Substance use is a growing but under-highlighted public health issue in Saudi Arabia. Between 3% and 7% of Saudis are illicit drug users, and the Saudi government spends, on average, 3.6 billion riyals annually for their treatment and rehabilitation. Most of the users (70%) are young (age: 12–22 years).[1] Substance use among Saudi females is on the rise, and the data show that the proportion of women has increased by 20% in the past few years. Because of the conservative nature of the society and the strict gender segregation, drugs are not as accessible to women as they are to men. Therefore, women are more likely to be addicted to primitive, volatile substances such as glue, gasoline, and shisha.[2] Substance use disorder (SUD) is a medical condition in which the use of substance(s) leads to clinically significant impairment or distress.[3] The most commonly abused substances in Saudi Arabia are amphetamines, heroin, alcohol, and cannabis, and a majority of the users are addicted to multiple substances.[4] The published literature on SUD in Saudi Arabia is deficient in terms of methodology as well as the coverage and depth of issues pertaining to addicts themselves and to their family members. For example, most studies on SUD enrolled only patients and did not have a control group,[5-9] which limited them from identifying risk factors for SUD. Studies from elsewhere in the world show that family aspects (e.g., parents’ marital status, parental drug use, child abuse, parenting style, relationship quality, and communication between parents and child) and religiosity play important roles in the substance use of adolescents and young adults.[10,11] These, along with factors unique to Saudi society (e.g., large family and multiple wives), need to be assessed in relation to SUD in Saudi Arabia with an appropriately designed study. Saudi studies have only minimally explored users’ experiences with drugs. The only information available are types of substances being used, number of substances (single vs. poly use), and method of administration (inhalation, ingestion, or injection).[4] What is missing is information related to motivations for drug use, factors that enable initiation of use (peer pressure, media, family enabling behavior, age at first use), drug culture (availability, cost, network), knowledge and experience of adverse effects of drug (overdose, signs and symptoms), and treatment-seeking behaviors (cessation attempts and relapses). Family members are affected in a multitude of ways (e.g., shame, self-blame, stress, depression, financial burden, breaking up of the spousal relationship, and physical violence) when there is an addict in the family.[12] There is one Saudi qualitative study that dealt with this particular dimension of addiction, but it was published in Arabic, and as a result, its findings are not known to the wider scientific community. Saudi society has been deeply traditional and religiously conservative, sustained by the Islamic principles of balance, restraint, and modesty. Its values are being challenged in this information age, where countries are connected in the virtual realm to western cultures that promote individual identity, glorify drug use, and peddle pop culture. Saudi youth is highly affected by this clash of cultures. They are increasingly alienated from their relatively more traditional parents, and it is in this vacuum where societal problems like substance use arise. Parents and children no longer understand one another, children do not look to their parents as role models, and parents cannot adapt to the fast-changing culture. It is safe to assume that most parents try to do what is in the best interest of their child, but because of the generation gap, they behave in ways that enable their child to continue their substance use. In conclusion, large epidemiological studies on addiction are needed, particularly for SUD. Such studies could evaluate risk factors for SUD, such as those that arise from the family environment, the effects on family members from having an addict in the family, and the experience and perspectives of addicts themselves. These types of studies can benefit the community by generating findings that can be disseminated through education and awareness campaigns so that future parents are better informed and better equipped to deal with substance use in the family. Furthermore, this information can be used as the basis for developing and testing interventions aimed at preventing drug initiation, reducing harm, and improving and tailoring rehabilitation.

Objectives: Atrial fibrillation (AF) is the most common arrhythmia treated in clinical practice, and the association of this arrhythmia with stroke has long been recognized. The combination of associated factors to identify stroke risk is still unclear; therefore, we aimed to determine the association between additional risk factors for non-valvular AF (NVAF) and first onset stroke patients and investigate the predictive ability of additional risks factors such as cardiac biomarkers and AF status for odds of incident stroke. Materials and Methods: We included 455 patients suffered from NVAF divided into two distinct groups (case–control observational study). Those two groups were based on whether the patients were having a first onset stroke (stroke group) or not having a stroke (non-stroke group). We made the baseline characteristic of our sample group from the substantial evidence of risk factors, lifestyle, and type of AF; to controversial risk described in the new international guideline of AF. Results: Statistically revealed that heart failure, coronary disease, cigarette smoking, type of AF, warfarin treatment, high sensitive troponin, and B-type natriuretic peptide (BNP) are associated with stroke in NVAF patients (P < 0.05). Otherwise, age, sex, hypertension, kidney disease, diabetes, thyroid disease, alcohol intake, season, aspirin, and D-dimer medication were not associated with stroke (P > 0.05). Multivariate analysis of age, smokers, coronary heart disease, heart failure, high sensitive troponin level, BNP, permanent AF, and warfarin was associated (P < 0.05). The combination of biomarkers with the clinical features can be useful (CHA2DS2-VASc/BS) for the prediction of stroke than CHA2DS2-VASc alone (P < 0.05). Conclusion: Impact of all associated factors and biological markers as additional risk factors may carry a synergy in this life-threatening event. Additionally, may hold a clinical role which may help to redefine and predict stroke event better than the current CHA2DS2-VASc.

