Family and Community Medicine

Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup Fahmi Y Khan Journal of Family and Community Medicine 2019 26(2):83-91 Disseminated tuberculosis (TB) is a life-threatening disease resulting from the hematogenous spread of Mycobacterium tuberculosis. The diagnosis is challenging owing to its subtle nonspecific clinical presentation, which usually reflects the underlying organ involved. Besides, tools for confirmatory laboratory diagnosis are limited. Therefore, a high index of suspicion is required for early diagnosis. Miliary pattern on chest radiography is a common finding that has an important role in the early detection of the disease. Nevertheless, approximately 10%–15% of patients have normal chest radiography. Although abnormalities are present, basic hematologic and biochemical tests as well as tuberculin skin test are nonspecific for the diagnosis. Imaging studies are helpful adjunct tools for disseminated TB as they can help determine the involved sites and guide technicians to obtain appropriate specimens for diagnosis. Clinical confirmation of the diagnosis of disseminated TB is usually based on bacteriological or histological evidence. Response to first-line anti-TB drugs is good as evidenced by many reports. This review aims to present a current update on disseminated TB with emphasis on the diagnostic workup of this devastating condition.

Stroke in atrial fibrillation: Review of risk stratification and preventive therapy Abdullah M Alshehri Journal of Family and Community Medicine 2019 26(2):92-97 Atrial fibrillation (AF) is a leading preventable cause of ischemic stroke for which early detection and treatment are critical. The risk of stroke in people with AF can be stratified by the use of such validated prediction instruments such as CHADS2 or CHA2 DS2–VASc. The CHA2 DS2–VASc adds to the evaluation of the risk of stroke by reliably identifying patients at very low risk. Additional points are assigned for an additional age category of 65–74 years (1 point), female sex (1 point), and vascular disease other than cerebrovascular disease (1 point). Two points are awarded for age ≥75 years. The risk of stroke increases according to point score: 0.5% per year (0 points), 1.5% per year (1 point), 2.5% per year (2 points), 5% per year (3 points), 6% per year (4 points), and 7% per year (5–6 points). For decades, Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for the prevention of stroke in AF. However, new oral anticoagulants (NOACs), such as apixaban, dabigatran, and rivaroxaban, are currently available and have proved to be safe and effective in preventing stroke in patients with nonvalvular AF. In addition, a nonpharmacologic procedure like left atrial appendage occlusion is a possible option in selected patients. In this article, we have reviewed the stratification of stroke risk in AF, prevention of stroke in nonvalvular AF, warfarin versus NOACs, weighting risk of bleeding versus stroke risk when deciding on the anticoagulation protocol in patients with AF, and the use of nonpharmacologic therapy for stroke prevention.

Quality of life assessment of breast cancer patients in Saudi Arabia Tahani H Nageeti, Huda R Elzahrany, Aisha O Gabra, Arwa A Obaid, Raid A Jastania Journal of Family and Community Medicine 2019 26(2):98-102 BACKGROUND: To assess the quality of life (QOL) of females with breast cancer in Saudi Arabia and its association with patients' demographic, social, and clinical data. MATERIALS AND METHODS: This analytical cross-sectional study was conducted among breast cancer patients attending King Abdullah Medical City, Makkah. Participants were asked to complete a self-administered structured questionnaire. We utilized the validated Arabic version of the European Organization for Research and Treatment of Cancer QOL-C30 (EORTC-QOL-C30) and breast cancer module QLQ-BR23 (EORTC-QOL-BR-23). Data were analysed using SPSS; mean and standard deviation computed for continuous variables, and percentages for categorical variables. Student's t-test performed to compare mean scores for various groups. RESULTS: Eighty-eight women participated in the study. The participants had a mean global health score of 64.0, standard deviation (SD) = 27.7. Of the functional scales, role functioning scored the highest (mean 71.2, SD = 31), while social and emotional functioning scored the lowest, (mean 57 SD = 35.8) and (mean 59.5 SD = 32), respectively. On the symptom scales, the most troubling symptoms were fatigue and insomnia, (mean 48.86 SD = 29.4) and (mean = 48, SD = 35), respectively. On the disease-specific tool (QLQ-BR23), body image and future perspective scored the lowest with a mean of 60.2 SD = 35 and 42.0 SD = 39.6, respectively. The most distressing symptom was hair loss (mean 61.56 SD = 41). CONCLUSIONS: Our population showed an acceptable overall global health score. However, they scored low on the important functional and symptoms domains. This study implies that patient age, social, and physical factors were possible determinants of global health and QOL scores. The healthcare system of Saudi Arabia should, therefore, address all these different aspects of QOL of breast cancer survivors.

