Objectives: Our objective was to determine the awareness, use of medications to suppress menstruation along with their side effects, and satisfaction level among the pilgrims. Methods: An observational cross-sectional survey was conducted during the pilgrimage (Hajj) period 1437 Hijrah in Makkah, Saudi Arabia. Women pilgrims (n = 594) between menarche and menopause were interviewed. The proportion of females who was aware of menstrual suppression by medication, who used the medication during Hajj period, and who experienced complaints while using drugs to postpone the periods, and after stopping the drugs were sorted. Results: The participants were mean aged 35.3 years (standard deviation = 8.4), with 413 (69.5%) being multiparous, 556 (93.6%) were aware of menstruation postponement by medications, and 313 (56%) got this information from their family doctors. However, 381 (64%) used medications, and 356 (93.3%) successfully achieved menstrual suppression. Out of 381, majority used Norethisterone, i.e., 301 (79%) and 80 (21%) complained of side effects, of which the most common was irregular spotting 31.3% (25/80) followed by abdominal pain. Satisfaction of medications users was 324 (85%). Out of 381 women, 87 (22.8%) reported side effects after discontinuing the hormones; the commonly experienced side effect was heavy prolonged bleeding 47 (54%). Conclusions: The awareness about hormones usage to postpone menstruation was high. Norethisterone was commonly used medication. Overall satisfaction with medications' usage was high. Most women did not know what to do in case of unscheduled bleeding.

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Context: The relationship between the staffs and the nursing students is an essential factor that affects the clinical learning experience of the nursing students. However, students conveyed negative experiences in the clinical setting that provided a negative impact on their learning process. Aims: This study explored the challenges and difficulties encountered by nursing students during their internship year. Settings and Design: This study used descriptive qualitative design. It was conducted in select hospitals in Qassim Region that provides clinical internship to nursing students. Subjects and Methods: Data were gathered using face-to-face semi-structured interview among select 17 nursing interns from three colleges of nursing in Qassim Region: Qassim University, AlGhad Private Colleges, and Buraydah Colleges between December 2016 and February 2017. Analysis Used: Data were analyzed using thematic content analysis established by Morse and Field (1996). Results: The nursing interns experienced inappropriate treatment from the clinical staffs through lack of communication, disregard, and exploitation from the staffs. Further, they perceived feeling lost because of the identified gap in the organizational structure in the training department of some hospitals, scarcity in regular follow-ups from the college, and lack of willingness to teach from the clinical preceptors. Furthermore, they feel shocked from reality due to the existence of some staffs who were found to have unsatisfactory knowledge and skills in the clinical area and the limitations set by the hospital policies and procedures in the scope of practice of nurses in their institution. Conclusions: There is a vast need to improve the internship program for nursing students in the Qassim Region. A joint effort between the hospital and college administrators should be encouraged to establish an internship program with well-defined policies and procedures.

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Displacement of copper intrauterine devices (IUDs) is not uncommon complication of these methods of contraception; many literatures have reported the translocation of IUDs to the peritoneum, bladder, and myometrium. A less common complication such as perforation of the ovary has equally been reported. Copper IUD penetrating the rectum is also a rare occurrence because of the anatomical relationship of the uterus and the rectum. This series aimed at highlighting a complication of copper IUD translocating through the uterus to the rectum. We present three cases of displaced IUD managed in our facility over a 2-month period. Two of the clients had their device inserted in primary facilities in the state and one in our institution. All the clients had laparotomy in view of their unusual symptoms. It is imperative for all facility providers to evaluate any client presenting with missing string both clinically and radiologically; they should also acquire or retrain on the criteria for correct insertion of Intra Uterine Contraceptive Device.

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Aim: Self-medication is developed to encourage responsible self-care but is often carried out without sound rationality. This study assesses the reasons, knowledge, attitude, and practices toward self-medication in rural areas of south-western Saudi Arabia. Materials and Methods: A cross-sectional, descriptive, and questionnaire-based study was carried out on respondents visiting the primary healthcare center. Data were collected, analyzed using SPSS software version 23 and presented as frequencies and percentage. Association between variables was established using the Chi-square test, and logistic regression. Results: Among the 500 responses obtained, 58% were female, and 42% were male. Self-medication was practiced for pain (38.3%), influenza (26.3%), cough (24%), and allergy (11.4%). Over 70% failed to consult a physician, lacked awareness of medicine information inserts (71.06%), and failed to check the expiration date (85.2%). Recurrence of symptoms and accessibility of medicines in pharmacies or online stores were a widely accepted reason for self-medication. The respondents were 2.5 times likely to use medications based on others recommendations (odds ratio [OR]: 2.56; 95% of confidence interval [CI]: 1.59–4.13); however, this was lower in females (OR: 0.55; 95% CI: 0.38–0.79; P = 0.002). A significant association was observed between the reasons for self-medication and practices undertaken if symptoms persist with demographic characteristics. Conclusion: Recurrence of symptoms, adopting others advice, the absence of information about medication inserts, and expiration date were issues that can impede responsible self-medication in rural areas. Appropriate patient counseling and conscious dispensing of medications are needed to minimize risks associated with self-medication.