Objectives: Emerging evidence suggests that inflammation due to periodontal diseases may not be limited to adjacent oral tissues but may have influence on systemic diseases such as chronic kidney diseases (CKD) and cardiovascular diseases. Hence, this study was aimed to evaluate and compare left ventricular mass (LVM) in patients with CKD undergoing hemodialysis (CKDH) in periodontally healthy, chronic gingivitis, and chronic periodontitis. Methodology: A total of 60 patients diagnosed with CKDH were divided equally into three groups based on periodontal status as CKDH patients with healthy periodontium (Group I), CKDH patients with chronic gingivitis (Group II), and CKDH patients with chronic periodontitis (Group III). These patients were assessed clinically, biochemically, and echocardiographically. LVM in each of these patients was calculated according to Devereux formula and was indexed to height. Results: Group II and Group III patients exhibited higher mean LVM of 199.51 ± 40.17 g and 200.35 ± 65.04 g, respectively, as compared to Group I of 161.56 ± 27.99 g. Similarly, LVM index (LVMI) was found to be more in Group II and Group III at 59.36 ± 13.14 g/m2.7 and 57.83 ± 19.94 g/m2.7, respectively, while it was 45.99 ± 11.87 g/m2.7 for Group I patients. Conclusion: Increasing the severity of periodontal diseases in CKDH patients is associated with increase in LVM and LVMI. Periodontal screening and intervention would enable the clinician to refine cardiovascular risk assessment in such patients.  

Background: In Saudi Arabia, cultural and language differences between expatriate nurses and patients affect the quality of nursing care. Hence, the Kingdom is eying Saudization in this field. The productivity of nurses can affect the productivity of the whole health system. The aim of this study was to investigate the health-care productivity of Saudi female nurses and socio-demographic determinants of their productivity. Methods: We conducted a cross-sectional survey of 256 randomly selected Saudi female nurses in the Qassim region. The nurses who were not working in public hospitals; not giving direct patient care or had <1-year patient-care experience were excluded from the study. The nurses’ work productivity was measured using a 17-item index. Results: The mean age of the nurses was 30.2 ± 5.6 years. Among the nurses, 62.6% were currently married, 33% were never married, and 4.4% were divorced/widowed. Most of the nurses were not willing to serve male patients (70.3%); they wanted to work only in female units (66.1%) and did not prefer night shifts (50.8%). Over the past 1 year, most of them demonstrated tendency of taking emergency leave (64.2%) and sick leave (56.4%), while 27.3% had unexcused absences and 19.5% had unplanned but excused absences. In addition, 20.3% demonstrated a tendency of taking frequent breaks during duty hours and 18.9% demonstrated tendency of being late on duty. Multivariable linear regression analysis revealed that being married was associated with 1.66 points decrease in the productivity index score when compared to never married nurses. Having one more child under 5 years of age was associated with 0.75 points increase in the productivity index score. In addition, nurses who employed household workers at home scored 1.04 points less than those who did not. Conclusions: Health-care productivity index score was lower among married Saudi female nurses than never married nurses. However, aspects of married life commonly believed to cause home work-life conflicts, such as number of children, living with or without family, having disabled children in household and personal factors such as age did not have statistically significant influence on the productivity index score. It is possible that unexplained cultural issues associated with being married may be responsible for a lower productivity index score among married female nurses in Saudi Arabia.  