Knowledge and attitude of Saudi female university students about first aid skills Lubna M Halawani, Shahad D Alghamdy, Manal M Alwazae, Wafa A Alkhayal Journal of Family and Community Medicine 2019 26(2):103-107 BACKGROUND: First aid is the first and most essential life saving care that can reduce the morbidity of an individual in a health-threatening circumstance. The aim of this study was to assess the knowledge and attitude toward the provision of first aid among students attending Princess Norah University (PNU). MATERIALS AND METHODS: A cross-sectional study was conducted at PNU in Riyadh, Saudi Arabia, from October 2017 to December 2017. A total of 1000 female students from 15 different colleges completed a self-administered questionnaire. RESULTS: The mean age was 21 years (range 18-26); 36% study participants were from health colleges and remaining from other colleges. Only 34.7% had good knowledge, 57.5% had moderate knowledge, and 7.8% had poor knowledge on first aid skills. Analysis of knowledge in specific emergency situations showed that the students were more knowledgeable in cases of epistaxis, ingestion of toxins, burns, hypoglycemia, and loss of consciousness. However, they were found to be less knowledgeable in handling situations of seizures, choking, and snake bite. About 20.2% of the students had encountered situations where cardiopulmonary resuscitation was required and 65.3% of these students had not provided first aid because of the lack of knowledge, nervousness, and other issues. Good knowledge was associated with previous first aid training and being a student in a health college. CONCLUSION: Overall, students had a positive attitude toward first aid; however, they still did not have the knowledge necessary to be able to act in emergency situations. There is a need for increased public health awareness. It is also advisable to introduce first aid courses in all universities and secondary schools.

Internet addiction and its relationships with depression, anxiety, and stress in urban adolescents of Kamrup District, Assam Anku M Saikia, Jahnabi Das, Pavel Barman, Mintu D Bharali Journal of Family and Community Medicine 2019 26(2):108-112 BACKGROUND: In these modern times of digitization, the use of Internet has become an integral part of everyday life, especially the lives of adolescents. At the same time, Internet addiction has emerged as a serious affliction. However, the impact of Internet addiction on these crucial years of life has not been well studied in India. The objective of this study was to determine the prevalence of Internet addiction in adolescents of the urban areas of Kamrup district and assess its association with depression, anxiety, and stress. MATERIALS AND METHODS: A cross-sectional study was conducted among students of higher secondary schools/colleges in the urban areas of Kamrup district in Assam. Out of 103 government and private higher secondary school/colleges of Kamrup district, Assam, 10 colleges were selected randomly, and a total of 440 students were enrolled in the study. A pretested, predesigned questionnaire, Young's Internet Addiction Scale, and Depression Anxiety Stress Scales 21 (DASS21) were used in the study. Chi-square test and Fisher's exact test were used to assess the association between Internet addiction and depression, stress, and anxiety. RESULTS: Majority (73.1%) of the respondents were females, and mean age was 17.21 years. The prevalence of Internet addiction was 80.7%. The main purpose of using Internet was social networking (71.4%) followed by study (42.1%), and majority (42.1%) reported spending 3-6 hours a day on internet. There was a significant association between Internet addiction and stress (odds ratio=12), depression (odds ratio=14), and anxiety (odds ratio=3.3). CONCLUSION: Internet addiction is a serious problem with a profound impact on mental health. Therefore, early intervention is crucial.

