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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 7 | Issue 1
Page Nos. 1-76

Online since Wednesday, July 27, 2022

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REVIEW ARTICLES  

Nonalcoholic steatohepatitis-induced hepatocellular carcinoma p. 1
Abdulrahman Mohammed Hakami, Erwa Elmakki
DOI:10.4103/KKUJHS.KKUJHS_1_22  
The incidence and prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)-related cirrhosis is globally increasing, especially among communities with sedentary lifestyles. NASH-related liver cirrhosis is an emerging etiology of liver cancer. Given the increasing rates of obesity and the other risk factors of NAFLD/NASH such as diabetes mellitus, dyslipidemia, hypertension, and metabolic syndrome, NASH-related liver cancer will remain a challenging disease in the coming decades. Recent reports have shown that NASH also can cause hepatocellular carcinoma (HCC) directly without causing liver cirrhosis, the so-called noncirrhotic liver cancer. Furthermore, the pathogenicity of noncirrhotic HCC caused by NASH is not well understood and needs more future research. In the present time, NASH-related HCC has become one of the leading indications of liver transplantation. However, as the major risk factors of NASH are controllable, NASH-related HCC is a potentially preventable condition.
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Women's awareness and rate of the use of contraception in the Kingdom of Saudi Arabia: A systematic review p. 10
Hamdah Musallam Alruwaili, Hanan A Badr, Wafaa A Fahim
DOI:10.4103/KKUJHS.KKUJHS_12_22  
Background: The prevention of unplanned pregnancies brings many benefits for women and their families alike, as well as for society in general. However, recent statistics indicate a need for increased knowledge and use of contraception in addition to the introduction of educational family planning services in the countries of the Middle East. Objectives: This review sought to explore women's awareness and rates of contraceptive use in the Kingdom of Saudi Arabia (KSA) and to determine whether and to what extent women currently receive counseling on modern contraception at health-care facilities in KSA. Methods: Three electronic databases – MEDLINE, ProQuest Central, and PubMed – were searched, in addition to the academic search engine Google Scholar. Three reviewers independently assessed the eligibility of studies, abstracted study data, and assessed study quality. Results: Thirteen studies were identified for inclusion in this review; overall, these studies were cross-sectional and showed awareness and use of contraception to be at a relatively low level in KSA. Conclusion: Although the few studies that were identified for inclusion in this review reported a relatively low level of awareness and rate of use of contraception in KSA, each conclusion was supported by high-quality research with low risk of bias. Overall, this review has shed light on the gaps in studies that have been conducted in KSA on modern contraception.
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ORIGINAL ARTICLES Top

The role of physical assessment in primary health care in the early detection of pediatric undescended testis in Saudi Arabia p. 18
Abdullah Mousa Alzahrani, Jumanah Hamad Basalelah, Abdulmalik Khamis, Abdulaziz Adel Almahaish, Shahad Homoud Aljehani, Fatmah Mohsen Alhejji, Maha Khalid Almadi
DOI:10.4103/KKUJHS.KKUJHS_43_21  
Background: The early detection of undescended testis is the key to minimizing infertility and malignancy risks associated with this condition. Thorough routine physical examination during scheduled visits for vaccines during the first year of a child's life can lead to early detection and referral to a surgeon for evaluation and surgical intervention in a timely manner. We aimed to investigate the role of physical examinations in primary health care for the discovery of undescended testis. Methods: Anonymous structured interviews were conducted in the waiting areas of a hospital and primary health-care center. Parents were asked about their perceptions of undescended testis and their experience during primary health-care visits for routine vaccinations. A descriptive analysis was carried out, and the percentage of boys who underwent genital examinations in a primary health-care setting was determined. Results: We interviewed a total of 352 parents, most of whom did not have a child with undescended testis (n = 322, 91%). Only 25 (7%) reported that a formal clinical genital examination was done at every primary health-care visit, whereas 50 (14%) indicated that their boy had been examined only once among their many vaccination visits. However, 160 (46%) parents stated that their primary health-care provider did not examine their boys' genitalia during any of these visits. Conclusion: Late detection of undescended testis could result from failure to adhere to the recommended genital clinical examinations of boys during immunization visits for infants among primary health-care providers.
