Background: Healthcare is a substantial industry globally, where nurses comprise the largest percentage of the healthcare system. There is a global nursing shortage and nursing staff retention has become a major human resource challenge. One of the critical indicators of quality of care is nurse-to-patient ratio (n:p ratio), but due to the extreme shortage of nurses, the quality of nursing care may have been affected leading to low nurse engagement results and substantial missed on aspects of nursing care. Identifying these key areas among nurses in King Saud Medical City (KSMC) will contribute to the improvement of staffing conditions at any levels. Aim: The primary objectives were (1) to investigate the impact of patient-to-nurse ratio (p:n ratio) on satisfaction and (2) to explore the impact of p:n ratio on missed care. The secondary objectives were (1) to compare the nurses' satisfaction categories, missed care categories across different hospitals included in our medical city, different age categories, and different education levels and (2) n:p ratio will be compared across hospitals. Methods: This was a cross-sectional analytical study. Setting: This was conducted at KSMC, Riyadh, Saudi Arabia, specifically in areas of main general hospital, medical tower, pediatric and maternity hospital. Outcome Measures: (n:p ratio), nurse engagement/satisfaction, and missed nursing care. Results: Of the total of 384 responses (96% response rate), the majority of respondents were satisfied (n=155, 40.4%), followed by Neutral (n=124, 32.3%), very unsatisfied category included only 17 responses (4.4%) and very satisfied were 35 nurses (9.1%). While responses to the missed care section revealed that overall the majority of missed care opportunities were in the category of never missed (278, 72.4%). As for the p: n ratio, the average was 4.2 (patients) ± 1 (nurse). Furthermore, the ratio of patients-to-nurse was not found to significantly impact overall satisfaction, neither in the univariable model nor in the multivariable model adjusted for age, education, and experience. Interestingly, age category was a significant predictor of nurse satisfaction (higher odds of satisfaction category with higher age category) yielding an adjusted odds ratio (OR) of 1.4 (95% confidence interval [CI]: 1.01–1.8; P = 0.04) although this was a post hoc finding. As for the impact of n:p ratio on missed care, it was significantly associated with missed care in the univariable model, with OR of 1.3 (95% CI: 1.01–1.6; P = 0.037) and an OR of 1.3 (95% CI: 1.02–1.6; P = 0.032) in the multivariable model. When the categories of satisfaction were compared across different hospitals of KSMC, different age groups, and education, there were no differences in any of the Chi-square tests performed. Similarly, there were no statistically significant differences when the missed care was compared across the same subgroups; moreover, it was distinguished that p: n ratio was significantly higher in the maternity hospital. Conclusion: A higher p:n ratio negatively affects missed care opportunities.

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Context: The impact of COVID-19 on the Arab world has been particularly striking. Less well known are the knowledge, feelings, and behaviors of health care providers (HCPs) regarding COVID-19 in these countries, which has significant influence on the quality, timing, and effectiveness of the health-care response. Aims: We evaluated the knowledge, attitudes, and practice regarding COVID-19 for health-care providers in five Arab countries. Settings and Design: Using a descriptive, cross-sectional approach, knowledge concerning COVID-19 was assessed in health-care providers in Saudi Arabia, Yemen, Sudan, Egypt, and Jordan. Materials and Methods: Five hundred and one participants answered nine validated questions, and a cumulative knowledge score was tabulated for each participating HCP. Attitudes about COVID-19 were assessed with ten questions with categorical response choices “true,” “false,” and “no opinion” and were rated with cumulative scores on a scale of “strongly negative” to “strongly positive.” Clinical practices regarding COVID-19 were assessed with eight questions, with ratings of “weak,” “moderate,” and “strong” patterns of practice for COVID-19 screening and treatment. Statistical Analysis Used: SPSS software program version 26 was used for statistical analysis. Chi-square was used to study the relationship between different variables. The statistical significance level was set at P < 0.05. Results: The vast majority of respondents knew the transmission method of COVID-19, its primary symptoms, and the recommended isolation period; however, most did not know the distance recommended by the World Health Organization for physical distancing, and over a third believed that wearing multiple masks provided additional protection against viral exposure. Country of residence was predictive of COVID-19 attitudes and practices. Conclusions: Health-care providers have “fair” knowledge about COVID-19, but they are still in need for further orientation, in line with international standards for protection against COVID-19. Several demographic factors can predict attitudes and practices regarding COVID-19, which may have implications for treatment outcomes.