May we improve vaccine timeliness among children? A cross sectional survey in northern Saudi Arabia Ghada Z.R. Alrowaili, Umar F Dar, Altaf H Bandy Journal of Family and Community Medicine 2019 26(2):113-117 BACKGROUND: The timeliness of vaccinating children is the pillar of the cost-effective strategy of decreasing the burden of many infectious diseases. Delayed immunization creates the risk of failure. There is regional variation in the rate of delayed vaccination. The purpose of present study was to determine the timeliness of vaccination and reasons for delay in vaccinating children under the age of 2 years in Sakakah, Northern Saudi Arabia. MATERIALS AND METHODS: This study included 195 children under 2 years of age consecutively taken from four randomly selected primary health centers in Sakaka, Al Jouf province. A pretested proforma was used to screen the vaccination cards of the children for any delays in vaccination. Parents of children whose vaccinations had been delayed for more than 4 weeks were interviewed to determine the reasons for the delay. The reasons for delay were grouped under three different themes, i.e., child related, facility related and social issues. RESULTS: The mean age of the children was 8.6 ± 5 months; 45% were girls and 38% were first or second order babies. In our sampled population, 23% children had delayed vaccinations of more than 4 weeks. The delay was similar for both male and female children (21.5% of males and 25% of females). High education of parents, working mothers and low birth order were positively associated with timeliness of vaccine uptake (P < 0.05). Of those with delayed vaccination, only 15.6% mentioned facility or appointment related reasons; illness of the child was reported by 46.7%. CONCLUSION: There is considerable delay in vaccination of children in Sakakah, Northern Saudi Arabia. A third or more birth order of the child, parents having less than university education, and child's mother being home maker are related with increased risk of delayed vaccination.

Effect of maternal anemia on the status of iron stores in infants: A cohort study Arvind K Shukla, Shitanshu Srivastava, Garima Verma Journal of Family and Community Medicine 2019 26(2):118-122 BACKGROUND: Iron deficiency anemia in pregnant women may affect the iron reserves of their infants and lead to anemia later. The objective of the study was to compare hemoglobin and iron store status of infants born to anemic and non-anemic mothers and to determine any correlation. MATERIALS AND METHODS: A cohort study was conducted in the Department of Pediatrics of a Teaching hospital after obtaining ethical approval and written informed consent from all participants. Total 180 mother-infant pairs were enrolled in the study were divided into two groups; Group I: 90 term infants born to anemic mothers (Hb <11 g/dl), Group II: 90 term infants born to non-anemic mothers (Hb >11 g/dl). Hemoglobin and ferritin levels were assessed in cord blood at birth and at 14 weeks after birth in the infants of both groups. Data was analyzed using SPSS 20.0; Chi-square test and t-test were applied to test for statistical significance. RESULTS: The final sample size was 85 for Group I and 78 for Group II. For Group I, mean hemoglobin and ferritin levels in the cord blood of infants at birth were 16.33 ± 1.19 and 135.40 ± 25.94, respectively. For Group II, Mean hemoglobin and ferritin levels in the cord blood of infants at birth were 17.62 ± 1.35 and 160.45 ± 28.50, respectively; differences were statistically significant. At 14 weeks, the mean Hb and ferritin was 11.24 ± 1.03 and 55.92 ± 10.44 in Group I and 13.18 ± 0.82 and 63.56 ± 10.15 in Group II; the differences were statistically significant. A significant correlation between maternal and infant hemoglobin and ferritin levels was observed at birth and 14 weeks after birth. CONCLUSION: Maternal iron deficiency may have an effect on the iron status of their infants. Thus, timely appropriate interventions are necessary.

Forecasting Indian infant mortality rate: An application of autoregressive integrated moving average model Amit K Mishra, Chandar Sahanaa, Mani Manikandan Journal of Family and Community Medicine 2019 26(2):123-126 BACKGROUND: The Infant Mortality Rate (IMR) reflects the socioeconomic development of a nation. The IMR was reduced by 28% between 2015 and 2016 (National Family Health Survey-4 [NFHS-4]) as compared to 2005–2006 (NFHS-3), from 57/1000 to 41/1000 live births. The target fixed by the Government of India for IMR in 2019 is 28/1000 live births (National Health Policy, 2017). One of the most common methods of forecasting this is the autoregressive integrated moving average (ARIMA) model. A forecast of IMR can help implementation of interventions to reduce the burden of infant mortality within the target range. MATERIALS AND METHODS: The objective of the study was to give a detailed explanation of ARIMA model to forecast the IMR (2017–2025). Secondary data analysis and forecast were done for the available year and IMR data extracted from “open government data platform India” website. RESULTS: The forecast of the sample period (1971–2016) showed accuracy by the selected ARIMA (2, 1, 1) model. The postsample forecast with ARIMA (2, 1, 1) showed a decreasing trend of IMR (2017–2025). The forecast IMR for 2025 is 15/1000 live births. CONCLUSION: In the current study, long-time series IMR data were used to forecast the IMR for 9 years. The data showed that IMR would decline from 33/1000 live births in 2017 to 15/1000 live births in 2025. When the actual data for another year (2017) are available, the model can be checked for validity and a more accurate forecast can be performed.

