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Hassan A Alzahrani,1 Mohammad Tauheed Ahmad,2 Ziyad S Alasmari,3 Fares A Aljarallah,3 Lubna M Hafiz,3 Basim A Almasoudi,3 Ahmad A Alibrahim,3 Walid M Abd El Maksoud,1 Mohammed A Bawahab,1 Mohammed A Alsaleem4 1Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia; 3Medical Student, College of Medicine, King Khalid University, Abha, Saudi Arabia; 4Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Hassan A Alzahrani, Department of Surgery, College of Medicine, King Khalid University, P.O. Box 641, Abha, Saudi Arabia, Email hahassan@kku.edu.saBackground: Saudi Arabian population has amongst the highest prevalence of obesity globally. Apart from nutritional measures, physical activity is considered a major modifiable risk factor for the prevention of obesity and its consequences. An insight into the physical activity and awareness parameters of healthcare professionals and those in the making can provide an insight into how prepared we are to deal with the epidemic of non-communicable diseases. The aim of this study is to find out about the degree of physical activity undertaken by the medical students, faculty and staff at the College of Medicine, King Khalid University, as well as their awareness regarding physical activity guidelines.Methods: This study surveyed 300 adult participants - medical students, faculty and staff - in the College of Medicine, King Khalid University. An international validated questionnaire was used to assess the physical activity profile of participants as well as BMI parameters. Moreover, awareness and knowledge of the recommended physical activity guidelines for adults were also assessed.Results: The study participants comprised around 83% students, 9% faculty members, and 7% staff members. Around 55% of the participants were male, while the rest were female. More than 65% of participants across all categories reported low levels of physical activity, with only about 4.5% of participants across various age groups reporting high levels of physical activity. There was no significant difference by gender across the group (P value = 0.227). Only 17% of the study participants were knowledgeable of the recommended physical activity guidelines for adults.Conclusion: We found a low level of physical activity as well as inadequate awareness about the physical activity guidelines amongst our study participants. This study reiterates the urgent need for well-researched and well-funded health promoting interventions to promote physical activity, especially in the context of health professions’ education.Keywords: obesity, overweight, physical activity, physical activity guidelines

Hassan A Alzahrani Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Hassan A Alzahrani, Email hahassan@kku.edu.saBackground: Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons.Methods: This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient’s discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level.Results: An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only.Conclusion: The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.Keywords: thyroid, endocrine, surgery, postoperative, pain medication, opioid, opioid addiction

The most prevalent serial congenital defects affecting the orofacial region are cleft lip and palate. It can happen alone, in various combinations, and/or in tandem with other congenital malformations, most notably congenital cardiac conditions. They are also associated features in over 300 recognized syndromes. To attain functional and aesthetic well-being, patients with orofacial cleft deformities must receive treatment at the appropriate time and at the appropriate age. Coordinated treatment from a variety of specialities, including oral and maxillofacial surgery, otolaryngology, genetics/dysmorphology, speech/language pathology, orthodontics, prosthodontics, and others, is necessary for the successful management of a child born with a cleft lip and palate. The purpose of this article is to review what is known about cleft lip and palate among general practitioners. The current study aims to summarize and update current evidences regarding surgical management of cleft lip and palate in pediatrics. The objective is to identify clinical judgments about cleft treatment that are supported by randomised controlled trials (RCTs) and to educate parents and future mothers and fathers how to prevent the occurrence of CLP in the first place. Introduction, epidemiology, clinical characteristics, etiologic factors, and management of cleft lip and palate have all been covered in a review of the literature.

