Saudi Arabia has witnessed an expansion of biomedical research in recent decades attributable to the increased spending in research and establishment of new universities and research centers throughout the country. Its research productivity is second among the Arab states and 16th in the World.[1] The majority of its research comes from a few universities: King Saud University (KSU) in Riyadh and King Abdul-Aziz University in Jeddah; for example, 41% of all publications between 2008 and 2012 originated from KSU.[2] Saudi Arabia ranks among the top countries for the prevalence of common chronic conditions (e.g., diabetes, obesity, and cardiovascular diseases [CVD]).[3,4] This necessitates that local researchers engage in high-quality research to identify causes of these conditions, their consequences, and the solutions to these health problems. They need to assess the incidence, risk factors, and prognosis of these diseases with prospective cohort studies and test the effectiveness of various drugs and interventions with experimental studies. Currently, the gamut of evidence comes mostly from studies done in the western countries. Therefore, the guiding principle for local researchers should be to confirm earlier findings as well as to identify unique aspects of these diseases for the Saudis. Hence, a quality assessment of research produced thus far in Saudi Arabia is timely and warranted. Bibliometric studies are a useful tool to determine the quality, and they provide either direct, indirect, or both types of evidence. The indirect metrics that denote research quality include “number of publications in high-impact journals,” citation frequency, and h-index. These indicators point out that Saudi Arabia not only is lagging behind from the western countries but also from the regional countries like Turkey or Israel.[5-7] The number of publications in high-impact journals and the overall citation frequency from Israel was 16 and 3 times higher, respectively, than their corresponding estimates from Saudi Arabia.[5] There are exceptions in certain fields where Saudi Arabia has made a marked improvement over the years. For example, it ranks 37th in the World in neuroscience research, and the h-index of Saudi neurosurgeons is comparable to that of their colleagues from the USA and UK.[8] In bibliometric studies, the direct evidence for quality assessment of included studies pertains to various parameters such as research design, sample selection, and analytic approaches. A few recent studies assessed the study quality in the leading public health problems for Saudi Arabia, namely, diabetes and CVD.[9,10] The main findings were that majority of the studies were cross-sectional (CVD = 58% and diabetes =65%) and only a small minority were experimental (CVD = 3% and diabetes = 4.5%) studies. Most cross-sectional studies were conducted at a local level (CVD = 74% and diabetes = 61%), with an insufficient size (n < 500 CVD = 66% and diabetes = 62%), and a non-random sample selection (CVD = 75% and diabetes =54%). These types of weaknesses seriously question the validity of a study and the representativeness of its results. Similarly, the majority of the experimental studies did not use randomization for group allocation (CVD = 66% and diabetes = 71%), which is key to control for confounders and minimize bias. Naturally, studies with great methodological deficiencies are less attractive to reputable journals for publication. Further analysis of research quality in Saudi Arabia investigated the quality of randomized controlled trials, specifically (n = 61); the findings are equally dismaying.[11] Quality was assessed in seven domains (e.g., randomization, allocation concealment, blinding of assessors or participants, incomplete outcome data, selective reporting, and other sources of bias) with Cochrane Collaboration risk of bias tool.[12] Saudi-based trials were largely free from certain bias (low-risk) such as incomplete outcome data (87%) and selective reporting (93%). However, they exhibited high risk of bias in blinding domains (outcome: 13% and participants and personnel: 28%). Bias could not be assessed in more than half of the Saudi trials because of a lack of information (unclear-risk) in the domains of randomization (54%), allocation concealment (44%), and blinding of outcome assessment (57%). When all seven domains were considered together (summary of the risk-of-bias), 0% trials had low risk, 39% had high risk, and 61% had unclear risk of biases. Greater proportion of high-risk trials had significant intervention effect than unclear-risk trials (79% vs. 67%). Given this, all the concerned parties (i.e., funding agencies, policy makers, journal editors, and researchers) should take concrete steps to improve the research quality in Saudi Arabia. Several recommendations are made herein for their consideration.  

