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   Table of Contents - Current issue
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January-April 2021
Volume 10 | Issue 1
Page Nos. 1-72

Online since Thursday, April 8, 2021

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REVIEW ARTICLE  

Immunology of coronavirus disease 2019 raises more questions than answers p. 1
Amre Nasr
DOI:10.4103/sjhs.sjhs_168_20  
Coronavirus disease 2019 (COVID-19) pandemic is by far one of the biggest global health crises of this century. Unfortunately, up till now, there is no preventative vaccine and treatment strategies are disadvantaged by the ever-emerging viral mutations and the significantly high morbidity and fatality rate. Theoretically, the main hope to change this situation would be to develop novel, effective treatment and vaccine against COVID-19 based on the activation of T- and B-cells. An important part of this process understands the mechanisms of innate and acquired immunity to COVID-19. In this review article, a literature search was conducted using PubMed search engine looking at what has been published up to the 20th of July 2020 about the immunology of COVID-19. The aim is to collate all the evidence and highlight key features of what we know thus far about the immunity of COVID-19. This should hopefully deepen our understanding of the activated immune responses which will take us a step forward in the search for an effective COVID-19 vaccine.
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ORIGINAL ARTICLES Top

The impact of chronic periodontitis on serum tumor necrosis factor-α and HbA1c levels in type 2 diabetic patients p. 7
Rehab Abdallah Abdalrahman, Bakri Gobara Gismalla
DOI:10.4103/sjhs.sjhs_224_20  
Background: Diabetic patients are subject to chronic periodontitis which could adversely affect glycemic control. Aim: This study determined the impact of chronic periodontitis in patients with diabetes mellitus type 2 (DM 2). Materials and Methods: We compared the levels of serum tumor necrosis factor-alpha (TNF-α) and HbA1c% between DM 2 patients with chronic periodontitis (study group) and DM 2 patients without chronic periodontitis (control group). Results: Statistically significant differences in fasting blood glucose (FBS), HbA1c, and gingival index (GI) were observed between the study and control group. No differences were found in TNF-α between the patients of both the groups. However, higher levels of TNF-α and FBS were shown in diabetic patients with mild periodontitis group than in those with moderate or severe periodontitis. Conclusion: Chronic periodontitis could affect HbA1c levels in DM 2 patients. In addition, HbA1c was positively correlated with FBS and GI, while negatively correlated with TNF-α, which exhibited a higher level in mild periodontitis compared with severe and moderate periodontitis.
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Clinical, serological, and radiological characteristics of COVID-19 patients in Makkah, Saudi Arabia p. 14
Imran Nazir, Mohammed Al Shareef, Sayed Shakeel Ur Rahman, Iffat Imran, Hanan Mohamed Moalim Abdullah, Hossam El-din Shaaban, Khalid Khalil, Anas Mohammad M Al Hazmi, Waleed Amasaib Mohammed Ahmed, Amna Al Kalkami
DOI:10.4103/sjhs.sjhs_231_20  
Background: The COVID-19 pandemic is spreading across the globe at an alarming rate. The number of COVID-19 cases in Saudi Arabia is increasing daily. Saudi Arabia is a hot zone for outbreaks of infectious diseases like COVID-19, especially the Makkah area. Hence, determining the clinical characteristics along with serological, hematological, and radiological abnormalities in COVID-19 patients is important for epidemiological decision-making, such as control and surveillance strategies. Materials and Methods: This was a retrospective descriptive study done in a single health-care hospital, Makkah, Saudi Arabia, for 4-month period. We include admitted COVID-19 patients (confirmed with qualitative real-time polymerase chain reaction test) of any gender with age >14 years. The complete data of COVID-19 patients were extracted from electronic medical records. Data were analyzed by the Statistical Package for the Social Sciences version 23. Categorical variables were presented as counts and percentages, where means and standard deviations (SDs) were extracted for continuous variables. Fisher's exact test was applied to assess association with mortality. Results: Total enrolled cases were 226. The mean age of the patients was 58 years with SD (±0.4458) and 95% confidence interval (2.688–2.810). The common clinical presentations were fever (77.4%), cough (77%), shortness of breath (53.5%), and myalgia (37.2%). Lymphopenia was observed in 54.4%, anemia in 8.4%, leukopenia in 16.4%, and thrombocytopenia in 9.3% of the patients. The fatality rate was 8.4% (n = 19) over this 4-month period. Conclusion: Advanced age and comorbidity plays a pivotal role in disease mortality. Elderly people's constant evaluation and management is of fundamental importance to decrease mortality.