The selectivity of biocatalysts based on enzymes, eco-friendly reaction systems, and strong catalyst performance is exceptionally compelling. For improving enzyme recyclability and stability, a good option that has been proved is immobilization. For enzyme immobilization, hydrogel sodium polyacrylate combined with nanoparticles is an interesting class of support matrices as compared to others. This study synthesizes and uses the cross-linked hydrogel sodium polyacrylate-decorated gold or silver nanoparticles (HSP/AuNPs or AgNPs) as immobilized support for peroxidase and FTIR characterizes it. The novel supports immobilized system properties enhanced biocompatibility. They have attained a greater immobilization yield (91% with HSP/AuNPs and 84% with HSP/AgNPs). The rest of the immobilized peroxidase activity, after 10 recurring cycles of HSP/AuNPs was 61% and HSP/AgNPs was 54%. The remaining activity of the immobilized enzyme onto HSP/AgNPs, after storing at 4°C for 6 weeks, was 73% and HSP/AuNPs was 75% of its initial activity. It was revealed that the optimum temperature for the free enzyme and the immobilized enzyme was 50°C and 50–60°C, respectively. For the immobilized enzyme, the optimum pH is 7–7.5, as compared to the optimum pH of free enzyme pH 6.5.

Background: multiple choice questions (MCQs) test is the most popular assessment tool that used in medical schools, faculty training on construction of MCQs and peer review are the main factors that contributing to have a good quality MCQs test. This study aimed to evaluate the effect of these two factors on the quality of MCQs test. Methods: an extensive training program was conducted for the staff members who participated in teaching and assessment of undergraduate medical students of clinical biochemistry and psychiatric courses during the academic year 2020-2021. Post-test item analysis was used to compare pre-training with post-training item analysis parameters. The Chi-square test was applied, the level of significance was 5%. Results: The difficulty index showed great improvement in the number of items which lie in the acceptable range of difficulty from 16% and 25% before the training program, to 61% and 42% after the training program for psychiatry and clinical biochemistry courses respectively. This is significantly different (P0.05). No significant improvement was noticed in biochemistry course regarding this aspect. The percentage of test items where all distracters were functioning was increased from 11% to 41% in psychiatry course (P value=0.0002), and from 12% to 46%, in biochemistry course (P value=0.0001). This is a significant improvement. Reliability after the training program and peer review processes also increased in both courses. However, this is not statistically significant. Conclusions: A dramatic improvement was observed in the quality of MCQs after peer review and training program. We recommend adopting training program on construction of MCQs to be mandatory for all medical school staff members in Saudi Arabia.

Nursing is a vital component of all healthcare services and has the potential to have a significant and lasting impact on the health outcomes of an aging global population. Over time, nurses have gained additional tasks and adopted expanded roles. Thus, this review aims to review the ethical care and quality management that can be affected by nurses. By searching the literature for all published studies that are relevant to review topic up to the middle of 2022. The patient is observed to assume a passive role, while the nurse assumes a maternalistic expert role. This relationship, along with others, defines the patients' decision-making autonomy. The nurse-patient interaction should not seek to alter the patient's values and traditions, but rather place the nurse as a witness to the health and disease experience of the patient and family.

Background Thyroid surgery is one of the most common surgical procedures with typical mild-to-moderate pain postoperatively. Thus, postoperative pain control is clearly of primary concern to patients, as well as surgeons. The unnecessary use of opioid analgesics is a well-known contributing factor to opioid addiction. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus to limit the use of opioid medications as the first-line pain medications after head and neck or endocrine procedures. Thus, this study aimed to evaluate the postoperative pain control medication prescription practices of head and neck or endocrine surgeons for patients who underwent thyroid surgery. Methods This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient’s discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. Results An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients whereas 43 (41%) were discharged on paracetamol only. Conclusions The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

Background COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic. Methodology This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant. Result All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures. Conclusion Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes.

Over the past three decades, minimally invasive robotic technology has evolved substantially in urological practice, replacing many open procedures and becoming part of routine clinical practice. The Health Sector Transformation Program for the Kingdom's Vision 2030 aims to restructure the health sector and optimize its status and prospects as an effective and integrated ecosystem centered on the patient's health. Therefore, this consensus seeks to endorse the clinical practice guidelines for robotic surgery (RS) in the KSA, highlighting its effectiveness, safety, and favorable outcomes compared to open and laparoscopic surgeries in certain procedures when used by trained surgeons in well-structured RS programs.

Two methods are reported for the one-pot preparation of high concentrations of gold nanoparticles (AuNPs) embedded throughout sodium polyacrylate hydrogels; this stabilises the AuNP in even extremely high ionic strength environments, and enables them to act as effective catalysts for the hydride-reduction of nitrophenols and of dyes, with zero order kinetics.