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Comparative evaluation of the accuracy and efficiency of silicone-based bite-registration record using handheld conventional versus recently introduced powered mixing gun – An in vitro study p. 21
Mohammed E Sayed, Manawar Ahmad, Hina Naim Abdul, Osama Abdu Ageeli, Talal AlShafie, Ali Mohammed Alrefaei
DOI:10.4103/KKUJHS.KKUJHS_52_21  
Purpose: An accurate and functional interocclusal record is very important in restorative dentistry, and any inaccuracies may lead to extensive intraoral adjustments, which can compromise the esthetics and/or mechanical strength of the restorations. The current literature lacks a direct comparison of dimensional accuracy and time efficiency between conventional and powered mixing techniques. The present study compared the accuracy and efficiency of recently introduced powered mixing gun with the conventional handheld gun that was used to mix two silicone-based bite-registration materials. Materials and Methods: A total of 100 bite registrations were recorded on maxillary and mandibular typodont models mounted on a semi-adjustable articulator. Of these, 50 bite registrations were recorded using a handheld conventional mixing gun technique and the other 50 using a handheld powered mixing gun technique. Both types of bite registrations were performed using fast and superfast set bite-registration materials. The dimensional accuracy and time efficiency of both techniques were analyzed and compared. Results: The accuracy and time efficiency of the handheld powered gun mixing technique were significant (P < 0.05) than the conventional mixing technique for fast set bite registration material in vertical distances A1A2 (P = 0.01), B1B2 (P = 0.015), and C1C2 (P = 0.001). However, for horizontal distances AB (P = 0.008) and AC (P = 0.001), accuracy was more significant (P < 0.05) for the superfast set bite registration material compared to the fast set material using the powered mixer. Conclusion: The powered mixing gun technique was more accurate and efficient than the conventional mixing gun technique for recording the bite registration using fast and superfast set materials.
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Awareness of Saudi women about causes of urinary tract infection and its complications in pregnant women in asir region p. 27
Asma Ali Asiri, Ali Ahmed Alasiri, Mofareh Ahmed Asiri, Mohanad Qasem Alshabab, Feras Mohammed Alqahtani
DOI:10.4103/KKUJHS.KKUJHS_41_21  
Background: Urinary tract infection (UTI) is one of the most common infections that occur during pregnancy. It can be symptomatic or asymptomatic and if left untreated, it could lead to maternal and perinatal morbidity and mortality complications. The highest prevalence of UTI in pregnant women is thought to be a result from significant physiological changes occur in the urogenital tract that lead to increasing the potential for pathogenic colonisation. Bladder volume increases and detrusor tone decreases and this will lead to stasis of urine and ascending of infection. In addition, pregnant women develop ureteric dilatation as the result of a combination of progestogenic relaxation of ureteric smooth muscle and pressure from the expanding uterus. Furthermore, this can lead to failure of treatment, recurrent infections, or significant morbidity and mortality with a poor outcome. The bacteria causing urinary infection in pregnancy are many, such as Escherichia coli, Gram-negative bacilli like Proteus mirabilis and Klebsiella pneumoniae. Staphylococcus saprophyticus is the second most frequently cultured uropathogen, 12 while other Gram-positive cocci, such as group B hemolytic streptococci, are less frequently isolated but remain clinically important. Other less common uropathogens include Staphylococcus aureus and Mycobacterium tuberculosis, which can arise through hematological inoculation rather than ascending infection. Nonbacterial causes include Chlamydia species and fungal infections, such as Candida albicans. Aim: The current study aimed to assess the awareness of Saudi women about the causes of UTI and its complications in pregnant women in Asir region, Southern of Saudi Arabia. Methodology: A cross-sectional study enrolled women at Asir region during the study period from Monday Feb 22, 2021–Jul 29, 2021 Data were collected using prestructured online questionnaire using social media platforms. Questionnaire included women bio-demographic data, children number, history of UTI, and awareness regarding UTI and its complications during pregnancy. Results: The study included 1662 Saudi females from Asir region with their ages ranged from 18 to 59 years with a mean age of 27.8 ± 12.4 years old. Majority of study participants (46%; 765) were single. Exact of 66.5% of the study females reported that pregnancy increases the chance of getting UTI. Regarding factors increases the risk of UTI in pregnant women, the most reported by the study females were prolonged retention of urine (72.4%). Also, 53.5% of the females know that the highest risk of getting UTI is at the 3rd trimester. As for complications for a pregnant woman with UTI, nephritis was known among 76.7% of the females. Conclusion: In conclusion, the current study revealed that females' awareness regarding UTI and its related causes and complications is poor in Asir region. Not all females know all risk factors, clinical presentation, or complications of UTI.
