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A case of digital autoamputation with concurrent Sjogren's syndrome, antiphospholipid syndrome, and ovarian cancer
(2022) Keles, Esra; Kabaca, Canan; Akis, Serkan; Celik, Zeynep
Sjogren's syndrome (SS) is a chronic autoimmune disease that is characterized by focal lymphocytic infiltration of the exocrine glands. SS mostly affects middle-aged women, and results in an increased risk of developing malignant neoplasm, particularly hematologic malignancies. The concurrent occurrence of SS, ovarian cancer, and autoimmune disease is very rare. Here, we present a case with postoperative digital autoamputation in a young Sjogren's patient diagnosed with high-grade serous ovarian cancer. The patient was later also diagnosed with antiphospholipid syndrome. Clinicians should note that female genital tract malignancies might occur in autoimmune diseases. In addition, when planning for surgery, they should also be aware of the possibility of another autoimmune disease and different patterns of postoperative complications such as venous thromboembolism and thrombophlebitis. A multidisciplinary approach is required to achieve successful management. To the best of the authors' knowledge, this is the second case with concurrent SS and ovarian cancer and the first case with concurrent SS, antiphospholipid syndrome, and ovarian cancer.
A rare case of xanthomatous meningioma
(2022) Altindag, Sultan; Cakalagaoglu, Fulya; Karaca, Gokay; Yuceer, Nurullah
Xanthomatous meningioma is an extremely rare subtype of metaplastic meningiomas with few cases reported in the literature. Histopathologically, it is composed of oval-shaped cells that have central nuclei and cytoplasm with lipid-filled vacuoles, resembling macrophages. Here, the authors present a case of xanthomatous meningioma and discuss the hypotheses related to its origin and the differential diagnosis. A 40-year-old woman presented with an increased headache complaint over the past month. A computed tomography scan revealed a heterogeneous mass on the right parietal lobe, following which a right craniotomy was done. Microscopic examination showed neoplastic meningothelial cells with whorl formation and areas of xanthomatous changes. Both meningothelial and xanthomatous cells were positive with vimentin, progesterone, and epithelial membrane antigen. CD68 and lysozyme were expressed only in the xanthomatous component, and there was no expression with periodic acid-Schiff (PAS) stain and PAS–diastase. As the diagnostic criteria of atypical meningioma were not observed, a diagnosis of xanthomatous meningioma, WHO grade I, was made. Owing to the characteristic xanthomatous changes, its differential diagnosis includes grade II clear cell meningioma, Rosai–Dorfman disease, and hemangioblastoma. To avoid misidentifying these cells as macrophages, a high degree of awareness of this unique subtype of meningioma is required.
An extremely rare case of Bonneau syndrome with novel cardiac and eye manifestations
(2022) Aburawi, Elhadi; Dakilah, Fozi
Anterior subcapsular cataract formation with pupil sphincter tear after using massage device over the globe
(2022) Al Habash, Ahmed; Al Somali, Abdulaziz; Otaif, Wael
Antibiotic-resistance genes in E. coli strains in GCC countries: A meta-analysis
(2022) Bindayna, Khalid; Joji, Ronni; Ezzat, Hicham; Jahrami, Haitham
Background: Antimicrobial resistance (AMR) in Escherichia coli is an alarming issue worldwide, including in the Gulf Cooperation Council (GCC) countries, yet the prevailing gene patterns have not recently been reviewed. This study was conducted to determine and report on the dominant E. coli antimicrobial resistant gene patterns in GCC countries. Method: A scoping review identified the predominant AMR genes in GCC countries: CTX M, TEM, SHV, NDM, OXA, and VIM genes. For the systematic review, two authors independently searched Scopus, PubMed, Google Scholar, Science Direct, and Web of Science for interventional, clinical, or observational studies on the chosen AMR-conferring genes in E. coli published from GCC countries between January 2013 and June 2019, when the last search was carried out. The sAearch strategy followed the PRISMA guidelines. The risk of bias was assessed using a 6-item standardized checklist. Random-effects modeling was used for all analyses. Results: A total 32 studies were included in the final synthesis of evidence. Overall, CTX-M (53.8%) was the most prevalent gene in the region followed TEM (40.6%), NDM-1 (28.4%), OXA (24.3%), VIM (8.5%), and SHV (7.8%). Most included studies were from Saudi Arabia: CTX-M was again most common with a prevalence of 46.8% from 5442 isolates. Conclusion: The risk of bias analysis showed a mean quality score of 4.25 ± 0.75, indicating high-quality in studies included in this meta-analysis. This review found that CTX-M gene is the most common AMR-conferring gene in E. coli strains from most GCC countries.
