Nabil Awadalla

Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients.

BACKGROUND: Obstructive sleep apnea (OSA) is a common, under-recognized, under diagnosed, under treated, and serious medical condition in adults. Polysomnography (PSG) is the gold standard for diagnosis of OSA; however, prohibitive cost of the test and rarity of sleep laboratory in the Arabic nations limit its access. So, searching for another simple, economical, reliable, and valid tool for identification of OSA at risk patients is of special public concern. OBJECTIVE: This study was conducted to evaluate the reliability and validity of Arabic version of Berlin questionnaire (ABQ) in detection of OSA at risk patients. METHODS: After hospital ethics approval and formal patients consent, 100 patients were subjected to full night PSG study after their response to the developed ABQ. The patients were classified into both low (30) and high risk (70) for OSA using ABQ and validated against apnea hypopnea index (AHI). Reliability was assessed by internal consistency using Cronbachs alpha test and consistency over time using test retest correlation. RESULTS: The study demonstrated a high degree of internal consistency and stability over time for the developed ABQ. The Cronbachs alpha coefficient for the 10-item tool was 0.92. Validation of ABQ against AHI at cutoff >5 revealed a sensitivity of 97%, specificity of 90%, positive and negative predictive values of 96% and 93%, respectively. CONCLUSION: The ABQ is reliable and valid scale in screening patients for the risk of OSA among Arabic-speaking nations, especially in resource-limited settings.

Workplace exposures and male infertility — A case-control study

OBJECTIVES This study examined the association between male infertility and certain occupational exposures. MATERIAL AND METHODS A case-control study was carried out from January 2008 to February 2009; on 255 infertile men and 267 fertile men controls. Occupational exposure to certain chemical, physical and psychological workplace hazards was assessed by self-report questionnaire. General and andrological examination was conducted for all participants, however, semen analysis was done only for the infertile men cases, because the fertile men controls refused to give semen samples. RESULTS After adjustment of confounders, the results revealed that the following workplace exposure factors significantly increased the risk of male infertility: solvents and painting materials (OR: 3.88, 95% CI: 1.50-10.03), lead (OR: 5.43, 95% CI: 1.28-23.13), VDTs and computers (OR: 8.01, 95% CI: 4.03-15.87), shift work (OR: 3.60, 95% CI: 1.12-11.57) and work-related stress (fairly present: OR: 3.11, 95% CI: 1.85-5.24; often present: OR: 3.76, 95% CI: 1.96-7.52). CONCLUSION In spite of the limitations of this study, it supports other studies that raise the attention to minimize the exposure to the workplace hazards that may affect the fertility of male workers.

A Multicenter Study of the Awareness and Attitudes of Egyptian Faculty towards Research Ethics: A Pilot Study

The awareness and attitudes of faculty towards research ethics committees (RECs) and research ethics practices are largely unknown. Accordingly, we conducted a cross-sectional survey study involving various faculties (Medicine, Nursing, Pharmacy, and Dentistry) from four universities in Egypt. A large majority (> 85%) held positive attitudes towards RECs, but almost a third thought that RECs would delay research. More than half had not received prior training in research or medical ethics, but more than 90% thought that this subject matter should be taught to postgraduates. A large majority recognized the need for informed consent and confidentiality protections in research, but some held attitudes regarding certain research ethics practices that were questionable. We conclude that a curriculum in research ethics should be developed for university faculty and that further qualitative studies should explore the basis of several of the attitudes regarding practices in research ethics.

Mobile Phone Use and Risk of Adverse Health Impacts among Medical Students in Jeddah, Saudi Arabia.

