than male patients for all the subscale items, except item 6. The case group, involving strabismic patients, showed significantly lower AS-20 scale mean scores as compared to control (48.53 ± 25.8 vs. 83.48 ± 18.1), with mean scores of 43.85 ± 25.9 and 53.87 ± 24.8 for males and females, respectively. Moreover, excellent overall score was obtained in internal consistency (Cronbach's alpha = 0.918). Conclusions: With its excellent test-retest reliability results, the Arabic version of the AS-20 questionnaire was an applicable tool for assessing strabismus among Arabic-speaking patients. Prominent impact of strabismus on patient's HRQoL was determined by the significantly lower AS-20 scores of the patients than those of the control.
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Hybrid assessment as a formative assessment tool for undergraduates in pathology: An untapped boon during the COVID-19 pandemic p. 203
Shivali Sehgal, Sabina Khan, Musharraf Husain, Sujata Jetley
DOI:10.4103/sjhs.sjhs_126_22  
Background: The online portal has been a vital tool for both teaching as well as assessment during the COVID-19 pandemic. While being the only safe option available during this period, online assessment has its own drawbacks. Students have access to their books as well as the internet; therefore, there is no regulation over plagiarism, compromising the reliability of the examination. On the other hand, traditional offline assessment, apart from issues of safety during the pandemic, also requires a substantial infrastructure. Aims: The study was conducted to explore the possibility of using a hybrid assessment method-an online examination in an offline setting-with the aim of compensating the shortcomings of both type of assessments and evaluating its potential as a formative assessment tool. Settings and Design: The study was conducted over a period of 1 month in the Department of Pathology of a Medical College of New Delhi. A batch of 100 students belonging to the second professional MBBS were evaluated toward the end of their fifth semester. Materials and Methods: A blueprint of the online practical examination was prepared by the faculty, including the entire syllabus. The assessments were conducted 4 times for a batch of 25 students at a time. Students were called on the day of their assessment with their mobile phones, and the test was sent through Google forms. At the end of the examination, a quick evaluation of the result was done question wise and the faculty gave detailed feedback discussing the results. Following this, the students were asked to fill out an online feedback form to gather their perceptions regarding hybrid assessment. Results: Most of the students considered hybrid practical assessment to be a better mode than conventional practical assessment, and the majority thought that this mode can be useful for final exam preparation and should be conducted more frequently. Most of the students were satisfied with the time given for answering the questions as well as with the difficulty level of the questions, and felt that the syllabus was appropriately covered. However, a few students faced problems such as Internet connectivity and form reloading issues. Conclusions: A hybrid assessment method that is conducting an “on campus” online examination can be effective mode of conducting regular formative assessments. It has the advantage of requiring minimal infrastructure as well as examination faculty.
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Assessment of awareness, experience, and attitude of Saudi women about oral health changes during the menstruation: A cross-sectional study p. 209
Abdullah Saleh Almutairi
DOI:10.4103/sjhs.sjhs_57_22  
Background: One of the systemic conditions that lead to several changes in the oral cavity is hormonal changes which occur during puberty, menstruation, pregnancy, or menopause, so the awareness of women about these oral changes during the menstruation is important to motivate them toward maintaining good oral hygiene to prevent or reduce oral health changes during menstruation and to seek treatment if needed and not ignore them. Aims: This study aims to assess awareness, experience, and attitude of Saudi healthy menstruating women about oral health changes during menstruation. Setting and Design: This study was performed by distributing a questionnaire in the Arabic language to 401 healthy menstruating females between 18 and 45 years of age among the general population of Saudi Arabia. Methodology: A self-administered closed-end questionnaire was designed comprising 21 questions to assess the awareness, experience, and attitude of females about oral health changes during menstruation. Statistical Analysis Used: The frequency analysis and percentages for all answers were calculated. In addition, pairs of Chi-square analyses were conducted between the dependent and independent variables. Results: This study's results showed that halitosis was the oral change that the participants experienced most during their menstruation followed by a mouth burning sensation (36.4%), gingival bleeding (33.9%), alteration in taste sensation (31.2%), gingival swelling (30.2%), formation of oral ulcers (23.25), and increased tooth mobility (18.7%). 53.11% of the participants in this study were aware of the relationship between menstruation and oral health changes and 48.87% of them agreed that maintaining good oral hygiene can reduce these oral changes during menstruation. Conclusion: More than half of the participants in this study were aware of the relationship between menstruation and oral health changes and approximately half of them agreed that maintaining good oral hygiene can reduce these oral changes during menstruation.
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CASE REPORTS Top

Adenovirus causing acute encephalitis in an immunocompetent elderly female - The first case reported in literature p. 215
Vishal Mangal, Shikha Yadav, Kaminder Bir Kaur
DOI:10.4103/sjhs.sjhs_124_22  
Encephalitis is a leading cause of morbidity and mortality in elderly patients. Prognostic factors independently associated with an adverse clinical outcome are age ≥65, fever, Glasgow Coma Scale score <13, and seizures. The most common viruses causing encephalitis are herpes simplex virus, varicella-zoster, human immunodeficiency virus, Epstein–Bar virus, cytomegalovirus, Japanese encephalitis, and arboviruses. We hereby present a case of a 55-year-old female who presented with a new-onset seizure, fever, and altered behavior. She was clinically diagnosed with encephalitis. Her diagnostic lumbar puncture was suggestive of lymphocytic pleocytosis, red blood cells, and raised protein with normal glucose. She had normal magnetic resonance imaging of the brain; however, cerebrospinal fluid demonstrated the presence of adenovirus DNA by real-time polymerase chain reaction. She was managed conservatively; however, the course was complicated by drug-induced acute kidney injury. Our patient had a favorable outcome. To the best of our knowledge, this is the first case of adenovirus encephalitis in an elderly immunocompetent female. Adenovirus is a rare cause of encephalitis in adults; however, high index of suspicion and timely management with available antivirals can lead to successful outcomes.
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Milk curd syndrome with goat's milk: Revisited p. 218
Rahul Gupta
DOI:10.4103/sjhs.sjhs_98_22  
Milk curd syndrome is an infrequent cause of intestinal obstruction in neonates and early infancy. We are adding to the literature an extremely rare case of milk curd syndrome in a 3-month-old infant who was being fed with goat's milk. A 3-month-old infant presented with features of intestinal obstruction. The patient used to pass a few pellets such as small, firm, white-colored stools after every 2 to 3 days often requiring enema. The baby was fed with goat's milk. Abdominal radiographs suggested large bowel obstruction. The conservative treatment with rectal washes failed. Exploration revealed dilated small bowel with the presence of very dense, inspissated, sticky, and white-colored intraluminal material in the terminal ileum and throughout the colon. Multiple attempts were made to milk the contents distally and finally out of the rectum but failed. A transverse loop colostomy was performed and inspissated milk curds were milked out. The outcome was favorable. The diagnosis of milk curd obstruction should be considered in neonates and infants with signs of the terminal ileum or large bowel obstruction fed with unmodified animal milk, for example, goat's milk (as seen in our case) or formula feeds.
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