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Georeferencing of current dental service locations in the Jazan Region, Saudi Arabia: A geographical information system-based approach p. 33
Mosa A Shubayr, Estie Kruger, Marc Tennant
DOI:10.4103/KKUJHS.KKUJHS_15_22  
Background: This study focused on the Jazan region, Kingdom of Saudi Arabia. To date, there has not been any documented evidence about geographical distribution of dental health-care services in the region. The study aimed to assess the geographical accessibility of dental health-care services in Jazan. Materials and Methods: Most recent, openly accessible, nonidentifiable data and information were used in this study. The location of health facilities was obtained from the Ministry of Health (MOH) Statistical Yearbook 2020 and interactive map of the MOH, which was converted to longitude and latitude, using Google Maps with 90% of the level building. The study data to be analyzed were imported from the integrated database in Quantum Geographic Information Systems into Microsoft Excel software, where the ratios of health-care facilities to the study population were computed. Results: There were 145 primary health cares (PHCs) and 19 hospitals with a dental component in the Jazan region of 17 governorates with a total of 1,726,739 residents. The overall PHC-, hospital-, and dentist-to-population ratios were 1 PHC to 114,365 residents, 1 hospital to 90,881 residents, and 1 dentist to 9136 residents. Only 14.5% of PHCs and 5.6% of the hospitals served 70% of the population who are living within 20 km from the governorate's center. Conclusion: This study shows that irregular distribution of health services has led to decreased access to services in the region. Further research is needed focusing in mapping MOH, private and other health facilities, and the burden of oral disease in the region.
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A cross-sectional comparative analysis of smoking and oral health-related quality of life p. 41
Nabeeh A AlQahtani
DOI:10.4103/KKUJHS.KKUJHS_18_22  
Introduction: Tobacco use is a major public health concern globally, and its usage has various harmful effects on both general and oral health. Thus, assessment of the oral health-related quality of life (QOL) is necessary among smokers to improve their oral health. The aim of this study was to assess the oral health-related QOL among smokers and nonsmokers. Methodology: A cross-sectional comparative research was conducted. A total of 520 participants, of which 260 were smokers and 260 were nonsmokers, were included in the study. To acquire data related to sociodemographic parameters and smoking status, the World Health Organization QOL-Brief version assessment tool was used, and to review the association between oral health-related QOL, the Oral Health Impact Profile-14 (OHIP-14) was used. Results: When comparing smokers and nonsmokers' OHIP, the mean rank of every OHIP-14 question was higher in smokers with a significant P = 0.001, except for “satisfaction of life,” where the P value was not significant (P = 0.347). The distribution of total OHIP-14 scores as per sociodemographic variable showed that a higher mean rank of OHIP-14 was found in unmarried, nonearning, and noneducated participants as compared to married, employed, and literate participants. However, the difference was not statistically significant. Conclusion: Oral health-related QOL among smokers is poor as compared to nonsmokers.
