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   Table of Contents - Current issue
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September-December 2020
Volume 9 | Issue 3
Page Nos. 177-265

Online since Friday, December 11, 2020

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REVIEW ARTICLES  

Gendered organizational theory and glass ceiling: Application to female Saudi paramedics in the workplace Highly accessed article p. 177
Abdullah Mohammed Alobaid, Cameron Gosling, Lisa Mckenna, Brett Williams
DOI:10.4103/sjhs.sjhs_56_20  
Women have faced employment discrimination and disparity in most countries for many decades globally. Healthcare establishments in Saudi Arabia mirror these trends, including having a low number of female paramedics (which is representative of the whole country in general). Although the paramedic situation has changed in many Western countries, there is still a lopsided gender ratio in the Middle East, especially in the Kingdom of Saudi Arabia. The Saudi government is implementing plans for the country's future in Saudi Vision 2030, which promotes increasing women's empowerment and employment. This paper focuses on developing a theoretical framework using gendered organizations theory (GOT) and glass ceiling theory to explore challenges that limit the participation of female paramedics in the Saudi prehospital setting. The theoretical framework has been developed using literature from previous studies and will assist in exploring challenges that Saudi female paramedics face in the workplace and how these challenges can be reduced or eliminated through policy changes and the provision of equal opportunities in emergency medical services. The framework focuses on the existence of a glass ceiling and GOT in the sector and how they affect the recruitment, education, retention, and work satisfaction of female paramedics.
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Risk factors for suicide: Systematic review p. 183
Alceu Ramos Conceicao Junior, José Francisco Danilo de Guadalupe Correa Fletes, Tadeu Lemos, Eneida Patrícia Teixeira, Maria de Lourdes de Souza
DOI:10.4103/sjhs.sjhs_83_20  
The occurrence of suicide has increased worldwide, and it is the second leading cause of death among young people between 15 and 29 years old. Therefore, to describe and understand the risk factors for suicide in this population is very important. To examine 30 articles were included in the body of analysis of this review, most of which were produced/published in economically developed countries. Randomized, quasi-randomized, and observational analytical studies (cohort, case-control, and cross-sectional), with populations sample between 10 and 25 years old were included. Risks related to factors of the social environment and life events, psychological factors, and sociodemographic characteristics were identified. The risk factors are presented under different analyses, but the authors claim that suicide is not a single-cause event. Suicide is a very complex phenomenon, determined by the interaction between several factors, such as biological, psychological, and sociocultural and family environment, with a great impact on the world public health.
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ORIGINAL ARTICLES Top

Influence of student non-mother-tongue language learning on the achievement of intended learning outcomes: Would code-switching help? p. 194
Saleh Ali Alrebish
DOI:10.4103/sjhs.sjhs_140_20  
Background: A stressful learning environment can hinder student achievement. Building on sociolinguistic theory, student learning is enhanced wherever the mother-tongue language is the same as the teaching instruction medium language. The present study aimed to evaluate the influence of students' non-mother-tongue language learning in the achievement of learning outcomes. Materials and Methods: The present study is a perception study with interventional, quantitative, and educational research component comparing the learning of 1st-year medical students in pure English with their learning using code-switching. The data were collected during the 2018/2019 academic year through a quiz and a questionnaire. Eighty-six 1st-year students' perceptions were compared to those of 72 4th-year students using the same questionnaire. Both t-tests and Chi-squared tests were used for the data analysis with SPSS for Windows, Version 21; P < 0.05 was considered statistically significant. Results: Code-switching students scored higher in the postsession quiz. One-third of the 1st-year students felt that learning in English was stressful, and they cited language issues as reasons for their low scores on examinations. They realized, however, that learning in English had positive consequences on their future careers and suggested that a bilingual approach be used, especially in the early stages and for complex topics. Fourth-year students were less apprehensive about learning in English. Conclusions: Ensuring appropriate English language proficiency during the admission process to medical schools and the use of simple, clear language during teaching with code-switching when needed are likely to decrease student stress during learning. This is likely to enhance students' achievement of the intended learning outcomes and maximize their performance after graduation.
