Isolated short stature as a presentation of celiac disease in Saudi children

The aim of this study is to assess the prevalence of isolated short stature as a clinical presentation of celiac disease in Saudi Arab children and whether some of the routine laboratory tests performed to determine the cause of short stature could suggest the diagnosis of celiac disease. A total of 91 children with short stature were included in the study. Extensive endocrine and biochemical assessments, including total protein, serum albumin, calcium phosphate and alkaline phosphatase assays; renal function tests; coagulation profile; anti-endomysial antibodies and anti-tissue transglutaminase antibody, growth hormone, thyroid stimulating hormone, free-thyroxin (FT4) assays; stool tests for giardiasis; bone age; and endoscopic intestinal biopsies, were done for all children. Ten of the 91 children had positive intestinal biopsies in the form of total villous atrophy, an increase in crypt height, and an increase in intra-epithelial lymphocyte (IEL) numbers up to >40 IEL/100 EC (Type 3C) according to the Oberhuber classification, confirming the diagnosis of celiac disease. Five children had mild villous atrophy according to this classification (Type 3A), and they were considered to have potential celiac disease. Seventy-six children had normal intestinal biopsies. Therefore, the prevalence of celiac disease among Saudi children with short stature was 10.9%, and 4.3% of the children were diagnosed as having potential celiac disease. After confirming the diagnosis of celiac disease, all children were kept on a gluten-free diet and all of them showed improvement in their growth rate. We concluded that celiac disease is a very important cause of short stature in children without gastrointestinal complaints in Saudi Arabia. We highly recommend anti-tissue transglutaminase and anti-endomysial antibody screening tests, and a small bowel biopsy to confirm the diagnosis of celiac disease irrespective of the results of the antibody assays, in children with short stature in Saudi Arabia. Once the diagnosis is confirmed, children should be kept on a gluten-free diet so they can catch up their growth early before they develop permanent short stature

Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first documented in the Kingdom of Saudi Arabia (KSA) in 2012 and, to date, has been identified in 180 cases with 43% mortality. In this study, we have determined the MERS-CoV evolutionary rate, documented genetic variants of the virus and their distribution throughout the Arabian peninsula, and identified the genome positions under positive selection, important features for monitoring adaptation of MERS-CoV to human transmission and for identifying the source of infections. Respiratory samples from confirmed KSA MERS cases from May to September 2013 were subjected to whole-genome deep sequencing, and 32 complete or partial sequences (20 were ≥99% complete, 7 were 50 to 94% complete, and 5 were 27 to 50% complete) were obtained, bringing the total available MERS-CoV genomic sequences to 65. An evolutionary rate of 1.12 × 10−3 substitutions per site per year (95% credible interval [95% CI], 8.76 × 10−4; 1.37 × 10−3) was estimated, bringing the time to most recent common ancestor to March 2012 (95% CI, December 2011; June 2012). Only one MERS-CoV codon, spike 1020, located in a domain required for cell entry, is under strong positive selection. Four KSA MERS-CoV phylogenetic clades were found, with 3 clades apparently no longer contributing to current cases. The size of the population infected with MERS-CoV showed a gradual increase to June 2013, followed by a decline, possibly due to increased surveillance and infection control measures combined with a basic reproduction number (R0) for the virus that is less than 1

Evaluating acceptance of lateral wedge insoles for knee osteoarthritis in Saudi Arabia: a mixed-methods study