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Assessment of professional nursing governance on nurses in a multi-cultural setting in the Kingdom of Saudi Arabia p. 46
Abdiqani Qasim, Khalid Suhail Alghamdi, Diana Selvamony Lalithabai, Mohamad Omar Hababeh, Wael Mohamad Ammar
DOI:10.4103/KKUJHS.KKUJHS_17_22  
Background: Health-care institutions constantly strive to enhance the care environment and promote staff satisfaction. Engaging nurses through shared governance helps achieve these institutional goals. Aim: This Saudi study aimed to assess the current status of professional nursing governance on nurses at King Fahad Medical City, Saudi Arabia. Methodology: A cross-sectional study was conducted with 247 nurse participants chosen by the convenience sampling technique. Data were collected using the Index of Professional Nursing Governance tool. Results: Staff nurses practiced the first level of shared governance with a mean score of 196.9 ± 49.7, showing they had primary decision-making responsibilities. The dimension with the lowest score was 'goal-setting and conflict resolution' (19.6 ± 6.12). Years of nursing experience was a statistically significant (P = 0.002) factor in governance. Conclusion: Nurse participants practiced shared governance in their given setting. However, their below-par score for “goal-setting and conflict resolution” underscores the need for professional development.
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Public knowledge and awareness toward glucose-6-phosphate dehydrogenase deficiency in Jazan region p. 52
Hassan A Hamali, Asma A Muasbil, Taif H Otaif, Maha K Qahtani, Muhammad Saboor, Gasim Dobie, Aymen M Madkhali, Mohammad Suhail Akhter, Rama Mohan Chandika, Abdullah A Mobarki
DOI:10.4103/KKUJHS.KKUJHS_11_22  
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia is the most common metabolic red cell abnormality worldwide. G6PD deficiency anemia is very common in Saudi Arabia. Objective: The aims of the current study were to evaluate and assess knowledge and awareness about G6PD deficiency anemia and to find any association between sociodemographic variables and knowledge about this disease in the Saudi population in Jazan region. Materials and Methods: A cross-sectional descriptive study was conducted at Jazan University. Results: A total of 709 individuals completed the questionnaire and were considered in the study. In general, the study population had overall fair knowledge, scoring 50% or above on all domains of the study. In addition, we found a significant association between sociodemographic variables, specifically gender, family income and education level, and knowledge/awareness of G6PD deficiency anemia. Conclusion: Our study found fair to good knowledge of G6PD itself, but not of the mode of inheritance among the study population. The study suggests that public health campaigns and screening programs should be conducted and established to screen for these disorders at younger ages, instead of only relying on premarital screening program.
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Do clinical experience and surgical technique affect outcomes in initial laparoscopic trocar placement? A prospective randomized clinical trial p. 59
Mohammed A Bawahab, Walid Mohamed Abd El Maksoud, Khaled Said Abbas, Hassan A Alzahrani, Abdullah Dalboh, Fahad S Al-Amri, Helmuth T Billy
DOI:10.4103/KKUJHS.KKUJHS_10_22  
Aim: The aim of this study was to compare the intraoperative and postoperative complications of laparoscopic cholecystectomy by closed (supraumbilical Veress needle) versus open infraumbilical technique for initial, first port laparoscopic access. Patients and Methods: Our study included 560 adult patients, who were randomized into four groups (i.e., expert Veress, expert open, junior Veress, or junior open). Time for placement of the first trocar and time to complete the port-site closure were compared in all study groups. The mean operative time for cholecystectomy was compared after successful placement of the initial trocar until removal of the gallbladder. Intraoperative, early, and late postoperative complications were compared. Results: Duration of the initial port placement was significantly shorter among senior compared to junior surgeons. The Veress technique had a significantly shorter duration of port entry, but a longer duration of port-site closure compared to the open technique. Apart from the extraperitoneal insufflation incidents that were significantly more reported by junior surgeons, no significant differences in incidents were reported by senior and junior surgeons between open and closed techniques. Junior surgeons showed a better satisfaction with the open than the closed technique. Conclusions: Both the closed and open techniques for laparoscopic cholecystectomy are equally safe and effective for initial port-site entry whether performed by senior or junior surgeons. Junior surgeons are more satisfied with the open technique than the Veress needle technique, due to a perceived concern of injuring intra-abdominal structures. Therefore, junior surgeons would benefit from additional training during their residency to use both the techniques confidently.
