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Objectives: To analyze the quantity and characteristics of Saudi Arabia’s (SA’s) dermatology research publications throughout the years. Methods : A literature search was conducted between October 2018 and July 2019 in the Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. PubMed was used as a search engine, to retrieve dermatology-related publications in SA - from the date of the first article publication in 1982 to December 31, 2018. Results : Five hundred publications were included. Two-thirds of them were written between 2010 and 2018. Approximately 50% were from the central region and only 3% were multiregional studies. Funding support was described in 13% of these publications. The top 5 most-researched fields were infectious disorders (12%), genodermatosis (10%), hypopigmentation disorders (9.4%), neoplastic disorders (9%), and hair disorders (7%). Two-thirds of the publications were observational studies, and mostly case reports (44%). Conclusion : Dermatology research in SA has increased over the past decade. However, the quality of research remains inadequate. Saudi Arabia’s dermatology research output is affected b y the availability of funding and national research projects, which could improve the studies’ quality. We recommend the establishment of data registry units that can aid researchers in producing high-quality studies, while encouraging the collaboration of different centers in various SA regions (and abroad) to conduct research with generalizable results. Saudi Med J 2020; Vol. 41 (5): 524-531 doi: 10.15537/smj.2020.5.25051 How to cite this article: Alsaif FM, Alsukait SF, Alsaad AB, Alfurayh NA, Alhallaf RA, Alhaddab SA, Alotaibi HM. Publications pattern of dermatology research in Saudi Arabia. Saudi Med J . 2020 May;41(5):524-531. doi: 10.15537/smj.2020.5.25051.

Objectives: To report the corneal elevation and thickness values for Saudi myopes and to evaluate the di erences between these parameters in subgroups of this target population. Methods: Pentacam corneal topographic maps of the right eyes of patients visiting Al-Hokama Eye Clinic, Riyadh, Saudi Arabia, a tertiary eye center between January 2009 and December 2015 were retrospectively analyzed in this cross-sectional study. e patients were grouped into 3 categories based on their spherical readings: mild )-0.25 to -2.75D(, moderate )-3.00 to -5.75D(, and severe )≥-6.00D(. Furthermore, patients with cylindrical readings of ≥-1.00 diopter were categorized as having myopic astigmatism, whereas those with less than -1.00 cylindrical diopter were categorized as having simple myopia. Results: Our sample was comprised of 1,276 patients; 838 )65.7%( had simple myopia and 438 )34.3%( had myopic astigmatism. e values for the whole myopic group were as follows: anterior corneal elevation )AE( at the apex= 2.60±1.48 )standard deviation(, thinnest AE= 2.56±1.68, posterior elevation )PE( at the apex= 3.67±3.58, thinnest PE= 4.92±3.81, central pachymetry= 550.09±34.29, apical pachymetry=550.73±34.64, and thinnest pachymetry= 546.30±34.61. All of the measurements, except the apical PE and thinnest PE, were statistically significant across the simple and myopic astigmatism groups )p

To identify predictors of recurrent arteriovenous fistula (AVF) stenosis. It also seeks to calculate the average primary patency duration in Saudi patients undergoing hemodialysis.A retrospective case-control study was conducted at a tertiary care hospital in Riyadh. Data from 180 patients who had undergone angioplasty between May 2009 and May 2020 were analyzed. Following the inclusion/exclusion criteria, 99 patients were included. Based on the presence or absence of recurrent AVF stenosis, the patients were divided into cases and controls, respectively. Recurrence was defined as an occurrence of stenosis within12 months of a previous stenotic event, or patients who had3 total stenotic events. Clinical, radiological, and laboratory variables were collected and subjected to multivariate binary regression analysis to assess the odds of a recurrence of fistula stenosis.A total of 29 patients were categorized as cases, while 70 patients were categorized as controls. The median primary patency duration was found to be seven months. Multivariate binary regression analysis revealed higher levels of serum calcium (Higher levels of corrected calcium, BMI, and the application of antiplatelet therapy were found to be predictors of recurrent AVF stenosis. No other traditional variables were found to be significant.