Background With the rapid spread of coronavirus disease 2019 (COVID-19), most countries took extreme measures to control the disease. Equitable access to safe and effective vaccines is critical to ending the COVID-19 pandemic. The Ministry of Health program in Saudi Arabia aimed to cover 17.4 million adults (70% of the adult population of Saudi Arabia) by the third quarter of 2021. We investigated the impact of the COVID-19 vaccine on the clinical course and outcomes of the admitted confirmed COVID-19 patients, in comparison to non-vaccinated patients. Methodology A retrospective cross-sectional record review was conducted for all hospitalized confirmed COVID-19 patients at Dammam Medical Complex (Eastern Province, Saudi Arabia) from June to July 2021. Two groups were studied according to the vaccination status (i.e., vaccinated and non-vaccinated). Information regarding comorbidities, length of stay, high oxygen requirements, ICU admission, and mortality data were collected and analyzed using the Python programming language (version 3.7.6) with the use of SciPy library (1.4.1) and Statsmodels module (v0.11.1). Results The sample included a total of 260 admitted confirmed COVID-19 cases. The mortality was significantly lower in the vaccinated group versus the non-vaccinated group with an odds ratio (OR) of 0.378 (CI 0.154-0.928). In addition, the OR of ICU admission was 0.476 (CI 0.218-1.042) and OR of endotracheal intubation was 0.561 (CI 0.249-1.265), but these did not reach statistical significance. We also detected a statistically significant relationship between mortality - regardless of vaccination status - and age ≥ 65 years (P=0.000, OR=7.51; 95%CI 3.13 to 18.04), chronic kidney disease (P=0.010, OR=5.62; CI 1.52 to 20.79), and renal transplant (P=0.037, OR=10.17; CI 1.15 to 89.76). Of note, most of our vaccinated patients received only a single dose (85%). Conclusion There is a significant reduction in mortality cases as well as less complicated hospital courses among the vaccinated group, in spite of the fact that most of our admitted patients had only a single vaccine shot. Suboptimal response to the vaccines was observed in the elder, chronic kidney disease, and renal transplant patients, hence the poorer outcomes in comparison to other patients.

Thermogalvanic systems represent a means to convert a temperature gradient into electricity, using only redox chemistry. However, the kinetics of electron transfer and physical mass transport of the redox couples are known limitations. In this study we present self-contained gelled thermogalvanic cells (or thermocells) containing the ferricyanide/ferrocyanide redox couple, which additionally have gold nanoparticles either immobilised at the gel/electrode interface, or distributed throughout the entire gel. Both methods of introducing the gold nanoparticles result in an apparent electrocatalytic improvement, as demonstrated by significant decreases in the electron transfer resistance. However, when used as thermogalvanic cells, only minor improvements were observed in power generation, and relatively rapid dissolution of the gold nanoparticles was observed, to yield passivating gold analogues of Prussian blue. Therefore successful preparation and short-term improvements have been demonstrated, but are offset by long-term stability issues. The relatively surprising instability of the generally inert gold nanoparticles in the presence of ferricyanide/ferrocyanide, particularly under thermogalvanic conditions, is of particular note. Keywords: Thermoelectrochemistry, Thermogalvanic cells, Gold nanoparticles

Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital in Saudi Arabia. Methods : We retrospectively reviewed consecutive cases of patients undergoing RPN at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia, between January 2008 and January 2018. The study reports patient’s demographics, tumor characteristics, operative details, and perioperative outcomes, using descriptive statistics of median and range values. Results : One hundred and one patients underwent RPN during the study period. Average tumor size was 3 (1.3-6.4) cm and average radius exophytic nearness anterior/posterior location (RENAL) score was 6 (4-10). Perioperative parameters were blood loss 200 (5-1500) ml and warm ischemia time 17 (8-40) minutes, excluding off-clamp surgery in 12 (11.9%); operative time was 166 (66-381) minutes. Conversion to open partial nephrectomy occurred in 9 (8.9%) patients, major complications in 3 (3%) patients, positive surgical margins in 5 (5%) patients, and the hospital stay was 4 (2-14) days. A total of 73 (73%) patients achieved a trifecta of freedom from any complication, negative surgical margins, and ischemia time ≤25 minutes. Study limitations included the retrospective design and small cohort size. Conclusions : The initial experience of robotic partial nephrectomy was associated with a surgical outcome comparable to that reported by higher-volume centers. Saudi Med J 2019; 40 (1): 33-40 doi: 10.15537/smj.2019.1.22782 How to cite this article: Seyam RM, Alalawi MM, Alkhudair WK, Alzahrani HM, Azhar RA, Alothman KI, Al-Hussain TO, Alotaibi MF. Operative outcomes of robotic partial nephrectomy: A report of the first 101 cases from a single center in Saudi Arabia. Saudi Med J 2019; 40; 33-40.