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Closure of excisional defects of pilonidal sinus surgery using a perforator-based island flap p. 202
Samir Ahmad Badr
DOI:10.4103/sjhs.sjhs_143_20  
Background and Aim of the Work: Pilonidal sinus disease is a common condition in the young adults, which carries significant patient discomfort. There is no consensus regarding the best surgical technique for the treatment of this disease. A controversy is present about the various options for closure of the wound following resection of the affected tissue. In this study, the perforator-based island flap was successfully used for closing the defect left after excising the pilonidal sinus. Methods: Twenty-three patients with a primary complex pilonidal sinus disease were operated upon and followed up in the period from October 2014 to October 2018 at the General Organization of Teaching Hospitals and Institutes hospitals. After wide excision of the pilonidal sinuses, the defects were reconstructed with perforator-based flaps, which were designed with an axis of 45°–90° angle to the vertical axis of the defects. Results: Of the 23 patients included in this study, only three patients developed minor complications (one case of mild seroma and two cases of minor wound infections), and they were treated conservatively. Mean time of hospital stay was <2 days. Mean time to return to normal daily activities was 5 days (range: 3–7). Mean time to complete healing of the wound was 12 days (range: 10–15). Mean time off-work days was14 days (range 12–17). All the patients did not show recurrences during the period of follow-up which continued for at least 9 months postoperatively with a mean time of 10 months (range: 9–15). Conclusions: This study shows that closure of postexcisional defect of pilonidal sinus using a perforator-based island flap is a reliable option for the treatment that fulfill the principles and criteria required to achieve complete cure of the condition in a short period of time.
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Maternal-perinatal outcome in pregnancies complicated by preeclampsia: Looking at early and late onset disorders p. 208
Ikeanyi Eugene M, Onyiriuka Alphonsus N, Ikeanyi Rita Assumpta U
DOI:10.4103/sjhs.sjhs_37_20  
Background: Globally, preeclampsia; an idiopathic pregnancy-related proteinuric hypertensive disorder remains one of the major causes of maternal and perinatal morbidity and mortality, worst so in low resources settings. Accumulating evidence indicates that the outcome is influenced by the gestational age at onset of the disorder. Aim: We investigated the perinatal and maternal outcomes of pregnancies complicated by preeclampsia and in addition compared the early onset and late onset types. Materials and Methods: An analytical observational study was carried on all cases of preeclampsia managed in tertiary hospital between 2013 and 2019. The participants were comparatively studied for maternal and perinatal outcomes. Results: The incidence of preeclampsia was 7.1%. About a third 31.9% were early onset and 68.1% late onset disease. Maternal complications were frequent in preeclampsia; 24.5% eclampsia, an incidence of eclampsia of 56/3474 (1.61%), 74.2% cesarean section, 23.6% severe proteinuria, 12.2% anemia, 11.4% postpartum hemorrhage, 3.1% pulmonary edema, 1.7% thrombocytopenia, 0.9% hemolysis, elevated liver enzymes and low platelet syndrome and acute renal failure, respectively. These were more frequent in late preeclampsia but severer in early onset disease. Case fatality rate was 1.75% and maternal mortality ratio 117.7/100,000 live births. Mean gestational age at delivery in preeclampsia was 35.4 weeks with 51% preterm births and 28.8% small for gestational age neonates with early onset disease contributing more than twofold. The perinatal mortality was high at 21.4%; a perinatal mortality rate of 14.2/1000 total births with 6-fold among early onset disease mostly from iatrogenic prematurity. Conclusions: The incidence of preeclampsia was high, maternal morbidity though more common among late onset disease, was severer among the early onset disease which also had worse adverse perinatal outcomes.
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New graduate nurses' transition: Role of lack of experience and knowledge as challenging factors p. 214
Omar Ghazi Baker
DOI:10.4103/sjhs.sjhs_88_20  
Context: Lack of experience and practical knowledge makes it difficult to deal with the issues related to health-care practices. This acts as a threat to the learner's theoretical ability. Aims: The study aims to identify the challenges and the associated factors which limit the knowledge acquisition of new nurse graduates in Saudi Arabia. Settings and Design: A cross-sectional study design was used in which a sample of 95 individuals was recruited from public hospitals in Al-Baha region. Subjects and Methods: A primary survey approach was used to collect data from nurses using close-ended questionnaire. Statistical Analysis Used: IBM SPSS (Statistical Tool for Social Sciences) version 20.0 was used to conduct the statistical analysis. Results: The challenges include role expectations, lack of confidence, workload, fear, and orientation issues, while other factors such as physical environment, responsibility, support, and professional development create a sense of dissatisfaction among nursing professionals. New graduate nurses are infrequently scheduled in situations where they cannot feel confident in dealing with clinical cases. Conclusions: The study concluded that transition is the major issue with respect to difficulties faced by nurses in the health-care environment.