Objective: The objective of this to find the prevalence of skeletal and visceral changes in thalassemics and its relationship with variation in blood components. Methodology: This is a cross-sectional study conducted in tertiary care hospital in Karachi among patients diagnosed with thalassemia major who require regular blood transfusions. Result: Among 200 individuals, 95 were females, whereas 105 were males. 96.5% of the study sample showed normocytic normochromic blood picture. Mean pre-transfusion hemoglobin (Hb) for 200 patients was 8.91 g/dl, while the mean post-transfusion Hb was 12.07 g/dl. Among all the variables, some strong predictors of change were age and HbA which were found associated with the development of cardiac change in transfusion-dependent thalassemia patients. Hepatomegaly was observed in 66.5% of the patients while normal liver span was observed in 33.5%. 6% of patients showed evidence of skeletal changes on X-ray. Splenomegaly was observed in 26.5%, while in 4.5% of the patients, spleen was not visualized due to splenectomy. Cardiac involvement was observed in 8% of the patients on T2*magnetic resonance imaging. Conclusion: Visceral changes particularly hepatomegaly is very common among transfusion-dependent thalassemia patients. Blood studies for Hb and ferritin levels help to detect these changes when conventional investigations are not possible.

Objectives: The use of non-prescribed antibiotics has become a public health concern, and this behavior continues to thrive in many countries of the world including Nigeria. Evidence from previous studies suggests that increased antibiotic prescriptions and patients’ past experiences are some of the factors contributing to the use of non-prescribed antibiotics. The present investigation was aimed at determining the factors driving this behavior and the extent of usage among people living in a sub-urban Nigerian community. Methods: A community-based, cross-sectional study was conducted in Nsukka, South-East Nigeria using a semi-structured and self-administered questionnaire. An estimated sample size of approximately 400 respondents, with ages ranging from 18 to 60 years participated in the study. A number of males were 233 and 197 were females. Results: Demographics showed that the majority of respondents were well educated. The behavior appeared to be common regardless of gender, age, and educational level. Results showed that more than 86% of the respondents use non-prescribed antibiotics for treatment or prevention or both. A significant percentage uses it to treat cold and cough. The most frequently used antibiotics where the penicillins (58%) followed by quinolones (22%). Tetracycline, aminoglycosides, and cephalosporin represented 20.75%, 14.75%, and 11% usage, respectively. Conclusion: This study revealed a substantial use of over-the-counter antibiotics, with this behavior cutting across gender, age and levels of education. However, participants’ knowledge and awareness of the hazards associated with this behavior were lacking.

Objective: Work-related musculoskeletal disorders (WMSDs) have a significant impact on university faculty members. However, very few studies addressed this issue. The objectives of this study were to determine the prevalence and factors associated with WMSDs among the College of Applied Medical Sciences (CAMS) faculty members of Majmaah University, Saudi Arabia. Methods: In this cross-sectional study, 60 faculty members were recruited using convenience sampling technique. After obtaining the informed consent, data regarding personal characteristics, workplace factors, and prevalence of WMSDs were collected by a valid, reliable, and self-administered musculoskeletal questionnaire. Results: The prevalence of WMSDs in anybody region among faculty members in this study was 55 %. The neck complaint was the most prevalent WMSDs (53.5%), followed by lower back (43.3%) and hand regions (31.6%). Computer use and lack of ergonomic training were associated with WMSDs in most of the body regions. Conclusion: More than half of the study participants were affected with WMSDs. The findings of this study emphasize the essentiality of ergonomic training for the faculty members.