Background: Knee osteoarthritis (KOA) is a degenerative cartilage condition marked by inflammation and mechanical processes. In Saudi Arabia (SA), one in ten older individuals suffer from it. KOA often leads to pain, functional limitations, reduced daily activities, and diminished quality of life. For those with medial knee osteoarthritis, lateral wedge insoles (LWI) can alleviate knee pain and enhance function. While LWI offers biomechanical and symptomatic benefits, the perspectives of Saudi KOA patients and physiotherapists on its clinical use are not well-understood. In addition, there is limited research on gait modification treatment for other types of KOA, especially regarding facilitators and barriers in the Saudi context. Aims: This study aims to identify the suitability and acceptable use of the gait modification approach for reducing knee pain and enhancing functional ability among KOA patients in Saudi Arabia using a mixed methods approach. Methods & Findings: A sequential exploratory mixed-methods approach was employed for this evidence-based study, following the Medical Research Council's (MRC) Framework for Developing Complex Interventions. The research consisted of a systematic review and qualitative investigations, along with the development and testing of a feasibility study. The first component (Background, chapter 2) assesses the efficacy of various gait modification approaches on knee loading, pain, and function with KOA patients, with evidence from the Saudi healthcare system highlighted. Research goals and questions were set. The second component (Systematic reviews and meta-analyses, chapter 4) identifies the most effective gait modification approaches and their primary clinical outcomes during walking. The analysis revealed that most gait modification methods did not significantly reduce the KAM 1st peak in the short and mid-terms. However, the systematic review indicated that lateral stiffener shoes could reduce the KAM 1st peak in the short term, and re-gait training with toe-out positioning might significantly improve the KAM 2nd peak. Furthermore, in the short term, LWI significantly impacted both the KAM 2nd peak and the knee adduction angular impulse (KAAI). Despite these specific benefits, the overall effectiveness of gait modification in reducing knee loading was limited. Subsequently, the third section (Qualitative – chapter 5) utilised semi�structured interviews and focus group discussions to grasp KOA patients' and physiotherapists' views on various gait modification techniques before adapting the LWI approach to the Saudi healthcare setting. This approach aimed to identify key features of gait modification and further understanding of stakeholders' knowledge, attitudes, and challenges in its application for KOA patients. The research indicated that implementing knee braces, canes, footwear and insoles was straightforward for patients and therapists, providing notable benefits and improving daily activities. Drawing from prior research, a feasibility study was designed, outlining the suggested LWI as a gait modification, implementation duration, outcomes, and satisfaction survey. The fourth component (Feasibility - chapter 7) evaluated the acceptability, tolerability, and feasibility of personalised LWI for KOA patients at a Saudi centre. This section implemented LWI as a gait modification, measuring recruitment, retention, adherence rates, the Numerical Rating Pain Scale (NRPS), the Osteoarthritis Index (WOAMC), and conducting satisfaction surveys for both patients and therapists. In the initial session, KOA patients were assigned LWI with baseline records, followed by self-reported outcomes, Then, at the 6th week, clinical outcomes (NRPS & WOAMC) were reassessed, and a survey was collected. Of the 21 KOA participants who consented for the quantitative analysis, 17 completed the final evaluation. The study achieved an 87.5% recruitment rate and an 81% retention rate after six weeks. However, it is important to note that comfort was an issue for some participants, as two withdrew citing insole discomfort. The compliance rate assisting at 5.47 hours/day, indicating a 71% adherence, which was below the targeted value. After six weeks, KOA participants showed significant improvements in the NRPS. A t-test revealed that these improvements were statistically significant (p = 0.007) with a large effect size (Cohen's d = 0.98). Similarly, the WOMAC results also demonstrated statistically significant improvements (p < 0.001) and large effect size (Cohen's d = 1.56). Seventeen KOA patients, who completed a survey, approved the LWI and expressed their satisfaction. They rated their satisfaction with the LWI application's clarity at 5 (extremely satisfied) and their symptoms improved satisfaction with the LWI at (64.7% - very satisfied). In the survey, KOA patients rated LWI as straightforward, well-tolerated and adverse-effect-free. The overall therapists’ satisfaction median was "Very satisfied," highlighting a positive response towards the practical skills enhancement provided by the insole, while the overall median for agreement items was "Agree," indicating a consensus among therapists on the insole's beneficial impact on their treatment routine. Given these results, the suitability of LWI in KOA recovery remains debatable. Conclusion: The LWI was viewed as a viable treatment option for KOA in the Saudi context. Both patients and physiotherapists had shown significant interest in this approach. The results of a six-week intervention highlighted its practical benefits, such as reduced knee pain and improved walking capability. Continuous support and guidance from physiotherapists contributed to high levels of adherence, contributing to maintaining activity levels. While LWI offered a promising option in KOA rehabilitation, its full potential remained unexplored. Factors like the current SA KOA clinical protocol, infrastructure difficulties, therapist expertise and LWI availability needed consideration. In the Saudi context, a follow-up trial was essential after this initial intervention to assess the programme's long-term viability and cost-effectiveness. Furthermore, Although the physiotherapists' satisfaction survey indicated that the LWI programme was debatable, the physiotherapy educators needed to integrate knowledge about assistive gait modification (LWI) into their academic and clinical programmes to enhance evidence-based practice

Knowledge and awareness of the Saudi general public toward epistaxis: a cross-sectional study