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Role of pharmacist's counseling on folate compliance p. 221
Kousalya K Prabahar, Tahani S Alenazi
DOI:10.4103/sjhs.sjhs_121_20  
Background: Pregnant women's compliance with a regimen of folate supplementation is an important factor in decreasing incidence of neural tube defects (NTDs). Because effective medication counseling can be used to enhance women's compliance with folate intake, pharmacists can help ensure good pregnancy outcomes by improving women's compliance through such counseling. Objectives: To determine the effect of medication counseling delivered by pharmacists on compliance among pregnant women in Tabuk, Saudi Arabia. Materials and Methods: A cross-sectional analytical study was conducted of 360 pregnant women who attended antenatal care clinics at primary health-care centers in 2018. A well-designed questionnaire was used for data collection. The data were analyzed using descriptive statistics and the Chi-squared test. Results: About half of the study participants began consuming folic acid after becoming pregnant (55.8%) and only 28.6% reported preconceptional intake. The most common reason for noncompliance was forgetfulness (64.40%). Almost two-thirds of women knew the importance of taking folate in pregnancy to prevent NTDs (64.2%). Their main sources of knowledge about folic acid were doctors (35.8%) and pharmacists (25%). A significant association was found between regular folate intake and pharmacist counseling as a source of folate information. Conclusion: Almost half of pregnant women complied with their folate supplementation regimen. However, lower preconceptional intake was observed. Participants' level of awareness of the importance of folic acid supplementation for pregnant women, though adequate, was not sufficient to ensure good pregnancy outcomes. Pharmacists were identified as a valuable source of information about folic acid, with their provision of medication counseling significantly associated with regularity of folate intake.
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Experiences of nursing interns with the application of knowledge and skills in drug administration: A qualitative study p. 227
Nusrat Bano, Hend Al Najjar
DOI:10.4103/sjhs.sjhs_78_20  
Context: Nursing interns are expected to practice safe medication administration. Pharmacology courses in their undergraduate education prepare them for safe medication administration. Most interns are challenged by the practical implementation of theoretical concepts in pharmacology. Aims: The purpose of this study was to describe the experiences of nursing interns with the application of medication knowledge and skills in clinical practice settings. Settings and Design: A qualitative descriptive design was used in health science university in Saudi Arabia. Subjects and Methods: face-to-face in-depth interviews with nursing interns recruited through purposeful sampling in a health science university in Saudi Arabia. Data were collected from December 2019 to January 2020 following Institutional Review Board approval. Statistical Analysis Used: Graneheim inductive approach was used for the content analysis of the data. Standard principles of trustworthiness were applied. Results: Two major themes emerged as “perceived readiness” and “bracing attributes.” There were two subthemes within each theme, which were populated by 13–23 statements. Conclusions: Nursing interns described certain challenges with the application of knowledge and skills in medication administration. Self-perceived lack of knowledge underlined description of most experiences. Learning acquired with case studies, classroom interactions, clinical exposure, and simulation, in undergraduate education was acknowledged in the context of retention of knowledge.
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The impact of body mass index and number of antihypertensive medications on clinical management of hypertension in primary health care p. 232
Hatouf H Sukkarieh, Rami T Bustami, Hadeel Al-Khaneen, Abdulkarim Saeed
DOI:10.4103/sjhs.sjhs_33_20  
Introduction: Hypertension (HTN) is an extremely common disease and its prevalence is increasing globally. The association between obesity and HTN is not yet fully understood, insulin resistance and renal dysfunction are said to be the main causes of obesity-related HTN. This study explored the effect of obesity and different number of medications on blood pressure (BP) control in patients with HTN. Methods: This was a retrospective study conducted in the outpatient primary care clinic at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results: A total of 286 patients were included in the study with an average weight of 80.6 kg and an average body mass index (BMI) of 32.2. Only 63% of the participants had controlled BP. There was a trend toward better controlled BP levels among male participants (67.1%) compared with females (57.7%) and among those with higher BMI levels, P = 0.099 and 0.094, respectively. Patients receiving two antihypertensive medications were more likely to have their BP controlled compared to those receiving four medications (odds ratio [95% confidence interval] =2.62 [1.32, 5.20]; P = 0.006). Conclusion: Uncontrolled BP was not associated with BMI. Taking two antihypertensive medications was associated with more BP control than monotherapy or combination of therapy with three drugs or more.