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Coping strategies during the COVID-19 pandemic and compliance with precautionary health behaviors: An online study among the Saudi adult population p. 21
Hussain Alyami, Mohsen Alyami, Christian U Krägeloh, Dalal M Nemenqani, Marcus A Henning
DOI:10.4103/sjhs.sjhs_222_20  
Background: The COVID-19 pandemic has caused major morbidity and mortality internationally. Most governments worldwide have enforced precautionary health measures such as social distancing, hand hygiene, and wearing gloves to limit the spread of this disease. In response to major health and economic stressors, individuals exhibit a range of different coping styles. Aim: The aim of this study is to identify coping strategies that are predictive of compliance with pandemic-related precautionary health behaviors in Saudi Arabia. Settings: A cross-sectional study was conducted online with a total of 1029 Saudi adult participants. Materials and Methods: The Brief Coping Orientation to Problems Experienced (COPE) questionnaire was administered as well as appraising the level of compliance with the Saudi Ministry of Health precautionary measures. Multiple regression analyses explored the associations between coping styles and precautionary health behavior compliance. Statistical Analysis: Multivariate multiple regression and linear regression analyses were used to analyze the data. Results: The active coping and religion Brief COPE subscales as well as age predicted compliance with all precautionary measures. The behavioral disengagement Brief COPE subscale predicted hand washing and social distancing while the substance use Brief COPE subscale and sex predicted wearing gloves. Conclusion: Compliance with COVID-19-related precautionary health behaviors is driven by different coping styles. Active coping and religion appeared to influence all three health behaviors which might guide public health officials in their efforts to develop effective public health campaigns, which further suggests the importance of involving the religious institutions in Saudi Arabia.
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Ocular manifestations of inflammatory bowel disease in the Taif region of Saudi Arabia during the COVID-19 pandemic, patient prospective p. 27
Abdulhamid S Alghamdi, Nada S Alrubaie, Jehan F Sarriyah, Bushra A Alqahtani, Bushra F Alshehri, Shadi A Alghamdi, Ali M Alahmari, Mohammed A Attar, Omar A Dammas
DOI:10.4103/sjhs.sjhs_267_20  
Background: Ocular manifestations of inflammatory bowel disease (IBD) considered being the most common extraintestinal complication. Eventually, early detection and management improve the patient's quality of life as well as prevent potentially visually threatening complications. Objectives: To assess the prevalence and pattern of ocular manifestations among patients with inflammatory bowel disease during the COVID-19 pandemic. Materials and Methods: Cross-sectional study was performed using anonymous online surveys were administered which included the participant's demographics, prevalence and pattern of IBD intestinal and ocular manifestations, precipitating factors, and quality of life. Data were analyzed using (SPSS) version 20 (Armonk, NY: IBM Corp.). Chi-squared test Mann–Whitney and Kruskal–Wallis tests were applied. A P < 0.05 was considered statistically significant. Informed consent and ethical approval were obtained. Results: A total of 216 participants responded to the survey with 50.50% of females and 49.50% were male. About 90.3% of the participants had their GIT symptoms start before their eye symptoms. Almost two-thirds of the participants, (68.5%) suffered from frequent severe bowel symptoms that prevented them from carrying out work and/or perform the normal daily activity. Furthermore, one-third of the participants (31.6%) are unemployed and described a positive family history (32.8%). More than 75% of participants described eye symptoms associated with the intestinal disease activity which range from mild self-limiting to more severe ones that required hospital visits (50%). Although, majority of participants (90.00%) did not routinely receive official referral to ophthalmologist. The non-significant difference was found between the presence of eye symptoms and participant's gender, marital status, educational level, stress, and smoking habits. Conclusion: Most of the IBD patients suffered from significant ocular manifestations with frequent hospital visits. Misdiagnosis and/or inadequate management negatively affect the quality of life of IBD patients during the COVID-19 pandemic. Risk-based Ophthalmic screening strategy may reduce the impact of IBD.