Objectives: To report the corneal elevation and thickness values for Saudi myopes and to evaluate the differences between these parameters in subgroups of this target population. Methods: Pentacam corneal topographic maps of the right eyes of patients visiting Al-Hokama Eye Clinic, Riyadh, Saudi Arabia, a tertiary eye center between January 2009 and December 2015 were retrospectively analyzed in this cross-sectional study. The patients were grouped into 3 categories based on their spherical readings: mild (-0.25 to -2.75D), moderate (-3.00 to -5.75D), and severe (≥-6.00D). Furthermore, patients with cylindrical readings of ≥-1.00 diopter were categorized as having myopic astigmatism, whereas those with less than -1.00 cylindrical diopter were categorized as having simple myopia. Results: Our sample was comprised of 1,276 patients; 838 (65.7%) had simple myopia and 438 (34.3%) had myopic astigmatism. The values for the whole myopic group were as follows: anterior corneal elevation (AE) at the apex= 2.60±1.48 (standard deviation), thinnest AE= 2.56±1.68, posterior elevation (PE) at the apex= 3.67±3.58, thinnest PE= 4.92±3.81, central pachymetry= 550.09±34.29, apical pachymetry=550.73±34.64, and thinnest pachymetry= 546.30±34.61. All of the measurements, except the apical PE and thinnest PE, were statistically significant across the simple and myopic astigmatism groups ( p less than 0.05). Comparing the mild to moderate myopia groups revealed a significant difference in the apical AE ( p =0.037). Moreover, the comparison between the mild and severe myopia groups revealed that the apical PE and the thinnest PE, as well as the central, apical, and thinnest pachymetry values were statistically significantly different ( p less than 0.05). Conclusion: The corneal elevation indices and thicknesses specific to the Saudi myopes were found to be comparable to the international databases in terms of the elevation and thickness in some of the parameters. Saudi Med J 2020; Vol. 41 (2): 168-176 doi: 10.15537/smj.2020.2.24876 How to cite this article: Norah K. Alsaif, Eman M. Al-Sharif, Sarah K. Alsaif, Ahmed Mousa, Abdulrahman M. Al-Muammar. Corneal elevation indices and pachymetry values of Saudi myopes using scheimpflug imaging. Saudi Med J 2020; 41: 168-176. doi: 10.15537/smj.2020.2.24876

Objectives: To describe causes of blindness and visual impairment (VI) in children in Eastern province, Saudi Arabia. Methods: A record-based descriptive cross-sectional study was conducted. Medical records of patients aged 2 to 16 years who were following up in the Pediatric Ophthalmology Clinics, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia between September and December 2018 were reviewed. Causes of vision loss according to visual acuity (VA) with best correction were recorded. Blindness was defined as VA less than 20/400, VI as VA from 20/400 to 20/60, and visual loss as VA of ≤20/60. Results: Of 818 patients, 39% had visual loss, 22.9% were blind, and 71.2% had VI. Common etiologies of bilateral blindness were retinal dystrophy disease and Leber’s congenital amaurosis, whereas unilateral blindness was most common due to trauma and refractive error (RE). Common etiologies of bilateral VI were RE, esotropia, and retinal dystrophy. Unilateral VI was mainly due to RE, cataract, congenital esotropia, and trauma. Of all patients, 58.8% had treatable causes, 22.6% had preventable causes, and 19.5% had non-preventable and non-treatable causes; mostly genetic or congenital (59.7%) rather than acquired (40.2%). Conclusion: Genetic or congenital causes are major factors causing blindness. Most causes are treatable and preventable, emphasizing on early detection and treatment of those causes. Saudi Med J 2019; Vol. 40 (10): 1063-1066 doi: 10.15537/smj.2019.10.24323 How to cite this article: Alzamil WM, Alshamlan FT, Alkhaldi HM, Almubaiyd AM, Alsaif AA, Alhamad JR, Alattas RH. Causes of blindness in a pediatric age group at a tertiary healthcare center in the eastern province of Saudi Arabia. Saudi Med J 2019; 40: 1063-1066 doi: 10.15537/smj.2019.10.24323