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Models of modern-day circadian rhythm disruption and their diabetogenic potentials in adult male Wistar rats p. 236
Mahdi Gambo Dissi, Salisu Ahmed Ibrahim, Yusuf Tanko, Aliyu Mohammed
DOI:10.4103/sjhs.sjhs_69_20  
Background: Light at night (LAN) threatens metabolic health by delaying our sleep timing and allowing us to eat at odds with our circadian clocks. Circadian research interests are majorly focused on jet lags, shift work, and the non-24-h days. Since exposure to LAN, sleep loss, and late night eating are common scenarios of modern-day circadian rhythm disruption, developing an animal model that better mirrors these scenarios and investigation of their diabetogenic potentials is a research priority. Materials and Methods: Over the course of 6 weeks, we developed chronic LAN exposure (LAN), sleep restriction (SR), abnormal feeding (AF), rural social jetlag (RSJ), night shift work (NSW), and urban social jetlag (USJ) models, using male Wistar rats. Gentle handling was used to induce SR, while LAN was instituted using a customized light rack system. Circadian and blood glucose rhythms were, respectively, determined using 4 hourly temperature and blood glucose measurements. Statistical analysis was done using SPSS V20.0 and ÒCosinor SoftwareÓ. The data were summarized using mean ± standard deviation as well as MESoRs, amplitudes, and acrophases. Statistical significance was considered as P ≤ 0.05. Results: Our findings have revealed a significantly (P < 0.01) higher average nocturnal glucose (126 mg/dL) and temperature (36.53°C) rhythms compared to diurnal glucose (108 mg/dL) and temperature (35.50°C) rhythms in the controls rats. All the developed models are noted to have a distorted light: dark glucose and temperature rhythms with acrophases of the core body temperature in controls, RSJ and USJ models occurring at 08:16 pm, 2:43 pm, and 7:48 pm local time, respectively. The vector components of the phase changes revealed 5 h phase delay in the LAN model and 28 min, 1 h, and 4.5 h phase advancements among the USJ, AF, and SR models, respectively. These indicate circadian disruption and blood glucose dysrhythmia among the SR, AF, LAN, RSJ, USJ, and NSW models. Conclusion: Our findings have suggested the circadian disruptive and diabetogenic nature of our widespread modern-day social behaviors.
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Preoperative cone beam computed tomography evaluation of mandibular second and third molars in relation to the inferior alveolar canal p. 243
Ebtihal H Zain-Alabdeen, Rahaf A Alhazmi, Rawan N Alsaedi, Abdulrahman A Aloufi, Omar A Alahmady
DOI:10.4103/sjhs.sjhs_127_20  
Objective: The aim is to evaluate the location and proximity of second and third molars roots to the inferior alveolar canal (IAC) and demographic factors associated with these proximities. Materials and Methods: Cone beam computed tomography scans were evaluated for 292 roots of 146 teeth from 40 patients. A radiologist read, measured, and evaluated the vertical and horizontal positions of the roots of the second and third molars in relation to the IAC. Results: No significant differences were found between the third molar roots and neighboring second molar roots in the closeness to the IAC. The most common horizontal relation was “roots above IAC” (54%) followed by “roots lingual to IAC” (41.78%), “roots buccal to IAC” (3.42%), and “IAC between the roots” (0.68%). No significant differences in second and third molar roots and their contrasting teeth in the proximity to IAC. The older age group had significantly higher vertical measurements between third molar roots and IAC. There were significantly larger vertical measurements in the right third molar roots to IAC in males than females. Conclusions: These anatomical relationships are important clinical knowledge to avoid potential surgical injury to the inferior alveolar nerve.
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Initial dose of vancomycin in adult patients at a major tertiary care hospital in Saudi Arabia: A retrospective observational study p. 248
Sultan Mubarki, Santhosh Joseph Menachery, Majid Ahmed Darraj, Abdulkarim M Meraya, Yaqoub M Khormi
DOI:10.4103/sjhs.sjhs_72_20  
Background: Therapeutic drug monitoring is commonly performed to confirm the safe and effective use of the vancomycin; however, the facility for it is not available in many hospitals. Many clinicians use conventional fixed dose of 1000 mg every 12 h irrespective of the body weight. Aim: The aim of the study was to assess the appropriateness of vancomycin initial dose in adult patients with normal renal function. Setting and Design: This was a retrospective observational study involving medical records of patients treated with intravenous vancomycin during January 1, 2016–December 30, 2016, at a major tertiary care hospital in southern region of Saudi Arabia. Materials and Methods: The study was conducted based on electronic medical records of the patients who received intravenous vancomycin, aged ≥ 18 years, weighing more than 50 kg, and with normal renal functions during the period of the study. Chi-square tests were used for categorical variables. Multivariable logistic regressions were computed to examine the relationships between the explanatory variables and the appropriateness of vancomycin dose. Results: The study evaluated records of 456 adult patients, of which 63.8% were male. As per vancomycin dose received, 229 patients received suboptimal dosing of vancomycin when the dose was recalculated using actual body weight. The majority of the prescriptions of junior residents (68.5%) were using an optimal initial dose of vancomycin as compared to 43.6% of the senior residents or 48% of the consultants. Conclusions: A significant number of patients were receiving suboptimal initial dose of vancomycin. Junior residents were more meticulous with the initial vancomycin dosing.