Background: The disease that obstructs social movements of people is Huntington’s disease (HD). Hence, the expedition of its molecular aspects and bioinformatics tools relating to precise confirmation of the disease is warranted. Due to social stigma, the care and attention to safeguard these patients had increased at community level. Objective: The objective of the study was to explore bioinformatics tools to trace the defects in Huntington’s gene and design its small-guided RNA (sgRNA). Methodology: The HTT gene sequence was retrieved, CRISPR sites were identified, and gRNA sequence was determined using the University of California Santa Cruz (UCSC) Genome Browser. HTT protein molecular structure elucidation was retrieved through PDB and Swiss Model. Ramachandran plot displayed the cluster of poly-Q at the Phi (−60–−36) and Psi (−60–−65) regions. The pattern of residues in the plot displayed that the HTT protein is alpha-helical predominant. Results: The CRISPR sites on HTT gene are viewed and sgRNA sequences are obtained through the UCSC Genome Browser. This sgRNA sequence along with Cas9 would be planned for genome editing in future experimental models. The Ramachandran plot for HTT protein derived through online Rampage revealed the recurrent appearance of polyglutamine (Q) at the Phi (−55–−65) and Psi (120–135) regions. Conclusion: Online bioinformatic tools such as UCSC Genome Browser, Swiss-Model, and Rampage help in exploring molecular basis of HD and disease-causing protein HTT, and the same invariably assists in creating awareness among health workers.

Objective: Although intensive care medicine has evidenced a significant growth in recent decades, the number of patients requiring prolonged mechanical ventilation (PMV) still represents a considerable burden on health-care expenditure. The prediction of the need for PMV seems to provide a plausible cost-effective intervention. The objective of this study is to systematically review the predictors of the need for PMV of adult patients admitted to intensive care units (ICUs) due to medical and surgical needs. Methods: We conducted a systematic search on three online databases (PubMed, Embase, and MEDLINE) till February 20, 2019. The search process employed several combinations of specific keywords and Boolean operators. Results: A total of 15 articles were included in the study. Based on pooling the outcomes of odds ratios (ORs) and their respective 95% confidence intervals (CIs) as reported from logistic regression analyses, the pooled PMV incidence in 8220 patients (69.59% males) was 17.67 cases per 100 ICU admissions (95% CI 13.69–21.65). We could not conduct a meta-analysis of ORs and 95% CIs due to the significant heterogeneity observed between the included studies (P < 0.001, I2 = 97%). Preoperative/ preadmission kidney dysfunction and chronic obstructive pulmonary disease were the most significant independent predictors of the need for PMV.  Following cardiac surgeries, repeated or emergency surgery, prolonged cardiopulmonary bypass time, and the need for blood transfusion were predictors of the need for PMV. Conclusion: Within the study limitations, several predictors were identified, which could be further investigated using a unified PMV definition. Successful prediction of the need for PMV would assist clinicians in identifying and adjusting a “weaning strategy” as well as improving patient care to reduce morbidity. Furthermore, establishing specialized weaning units could be warranted based on PMV incidence and prediction in the local settings.    

Objectives: Uncontrolled hypertension is a main predisposing risk factor leading to chronic atrial fibrillation (AF). Although several treatment methods for patients with HTN and AF were developed in past decades, further investigations of their efficacies are needed. This systematic narrative review presents an overview of studies reporting treatment efficacies in patients with HTN and/or AF. Methods: A narrative-based systematic review was performed using EMBASE, Medline, PubMed, Google Scholar, and the Cochrane Library searching for relevant papers published between October 2008 and October 2018. Out of 4481 studies, only 15 studies could be included following the inclusion criteria. Results: Included studies reported treatment measures, measured outcomes, and efficacies in adult patients with HTN and AF with defined interventions and methodologies. Treatment methods with effective outcomes were administration of hydrochlorothiazide, losartan or atenolol, telmisartan or amlodipine, or general antihypertensive drugs. Treatment methods that showed the most effective outcomes (lowering AF recurrence and improving BP control) were those containing pulmonary vein (or antrum) isolation (PVI/PVAI) (6 studies) and/or in conjunction with renal denervation (RDN)(6 studies). Treatment methods showing the most effective outcomes were PVI/PVAI in conjunction with RDN. Conclusion: The latest evidence shows that PVI (in conjunction with RDN in some instances) was more efficacious among patients suffering from HTN and/or AF.  

Vascular variant of leiomyomas termed angioleiomyomas rarely present in the oral cavity. They present themselves as well-circumscribed, slow-growing, superficial lesions covered by normal mucosa and sometimes bluish or purple in color. Clinicians often tend to overlook this entity due to the rarity and asymptomatic nature of the lesion. Scrupulous knowledge of this entity and a thorough examination is of value, as the lesion can impersonate or transform to malignancy, as a malignant counterpart exists. We present a case of angiomyoma of hard palate in a 46-year-old patient with a detailed review.