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Background: Many factors in Saudi society have led to the need for health education services in schools, while concerns related to the role of health educators in schools still unclear. The aim of this study was to analyze the role of health educators in public schools exploring the obstacles which affect their role. Subjects and Methods: A cross-section design was used; data were collected using self-administered questionnaire which consisted of four parts: covered demographic data, roles of health educators, the obstacles that affect them, and the attitudes regarding their role. A sample of 234 health educators working in public schools in Riyadh city participated in the study. Descriptive statistics and a Chi-square test were used for data analysis. Results: The results showed that the mean age of the participants was 40.31 years. There was no statistically significant difference between males and females in performing the majority of roles related to implementing health education activities in their schools, while there was a statistically significant difference between elementary, middle, and secondary schools in performing most of these roles. There are many obstacles that affect the role of health educators in public schools, while they have a positive attitude regarding their role with a mean score of 2.58 ± 0.28. Conclusion: The findings revealed that health educators in public schools face many obstacles when implementing health education activities which negatively impact on the health promotion of school children. The attitude of health educators was positive, indicating that they like their role; therefore, they need more training programs to be well prepared in order to perform their role effectively.

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Objectives: The present study was undertaken to analyze bitewing digital images detection of interproximal caries through interobserver agreement. Materials and Methods: The study evaluated 152 bitewing radiographs for detection of interproximal caries by two observers: an operative dentist and oral radiologist. Results: The Kappa values for interobserver agreements were 0.47 and 0.44 in the first and second observations, while for intraobserver agreements, these values were 0.61 and 0.69 for the operative dentist and oral radiologist, respectively. Comparison of area under the receiver operating characteristic curves for inter- and intra-observer ratings was nonsignificant. Conclusion: The digital bitewing radiography resulted in no variation in both the agreements, and it was useful with respect to the reliability of diagnosis of interproximal caries.

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Objective: To assess the relationship between maternal anxiety and depression and parent-reported quality of life (QOL) of children with cerebral palsy (CP). Methods: A cross-sectional study was done on 232 mothers of CP children aged 5–18 years. Children QOL and mothers' depression and anxiety were assessed using the Pediatric Inventory Parent Version (PedsQL-P), Beck Anxiety Scale (BAS), and Beck Depression Inventory (BDI), respectively. Results: Different degrees of depression in 55.5% of mothers were noted, and 47.4% and 21.6% had moderate and severe anxiety. The mean value of PedsQL-P scores was 69.35 ± 18.18. A significant negative correlation was found between PedsQL-P and both BAS and BDI scores. Conclusion: CP children's mothers had high prevalence of depression and anxiety that had a negative impact on children QOL. The study calls for interventions to improve the mothers' psychiatric status.

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Background and Aim of the Work: Recent studies proved that ionic silver hydrogel is a cost-effective and clinically effective method of the treatment of wounds and in particular diabetic foot ulcer; in addition, the antibacterial and tissue-healing properties of manuka honey (MH) had been proved by various investigators. This study aimed to compare the effectiveness of the use of controlled release ionic silver hydrophilic dressing with that of MH-impregnated dressings in patients with diabetic neuropathic plantar ulcers. Patients and Methods: This was a prospective, double-blind, randomized comparative clinical trial conducted in diabetic foot care unit at the King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. Seventy-one patients were enrolled from January 2015 to December 2017. Patients with neuropathic plantar ulcers were included in the study with exclusion of ischemic and neuroischemic ulcers. Patients who met the inclusion criteria of this study were subdivided and randomized into two groups: Group I (honey group) and Group I (silver hydrogel group); in both the groups after drainage of any collection and surgical debridement of hyperkeratotic and necrotic tissues and irrigating the ulcers, in Group I, MH-impregnated dressing containing 35 g of Unique Manuka Factor-13 was applied, and in Group II, controlled release ionic silver hydrophilic dressings were used to cover the ulcer. The mean time required for eradicating infection, hospital length of stay (LOS), and the mean time of complete healing of the ulcers were the primary outcomes. Secondary outcome was to correlate the mean time of ulcer healing with duration of diabetes, hemoglobin A1c, and presence of nephropathy or neuropathy. Results: There was no significant difference in the demographic data, size of the ulcers, mean duration of diabetes, and clinical and laboratory data between both the groups (P > 0.05). The mean time to eradicate infection and hospital LOS were reduced in the silver treatment group compared to honey treatment group, but the difference does not reach a statistical significance (P > 0.05); the table shows also that the mean time required for complete ulcer healing was shorter in MH group than the silver hydrophilic dressing group (P > 0.05, insignificant). In both the groups, the duration of healing was significantly correlated with the patient age, pretreatment level of HbA1c, pretreatment duration of the ulcer, and the ulcer size; however, there was no significant correlation with gender and duration of diabetes. Conclusions: The present study verified the effectiveness of MH-impregnated dressings and the controlled release silver hydrophilic dressings in controlling wound infection and promoting the complete healing of neuropathic ulcers.