Introduction: Constipation is a common complaint. The elderly are five times more prone to constipation than young people because of the effects of medication, immobility, and a blunted urge to defecate. Many of these patients are demented, have cognitive deficits, or suffer from a psychiatric disorder. Colonic perforation caused by hydrostatic pressure is rare, and this typically occurs during fluoroscopic studies resulting when there is excessive intraluminal colonic pressure. Self-induced colonic perforation is even rarer. Case report: We report the case of a 95-year-old man who presented to the emergency department with an acute surgical abdomen and symptoms of sepsis. He had a history of longstanding constipation. He gave a history of frequent insertion of a rubber hose into his anal canal to relieve his constipation while rinsing his anus after defecation. After resuscitation, an emergency operation was performed, and sigmoid colon perforation was found in addition to pre-existing diverticular disease. Hartmann’s procedure was performed after abdominal washout. Unfortunately, the patient died of multi-organ failure two days after surgery. Conclusion: Self-induced hydrostatic colonic perforation is rare. The consequence is fatal, especially in the elderly or in cases of delayed presentation.

This research aimed at study some of the linguistic lexical rules that were established by the pioneer of language and the Arabic lexicon, Al Khalil bin Ahmed Al- Farahidi, and which Al- Khalil included in his dictionary and referred to it in his exclusive comprehensive genius style.The study deals with the names of letters and the rooting for them in Al Khalil and those who came after him from the linguists and the dictionary Interpretation and others who devoted his knowledge and age to serve the language of the Noble Qur’an,. The study came as an analytical morphological lexical, and it is unique as far as I know regarding the general rules in Al Ain’s dictionary of Al Khalil.

The Mashreq region and, in particular, the countries of Iraq, Jordan, and Lebanon are facing major policy and fiscal challenges to growth and job creation. The Maximizing Finance for Development (MFD) approach aims to optimize the relationship between the public and the private sector.It would achieve this in two major ways: (i) maximizing the volume of investment and commercial finance that can be crowded in by effective reforms coupled with targeted deployment of scarce domestic and international public funds; and (ii) efficiency gains with extensive involvementof the private sector to expand and improve public services while minimizing the burden on the national budget and tax resources. The World Bank Group seeks, for the first time, todevelop and implement the MFD agenda based on a standardized subregional framework. This note describes the prerequisites recently put in place in Jordan for effective MFD implementation through a combined public investment management (PIM) and public-private partnership (PPP)policy framework.

Purpose Data regarding patients' perception and satisfaction about physicians providing the medical care based on their attires in Southern Region of Saudi Arabia are scarce and even lacking. The aim of this study was to assess the patients' opinion regarding the suitable attires of physicians. Materials and methods A descriptive cross-sectional survey was performed on a random sample of patients from Aseer Central Hospital, Southern Military Hospital and Abha Maternity Hospital. The questionnaire collected data on their perception of physicians' attire as well as reflection of dress on trust and willingness to discuss personal issues. Results The study included 248 patients. The majority (81.9%) of the participants agreed on the importance for physicians to wear their medical attires. Also 84.3% of them confirmed that physician's appearance is important source of their confidence. Skirt plus lab coat was the most favored for female physicians (39.3%). As for male physicians, scrub plus lab coat was the most preferred (33.6%) attire. Conclusion Patients attending hospitals in southwestern Saudi Arabia preferred for their physicians to wear formal attire with white coats, rather than the Saudi national dress. Skirt plus lab coat was the most preferred for female physicians. As for male physicians, scrub plus lab coat was the most preferred attire. Patients approved the importance for physicians to wear their medical attires and confirmed that physician's appearance is important source for their confidence. The study recommends that physicians should adopt formal attire and the institutional dress code policy should be modified to fit these preferences.