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CASE REPORTS Top

Persistent Mullerian duct syndrome in two brothers from a Saudi family with a homozygous variant in the AMHR2 gene p. 253
Adnan Al Shaikh, Bader Shirah
DOI:10.4103/sjhs.sjhs_169_20  
Persistent Mullerian duct syndrome (PMDS) is a rare disease characterized by normal virilization and XY genotype including failure of Mullerian duct regression. In this article, we report two cases of PMDS in Saudi patients with a pathogenic homozygous variant in the AMHR2 gene and review the literature. PMDS should be taken into consideration in all cases of bilateral cryptorchidism. Laparoscopy is the elective procedure for the diagnosis of this disease, and laparoscopic surgery for orchidopexy of intra-abdominal testes is the intervention of choice. It remains unclear at present whether the anti-Mullerian hormone is necessary to maintain normal testicular function. Early surgical intervention is important to reduce the risk of malignancy. The patient and his family should be completely informed about the diagnosis, the surgical options, and the need for long-term follow-up. A genetic cause can be strongly suggested in the presence of parental consanguinity.
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Gangrene and sepsis in sickle cell disease p. 257
Umma Abdulsalam Ibrahim, Ibrahim Aliyu, Nuraddeen Lawal, Aisha Musa Bala
DOI:10.4103/sjhs.sjhs_75_20  
Infection is common in sickle cell disease (SCD), and consequences of infection such as abscess formation and osteomyelitis are commonly reported events. However, gangrene is an uncommon complication of SCD. A 3-year-old boy with sickle cell anemia presented with fever, bone pains, and gangrene of the digits. Peripheral pulses were palpable. His full blood count showed a progressive increase of the white blood cell count, but the clotting profile was normal, and blood culture yielded Proteus vulgaris. Arterial Doppler scan showed reduced flow in the right ulnar and both dorsalis pedis arteries. X-ray of the upper and lower limbs showed chronic osteomyelitis. Pus aspirate from incision and drainage of anterior tibia abscesses showed Gram-negative cocci in clusters, but the culture was negative. He received blood transfusion, fresh frozen plasma, heparin, and antibiotics. Early recognition and prompt treatment of infection will minimize the development of these devastating complications of SCD.
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Feral dog bite causing paralytic rabies: Difficult diagnosis and failure of prevention p. 260
Hussein Algahtani, Bader Shirah, Emna Chtourou, Osama Abuhawi, Nawal Abdelghaffar, Mohammad Alshehri
DOI:10.4103/sjhs.sjhs_106_20  
Rabies is an acute encephalitis caused by a virus from the genus Lyssavirus (family Rhabdoviridae). It has the highest case fatality rate when compared with other infectious diseases, with over 99% of human deaths occurring in Asia and Africa. Animal-related injuries in Saudi Arabia remain a public health problem, with feral dogs accounting for the majority of bites to humans. Eradication of rabies is not achieved yet, and efforts from different parties including the Ministry of Health, the Ministry of Municipal and Rural Affairs, the Saudi Wildlife Commission, and the Preventive Medicine Department should be coordinated. Training courses for emergency physicians and campaigns to educate the general population about animal-related injuries should be conducted. In this article, we report a case of feral dog bite causing paralytic rabies in a Saudi patient. Our case is unique since the cause of death in this patient was lack of family assistance and proper follow-up of the patient to ensure completing the vaccination schedule rather than lack of treatment and resources. The involvement of infection control department should be from the 1st day of dog bite.
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LETTER TO EDITOR Top

The challenge of concurrent thrombosis and hemorrhage in catastrophic antiphospholipid syndrome p. 264
Muneerah M ALBugami
DOI:10.4103/sjhs.sjhs_173_20  
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