ARABIC ABSTRACTS
(2022)
Arabic Abstracts
(2022)
Arabic Abstracts
(2022)
Artificial intelligence-assisted optical biopsies of colon polyps: Hype or reality?
(2022) Goyal, Hemant; Perisetti, Abhilash; Inamdar, Sumant; Tharian, Benjamin; Anastasiou, Jiannis
Awareness and knowledge of postoperative surgical site infections in patients from Saudi Arabia: A multi-regional cross-sectional study
(2022) Alsahli, Alaa; Alqarzaie, Abdullah; Alasmari, Ali; AlOtaibi, Mohammed; Aljuraisi, Abdulrahman; Khojah, Abdulaziz; M. Alzahrani, Nadia; Alaqeel, Faten
Background: Knowledge regarding surgical site infections (SSIs) can help reduce hospital stay, morbidity, and mortality associated with SSI. Objectives: This study aimed to determine the knowledge and awareness of SSI among patients undergoing surgeries across Saudi Arabia. Methods: This multi-center cross-sectional study included adult patients (aged >18 years) who underwent surgery at six centers located across the five regions of Saudi Arabia. A 36-item questionnaire was used to elicit data regarding demographics, patient's health status, procedures, and hospitalization history and awareness and knowledge about SSIs. Results: A total of 375 patients were included (equally for all five regions of Saudi Arabia). Most patients were male (55.7%) and aged 18–34 years (44%). Most respondents (49.1%) had poor awareness; being illiterate and from the Northern region were significant factors (P = 0.001). Patients with no history of surgery (P = 0.001) or SSI (P = 0.003) also had poor awareness levels. In terms of knowledge, 45.8% and 35.2% of the participants had fair and poor knowledge, respectively, with the level of knowledge being significantly associated with region (P = 0.001). Patients those aged >65 years had poor knowledge (P = 0.033), while of males had good knowledge (P = 0.02). Patients with no history of surgery had poor knowledge of SSIs (P = 0.003). Only 32.8% of the patients recalled having been educated by healthcare workers. About 42% learned of SSIs from sources outside the hospital, with internet/social media platforms accounting for 48.4% of such sources. Conclusion: A significant proportion of the patients included in this study had poor awareness and knowledge of SSIs. The study highlights the need for strengthening the preoperative patient education in Saudi Arabia to reduce the likeliness of SSIs.
Awareness of dental trauma management among school teachers in Dammam, Saudi Arabia
(2022) Al-Khalifa, Khalifa; AlYousef, Yousef
Background: Children and young adolescents commonly suffer traumatic dental injuries. Teachers are frequently first responders and responsible for the initial management of the injury; the prognosis of a traumatized tooth is dependent on the initial management. Aim: To evaluate intermediate school teachers' level of knowledge and attitudes toward dental trauma. Materials and Methods: This is a questionnaire-based cross-sectional study where all teachers from eight non-probability selected intermediate schools in Dammam, Saudi Arabia, were invited for participation. The questionnaire elicited data regarding demographics, teaching experience, knowledge and attitudes regarding dental trauma and its management. Results: A total 398 of 433 invited teachers responded (92%). The male-to-female ratio was 2:1. Only 30% of the respondents had previously participated in first aid training; only 11% specifically also focused on dental traumas. Health-care providers represented the main source of knowledge regarding dental trauma. Bivariate analysis revealed that in terms of attitudes toward dental trauma, urgency of care for luxation injuries was significantly associated with teaching experience (P = 0.042), while the urgency of care for avulsed teeth was significantly associated with dental trauma experience (P = 0.007). The only significant association between teaching experience and knowledge about management of avulsed teeth was regarding which tooth should be replanted (P = 0.041). Conclusions: School teachers in Dammam, Saudi Arabia, lack proper knowledge in dental emergency management. Educational training programs are needed to ensure that teaching staff have adequate knowledge to effectively manage dental traumas.