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The role of clinical pharmacists in the medication reconciliation (MR) process has been limited in the literature. Medication discrepancies and drug-related problems are safety challenges for hospitalized patients and healthcare professionals. The MR process is a standard practical tool at different hospital settings to optimize the correct use of medicines. The aim of this review was to evaluate the role of clinical pharmacists in the implementation of MR process at different practice settings. A literature search of Google Scholar, PubMed, ScienceDirect, and ELSEVIER for “medication reconciliation” and “medication discrepancies” with “clinical pharmacist” from 2011 up to September 2020 was conducted. The search findings revealed that; clinical pharmacist is the most capable health care provider in implementation of MR process due to his vast experience in medication history taking and drug therapy management. Medication discrepancies that can result in serious discomfort or clinical impairment of patients can be prevented by a clinical pharmacist-led MR process. Studies confirmed that clinical pharmacist's interventions contribute substantially to the detection and resolution of medication discrepancies in hospitalized patients. Moreover, another estimated benefit of pharmacist-led MR was cost reduction for patients, families, and healthcare system. These findings highly recommend further inclusion of a clinical pharmacist in a team-based MR in different health settings.

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Background: Postpartum depression (PPD) afflicts women and their families negatively. Unfortunately, PPD often goes undetected and untreated. We previously reported that PPD prevalence was 19.4% in Al-Madina region, Saudi Arabia. Objectives: The objective of the study was to identify significant risk factors of PPD among women in Al-Madina, Saudi Arabia. Methodology: A multistage random sampling technique recruited women visiting primary health-care centers in Al-Madina to immunize their babies. A cross-sectional descriptive study was done using Arabic translation of Edinburgh Postnatal Depression Scale for PPD screening using a cutoff score of ≥12. Our study also investigated demographic and other possible PPD risk factors. Results: This study enrolled 216 women out of 224 (response rate is 96.4%). PPD was not significantly associated with pregnancy planning, infant's gender, or infant's age. Primiparous women (n = 92, 42.7%) had a significant PPD risk (P < 0.05). More than half of mothers enrolled in our study (n = 124, 57.4%) were multiparous. Nearly 30.6% of participants (n = 66) used breastfeeding, while formula feeding was present in 40.7% (n = 88). PDD was reported more among women who breastfed their babies (27.3%) compared to those who artificially fed their babies (15.9%) and those using mixed feeding (16.1%). PPD was more significant among women who delivered by vaginal delivery (P < 0.05) compared to those delivered by cesarean section. Congenital abnormality of babies was reported by almost one-sixth of women (n = 36, 16.7%) but were not significantly associated with PPD. Conclusion: More than half of women having PPD (n = 124, 57.4%) were multiparous. PPD may negatively impair women's future pregnancy plans due to depression. PPD is significantly associated with primiparity and vaginal delivery and increases with breastfeeding. To the authors, PPD is a serious medical condition that should be taken into account with all deliveries. Primiparity is a risk factor, and PPD should be anticipated in primiparous women. Psychiatric evaluation and psychotherapy may be needed to help women and alleviate their fears in future pregnancies. Gynecologists should be aware of PPD and should receive a clinical experience in that. Psychiatric consultation is highly recommended whenever necessary.

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Background: Within few months of its outbreak, coronavirus disease 2019 (COVID-19) has ravaged over 200 countries, resulting in over a million deaths. As the disease curve flattens in most countries, the instituted guidelines were receded to mitigate the effect on citizens and the national economy. Aims: To assess the knowledge and level of adherence of Nigerians and Egyptians to the COVID-19 preventive measures. Settings and Design: A validated web-based cross-sectional questionnaire was utilized to obtain 915 respondents via a convenient sampling technique. Materials and Methods: Data were obtained from Egyptians and Nigerians who gave consent for participation and are above 18 years of age. Statistical Analysis Used: Data obtained were analyzed using the Statistical Package for the Social Sciences, v. 20. Chi-square test, correlation and one-way analysis of variance were performed to test for relationships between variables. Statistically significant results (P < 0.05) were subjected to further test. Results: Most Egyptians (87%) had satisfactory COVID-19 knowledge compared to Nigerians (40%). Age (18–30 years), tertiary education and educational background were factors that influenced respondents' knowledge. Although majority (73%) believe that the prevention measures are required to curtail the menace of COVID-19, the adherence of most respondents (59.1%) to the measures was unsatisfactory. The pandemic and the regulatory policies negatively affected respondents' education, school or job (90.3%), finance (87.9%) and social interaction (87.5%). Conclusion: Both countries showed a good knowledge of the disease but poor adherence to the preventive measures. The pandemic negatively affected people's finance, education, job, and social interaction.