BackgroundEpistaxis is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency or primary care centers.Study aimThis study aimed to assess the knowledge of the Saudi general public toward epistaxis.MethodsThis study adopted a cross-sectional analytical study design. The questionnaire link was distributed using social media channels. The participants were adult Saudi nationals that live in Saudi Arabia. The data was collected using a self-administered questionnaire that assessed knowledge related to epistaxis. The knowledge score was calculated using the 10 knowledge evaluation questions. Each correct response was assigned a value of “one.” The scores ranged from “zero” to “ten,” with higher scores signifying greater knowledge. A percentage score was computed, and the participants’ knowledge was classified as poor (% score: ≤50%), moderate (% score: 51 to 70%), and good (% score: 71 to 100%). Statistical Package for Social Sciences (SPSS) version 26 was used for statistical analysis.ResultsThe study included 452 participants of whom 70.1% were females. Married individuals comprised 60.8% of the sample. The prevalence of self-reported epistaxis was 43.6% in the last 6 months. Among the participants, 42.9%, had “Poor” knowledge score, followed by 39.6% who had “moderate” score, and 17.5% had “Good” score. These results show that most participants had poor to moderate knowledge, with a minority demonstrating a good level of knowledge. All demographic variables have significantly influenced the adequacy of knowledge about epistaxis. Furthermore, participants who believed that the general public has insufficient knowledge on epistaxis had a significantly lower knowledge score (p = 0.001).ConclusionThe present study found a non-satisfactory, low-to-moderate knowledge level of the Saudi general public toward epistaxis. We propose emphasizing public knowledge and education about first aid for epistaxis because proper first aid can minimize significant complications when done properly

Evaluating acceptance of lateral wedge insoles for knee osteoarthritis in Saudi Arabia: a mixed-methods study

Background: Knee osteoarthritis (KOA) is a degenerative cartilage condition marked by inflammation and mechanical processes. In Saudi Arabia (SA), one in ten older individuals suffer from it. KOA often leads to pain, functional limitations, reduced daily activities, and diminished quality of life. For those with medial knee osteoarthritis, lateral wedge insoles (LWI) can alleviate knee pain and enhance function. While LWI offers biomechanical and symptomatic benefits, the perspectives of Saudi KOA patients and physiotherapists on its clinical use are not well-understood. In addition, there is limited research on gait modification treatment for other types of KOA, especially regarding facilitators and barriers in the Saudi context. Aims: This study aims to identify the suitability and acceptable use of the gait modification approach for reducing knee pain and enhancing functional ability among KOA patients in Saudi Arabia using a mixed methods approach. Methods & Findings: A sequential exploratory mixed-methods approach was employed for this evidence-based study, following the Medical Research Council's (MRC) Framework for Developing Complex Interventions. The research consisted of a systematic review and qualitative investigations, along with the development and testing of a feasibility study. The first component (Background, chapter 2) assesses the efficacy of various gait modification approaches on knee loading, pain, and function with KOA patients, with evidence from the Saudi healthcare system highlighted. Research goals and questions were set. The second component (Systematic reviews and meta-analyses, chapter 4) identifies the most effective gait modification approaches and their primary clinical outcomes during walking. The analysis revealed that most gait modification methods did not significantly reduce the KAM 1st peak in the short and mid-terms. However, the systematic review indicated that lateral stiffener shoes could reduce the KAM 1st peak in the short term, and re-gait training with toe-out positioning might significantly improve the KAM 2nd peak. Furthermore, in the short term, LWI significantly impacted both the KAM 2nd peak and the knee adduction angular impulse (KAAI). Despite these specific benefits, the overall effectiveness of gait modification in reducing knee loading was limited. Subsequently, the third section (Qualitative – chapter 5) utilised semi�structured interviews and focus group discussions to grasp KOA patients' and physiotherapists' views on various gait modification techniques before adapting the LWI approach to the Saudi healthcare setting. This approach aimed to identify key features of gait modification and further understanding of stakeholders' knowledge, attitudes, and challenges in its application for KOA patients. The research indicated that implementing knee braces, canes, footwear and insoles was straightforward for patients and therapists, providing notable benefits and improving daily activities. Drawing from prior research, a feasibility study was designed, outlining the suggested LWI as a gait modification, implementation duration, outcomes, and satisfaction survey. The fourth component (Feasibility - chapter 7) evaluated the acceptability, tolerability, and feasibility of personalised LWI for KOA patients at a Saudi centre. This section implemented LWI as a gait modification, measuring recruitment, retention, adherence rates, the Numerical Rating Pain Scale (NRPS), the Osteoarthritis Index (WOAMC), and conducting satisfaction surveys for both patients and therapists. In the initial session, KOA patients were assigned LWI with baseline records, followed by self-reported outcomes, Then, at the 6th week, clinical outcomes (NRPS & WOAMC) were reassessed, and a survey was collected. Of the 21 KOA participants who consented for the quantitative analysis, 17 completed the final evaluation. The study achieved an 87.5% recruitment rate and an 81% retention rate after six weeks. However, it is important to note that comfort was an issue for some participants, as two withdrew citing insole discomfort. The compliance rate assisting at 5.47 hours/day, indicating a 71% adherence, which was below the targeted value. After six weeks, KOA participants showed significant improvements in the NRPS. A t-test revealed that these improvements were statistically significant (p = 0.007) with a large effect size (Cohen's d = 0.98). Similarly, the WOMAC results also demonstrated statistically significant improvements (p < 0.001) and large effect size (Cohen's d = 1.56). Seventeen KOA patients, who completed a survey, approved the LWI and expressed their satisfaction. They rated their satisfaction with the LWI application's clarity at 5 (extremely satisfied) and their symptoms improved satisfaction with the LWI at (64.7% - very satisfied). In the survey, KOA patients rated LWI as straightforward, well-tolerated and adverse-effect-free. The overall therapists’ satisfaction median was "Very satisfied," highlighting a positive response towards the practical skills enhancement provided by the insole, while the overall median for agreement items was "Agree," indicating a consensus among therapists on the insole's beneficial impact on their treatment routine. Given these results, the suitability of LWI in KOA recovery remains debatable. Conclusion: The LWI was viewed as a viable treatment option for KOA in the Saudi context. Both patients and physiotherapists had shown significant interest in this approach. The results of a six-week intervention highlighted its practical benefits, such as reduced knee pain and improved walking capability. Continuous support and guidance from physiotherapists contributed to high levels of adherence, contributing to maintaining activity levels. While LWI offered a promising option in KOA rehabilitation, its full potential remained unexplored. Factors like the current SA KOA clinical protocol, infrastructure difficulties, therapist expertise and LWI availability needed consideration. In the Saudi context, a follow-up trial was essential after this initial intervention to assess the programme's long-term viability and cost-effectiveness. Furthermore, Although the physiotherapists' satisfaction survey indicated that the LWI programme was debatable, the physiotherapy educators needed to integrate knowledge about assistive gait modification (LWI) into their academic and clinical programmes to enhance evidence-based practice