Objectives: Individualized education is important for preparing patients for the operation both physically and psychologically. This study investigated the effects of pre-operative individualized education for open-heart surgery patients on post-operative anxiety and pain severity. Methods: This quasi-experimental study was conducted in a university hospital between January and October 2014 and involved 109 patients. Data were collected through a form developed by the authors, the State-Trait Anxiety Inventory (STAI), and the visual analog scale (VAS). Patients underwent STAI 1 day before the operation to identify their sources of anxiety and educational needs, and then individualized education was given accordingly. 1 day after the operation, STAI was used to measure patients’ state anxiety level, and VAS was used to measure their pain level. The effect of demographic variables on differences in anxiety and pain was investigated. Results: The average age of the participants was 59.62; 69.7% were male, 92.7% were married, 49.5% graduated from primary school, and the majority (71.6%) had coronary heart disease. The most common sources of anxiety reported the participants included lack of knowledge, being away from family, risk of death, and pain. An analysis of the participants’ pre-operative mean scores for state anxiety displayed statistically significant differences (P < 0.05) according to age groups and gender. No significant difference was detected between mean pre- and post-operative state anxiety scores. There was a statistically significant relationship between mean pre- and post-operative state anxiety scores and mean pain scores. Conclusions: The individualized education is given to patients before surgery was found to have potential effects on their post-operative pain levels.

Objectives: This study aimed to explore deep breathing exercise education receiving and performing status of patients undergoing abdominal surgery and the relation between them. Methodology: This descriptive and cross-sectional study was conducted at the surgical ward of a university hospital with 130 patients between August 17 and October 15, 2015. A patient information form and a deep breathing exercise questionnaire were used for data collection. The patients were visited in their rooms after their surgeries and were asked to answer these questions through face-to-face interviews. Descriptive statistics, the Mann–Whitney U test, Spearman’s correlation, and Pearson’s Chi-squared test were used for analyzing the data. Results: Of the patients, 56.2% of the patients received education about deep breathing exercises, and 51.5% of them performed it. A total of 60.3% of the patients received their education from nursing students. Furthermore, 54.8% of them received this education after surgery. A strong correlation was found between the status of receiving education and performing statuses of patients (P < 0.001). Conclusion: The study results indicated that the surgical patients did not receive adequate education about deep breathing exercises and most of them received this education after their surgeries. As a good finding, receiving education affected patients’ exercise performing statuses positively. It is advised from this study that clinical nurses should receive in-service education on the importance of pre-operative deep breathing exercise education to improve the exercise application rate among surgical patients.

Objective: The incidence of refractive errors is on the rise globally. This study was done to assess the pattern and prevalence of various errors of refraction including myopia, hypermetropia, and astigmatism in Qassim region of Saudi Arabia. Methods: This is a cross-sectional study conducted in Buraydah city during January 2015. The participants consisted of 188 subjects of both sexes ranging from 2 to 75 years in a shopping mall picked randomly regardless of age and gender. The study subjects were picked up from a temporary eye clinic established for 2 days in a busy shopping mall in Qassim. The refraction was performed on those patients who were willing for the examination and gave consent to be inducted in the study. Those who had any sort of refractive disorders were assessed and classified by the kind of refractive error. Results: The incidence of refractive errors was found to be reasonably high among general population regardless of gender; however, increasing age was found to be associated with increasing incidence. We found myopia as the most common error of refraction found in 91 (48.40%) study subjects, while astigmatism and hypermetropia were other errors detected. Conclusions: Refractive errors are one of the main reasons of treatable visual impairment in youth. There is a need of standard vision testing in young population to diagnose any such problem at an early stage.

Objectives: The purpose of this study is to evaluate and ascertain the current knowledge, perception, level of awareness, and attitudes toward cervical cancer (CC) among women in Malaysia. Methods: A cross-sectional study was conducted which involved 210 women aged between 21 and 60 years old at the public in Malaysia, a subsequent statistical analysis was performed by SPSS version 22. Results: In comparison with other studies, there is still lacking of awareness on CC and these induced informal cluelessness and poor attitudes toward it. In terms of risk factors, there are two factors with some degree of awareness among women in Malaysia, i.e., multiple sexual partners and sexually transmitted diseases. Women in Malaysia have less awareness on the causes and clinical manifestations of the disease (P < 0.05). They are aware that regular papanicolaou (Pap) smear would screen CC and surgery could be a treatment of choice. In addition, women in Malaysia also have moderate awareness about Pap smear as prevention to detect and prevent CC at the early stage. Conclusions: Women in Malaysia only has a good awareness about multiple sex partner and sexually transmitted disease as a risk factor for CC, they also have good knowledge on regular Pap smear as a tool to diagnose and surgery as a treatment. Future, further effort is required to promote awareness of women’s perception and attitudes toward CC.