Beliefs, attitudes, and behaviors of Saudi physiotherapists toward evidence-based practice: A multicenter, cross-sectional study
(2022) Alsaadi, Saad
Background: Evidence-based practice (EBP) has gained significant importance in clinical practice worldwide, including physiotherapy, but there are limited studies that have assessed the knowledge, attitude, and behaviors of Saudi physiotherapists toward EBP. Objective: To determine the beliefs, attitudes, knowledge, and experience of Saudi physiotherapists in public hospitals of the Eastern Province of Saudi Arabia toward EBP as well as identify barriers that limit the integration of EBP in clinical practice. Materials and Methods: This cross-sectional design included all Saudi physiotherapists working in four major tertiary hospitals in the Eastern Province of Saudi Arabia. The Evidence-Based Practice Questionnaire was used to elicit responses. The association between attitudes, awareness, and knowledge scores and the demographic data such as age group, years of experience, and level of education was assessed. Results: The questionnaire was distributed to a total of 171 physiotherapists, of which 118 (69%) responded. About 90% of the participants agreed or strongly agreed that EBP is necessary for clinical practice. However, about 25%, 19%, and 18% of the participants reported that EBP does not consider clinical limitations, support physiotherapy intervention, or consider patients' physiotherapy preferences, respectively. The most common barrier in the implementation of EBP in daily clinical practice was insufficient time (>50%), followed by self-efficacy in retrieving evidence from the literature and translating research findings into clinical practice. Years of experience, age, and gender were significant factors associated with physiotherapists' beliefs and attitudes toward implementing EBP. Conclusions: Although EBP was favored, several barriers exist that hinder its adoption by physiotherapists. Institutional support and research skill development may help accelerate EBP adoption levels and should be considered by policymakers.
Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital
(2022) Malik, Azhar; Aziz, Faisal; Beshyah, Salem; Aldahmani, Khaled
Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.
Clinical characteristics and outcome of candidemia: Experience from a tertiary referral center in Saudi Arabia
(2022) Alhatmi, Hind; Almansour, Sarah; Abanamy, Reem; Akbar, Abdullah; Abalkhail, Mohammed; Alharbi, Ahmad; Alsaedy, Abdulrahman; Mahmoud, Ebrahim; Alalwan, Bassam; AlJohani, Sameera; Aldibasi, Omar; Bosaeed, Mohammad; Alothman, Adel
Background: Candida bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding Candida species causing invasive infections in Saudi Arabia. Objective: To identify Candida species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia. Materials and Methods: This retrospective study included all cases of positive blood culture for Candida in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019. Results: A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common Candida species isolated was Candida albicans (26.7%), followed by Candida glabrata (22.7%), Candida parapsilosis (22.2%), and Candida tropicalis (18.4%). Non-albicans candidemia was more common in patients with diabetes (76.7%; P = 0.0560), neutropenia (89.8%; P = 0.0062), recent exposure to fluconazole (85.7%; P = 0.0394), and active chemotherapy (83.1%; P = 0.0128). In non-albicans, susceptibility to fluconazole varied from 95.9% with C. tropicalis to 41.5% with C. parapsilosis; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-albicans species at 30 days (41.2% vs. 35.9%; P = 0.2634) and 90 days (58.2% vs. 51.4%; P = 0.1620). Conclusion: This study found a changing pattern in the Candida species causing bloodstream infections and an epidemiological shift toward more non-albicans Candida species in Saudi Arabia.