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Objective: This study aimed to evaluate the usage and social media habits of orthodontic patients. Materials and Methods: A descriptive cross-sectional design was employed to carry out this study. The questionnaire that was used contained the following sections: Demographic data, questions relating to social media behaviors and sociodemographic characteristics, and questions relating to orthodontists' utilization of social media. The validity and reliability of the questionnaire were examined. The final Arabic version was adopted and the Google Drive template was used. The link was sent to the orthodontic patients via different social media platforms and applications. Results: A total of 139 orthodontic patients agreed to take part in this study, of which 78 were females and 61 were males. The most popular applications for obtaining orthodontic-related information were Snapchat (28.7%) followed by Instagram (23.7%), and WhatsApp (22.3%). Approximately 58.9% of the patients reported that social media has no direct impact on their decision-making involving orthodontic treatment. Treatment modalities were found to be the most searched topic by the orthodontic patients (44.6%) followed by treatment costs (30.2%). Conclusion: Our study revealed that women not only use social media to check their treatment progress more than men, they are also more curious to compare their progress with other people than their male counterparts. In addition, the findings showed that social media has a greater impact on female patients when it comes to making a decision about orthodontic treatment. Treatment modalities and treatment costs are the topics most searched for by orthodontic patients.

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Background: Since millions of Muslims visit the Holy Mosque in Makkah, it is essential to highlight that such mass gatherings carry a risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission. In this study, we assessed the level of knowledge and practices among visitors to the Holy Mosque related to the coronavirus disease 2019 pandemic. Methods: A cross-sectional survey of Holy Mosque visitors was conducted in Makkah from January 19, to February 9, 2020, using a self-administered electronic questionnaire. Knowledge and practices scores were compared and multiple logistic regression analysis was used to identify the association between variables. Results: A total of 451 participants were interviewed, while 413 completed the questionnaire and were eligible for inclusion. The range of correct answer rate was 13.1%–93.5%. The mean knowledge score was 11.3 with a 64.9% correct response rate, while the mean practices score was 2.92 with a 73.2% correct response rate. The knowledge score was significantly different among nationalities and education levels (P < 0.05). A higher level of education was associated with better knowledge regarding SARS-CoV-2 (odds ratio 1.18, P = 0.028). Conclusions: Most of the visitors to the Holy Mosque had an appropriate level of knowledge and practices related to SARS-CoV-2 infection; however, there is room for improvement in some areas.

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Background: Evidence-based practice (EBP) is an integration of the research evidence with clinical expertise and the values of patients to assist the health profession in clinical decision-making. Recent studies indicate that education on EBP is considered a core component in the learning curricula for all health-care professions. In addition, it has been recommended to use a variety of teaching strategies to enhance EBP knowledge and skills. Aims: The aim of this study is to develop an explanatory theory to guide the process of EBP among clinical teaching assistants (CTAs) within the Saudi context that is characterized by a multicultural environment. Setting and Design This study used grounded theory approach by Strauss and Corbin (1990), and was conducted in a college of nursing, Jeddah, Saudi Arabia. Materials and Methods: The study participants included 22 CTAs. Initially, three participants were conveniently sampled. As data collection and data analysis continued, sampling changed from conveniently to theoretical until data saturation was reached. The data collection was through in-depth interviews and was recorded with the permission of the participants. Analysis: The data were analyzed by following the coding in grounded theory, namely open, axial, and selective coding. Results: Twenty two CTAs participated in this study. The average age of participants was 46 years with average years of experience of 7.5 years. The theory that emerged from this study was the “theory of EBP among CTAs.” There were one core concept emerged from the study (confident to care) and four subconcepts (teamwork, forcing inquiry, EBP champions, and formal education). Conclusion: This study provided insight into the process of EBP among CTAs and provided a middle range theory for CTAs toward becoming confident in caring through adopting EBP approach to care.