Objectives: The method of colorectal cancer (CRC) tissue sampling would affect its molecular profile and the downstream processing. In this study, we described the impact of CRC tissue sampling procedures on the quality control (QC) metrics of cytoscan HD array. Methods: We employed a high-resolution cytoscan HD microarray platform to investigate the chromosomal aberrations that could be associated with CRC. We compared the tissue extraction procedures and their impact on the QC parameters from the cytoscan HD array determined by chromosome analysis software (Suite3.1). Median of absolute values of all pairwise differences (MAPD), waviness-standard deviation (Waviness-SD), and single nucleotide polymorphism QC (SNPQC) were the QC parameters that were analyzed. Results: From 67 patients, we collected 843 colorectal tissues. Of these, 65.7% were obtained through endoscopic procedures, and the rest was after surgical resections. The mean transit time between tissue excision and preservation was 26 ± 15.5 and 74.6 ± 24.8 min, respectively. The tissues extracted from the surgical procedure showed mean MAPD of 0.28 ± 0.06 compared to 0.24 ± 0.06, for endoscopy, P = 0.005, degree of waviness-SD of 0.20 ± 0.1 compared to 0.2 ± 0.1, P = 0.64, and SNPQC of 9.6 ± 4.2 compared to 11.1 ± 4.6, P = 0.23. Conclusions: This report provides objective results that can help in tissue sampling intended to be used for DNA based molecular studies. Tissue collection protocol should be optimized to support microarray-analysis methods. Tissue extraction from endoscopic procedures had faster transit time and relatively better quality metrics outcome than surgical procedures. However, surgical procedures have less refusal rate, higher tissue quantity, and less negative results for malignancy.

Objective: Health-care waste has not attended much attention in developing countries. Staff is involved in cleaning and collect waste may often be at greater risk due to their less education and training. The current intervention study was conducted to improve knowledge and practice skills for medical waste handlers in some selected hospitals of Alexandria, Egypt. Methods: An intervention study was conducted on medical waste handlers from some selected hospitals who accepted to participate in the study in the period of May 2015 to June 2016. A predesigned questionnaire was developed to measure knowledge, skills, and practice on medical waste management pre- and post-intervention. Results: Analysis of pre-intervention data revealed that 9.6%, 80.8%, and 9.6% of participants had high, moderate, and low knowledge levels, respectively. Whereas post-intervention, data revealed that 97.3%, 2.2%, and 0.5% of workers had high, moderate, and low knowledge levels, respectively. A significant increase in knowledge after the intervention was detected among all knowledge items except in four items which were related to the necessity to segregate medical waste, knowledge of color coding system for segregation, disposal of general waste in black bags and disposal of infectious waste in red bags. Regarding practice of waste handlers, 80% were in poor practice category pre-training and changed to 0.8% post-training; 1.1% were in good practice category and increased to 92.1% post-training. Conclusion: The current findings emphasize the role of educative skill-raising training in enhancing knowledge and practice skills of medical waste handlers.