Objectives: To raise awareness of practitioners on benign treatable conditions such as pancreatic tuberculosis (TB). Methods: A retrospective study at King Khaled University Hospital, Riyadh, Saudi Arabia of all patient charts presented with pancreatic mass for a period of 10 years (2007-2017) with a study duration of 4 years between 2013 and 2017. Patients with confirmed diagnosis of pancreatic cancer were excluded. A written ethical approval was obtained accordingly. Results: All adult patient charts were retrospectively reviewed with a pancreatic mass for a period of 10 years (2007-2017). Nine patients were identified with proven diagnosis of TB. The data were obtained based on demographic features, sign and symptoms, duration of illness, imaging, ultrasound, contrast enhanced computed tomography scan, cytology or histopathology, polymerase chain reaction, culture and follow up with anti-tuberculous therapy and samples for cytology or histology. The histological findings of granuloma with caseation or positive culture were used confirming the diagnosis of TB. All patients were immunocompetent and screened for human immunodeficiency viruses before starting anti-TB treatment. Results were negative. All patients who underwent fine needle aspiration (FNA) and endoscopic ultrasound (EUS) for suspicious pancreatic mass were provided trial of antibiotics as cases of pancreatic tuberculosis showed dramatic improvement during follow up and cured from the disease. Conclusion: The EUS and FNA are good tools to confirm malignancy and rule out benign treatable conditions like TB for any patient with a pancreatic mass suspicious for carcinoma. Saudi Med J 2019; Vol. 40 (10): 1052-1057 doi: 10.15537/smj.2019.10.24245 How to cite this article: Alsaif FA, Hassanain MM, Aljebreen AM, Alsharaabi AB, Alalem FA, Alharbi RA, Ali FA, Idriss HK, Alkhalaf OA. Pancreatic tuberculosis in immunocompetent patients. At the University Hospital in Kingdom of Saudi Arabia. Saudi Med J 2019; 40: 1052-1057. doi: 10.15537/smj.2019.10.24245

Objectives: To compare King Saud University Medical City experience in laparoscopic liver resection with our previously established database for open resections. Methods: A retrospective study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. All adult patients who underwent liver resection from 2006 to 2017 were included. Patients who had their procedure converted to open were excluded. Results: Among the 111 liver resections included, 22 (19.8%) were performed laparoscopically and 89 (80.1%) were performed using the open technique. Malignancy was the most common indication in both groups (78.5%). The mean operative time was 275 min (SD 92.2) in the laparoscopic group versus 315 min (SD 104.3) in the open group. Intraoperative blood transfusion was required in the laparoscopic (9%) and open groups (31.4%). The morbidity rate was 13.6% in the laparoscopic group and 31.4% in the open group, and the mortality rate was 0% in the laparoscopic group and 5.6% in the open group. Conclusion: Laparoscopic liver resection appears to be a safe technique and can be performed in various benign and malignant cases. Saudi Med J 2019; Vol. 40 (5): 452-457 doi: 10.15537/smj.2019.5.24086 How to cite this article: Al-Saif FA, Aldekhayel MK, Al-Alem F, Hassanain MM, Mattar RE, Alsharabi A. Comparison study between open and laparoscopic liver resection in a Saudi tertiary center. Saudi Med J . 2019 May;40(5):452-457. doi: 10.15537/smj.2019.5.24086.

Objectives: To raise awareness of practitioners on benign treatable conditions such as pancreatic tuberculosis (TB). Methods: A retrospective study at King Khaled University Hospital, Riyadh, Saudi Arabia of all patient charts presented with pancreatic mass for a period of 10 years (2007-2017) with a study duration of 4 years between 2013 and 2017. Patients with confirmed diagnosis of pancreatic cancer were excluded. A written ethical approval was obtained accordingly. Results: All adult patient charts were retrospectively reviewed with a pancreatic mass for a period of 10 years (2007-2017). Nine patients were identified with proven diagnosis of TB. The data were obtained based on demographic features, sign and symptoms, duration of illness, imaging, ultrasound, contrast enhanced computed tomography scan, cytology or histopathology, polymerase chain reaction, culture and follow up with anti-tuberculous therapy and samples for cytology or histology. The histological findings of granuloma with caseation or positive culture were used confirming the diagnosis of TB. All patients were immunocompetent and screened for human immunodeficiency viruses before starting anti-TB treatment. Results were negative. All patients who underwent fine needle aspiration (FNA) and endoscopic ultrasound (EUS) for suspicious pancreatic mass were provided trial of antibiotics as cases of pancreatic tuberculosis showed dramatic improvement during follow up and cured from the disease. Conclusion: The EUS and FNA are good tools to confirm malignancy and rule out benign treatable conditions like TB for any patient with a pancreatic mass suspicious for carcinoma.

