1011P- DERMATOLOGY RESEARCH IN SAUDI ARABIA: A NEEDS ASSESSMENT

ABSTRACT

1.0 Introduction

The paper identifies gaps in dermatological research in Saudi Arabia by review of published literature and questionnaire survey of dermatologists interested in research as shown by their research track. No reliable data are available on the incidence, prevalence of skin diseases since they are not given any special attention in official statistical reports by the Ministry of Health. The impression of clinical practitioners is that skin disorders are a common cause of medical consultations. However very little is known about these disorders due to limited research. Al Aboud et al (2004) reported results of analysis of dermatological publications in Gulf Cooperation Council countries in the period 1966-2004 by searching medline using pubmed. A total of 140 publications were found with Saudi Arabia publishing the most followed by Kuwait. They recommended a better research infrastructure. The paper recommends measures to improve dermatological research.

2.0 METHODS

A total of … articles were retrieved from the pubmed database using the key words ‘dermatology’, ‘skin’, and ‘Saudi Arabia’. After removing irrelevant articles, the remaining …. Articles were categorized in the following categories: clinical presentation, etiology, and therapy. The articles were further categorized according to the author (Saudi or non-Saudi), nature (review, letter, case report), study design (cross sectional, follow up, quasi experimental, and randomized), journal of publication (international, regional, or local). Cross tabulations of the various categories were made and the results were interpreted. Further analysis was confined to publications that can be vategorized as research using criteria of a good research (see Table #).  In addition a questionnaire on opinions of researchers about the adequacy of the research efforts was sent to….. dermatologists whose emails were obtaibed from publications or from directories of departments of dermatology in hospitals and universities. 

3.0 RESULTS:

Only … of …. Publications could be considered research involving testing an identifiable scientific hypothesis. Most of the publications were case reports of rare or unusual conditions.

Clinical presentations were reported in …. Case reports and …. Case series, ….. cross sectional prevalence studies and no true incidence studies. The case reports tended to focus on rare and therefore diagnostically interesting cases such unusual sites of lesions, as dermatological complications of hemodialysis (Afr J Med Med Sci. 2002 Jun;31(2):175-8 Somorin AO,) and central venous lines (Am J Clin Dermatol. 2005;6(1):61-4. Bukhari I, et al), or as local examples of syndromes reported in the literature (Dermatol Online J. 2003 Aug;9(3):20 Al Aboud et al). In several case reports there was no obvious scientific reason warranting their reporting because they seemed routine (). For the benefit of practicing clinicians a good number of case reports educated them about elusive or unexpected presentations of conditions that are diagnostic dilemmas (). Authors of case reports reviewed relevant international literature and tried to relate to the Saudi experience on several cases interesting and insightful comparisons were made and were explained sometimes based on environmental (hot climate or mass congregation during hajj) or genetic variations (due to consanguinous inbreeding).  Cross sectional studied of clinical and epidemiological features were based on secondary data in medical records

Etiological research was reported as … case reports, …. Case series,  the etiological association in case reports was reported as incidental and involved unexpected associations. These were not usually followed up by deeper investigation. The genetic element took a prominent position in etiological speculations.

The distribution of therapeutic research was … quasi experimental, ….follow up, 

Translation of a family impact questionnaire was found to be reliable and valid (Al Robaee et al 2010 Int J Dermatol 49(9):1063-7). Assessment of KAP found wide spread misconceptions and negative attitudes about vitiligo (Alghamdi et al 2010 Int J Dermatol 49(10):1145-5)

A number of reports were CPE for dermatologists about diagnostic tips, concepts, and terminology.

KAP studied showed widespread misconceptions and misunderstandings

QOL

4.0 DISCUSSION AND CONCLUSIONS

The majority of published reports are case reports which are not strictly speaking research.  Most of the reports on the epidemiology, etiology, and therapy of skin diseases were not rigorously designed studies being based on record review that is liable to confounding. This leaves us with the conclusion that research on dermatology in Saudi Arabia is limited. Genetic factors based on consanguinity are often mentioned indicating that this is an area of potential research.

It is difficult to compare the quantity and quality of in different countries because of many confounders. A pubmed search of selected western, middle eastern, African countries using the same key words and adjusting for differences in population size and per capita income revealed……

5.0 RECOMMENDATIONS:

TABLE #1: CHARACTERISTICS OF PUBLISHED REPORTS

Journal	Year	Research					Others
		Epidemiological	Etiological	Therapeutic	CPE	KAP	Case report	Case series	Review
International	Less than 5 yr
	5 yr or more
Saudi	Less than 5 yr
	5 yr or more
Total

TABLE #2: CLINICAL PRESENTATIONS

Journal	Single Case	Case Series	Cross sectional	Follow up	Other
International
Saudi
TOTAL

TABLE #3: ETIOLOGICAL RESEARCH

Journal	Anecdotal/ case eport	Cross sectional	Case Control	Follow up	Quasi experimental	Randomized Trials	TOTAL
International
Regional
Saudi
TOTAL

TABLE #4: THERAPEUTIC RESEARCH

International	Anecdotal / case report	Quasi experimental	Randomized trial	Laboratory	Follow up	TOTAL
Regional
Saudi
TOTAL

TABLE #5: QUALITY OF LIFE RESEARCH

Journal	Anecdotal/ case eport	Cross sectional	Case Control	Follow up	Quasi experimental	Randomized Trials	TOTAL
International
Regional
Saudi
TOTAL

TABLE #6: COMMONEST DISEASES CITED IN PUBLICATIONS

Disorder	Review	Letter	Case Report / Series	Research epidemiological	Research Etiological	Research Therapeutic

TABLE #7: BACKGROUND INFORMATION OF RESPONDENTS

Nationality & gender	Place of Practice		Professional Appointment		Years of experience		Research publications in past 5 years
	Public	Private	Consultant	Other	0-5	6 and above
Saudi male
Saudi female
Non Saudi male
Non Saudi female
TOTAL

TABLE #8: OPINIONS ABOUT DERMATOLOGY RESEARCH IN KSA

(Likert scale    )

Disease group	Research			Publication			Books	Conferences
	Epidemiology	Etiology	Therapy	Epidemiology	Etiology	Therapy

TABLE #9: OPINIONS ABOUT BARRIERS TO DERMATOLOGY RESEARCH

(Likert scale: High, Intermediate, Low)

Barrier	Magnitude	Potential of a Solution	Efforts already  taken

TABLE #10: OPINIONS ON OCCURRENCE, SEVERITY, and PUBLIC HEALTH SIGNIFICANCE OF VARIOUS SKIN DISORDERS

Disorder	Prevalence / occurrence	Severity	Public Health Importance