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Background: Hyperlipidemia is one of the most challenging clinical disorders and is known to be a causative factor in a number of related conditions. Garlic has traditionally been used to lower serum lipids in hyperlipidemia patients. The present study evaluates the renoprotective role of garlic against induced changes in rat kidneys as a result of a high-fat diet (HFD). Materials and Methods: Twenty adult male Wistar rats were arranged into 4 groups: Group 1 (control) were fed a normal rat diet; Group 2 were fed an HFD (butter in a dose of 20g/100g food); Group 3 were fed fresh garlic juice (GJ) in their diet (6g/100g food); and Group 4 were fed with butter and GJ in their diet (HFD + GJ). The experimental period was 8 weeks. Serum lipid profiles and renal function tests were carried out and evaluated. Results: The HFD significantly increased body weight, total serum cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), uric acid, creatinine, and blood urea nitrogen (BUN), and decreased total protein and albumin, as compared to the control. In the HFD + GJ group, normal body weight was restored; serum levels of total cholesterol, creatinine, BUN, and albumin were similar to the control, and serum levels of triglyceride, LDL-C, uric acid, and total protein were partially restored to the levels of the control. Conclusions: The incorporation of GJ into an HFD resulted in improved lipid profile and kidney function. Hence, the consumption of GJ may be a useful supplement for renal protection in hyperlipidemic patients.

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The current case report bears the details of the adverse drug reactions (ADRs) associated after the administration of the levetiracetam for the management of newly diagnosed epilepsy in a female patient aged 37 years. Datum related to the patient, medications and observed ADRs were noted after getting the consent from the patient during which she has explained her experiences after the beginning of the consumption of the said drug. The Naranjo's scale and World Health Organisation, Uppsala Monitoring Centre scales analysis for the assessment of the correctness of the ADR paved for the certainty of the side effect. Drug regimen modification was initiated by the neurologist after the complaints of uneasiness from the patient after which she was identified to be complying with the other medication. Therefore, it can be said that if any patient on antiepileptic medications experiences discomfort, must bring those issues in light as there is always other options available for the management of the epilepsy without delay.

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Background: Reactive arthritis (RA), apart from presenting as an immune reaction to certain microorganisms, had also shown to have a genetic predisposition. Human leukocyte antigen (HLA-B27) is an allele of the HLA Class I molecules and its positivity in a person is shown to be a strong predictor of RA. The present study was aimed to study the significance of HLA-B27 positivity in clinical presentation and progress of RA in rural central India. Materials and Methods: One hundred rheumatoid arthritis factor seronegative patients of symptomatic RA were enrolled in the study. HLA-B27 was detected by flow cytometry method and patients were divided into two groups, each of 50 depending on HLA-B27 positivity and negativity as case and control groups. The patients were contacted on their follow-up visits and the clinical information and progress of the disease was assessed and correlated with HLA-B27 status. Results: About 74% in study group and 62% in control groups were males in RA (P = 0.001 and 0.0007, respectively). Study cases with HLA-B27 positivity showed many significant differences in their clinical presentation and disease severity and progression over the control cases (HLA-B27 negative). The mean duration of symptoms in the study group was 22.7 ± 31.26 and 12.98 ± 6.94 in control group. Severity of arthritic pain was more in study group as compared to control group (P = 0.0007). Study cases showed more axial skeletal involvement (P = 0.0002), enthesitis (P = 0.0001), and sacroiliac joint involvement (P = 0.0005). Clinical evaluation of back pain with different clinical tests in study cases showed more morning spinal stiffness (P = 0.0001), low Schober index (P = 0.001), higher lateral flexion (P = 0.0001), and lower chest expansion (P = 0.0001). The severity of disease in follow-up period increased significantly in 92% of patients in the study group despite initiation of clinical management of arthritis, while decreased in 60% of patients in the control group (P = 0.0001). Conclusion: HLA-B27-associated RA presents with significantly more severe primary disease and a rapid course of disease. Thus, HLA-B27 association should be done in all patients of RS and positive patients must be followed more rigorously to prevent many possible complications. To the best of our knowledge, this is the first study in central India to report the importance of HLA-B27 in patients of RA with regard to its management and prognosis.

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Leiomyoma is a benign mesenchymal neoplasms arising from smooth muscles which accounts for 20%–30% of all benign gastrointestinal tumours. The occurrence of leiomyoma in ileum is rare. Very few cases of intestinal obstruction due to intestinal leiomyoma have been documented till date as per our knowledge. Here, we report a case of leiomyoma of ileum causing intestinal obstruction in a young woman who presented with pain in abdomen since 7 days. Intraoperative findings showed presence of 15 cm × 14 cm × 12 cm mesenteric tumour encircling the ileum. Microscopically, the benign spindled tumour cells were arranged in whorled pattern. Immunohistochemistry showed positivity for smooth muscle actin and negativity for CD117. One should always consider this rare entity in differential diagnosis of patients presenting with intestinal obstruction.

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