Pattern and severity of sleep apnea in a Saudi sleep center: The impact of obesity Khalid A Alshehri, Lujain F Bashamakh, Hussein M Alshamrani, Ibtihal O Alghamdi, Bsmah A Mahin, Ahmed A Alharbi, Waleed M Alqulyti, Hisham Z Alshehri, Mohannad T Alghamdi, Faris F Alhejaili Journal of Family and Community Medicine 2019 26(2):127-132 AIM: The aim of this study was to estimate the effect of obesity on the severity of obstructive sleep apnea (OSA) by assessing the relationship between OSA and body mass index (BMI). MATERIALS AND METHODS: A cross-sectional study was conducted in 2017 among patients who had been referred to the sleep center at King Abdulaziz University Hospital (KAUH, Jeddah, Saudi Arabia) for polysomnography between January 2012 and September 2017. The data were abstracted from the medical records of these patients at KAUH. Initial data analysis included descriptive statistics; Chi-square test, t-test, and one-way ANOVA as appropriate were used to assess the associations between the variables. RESULTS: The study included 803 patients; the average age of the patients was 45.9 years and 56.5% were male. About 70.4% were obese, 54% of whom were classified as having Class 3 obesity. Approximately, 75% patients had OSA. The prevalence of OSA was higher among obese patients (77.7%) compared to nonobese patients (22.3%). Moreover, the severity of OSA was higher in obese patients, with 85.3% of obese patients considered as having severe OSA. CONCLUSION: Obesity is a considerable risk factor for developing OSA and could play a major role in increasing the severity of the disease. We encourage further studies on the impact of sedentary lifestyle and its association with OSA in Saudi Arabia, with an emphasis on the evaluation of the cost-effectiveness and burden of the disease.

Perceptions and attitudes of family medicine residency program directors regarding ranking applicants for residency programs using their social media accounts: A national study in Saudi Arabia Amani M Al Qarni, Shaher Z Al Shehri, Moataza M.A. Wahab Journal of Family and Community Medicine 2019 26(2):133-140 BACKGROUND: In contemporary times, employers use information available on the social media (SM) to assess attitudes before interviews and recruitment of potential employees. It is used as one of the criteria to rank applicants for acceptance as residents in the Middle East. In this study, an evaluation was done of this new practice in which program directors (PDs) take into account e-professionalism for the acceptance of applicants. It was a national study of all 41 hospitals in the Kingdom of Saudi Arabia involved in Saudi board family medicine training programs. MATERIALS AND METHODS: A 36-item questionnaire was administered to PDs. Next, a focus group discussion (FGD) was held, after which there was social listening. We recorded the FGD. There was verbatim transcription and coding of the qualitative data. We held social listening using Keyhole. The percentage of positive attitudes (PPAs) was normally distributed; we tested its relationship with different factors by comparing the mean score values among categories using the Student's t-test and one-way analysis of variance. RESULTS: The average PPA toward the ranking of applicants by using their SM was 55.5% ± 17.3% (median: 56.6%). The average PPA was higher in those who used SM to communicate with residents (60.2% ±19.5%) than those who did not (49.4% ±12%; P = 0.04), even after adjusting for familiarity with Internet use. Directors in hospitals of the Ministry of Education had higher percentages; these figures, however, are not statistically significant. PDs considered the importance of establishing culturally acceptable guidelines for the assessment of e-professionalism and social reputation. CONCLUSIONS: Culturally appropriate, bioethical regulations that meet the needs of modern times should be designed. We need to solve ethical dilemmas, especially with regard to privacy in SM.