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Introduction: Antibiotics continue to be widely prescribed in critically ill patients, and they form a significant proportion of the total drugs consumed in the intensive care unit (ICU). Objective: The aim of the present study was to identify antibiotics prescribing patterns for patients admitted to ICU at King Faisal Medical Complex (KFMC), Taif, Saudi Arabia to assess the appropriate use of antibiotics and its compliance to the KFMC local guidelines. Materials and Methods: The study participants included all patients admitted for at least 48 h at the ICU in KFMC and received antibiotic(s). A prospective, observational study was carried out over a period of 3 months from August to October 2017. A standard clinical record form was used. Data were analyzed using Statistical Package for the Social Sciences (IBMSPSS, version 22). Results: From a total of 92 patients admitted to the ICU during the study, 429 antibiotic prescriptions were recorded that have been given to the patients, with an average of 4.6 antibiotics/prescription. Patients' average length of stay was 7.4 days. Ceftriaxone was the most frequently (21.7%) prescribed antibiotic followed by Tazocin^® (17.7%), Metronidazole 15.1% and Meropenem 9.5%. Moreover, 69% of all prescribed antibiotics were compliant with the KFMC local guidelines. Conclusion: The high utilization rates of antibiotics prescribed during admission at KFMC's ICU were a matter of great concern. Therefore, they needed to be controlled by the use of local guidelines, surveillance, and antibiotic restriction policies of health care.

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Colonic xanthomas are rare, benign lesions of the gastrointestinal tract characterized by a foamy cell containing lipid in the lamina propria and mucosa. They have been commonly described in the stomach and rectosigmoid region in few case reports. Their association with adenoma and adenocarcinoma had made them a visible indicator of malignancy. Hence, a thorough investigation and follow-up of the patient are mandatory to search for such lesions.

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Background: Around 30% of the population of both developing and developed countries are infected by Toxoplasma gondii. Research has shown that in the Toxoplasma infection's initial stage, changes are made in the infected human physiology, behavior, as well as in the animals that are infected artificially. Changes in personality shifts were observed in simple response times and psychiatric diseases and intelligence consisting of schizophrenia, dementia, and suicidal tendencies. Correspondingly, changes in behavior such as raised attraction toward feline odors and reduction in neophobia were observed in experimental studies. Aims: The aim of our study is to investigate the association between latent T. gondii infection and various mental illnesses in the city of Taif, KSA. Settings and Design: A cross-sectional study involving patients who are receiving medical care for various mental disorders in a psychiatric health hospital in Taif, KSA, and a control group of patients not suffering from any previous mental disorders. Materials and Methods: Blood samples were drawn from patients with different mental disorders and a control group. T. gondii-IgG ELISA was performed. Statistical Analysis Used: Statistical tests data were analyzed using a Chi-square test. Statistical analyses were carried out using SPSS version 11. Results and Conclusions: A statistically significant association between mental disorders and latent Toxoplasma infection (IgG positive) was observed. 60% of the study group were positive for Toxoplasma IgG compared to only 30% of the control group. The most frequent mental disorder observed in the positive cases was schizophrenia (55%), followed by depression with suicidal tendencies (22%). Moreover, 66% of the study group reported having owned a cat or had come into close contact in their history. Our results support the hypothesis of major involvement between latent T. gondii infection and mental disorders. We recommend that Toxoplasma-IgG test routinely be performed to all patients with mental disorders and considering administering anti-Toxoplasma drugs to all positive cases.

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Background: Humans process their lifetime experiences internally as mental images that constitute their cognitive maps, which they employ to recall and assess important features in their relative contexts. This study aims to develop a cognitive map of the public's risk perception based on gender and age in the unique Saudi cultural context. Methods: Data were collected using a self-administered survey measuring the public's perceived risk of nine common life hazards. Differences in gender (bivariate analysis) and age (correlation analysis) over each domain were presented. Cognitive mapping was developed. Results: Of the 317 participants, there were 211 (67.6%) females and 101 (32.4%) males with 32.5 ± 10.7 years as the mean and standard deviation of their age. A series of regression models showed that males had a better perception on the knowledge and control domain compared to females about the hazard of nuclear reactors (β = −0.2, adjusted P < 0.001), yet worse perception on the knowledge and control domain about caffeine intake (β = 0.21, adjusted P < 0.001). Males also had a worse perception of the severity and dread domain in regards to caffeine intake (β = −0.16, adjusted P = 0.005) and pesticides (β = −7.54, adjusted P = 0.002) compared to females, yet females had worse perception of the severity and dread domain concerning bicycles (β = 0.31, adjusted P < 0.001) compared to males. Older study participants had a better perception on the dread and severity domain in regards to caffeine intake (β = −0.26, adjusted P < 0.001) compared to younger participants. Conclusion: Gender and age differences in the risk perception toward some life hazards were observed among Saudi adults, which define the structural features of the Saudi cognitive map.

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