Background: Internationally, there is growing concern about the adverse health effects of mobile phone use by young people. Aim: To determine the pattern of mobile phone use among medical students and determine the potential association between degree of use and self-reported health impacts. Methods: A cross-sectional study was carried out on 472 medical students in King Abdulaziz Original Research Article Hegazy et al.; BJMMR, 15(1): 1-11, 2016; Article no.BJMMR.24339 2 University. Self-administered specially designed questionnaire was used to collect data regarding the following: Socio-demographic characteristics, pattern of phone use and self-reported health complaints. Results: The students’ median duration of mobile phone use was 330 min/day and was significantly higher in females (P= 0.04). A positive significant correlation was observed between the health complaints score and the average daily duration of use (r =0.139, P=0.002). Adjusted multiple logistic regression analysis revealed that heavy mobile use was significantly associated with self-reported sleep disturbances, headache (AOR=4.76), fatigue (AOR=4.67), depression (AOR=2.63), nervousness (AOR=1.64), musculoskeletal pain (AOR=2.14) and visual problems (AOR=2.40). Conclusion: mobile phone use occupies a significant part in the daily life of medical students. The heavy use of mobile phone in calling and non-calling activities was associated with a high level of subjective health complaints with dose dependent pattern. After controlling for other important predictors, heavy mobile use was associated with sleep disturbances, headache, depression, nervousness, eye and musculoskeletal problems. Excessive use of mobile phones should be avoided and social awareness increased through health education activities. In addition, employing a speaker-phone device for longer daily use and recommended parental procedures are taken to prevent young people being woken by their mobile phones.

Environmental Factors Associated with Type 1 Diabetes Development: A Case Control Study in Egypt

Uncertainty still exists regarding the role of some environmental risk in the development of type 1 diabetes mellitus (T1DM) both globally and in Egypt. The objective here was to explore the potential environmental risk factors associated with the development of T1DM among children in Egypt. A case-controlled study of 204 T1DM children and an equal number of age and sex-matched controls was conducted in Assiut, Egypt. Data regarding the parental, gestational, neonatal, and childhood possible risk factors for T1DM were evaluated. The final sex adjusted multivariable logistic regression model revealed that the risk for T1DM was significantly higher among rural residents (aOR = 2.03, 95% CI: 1.30–4.25), those with parental history of T1DM (aOR = 9.03, 95% CI: 1.02–83.32), birth through cesarean section (aOR = 2.13, 95% CI: 1.09–5.03), and having history of early introduction of cow milk in the first year of life (aOR = 19.49, 95% CI: 8.73–45.53). On the other hand, a protective effect was observed between at least six months’ breastfeeding, vitamin D supplementation in the first year of life, high physical activity, and the development of T1DM. Educational programs should be adopted to improve awareness and knowledge of the parents to avoid the increased risk factors and encourage protective practices.

Environmental Determinants of Bronchial Asthma among Saudi School Children in Southwestern Saudi Arabia

The aim here was to study the possible environmental and dietary determinants of asthma among school-aged children in Southwestern Saudi Arabia. In a cross-sectional study on a representative sample in Najran in Southwestern Saudi Arabia using an Arabic version of the modified ISAAC Phase III, parent-administered questionnaire data were collected. Skin prick tests (SPTs) were performed. The study included 1700 school children, out of them 468 (27.5%) were diagnosed with, cases of bronchial asthma and 20.8% (353) reported a 12-month nocturnal cough (as a proxy of severe asthma). In multivariable analysis, the study identified the following risk factors for having asthma or severe asthma: having dogs in the house, being male, being exposed to dense truck traffic on the street, using wood as a cooking fuel, conducting vigorous exercise, consuming eggs, consuming vegetables, having an allergic sensitization to dog hair, and being exposed to Cladosporium, pigweed, and Bermuda grass. On the other hand, the following food stuffs were found to be protective: seafood, fruit, and dairy products. Comprehensive school educational programs for both children and their parents should be adopted to prevent the use of wood in cooking and heating, to ensure that house pets are properly cared for, and to encourage proper dietary habits. Physicians should be informed of the patterns of allergens in order to improve asthma diagnosis and management.

In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia

Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.