Clinical characteristics of Crohn's disease in a cohort from Saudi Arabia
(2022) Qari, Yousef
Objective: In Saudi Arabia, there are limited studies on the clinical characteristics of patients specifically with Crohn's disease (CD). This study was conducted to describe the clinical characteristics of CD at a tertiary care center in Jeddah, Saudi Arabia. Methods: This retrospective study included all patients aged >14 years who had a definitive diagnosis of CD and were managed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2012 and 2018. Data were collected for the following categories: clinical, laboratory, radiological, histological features at presentation, and disease-related complications. Results: The study included 245 newly diagnosed CD patients, aged 14–73 years (median: 26.3 years). All subjects presented with abdominal pain. Majority of the patients (59.7%) received a definitive diagnosis of CD >3 months after the onset of symptoms; 15.1% were initially suspected to have intestinal tuberculosis. Diarrhea and bleeding per rectum were reported in 60.8% and 49.7% of the patients, respectively. Sacroiliitis was the most frequent extraintestinal manifestations (11.4%). In terms of disease location, the terminal ileum (L1) was the most affected area (46.9%). Twenty-five patients had perianal disease, of which 40% had complex fistulae and 36% had perianal abscesses. The majority had hemoglobin levels >10 g/dl (74.1%), decreased serum iron (69.6%) and ferritin (50.5%) levels, and elevated erythrocyte sedimentation rate (68.2%) and C-reactive protein (82.2%). Conclusions: The majority of the patients in our cohort presented with the characteristic quartet of abdominal pain, weight loss, fever, and diarrhea. This study also found a significant number of patients with CD in Saudi Arabia experience diagnostic delay, which may contribute to disease morbidity and complications. These findings highlight the need for future studies to determine factors influencing this diagnostic delay.
Do mock medical licensure exams improve performance of graduates? Experience from a Saudi medical college
(2022) Al-Sheikh, Mona; Albaker, Waleed; Ayub, Muhammed
Background: All medical graduates in Saudi Arabia are required to pass a Saudi Medical Licensure Exam (SMLE) to be able to practice and/or enroll in postgraduate training. Mock exams are a useful preparatory tool, but no study from Saudi Arabia has assessed its impact on performance in the actual licensure examinations. Objectives: To evaluate the impact of a series of mock SMLEs with immediate personalized feedback on graduate scores and their performance in the actual SMLE. Methods: This retrospective study included medical students who graduated in the 2019-20 academic year from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, and undertook mock SMLE exams offered in August 2020. Three mock exams were constructed using the SMLE blueprint and were offered to graduates 1 week apart. Immediately after each exam, a personalized learning outcomes achievement report was sent to each graduate. Exam reliability was measured by the Kuder–Richardson formula, and were 87%, 94%, and 96% for the first, second, and third exam, respectively. Results: A total of 71, 70, and 61 students completed the first, second, and third exams, respectively. Across the three mock exams, the mean (±SD) score showed an increasing trend, from 87.6 (±33.4; range: 28–191) in the first test to 93.5 (±45.6, range 15–204) in the second and 96 (±42.6; range: 25–203) in the third. Forty graduates completed all three mock exams; of these, the scores of 25 (62.5%) students significantly improved in both the second and third exams compared to the prior test (P = 0.002). A nonsignificant positive correlation was found between the average mock and the actual SMLE scores for whom data were available (r = 0.29; P = 0.27). Conclusion: The performance of graduates improved in subsequent mock exams, and there was a nonsignificant positive correlation between the mock and actual SMLE exam results. This study presents the usefulness of using mock exams as a preparatory tool for licensure examinations in Saudi Arabia.
Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study
(2022) Aletreby, Waleed; Mady, Ahmed; Al-Odat, Mohammed; Balshi, Ahmed; Mady, Anas; Al-Odat, Adam; Elshayeb, Amira; Mostafa, Ahmed; Abd Elsalam, Shereen; Odchigue, Kriz
Background: Practices of Do-Not-Resuscitate (DNR) orders show discrepancies worldwide, but there are only few such studies from Saudi Arabia. Objective: To describe the practice of DNR orders in a Saudi Arabian tertiary care ICU. Methods: This retrospective study included all patients who died with a DNR order at the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 1 to December 31, 2021. The percentage of early DNR (i.e., ≤48 hours of ICU admission) and late DNR (>48 hours) orders were determined and the variables between the two groups were compared. The determinants of late DNR were also investigated. Results: A total of 723 cases met the inclusion criteria, representing 14.9% of all ICU discharges and 63% of all ICU deaths during the study period. The late DNR group comprised the majority of the cases (78.3%), and included significantly more patients with acute respiratory distress syndrome (ARDS), community acquired pneumonia (CAP), acute kidney injury, and COVID-19, and significantly fewer cases of readmissions and malignancies. Septic shock lowered the odds of a late DNR (OR = 0.4, 95% CI: 0.2–0.9; P = 0.02), while ARDS (OR = 3.3, 95% CI: 2–5.4; P < 0.001), ischemic stroke (OR = 2.5, 95% CI: 1.1–5.4; P = 0.02), and CAP (OR = 2, 95% CI: 1.3–3.1; P = 0.003) increased the odds of a late DNR. Conclusion: There was a higher frequency of late DNR orders in our study compared to those reported in several studies worldwide. Cases with potential for a favorable outcome were more likely to have a late DNR order, while those with expected poorer outcomes were more likely to have an early DNR order. The discrepancies highlight the need for clearer guidelines to achieve consistency.