Objectives: We determined the surgical and oncological outcomes of laparoscopic nephroureterectomy (LNU) in comparison to open nephroureterectomy (ONU) and factors predicting bladder recurrence after nephroureterectomy. Methods : We retrospectively reviewed and compared the data of patients who underwent ONU or LNU for non-metastatic, upper-tract urothelial carcinoma from 2000 to 2016. The primary endpoint was to determine bladder cancer recurrence-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). The data were analysed using Student’s t-test, Chi-square test, and Kaplan-Meier curve. Results : Total of 50 patients, of which 24 had LNU and 26 had ONU, met the inclusion criteria. Median durations of follow-up were 4.2 and 6.5 years ( p =0.1070) in LNU and ONU, respectively. Operative time, blood loss and hospital stay were significantly lower in the LNU group than in the ONU group ( p =0.0001, p =0.0001, p =0.0018). Cancer-specific survival rate in the LNU was 75% and ONU was 73.3% ( p =0.1902), whereas BCRFS and CSS were not significantly different in both groups (log-rank test; BCRFS: p =0.809 and CSS: p =0.802). Patients who underwent ureteroscopy with biopsy ( p =0.001), had multifocality ( p =0.001) and previous history of (H/O) bladder cancer ( p =0.020) were at significant risk for developing bladder cancer recurrence after nephroureterectomy. Conclusion : Laparoscopic nephroureterectomy can benefit patients because of its minimal invasiveness, and oncologic outcomes are comparable to ONU. Preoperative ureteroscopy with biopsy, multifocality and previous H/O bladder cancer might be risk factors for bladder cancer recurrence. Saudi Med J 2020; Vol. 41 (1): 25-33 doi: 10.15537/smj.2020.1.24780 How to cite this article: Alothman KI, Mehmood S, Alzahrani HM, Alotaibi MF, Alkhudair WK, Eldali AM. Surgical and oncological outcome after laparoscopic versus open nephroureterectomy for non-metastatic, upper-tract urothelial carcinoma. A single-centre experience. Saudi Med J . 2020 Jan;41(1):25-33. doi: 10.15537/smj.2020.1.24780.

Background: Earlier, medical literature replicated that diet was not a proven cause of acne. Nonetheless, studies in recent years have demonstrated a relation between certain dietary factors and acne. It is uncertain whether patients are aware of recent research findings. Purposes: Acne patients were surveyed to explore beliefs concerning the relationship between diet and acne, to determine whether these beliefs translated into behavior change and to recognize health information sources. Materials and Methods: Surveys were managed to 104 acne patients at King Abdulaziz Hospital from March2016 till February 2017, with 98 completed in full and included in this analysis. Results: of the 104 questionnaires administered, 98 were completed in full and were included in the analysis. The mean age of patients was 29 years (range, 15 to 45 years); 76 were female and 22 were male. Six respondents had an under-weight BMI of less than 18; 62 respondents had a normal BMI between 18–25; 26 respondents were overweight with BMI 25–30; and 4 respondents were qualified as obese with BMI greater than 30. A majority,( 90 of 98 ) of respondents, was educated at the college level . Conclusion: In this exploratory study, patients reported utilizing a diversity of information sources, a majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/greasy foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by recent research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources among acne patients in our survey, there is a need to establish an up-to-date and reliable methods to educate patients the relationship between diet and occurrence of acne.