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The compliance of dentists toward prescribing prophylaxis antibiotic for special care patients at risk of having infective endocarditis p. 67
Loujayne Maghrabi, Alanood Algarni, Jameel Abuljadayel, Mohsen Aljabri, Khalid Aljohani, Hassan Abed
DOI:10.4103/KKUJHS.KKUJHS_19_22  
Background: Prescribing antibiotics (Abs) as a prophylactic before dental procedures is recommended by the American Academy of Pediatric Dentistry (AAPD) in patients with cardiac diseases to prevent a potentially life-threatening infection of the cardiac valves or endocardium called “infective endocarditis (IE).” Aim: This study aimed to assess the compliance of dentists in Makkah city with the AAPD recommendations of prescribing prophylaxis Abs for special care pediatric patients at risk of having IE. Materials and Methods: This was an observational cross-sectional study among dentists who are working at the major hospitals in Makkah city, Saudi Arabia. Participants' perception regarding the prescription of prophylactic Abs was measured using validated and reliable questions. The reliability analysis was used with a model of alpha (Cronbach) to study the properties of measurement scales and the items that compose the scales and the average inter-item correlation. Results: One hundred and thirty-two dental practitioners were participated. Dental care providers would prescribe Abs with dental extraction (92.4%), periodontal surgery (89.4%), nonsurgical root canal treatment beyond apex (77.3%), supragingival scaling (67.4%), and retraction cord placement (46.2%). On the other hand, dental practitioners would not prescribe Abs for orthodontic appliance (87.9%), intraoral radiograph (87.1%), primary teeth shedding (81.8%), tooth preparation when taking an oral impression (76.5%), local anesthesia infiltration (68.2%), and restoration of Class II caries with matrix and wedge (56.8%). A significantly lower knowledge score was obtained by general dental practitioners when compared with consultant and specialists (P = 0.044). Consultants and specialists recorded significantly lower knowledge on the prescription of prophylaxis Abs for Class II caries with matrix and wedge (P < 0.001) when compared with general dental practitioners. Conclusions: Most dentists followed the AAPD recommendations of prophylactic Abs for children who have a high risk of developing IE. However, Class II dental restorations with matrix and wedge and placement of retraction cord have recorded more invalid responses. General dental practitioners had lower knowledge when compared with consultants and specialists when prescribing Abs for children who have a high risk of developing IE.
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CASE REPORT Top

Surgical management of complex odontoma associated with impacted tooth: A case report and review of literature p. 73
Manea Mousa AlAhmari
DOI:10.4103/KKUJHS.KKUJHS_6_22  
Odontomas are a type of mixed odontogenic tumor made up of mineralized ectomesenchymal tissue. Odontomas are divided into two categories by the World Health Organization: complex and compound. They are commonly observed in regular radiography tests and can be caused by a variety of factors. They are, however, rarely linked to impacted teeth. Through a clinical case report, this study attempts to highlight the clinical and histological aspects of this rare dental tumor. In the present case report, a 28-year old male patient visited with a complaint of impacted anterior tooth and swelling. After a thorough clinical and radiological examination, it was decided to excise the growth by curettage. On histological investigation, the tissue was diagnosed with complex odontoma. One-year follow-up of the case revealed excellent healing with no sign of recurrence.
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