A clinical and ultrastructural investigation of the cornea in keratoconus

Keratoconus is a non-inflammatory corneal disease that progressively causes topographical alteration of the cornea as a result of thinning, and consequently leads to impaired vision. In this thesis, the clinical studies are showed that the incidence rate and severity of keratoconus in Asir province, Saudi Arabia is high with an early onset and more rapid progress to the severe disease stage at a young age compared to other countries. The result also showed that the disease required different contact lens designs to be available in the clinics and the selection of initial back optic zone radius for multiple contact lens designs should be based in the steepest keratometric reading in early stage, and on average keratometric reading on moderate and advanced stages. However, regardless of the stage of disease, tricurve contact lens design should be selected based on average keratometric reading. Ultrastructure investigation of the anterior surface of Bowman's layer using different microscopes revealed that the changes are not limited to the apical cone only, but extend to the periphery of the cornea especially in the advances stage of keratoconus. Also, although the topographical map is usually used in trephination, it was found that the topographical features alone failed to indicate the full extent of the progress of keratoconus towards the corneal periphery. Data from transmission electron microscopy and high-angle X-ray diffraction suggest that the structural abnormalities in the stromal fibrillar matrix might be influential underlying reasons for topographic changes in the keratoconic-like changes of SPARC-null and JKC mice

A clinical and ultrastructural investigation of the cornea in keratoconus

Keratoconus is a non-inflammatory corneal disease that progressively causes topographical alteration of the cornea as a result of thinning, and consequently leads to impaired vision. In this thesis, the clinical studies are showed that the incidence rate and severity of keratoconus in Asir province, Saudi Arabia is high with an early onset and more rapid progress to the severe disease stage at a young age compared to other countries. The result also showed that the disease required different contact lens designs to be available in the clinics and the selection of initial back optic zone radius for multiple contact lens designs should be based in the steepest keratometric reading in early stage, and on average keratometric reading on moderate and advanced stages. However, regardless of the stage of disease, tricurve contact lens design should be selected based on average keratometric reading. Ultrastructure investigation of the anterior surface of Bowman's layer using different microscopes revealed that the changes are not limited to the apical cone only, but extend to the periphery of the cornea especially in the advances stage of keratoconus. Also, although the topographical map is usually used in trephination, it was found that the topographical features alone failed to indicate the full extent of the progress of keratoconus towards the corneal periphery. Data from transmission electron microscopy and high-angle X-ray diffraction suggest that the structural abnormalities in the stromal fibrillar matrix might be influential underlying reasons for topographic changes in the keratoconic-like changes of SPARC-null and JKC mice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection

Background: In the Kingdom of Saudi Arabia (KSA), Leishmania major and L. tropica are the main causative agents of Old World cutaneous leishmaniasis (CL). The national CL treatment regimen consists of topical 1% clotrimazole/2% fusidic acid cream followed by 1–2 courses of intralesional sodium stibogluconate (SSG); however, treatment efficacy is highly variable and the reasons for this are not well understood. In this study, we present a complete epidemiological map of CL and determined the efficacy of the standard CL treatment regime in several endemic regions of KSA.Results: Overall, three quarters of patients in all CL-endemic areas studied responded satisfactorily to the current treatment regime, with the remaining requiring only an extra course of SSG. The majority of unresponsive cases were infected with L. tropica. Furthermore, the development of secondary infections (SI) around or within the CL lesion significantly favoured the treatment response of L. major patients but had no effect on L. tropica cases.Conclusions: The response of CL patients to a national treatment protocol appears to depend on several factors, including Leishmania parasite species, geographical location and occurrences of SI. Our findings suggest there is a need to implement alternative CL treatment protocols based on these parameters

Deletion of low molecular weight protein tyrosine phosphatase (Acp1) protects against stress-induced cardiomyopathy.

The low molecular weight protein tyrosine phosphatase (LMPTP), encoded by the ACP1 gene, is a ubiquitously expressed phosphatase whose in vivo function in the heart and in cardiac diseases remains unknown. To investigate the in vivo role of LMPTP in cardiac function, we generated mice with genetic inactivation of the Acp1 locus and studied their response to long-term pressure overload. Acp1(-/-) mice develop normally and ageing mice do not show pathology in major tissues under basal conditions. However, Acp1(-/-) mice are strikingly resistant to pressure overload hypertrophy and heart failure. Lmptp expression is high in the embryonic mouse heart, decreased in the postnatal stage, and increased in the adult mouse failing heart. We also show that LMPTP expression increases in end-stage heart failure in humans. Consistent with their protected phenotype, Acp1(-/-) mice subjected to pressure overload hypertrophy have attenuated fibrosis and decreased expression of fibrotic genes. Transcriptional profiling and analysis of molecular signalling show that the resistance of Acp1(-/-) mice to pathological cardiac stress correlates with marginal re-expression of fetal cardiac genes, increased insulin receptor beta phosphorylation, as well as PKA and ephrin receptor expression, and inactivation of the CaMKIIδ pathway. Our data show that ablation of Lmptp inhibits pathological cardiac remodelling and suggest that inhibition of LMPTP may be of therapeutic relevance for the treatment of human heart failure

Effect of Instructional Sessions on Nurses' and Doctors' Knowledge and Practice regarding Developmental Care in NICU in Abha City

Preterm / low birth weight (LBW) infant is a live born infant delivered before 37 weeks from the first day of last menstrual period (LMP). It represents the highest percentage of high risk group and accounts for the largest number of admissions to neonatal intensive care unit (NICU). Preterm infants can develop a range of problems because their organs are not mature and an unfavorable environment in the neonatal intensive care unit may compound this morbidity. Developmental care (DC) is a non-traditional kind of care and it represents a framework for practice in NICU which optimizes this environment through reducing its stresses, help preterm infants cope better with this environment and has been proposed to ensure healthy outcomes for premature babies. These interventions include reducing noise and light, control of external stimuli, minimal handling, kangaroo care ( KC; skin-to-skin contact between an infant and parent), co-bedding, positioning or swaddling, clustering of nursery care activities, and giving longer rest periods. The aim of the current study was to evaluate the effect of instructional sessions on nurses' and doctors' knowledge and practice regarding developmental care in NICU in Abha city. The study was conducted at Neonatal Intensive Care Unit in both Abha General Hospital and Asser Central Hospital, Abha city, Kingdom of Saudi Arabia. The study involved 54 nurses and 12 doctors. A pre - post assessment questionnaire was developed after extensive literature review and validated by the research investigators to measure the knowledge and practice of nurses and doctors before and after the instructional sessions. The study concluded that there was change in nurses and doctors' knowledge about developmental care post instructional session's implementation. Furthermore, nurses' practice regarding developmental care was improved post instructional session's implementation which means that  the  instructional sessions had an effective role in enhancing both their knowledge and their practice. The study recommended that when designing a new neonatal intensive care unit or refitting an older one with more modern equipment, the infrastructure and design of it must be suitable to facilitate the application of developmental care. Moreover, the economic impact of the implementation and maintenance of developmental care practices should be considered by individual institutions. Key Wards: Developmental care, premature and low birth weight infants, neonatal intensive care unit