Objectives: To assess knowledge, attitudes and practices towards the reporting of medication errors among health practitioners at King Abdulaziz Medical city in Riyadh, Kingdom of Saudi Arabia. Methods: A cross-sectional study using a self-administered questionnaire was conducted in a convenient sample of 62 physicians and 303 nurses, between June and September 2017 at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Results: The sample consisted of 365 subjects, with a response rate of 73%. Approximately 97% had sufficient knowledge and a favorable attitude (90%) towards medication error reporting. With regard to reporting practices, some participants (21.6%) preferred to educate those who made a medication error, rather than reporting it. Approximately 44.8% had not reported medication errors during their work experience. Conclusion: Study participants demonstrated a sufficient knowledge base with regard to medication error reporting. Despite sufficient knowledge and favorable attitudes towards medication error reporting, there is still an under-reporting of medication errors when it comes to practice. We recommend the establishment of frequent medication safety courses as a prerequisite for all health care providers. We also advocate the application of error detecting alarms such as digital programs to minimize medication errors. Saudi Med J 2019; Vol. 40 (3): 246-251 doi: 10.15537/smj.2019.3.23960 How to cite this article: Alsulami SL, Sardidi HO, Almuzaini RS, Alsaif MA, Almuzaini HS, Moukaddem AK, et al. Knowledge, attitude and practice on medication error reporting among health practitioners in a tertiary care setting in Saudi Arabia. Saudi Med J . 2019 Mar;40(3):246-251. doi: 10.15537/smj.2019.3.23960.

Objectives: In response to rising incidence and mortality we aimed to investigate the demographic characteristics of patients with operative breast cancer in our region. Methods : We performed a retrospective study of 224 patients who underwent surgery for breast cancer at King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia between 2005 and 2012. Results : We identified a young population overall with a mean age of 48.8±12.2 years (range: 26-93 years). Survival rate were however similar across all age groups with a 10-year overall survival of 87%. Conclusion : Patients in our study were generally younger than those with breast cancer in Western nations. However, unlike Western countries, young age was not associated with worse outcomes. Saudi Med J 2018; Vol. 39 (5): 464-469 doi: 10.15537/smj.2018.5.21993 How to cite this article: Alabdulkarim B, Hassanain M, Bokhari A, AlSaif A, Alkarji H. Age distribution and outcomes in patients undergoing breast cancer resection in Saudi Arabia. A single-institute study. Saudi Med J . 2018 May;39(5):464-469. doi: 10.15537/smj.2018.5.21993.

Objectives: To evaluate the role of applying a limited panel of immunohistochemical stains on the cellblock preparation from samples obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the aim of differentiating solid pseudopapillary neoplasms (SPNs) from neuroendocrine tumors (NETs). Methods: We retrospectively retrieved all the EUS-FNAs of the pancreas that have a diagnosis of NET or SPN that were performed at 2 tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia from May 2004 to December 2014. Diff-Quik, Papanicolaou, and Immunohistochemistry stains on cellblock preparations were performed. Results: Twenty cases were available (16 pancreatic neuroendocrine tumors (pNETs) and 4 SPNs). The pNETs were immunoreactive for synaptophysin, chromogranin A and CD56 while E-cadherin was diffusely to focally cytoplasmic positive. β -catenin was negative or showed focal cytoplasmic immunoreactivity. In comparison, SPNs were positive for vimentin, CD10, CD-56, focally positive for progesterone receptors and synaptophysin, and revealed nuclear immunostaining for β -catenin. They were negative for chromogranin A and E-cadherin. Conclusion: Based on EUS-FNA samples, nuclear immunoreactivity for β -catenin with loss of membranous immunostaining for E-Cadherin can potentially facilitate differentiating SPNs from pNETs. Saudi Med J 2016; Vol. 37 (7): 744-749 doi: 10.15537/smj.2016.7.14212 How to cite this article: Raddaoui EM, Almadi MA, Aljebreen AM, Alsaif FA, AlShedoukhy AA, Al-Lehibi AH, Almohameed KA, Tsolakis AV, AlAbbadi MA, Almutrafi AR. Differential diagnosis between pancreatic neuroendocrine and solid pseudopapillary neoplasms on endoscopic ultrasound-guided fine-needle aspiration. An immunohistochemical study. Saudi Med J . 2016 Jul;37(7):744-9. doi: 10.15537/smj.2016.7.14212.