Influenza Vaccination in Type 2 Diabetes Patients: Coverage Status and Its Determinants in Southwestern Saudi Arabia

Despite the significant role of seasonal influenza vaccination in preventing and minimizing the serious complications of influenza infection in type 2 diabetes mellitus (T2DM) patients, unsatisfactory compliance still exists for vaccination. Study objectives were to explore the vaccination status and determinants in T2DM patients in southwestern Saudi Arabia. A cross-sectional study on a representative sample of T2DM patients in Abha city, southwestern Saudi Arabia, was conducted. Data for sociodemographic characteristics, clinical criteria, vaccination status, vaccination motivators and barriers and seasonal influenza knowledge were collected. Out of 353 T2DM patients included in the study, seasonal influenza vaccination coverage was 61% in year 2017. A significant factors associated with non-vaccination were; poor influenza and its vaccine knowledge (OR = 4.31, 95% CI: 2.73–6.80), illiteracy (OR = 1.93, 95% CI: 1.11–3.37), and more than 10 years disease duration (OR = 2.07, 95% CI: 1.11–3.87). Presence of family history of DM and ischemic heart comorbidity minimized the possibility of non-vaccination (OR = 0.54 and 0.28 respectively). Healthcare givers’ advice was the most reported vaccination motivator (84.7%) while; fear of vaccine side effects was the most stated barrier (73%). In conclusion, influenza vaccination rate among T2DM in the present study is less than the recommended level. Continuous primary health care center-based educational programs should be implemented to aware and encourage influenza vaccination among T2DM patients.

Occupational ocular incidents in dentists: a multicentre study in southwestern Saudi Arabia.

BACKGROUND Dental practitioners are at high risk of occupational ocular incidents during their daily work practice. The aim of this study was to assess the prevalence, pattern and determinants of ocular incidents and to establish the use of eye protection by dental staff in southwestern Saudi Arabia. METHODS This multicentre cross-sectional study was conducted among dental practitioners working in private, military and Ministry of Health dental clinics in southwestern Saudi Arabia. A predesigned self-report questionnaire was used to elicit information on demographics, splash or foreign body ocular incidents, postincident practices and use of eye protection. RESULTS Of the 233 dental practitioners examined, 29.6% and 51.1% reported ocular incidents as a result of foreign bodies and fluid splashing, respectively. The risk of ocular incidents as a result of fluid splashing was significantly higher in the absence of postgraduate qualification [odds ratio (OR) = 3.04, 95% confidence interval (95% CI): 1.70-5.43], poor compliance with wearing eye protection (OR = 2.52, 95% CI: 1.49-4.28) and long work hours (OR = 2.16, 95% CI: 1.17-3.96). The most frequent postexposure practice was to rinse eyes under running water (87.5%). Approximately 4.2% and 9.2% of dental practitioners reported incidents of ocular injury and infection, respectively, and 14% reported that they never wore any eye protection. CONCLUSION Occupational ocular incidents as a result of splashing and foreign bodies are relatively common among dental practitioners in southwestern Saudi Arabia. The absence of postgraduate qualification, poor compliance with wearing eye protection and working long hours are predictors of ocular incidents. Awareness about eye safety is therefore considered mandatory for dental practitioners in southwestern Saudi Arabia. Also, dental clinic administrators should provide and promote the use of eye protection.

Reliability and discriminant validity of an Arabic translation of the Children’s Automatic Thought Scale

IntroductionThe Children’s Automatic Thoughts Scale (CATS) was developed to assess automatic thoughts in children and adolescents across a wide spectrum of internalizing and externalizing disorders. It has been found to be a developmentally sensitive and psychometrically valid measure. AimTo estimate the reliability and discriminant validity of the CATS after translating it into Arabic. MethodsThe English version of CATS was translated into Arabic and was used in this study. The scale was administered to a community sample of 176 children and adolescents and a clinical sample of 32 young people. Statistical analysis was performed to test internal consistency, test–retest reliability, and discriminant validity. ResultsCronbach’s &agr; coefficient (to test internal consistency) was found to be 0.90 for the total scale and satisfactory for the four subscales. Test–retest reliability was high for the total and subscales using a sample of 29 children and adolescents who were reassessed 1 month after the initial administration of the scale. Discriminant validity was assessed by comparing the responses of clinical groups with those from the community sample. The Arabic-translated version of CATS discriminated well between clinical groups and between clinical and nonclinical children and adolescents. ConclusionThe resulting Arabic-translated version of CATS is an acceptable, reliable, and moderately valid measure of negative automatic thoughts across emotional and behavioral disorders in children and adolescents. We expect that it will be used widely in Egypt and Arab countries.