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Radiographic evaluation of third molar impaction: A digital panoramic stud p. 34
Soban Qadir Khan, Abdul Khabeer, Nujood Ibrahim Alyousef, Mashael Abdullah Benrashed, Yara AlMaimouni, Ahmad Al-Thobity, Mohammed M Gad, Sarfaraz Akhtar
DOI:10.4103/sjhs.sjhs_221_20  
Background: The impaction of third molar can compromise adjacent teeth by increasing the risk of developing dentoalveolar lesions. Aims: The aim of this study was to evaluate the prevalence of impacted third molar in association to patients' demographics and its angulation among patients who visited dental clinics at the College of Dentistry, Imam Abdulrahman Bin Faisal University. Settings and Design: Retrospective radiographic study of patients visiting Dental Hospital. Subjects and Methods: Data were obtained from the dental records and digital orthopantomogram (OPG) of included study sample. Statistical Analysis: The Chi-square test was used to determine the association of impacted third molars with sex and nationality, whereas another two methods, analysis of variance, and Tukey post hoc test were applied, respectively, to establish the association of impacted third molars with the age of the patients. Results: A total of 1286 OPGs were collected and analyzed for the suitability of the study. Of these 1068 patients fulfilled the criteria for inclusion in the study, among them, 206 (19.3%) had at least one impacted third molar. Female population had a significantly high prevalence of third molars compared to male (P = 0.02). Similarly, the age of the patients was found to be significantly associated with impacted teeth (P < 0.001); also, the vertical and mesioangular impactions were found in 46.5% and 32.2% of the patients, respectively. Conclusion: The study found a low female predilection for the prevalence of third molar impaction with highest inclination at the young age that decreases with the growing age. Vertical impaction had the highest prevalence followed by mesioangular angulation.
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The pattern of health care provision and utilization among adult patients with sickle cell disease in Southern Saudi Arabia p. 38
Husain Y Alkhaldy, Bandar S Asiri, Meteb A Ahmed, Sabah A Khozam, Abdulbari A Alzahrani, Yahya M Alqahtani, Nouf D Alshamrani, Omayma S Bakheet
DOI:10.4103/sjhs.sjhs_228_20  
Background: Sickle cell disease is a common hereditary hemoglobin disorder in southern Saudi Arabia. The current models of health care provision and health service utilization are not homogeneous across the kingdom. Aim: The current models of health care provision and health service utilization in a single center in our region were audited to evaluate the current provided healthcare services and suggest improvement if needed. Methodology: In this retrospective chart review study, from 2015 to 2019, all patients with sickle cell anemia admitted to a tertiary care hospital were enrolled in the study. All related data including demographics, laboratory interventions, and management procedures were collected. Descriptive analysis and statistical tests of association were performed. Results: One hundred and twenty-one patients were admitted 165 times over the study period. Vaso-occlusive pain episodes was the most commonindication (58%) for admission, followed by hepatobiliary (16%), and pulmonary complications (12.7%). Most of the provisioned services were of nonspecialized medical or surgical specialties. Blood transfusion was overused (64%), whereas adequate hydroxyurea (HU) therapy was underused (25%). Conclusion: The current study offers a glimpse of some gaps between the current practice and the established local, national, and international guidelines in terms of underutilizing HU and over utilizing blood transfusion. Comprehensive care centers were not available, and care was provided mainly by nonhematologists. Educating health providers and establishing comprehensive care centers would enhance the current model of health care provision.