Effect of hanna somatic education on low back and neck pain levels
(2022) Huang, Qiuju; Babgi, Amani
Background: Neck and low back pain are very common worldwide. Hanna somatic education (HSE) is a method of neuromuscular (mind–body) movement retraining that helps in managing pain, but its efficacy has not yet been studied. Objective: To evaluate the clinical effect of HSE on low back and neck pain and determine differences in pain, use of pain medication, and number of doctor visits before and after 6 months of HSE sessions. Methodology: This retrospective study included patients with neck and/or low back pain of >2-month duration who underwent HSE sessions between January 2016 and January 2018 and completed a minimum one follow-up session. Two to five one-to-one sessions of 40–60 min once every 1–2 weeks for 2–8 weeks were provided for each patient. Pain levels were recorded at each visit using the Wong-Baker FACES Pain Rating Scale. Data regarding medication use and number of doctor visits for pain management were also recorded. Results: A total of 103 patients were included, of which 81 (78.6%) were female. Completing a mean 2.8 HSE sessions resulted in a significant pain level reduction. There were significant reductions in the mean low back, neck, and low back + neck pain values between the first and the last visits (P < 0.001). In the 6 months before and after the HSE intervention, the number of patients using pain medication decreased from 53 (53.5%) to 14 (13.6%), respectively, and the mean number of doctor visits reduced significantly from 2 (±1.6) to 0.5 (±1.16) (P < 0.001), respectively. Conclusion: Clinical sessions of HSE were found to significantly reduce chronic spinal pain. Further investigations are recommended regarding evidence-based treatment of HSE in patients with muscles pain.
Effectiveness of a short course on undergraduate medical students' acquisition of basic ultrasound skills: Findings from a Saudi University
(2022) Hendi, Ali
Background: Medical schools in Saudi Arabia generally do not integrate ultrasound training in undergraduate medical study despite its widespread use. Objective: To determine the efficiency of a short course in acquiring basic ultrasound skills at the undergraduate medical level. Subjects and Methods: Fourth-year medical students of Jazan University (2016/2017; N = 118) were divided into 13 groups. A radiology expert provided each group with a 50-min lecture on “ultrasound in clinical practice” and a 2-h hands-on ultrasound training session. Then, the students were invited to participate in the study by completing a questionnaire eliciting data regarding their opinion, experiences, and satisfaction level for the session and then undertaking skill assessment using two OSCE stations. Results: Eighty-one students (68.6%) were enrolled in the study (male: 42; female: 39). The mean scores were high for handling the probe (4.33 ± 1.01) and identifying kidney (4.46 ± 1.08) and liver (4.22 ± 0.97), and moderate for identifying spleen (3.89 ± 0.75), aorta (3.35 ± 0.44), and hepatorenal pouch (3.05 ± 0.35). The students were highly satisfied with the course (4.37 ± 1.01). In the first OSCE station that assessed ultrasound techniques, the mean score was 14.96 (of 18 points; 83.11%) for males and 15.40 (85.56%) for females. In the second station that used static ultrasound image with common pathology, the mean score was 2.4 (of 2.5 points) for both males and females. Conclusion: Undergraduate medical students in this study gained adequate skills and satisfaction in terms of using ultrasound and identifying anatomy following the short course. This study highlights the benefits of introducing programs dedicated to ultrasound for undergraduate medical students in Saudi Arabia.
Endoscopic hemostasis of a bleeding diverticular Dieulafoy's lesion in the third portion of duodenum
(2022) Anam, Hameed; Abhilash, Perisetti; Sumant, Inamdar; Jiannis, Anastasiou

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