Objectives: To develop and test the psychometric properties of an Arabic version of Fatigue Severity Scale (FSS-Ar) that can be used to measure fatigue in Arabic patients with disorders where fatigue is a major symptom. Methods: Forward and backward translations of FSS were undertaken to develop an Arabic version. The validity and reliability of the FSS-Ar was then tested on 28 patients with systemic lupus erythematosus (SLE), 24 patients with multiple sclerosis (MS), and 31 healthy subjects. Exploratory factor analysis and hypothesis testing methods were used to examine construct validity. The correlation between FSS-Ar and the vitality domain of the RAND 36-Item Health was examined to test construct validity. The study was conducted at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between February and June 2012. Results: Using a score of ≥4.05 to define fatigue, 39 of 52 (75%) participants were fatigued compared with 10 out of 31 (32%) healthy participants. The correlation between the FSS-Ar and the vitality domain of the RAND-36 was acceptable (r = -0.46). Factor analysis showed that items of the FSS-Ar measured one underlying construct, namely, fatigue. Test-retest reliability and internal consistency of the FSS-Ar was acceptable (intraclass correlation coefficient model 2,1 = 0.80; Cronbach’s alpha = 0.84). Conclusion: The Arabic version of the FSS demonstrated acceptable psychometric properties and was able to differentiate between patients with SLE or MS, and healthy subjects. Saudi Med J 2016; Vol. 37 (1): 73-78 doi: 10.15537/smj.2016.1.13055 How to cite this article: Al-Sobayel HI, Al-Hugail HA, AlSaif RM, Albawardi NM, Alnahdi AH, Daif AM, et al. Validation of an Arabic version of Fatigue Severity Scale . Saudi Med J 2016; 37: 73-8.

Objective: To test the hypothesis that identification and blockade of the intercostobrachial nerve ( ICBN) can be achieved under ultrasound (US) guidance using a small volume of local anesthetic. Methods: Twenty-eight adult male volunteers were examined at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from November 2012 to September 2013. Intercostobrachial nerve blockade was performed using one ml of 2% lidocaine under US guidance. A sensory map of the blocked area was developed relative to the medial aspect of the humeral head. Results: The ICBN appears as a hyper-echoic structure. The nerve diameter was 2.3±0.28 mm, and the depth was 9±0.28 mm. The measurements of the sensory-blocked area relative to the medial aspect of the humeral head were as follows: 6.3±1.6 cm anteriorly; 6.2±2.9 cm posteriorly; 9.4±2.9 cm proximally; and 9.2±4.4 cm distally. I ntercostobrachial nerve blockade using one ml of local anesthetic was successful in all cases. Conclusion: The present study described the sonographic anatomical details of the ICBN and its sensory distribution to successfully perform selective US-guided ICBN blockade. Saudi Med J 2015; Vol. 36 (10): 1241-1244 doi: 10.15537/smj.2015.10.11758

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery May and Thurner syndrome is a well-known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy.

Osteosarcoma OS of the talus is extremely rare, and few cases have been reported in the literature. We present a case of a 33-year-old male with painful swelling of his left ankle joint. He underwent several radiological diagnostic modalities that showed osteolytic lesion in the posterior aspect of the left talus associated with new bone formation projecting from the posterior-medial aspect of that bone. His chest x-ray showed multiple rounded lung metastases, some of them showed calcifications. Open biopsy was performed. The histopathology confirmed the diagnosis of osteoblastic OS of the talus.

The purpose of this study was to investigate the knowledge and practice of breast self-examination (BSE) among Saudi female nursing college students in Riyadh, Kingdom of Saudi Arabia (KSA).A cross-sectional study was conducted between October and December 2003. Saudi female nursing students (149) from the College of Applied Medical Sciences, King Saud University, and from the College of Nursing, King Abdulaziz Medical City, National Guard, Riyadh, KSA, constituted the study population. The questionnaire contained items on the demographic characteristics of the respondents, knowledge of breast cancer, attitudes toward BSE and questions regarding the practice of BSE. The analysis included descriptive statistics and chi-squared tests to examine the association between BSE and demographic, medical history, knowledge of BSE and attitudes toward BSE.The results of the study indicated that 66% of the sample performs BSE. Approximately 62% of those who perform BSE said they learned information regarding BSE in their college curricula. The significant relation was found between higher levels in nursing college and BSE practice. Except for age, no significant relation was found between the socio-demographic factors and BSE practice. The sample showed strong belief in nipple discharge as a causing factor of breast cancer and had significant correlation and BSE practice.Positive correlations were found between nursing students BSE practice and their academic experience in nursing college. Studies like these can enhance the knowledge regarding BSE among nurses and other medical professionals.