Objective: Little is known about the pattern of antibiotics’ prescribing for hospitalized adult patients in the Kingdom of Saudi Arabia. This study explored the prescribing practices of antibiotics in a large tertiary care setting serving diverse population. Methods: This retrospective cross-sectional study included 1.666 antibiotic prescriptions prescribed over a period of 3 months (January 2016–March 2016) in an adult inpatient department of King Saud Medical City (KSMC). Data were collected from pharmacy electronic database. The World Health Organization (WHO) prescribing indicators were also used. Results: Of the 13.414 prescriptions in pharmacy database, percentage share of antibiotic prescriptions was 12.41. The average number of drugs per encounter was 1.2. 61% of the prescriptions contained parenteral antibiotics. The percentage of drugs prescribed from essential drug list and by generic name was 100% in each indicator. The most frequently prescribed antibiotics were cefuroxime (19.44%), piperacillin/tazobactam (16.30%), and cefazolin (13.85%). Ciprofloxacin and ceftriaxone were prescribed without stated indications in 62 prescriptions. Restricted antibiotic such as meropenem was prescribed without a diagnosis in 52 prescriptions. Conclusion: This study gathered baseline data pertinent to the prudent use of antibiotics in KSMC. The diagnosis was not documented in more than one-third of the admission episodes. Majority of the antibiotics were broad spectrum. Three prescribing indicators shows deviation from the WHO’s standard values while prescribing from essential drug list and by generic name was not a problem in this setting. There is a need to explore the impact of prescriptions lacked indication on patient’s safety.

The use of immunosuppressants to reduce the likelihood of acute graft rejections is a cornerstone in the post-transplantation management of recipients. However, these agents were always associated with increased risk of deleterious effects such as infections vulnerability and comorbidities. The objective of this review is to discuss the impact of different immunosuppression strategies used in liver transplant recipients (LTRs) on the recurrence of hepatitis C virus (HCV) infections after transplantation. Traditionally, corticosteroids were a mainstay in immunosuppressive regimens in LTRs. Several trials have suggested early tapering of corticosteroids or steroid-free immunosuppression protocols to minimize metabolic complications and other accompanied adverse events. However, there is no consistent agreement on the apparent benefit of steroid-avoidance regimens on HCV recurrence. At present, calcineurin inhibitors alone or in combination with other immunosuppressants are the standard regimen for immunosuppression in LTRs. Although the use of mycophenolate mofetil and sirolimus were sometimes associated with a significantly lower risk of liver injury as a result of HCV recurrence, they were associated with an increased risk of acute graft rejection compared to calcineurin inhibitors. Consequently, reducing the incidence of HCV recurrence in LTRs could be at the expense of other potential complications. The appropriate selection of adequate immunosuppression could diminish the associated increased risk of HCV recurrence after liver transplantation. However, further clinical studies are still pivotal to establish the appropriate/optimal immunosuppressive therapies for HCV-positive LTRs.

National health account (NHA) is considered as an effective tool to support policymakers in capturing financial flows within the health system and providing information required to develop effective health policies. Global experiences on NHAs have demonstrated a significant impact on health policy development for better health care. Many countries in the Arab region have already made efforts to institutionalize the NHA in their health systems. Based on extensive review of different reports, documents, and empirical studies in the field of NHA, the paper gives the concept and evolution of NHA and discusses the Saudi health system perspectives and the way forward for institutionalizing a NHA system. The findings indicate the significance of implementing the NHA framework for evidence-based decision-making as well as an aid to the development of a robust and effective policy for the health sector to achieve Saudi Arabia’s “Vision 2030.” The paper also offers a plan of action to be followed to institutionalize a NHA system in the Ministry of Health.

Giant-cell tumor of soft tissue (GCT-ST) is a rare neoplasm that was first described in 1972. Due to its histological and immune-histochemical similarities with GCT of bones, GCT-ST is thought to be its counterpart. This review article aims to recognize the characteristics of this rare tumor along with a favorable way to diagnose and treat. We reviewed 12 cases of GCT-ST in the head and neck. This tumor involves both sexes at any age. Histopathology in many cases revealed the presence of mononuclear cells and spindle cells. Immunohistochemistry was positive in many cases for CD68. Complete excision was the most accepted management technique; however, few cases reported recurrence and metastasis. Post-operative radiology is suggested to prevent local recurrence and in case of incomplete excision of the tumor.

Epidermoid cysts are slowly growing pseudotumors usually measuring <2 cm in diameter. Large epidermoid cysts invading bones have been rarely reported in the literature. They may be a source of diagnostic difficulties before pathological analyses, and radiological examinations are essential to determine the extension of the cyst and to guide the surgical technique. We report, herein, on a patient having an unusually large epidermoid cyst located in the left occipital area invading the occipital bone.