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Prevalence of undiagnosed, preventable visual impairment in children with intellectual disability in special needs schools in Western Saudi Arab p. 43
Lina Hassan Raffa, Abdulrahman Zaid Al-Shamrani, Firas Mohamed Madani, Ali Saad AlQarni, Kareem Fawzi Allinjawi, Abdulrahman Khalid Fagih, Nizar Alhibshi
DOI:10.4103/sjhs.sjhs_236_20  
Background: Visual disorders have been reported to be higher among children with intellectual disability (ID) than among their peers without special needs; however, prevalence data on visual problems in children in Saudi Arabia are scarce. Aims: The aim of this study is to report the prevalence and causes of undiagnosed, correctable visual impairment in children with ID. Materials and Methods: A cross-sectional study of students enrolled in special educational needs schools in the western region of Saudi Arabia in April 2018. Teller visual acuity (VA) assessment and refractive errors were noted. Participants with mild to profound ID underwent detailed ophthalmologic examinations, including cycloplegic refraction, full orthoptic workup, biomicroscopy, and funduscopy. Results: A total of 61 students participated in this study. Ocular findings in decreasing prevalence were as follows: Subnormal VA (n = 41, 67.2%), refractive errors (n = 31, 51.7%), fundus anomalies (n = 13, 22%), significant strabismus (n = 9, 14.8%), abnormal head posture (n = 8, 13.3%), nystagmus (n = 3, 4.9%), anterior segment abnormality (n = 3, 4.9%), and extraocular motility abnormality (n = 2, 3.3%). Astigmatism was found in 22 cases (36.7%), followed by hyperopia (n = 13, 21.7%), myopia (n = 10, 16.7%), and anisometropia (n = 5, 8.3%). Students with syndromic ID had significantly more moderate-to-severe subnormal VA (P < 0.001) and myopic shift on cycloplegic refraction (P = 0.014 right eyes and P = 0.004 left eyes) than those with nonsyndromic ID. Conclusions: A considerable proportion of ID children have significant visual disorders. This emphasizes the need for adequate diagnostic and therapeutic national eye care services for children with ID.
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Breastfeeding knowledge, attitude, and practice among mothers in Al-Taif region, Saudi Arabia p. 49
Sultan Abdullah Al-Malki, Bayan Mansour Alnefaie, Morouj Mansor Aljoudi, Raghad Hasan Almosawei
DOI:10.4103/sjhs.sjhs_219_19  
Background: The World Health Organization and other international health organizations have recommended exclusive breastfeeding (BF) for 6 months after birth. In Saudi Arabia, many studies reported that BF duration had regression over the past 30 years. Objectives: The aim of this study was to assess knowledge, attitude, and practice of BF among mothers in the population of Al-Taif region, Saudi Arabia. Materials and Methods: Samples of 300 mothers were called to participate in the study where a self-administrated online questionnaire was designed to collect data on knowledge, attitude, and practice of BF among participants' mothers. Results: The results showed that 98.7% of the participants thought that BF is important for their health, 98% thought that breast milk has immune stimuli for child protection, 91.3% saw that breast milk is a full nutrition child's food, 89% knew the benefits of colostrum, and 64% reported that the child should breastfeed only natural milk for 24 months. Most of the participants (62%) used breast and artificial feeding for their child, and 95.1% reported that they started BF after birth, but only 17% started in <2 h after delivery. There is no significant relationship between the type of infant feeding and educational level, occupation, and family income of the participant and her husband. Conclusion: The study revealed a good knowledge of mothers regarding breast feeding but demonstrated some challenges in their practice and attitude and calls for future studies to assess barriers to breast feeding and how to overcome it in Saudi Arabia.
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Perceived evidence-based practice competency among Saudi nurse managers p. 55
Majed Alamri
DOI:10.4103/sjhs.sjhs_149_20  
Background: Nurse managers have a vital part in the integration of evidence-based practice (EBP) in the clinical setting. This study measures perceived EBP competency among Saudi nurse managers. This survey was conducted in four government hospitals in Saudi Arabia. Methods: A total of 308 Saudi nurse managers in four government hospitals utilizing a descriptive cross-sectional method were employed. A survey was used to determine the EBP competency. Nurse managers are somewhat competent in EBP (1.19). This holds true in both subcategories: knowledge (1.15) and activities (1.21). It was observed that the fewer years' experience as a manager the better the EBP competency. Conclusion: There is a need to review the strategies to integrate EBP in actual practice in the Kingdom, especially since EBP is associated with nurses as a researchers' role. EBP competency (1.0) is 0.78 EBP activity and 0.22 EBP knowledge. Only years of experience impacted EBP competency when linear regression was run. Nurse managers new to a unit perceived that they are more competent and show the willingness to learn, implement, and utilize EBP.
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Severe obesity associated with hyperglycemia and abdominal fats in metabolic syndrome patients p. 61
Khansa Ibrahim Musa, Mariam Abbas Ibrahim, Mai Abderahman Al Masri, Amar Mohamed Ismail
DOI:10.4103/sjhs.sjhs_18_20  
Background: Obesity is a major public problem in developed and developing countries associated with a high mortality rate. Herein, we determined the relationships between severe obesity, lipid profile, blood glucose in metabolic syndrome (MS) patients. Materials and Methods: In a cross-sectional 215 MS patients, ages ranged from 37 to 84 were randomly selected. Body mass index and waist circumference (WC) were estimated. Fasting serum lipid profile and plasma blood glucose were measured. Results: In total, 132 (61.4%) were female, 151 (70.2%) were obese, 64 (29.8%) were sever obese, and 143 (66.5%) had WC ≥ 110. Chi-square analyses show that severe obesity was significantly associated with increased WC and hyperglycemia with (odds ratio [OR] = 2.230 and 2.400) and (P = 0.019 and 0.005), respectively. The severe obesity in females was two-fold increased than males (OR = 1.93, P = 0.028). Conclusion: Severe obesity associated with central obesity and hyperglycemia in MS patients. Moreover, females at higher risk to have severe obesity.
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Onchocerca volvulus infection among ivermectin-treated population in a rural setting in Edo State, Nigeria p. 65
Frederick Olusegun Akinbo, Joseph Oyelami Olawale, Richard Omoregie, Christopher E Okaka, Mathias Abiodun Emokpae, Gerald Ikechi Eze
DOI:10.4103/sjhs.sjhs_79_20  
Background: West Africa includes the most endemic areas in the world with Nigeria being one of the largest countries of West Africa that has been reported to have a high incidence of onchocerciasis. Aim: The aim of this study was to determine Onchocerca volvulus infection among ivermectin-treated population in Ekpan community, Edo State, Nigeria. Setting and Design: A total of 105 participants including 60 males and 45 females with an age range of 15–81 years were recruited in the study. Random sampling technique was employed in the recruitment of participants. Materials and Methods: Two skin snip specimens were taken from the left and right iliac crests of each participant into a microtube containing physiological saline. The skin snips were processed using standard technique and examined microscopically for microfilariae of O. volvulus. Statistical Analysis: The data collected were analyzed using the Chi-square (X2) test and odd ratio. The statistical package used was GraphPad INSTAT. Results: An overall prevalence of 74.3% of O. volvulus infection was observed among ivermectin-treated subjects in Ekpan. Age, occupation, noncompliance of ivermectin treatment, and source of water significantly affected the prevalence of O. volvulus infection among ivermectin-treated population in Ekpan (P < 0.05). Conclusion: Effective distribution of ivermectin and strict compliance of ivermectin treatment are advocated as these efforts will go a long way at controlling as well as reducing the effects of onchocerciasis in this community.
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CASE REPORT Top

Lipomatous hemangiopericytoma of the larynx: An extremely rare tumor at an unusual location p. 70
Kanika Singh, Mukta Pujani, Avani Jain, Aparna Khandelwal
DOI:10.4103/sjhs.sjhs_38_20  
Hemangiopericytoma (HPC) arising from the contractile pericyte of Zimmerman comprises less than 1% of the vascular tumors with approximately 200 cases documented in the literature, out of which only 11 cases are reported in the larynx. Lipomatous hemangiopericytoma (LHPC) is an uncommon histological variant composed of a mixture of HPC and mature lipomatous component with around 50 cases reported so far, and majority have been found in the deep soft tissue of the lower extremities and retroperitoneum. HPCs are closely related to solitary fibrous tumors, and the LHPC was designated as a separate entity according to recent the World Health Organization classification of soft tissue tumors in 2002. To the best of our knowledge, even on extensive search of literature, LHPC of the larynx has not been reported till date. We report an extremely rare case of LHPC in a middle-aged female presented with a mass in the arytenoid cartilage of the larynx.
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