Background: the female pattern hair loss is the most common cause of hair loss in female, which is androgenic pattern, medical treatment such as anti-androgenic therapy and topical preparation may simply arrest progression of female pattern hair loss or in some women stimulate partial growth of hair, but the response is slow. This study aimed to determine the most common causes of hair loss among female with regard to the age, the effect of some drugs, balanced diet, average amount of hair loss per day. Objectives: this study aimed to determine the most common causes of hair loss among Saudi females. Materials and method: this was a cross sectional study of the women aged 20-50 years designed in a questionnaire form involved series of questions with multiple choices answers. It was conducted in Saudi Arabia in October 2017. The data entry was done by using Microsoft Excel, while the analysis was done by using SPSS version 23 and we used it in test correlation coefficient Spearman with measuring the mean value for all questions. Results: data were analyzed via using SPSS program, version 23 and we used it in test correlation Coefficient Spearman between Q1 AND Q9=0.146 week positive and p-value=.087 >0.05 we didn’t reject the null hypothesis. Correlation Coefficient Spearman Q23 and Q29=.008 no relation and p-value=0.927>0.05 we didn’t reject the null hypothesis. In Q3 the mean was =6.83 and Q7; the mean was =2.50. Conclusion: in KSA we found the unbalanced diet to be the most effective factor that leads to hair loss among out sample size. In the present study we need to educate the population about the importance of balanced diet for maintaining of healthy hair and skin.

More than 100 alkaloids have been found in periwinkle, of which vincristine and vinblastine are the most notable for the treatment of diseases such as leukaemia. In this study, characterization of naturally occurring Cucumber mosaic virus (CMV) infection showed mosaic, leaf deformation and stunting of plants. Viral identification was confirmed by double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) with a specific CMV polyclonal antibody and reverse transcription PCR with a specific primer for the CMV-RdRp-gene, which yielded a 513 base pair DNA fragment. The effect of CMV infection on the antineoplastic alkaloids in periwinkle leaves was determined. We also studied the effect of using plant-growth-promoting rhizobacteria (PGPR) isolates against virus infection to stimulate resistance induction in host plants. Bacillus subtilis 281 and B. pumilus 293 were examined individually (B1 and B2) and in a mixture (B1&B2) for their effectiveness against infection with CMV. The results of greenhouse experiments were confirmed by artificial mechanical inoculation. The PGPR strain treatments and results were reinforced by analysing the protein patterns as well as determining the total phenol, total flavonoid and total alkaloid contents. PGPR treatment evidently lowered the virus concentrations, the percentage of infected plants and the disease severity compared with healthy and infected controls. Seedlings treated with the B1&B2 strain mixture yielded significantly lower levels of virus infection than B1 or B2 individually in all experiments compared to controls. Our findings demonstrate the possibility of using selected Bacillus spp. strains to induce systemic resistance for CMV infection control.

Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at risk of bleeding and provide a prophylactic treatment. According to the clinical presentation, different treatment modalities, prophylactic or therapeutic, are available that span the spectrum of observation, embolization, or surgery. Renal impairment may result from extensive tumor burden or as a complication of the management itself. Improvement of diagnostic techniques, super-selective embolization, nephron-sparing surgery, and late treatment with the mammalian target of rapamycin inhibitors have provided more effective and safe management strategies. In this review, we examine the evidence pertaining to the risks imposed by RAML to the patients and identify merits and hazards associated with different treatment modalities.

Background: Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. Purpose: The purposes of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25–12.5 mg⁄kg⁄day) to 4 weeks of terbinafine (3.125–6.25 mg⁄kg⁄day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel–Haenszel method and random effects model; results were expressed as odds ratios with 95%. Results: Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporumspp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Conclusion:Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.

Introduction: Optic nerve sheath meningiomas (ONSMs) are tumors of the meninges surrounding the optic nerve, they are usually benign neoplasms. It is usually presented with vision loss, optic atrophy, and optociliary shunt vessels on fundoscopy, in patients between 30-39 years old. Although the tumors of optic nerve are considered rare, ONSMs account for nearly 30% of optic nerve intrinsic tumors. ONSMs can be associated with type II neurofibromatosis. Usually, ONSMs are not associated with any mortalities and with very little nonvisual morbidities. On the other hand, they are often associated with visual loss in the affected eye. Treatment of ONSMs also have a high risk of loss of vision, so, the goal of the management of ONSMs patients is to balance the risk of progression leading to visual loss with the risk that accompany the treatment Aim of work: In this review, we will discuss Ocular-and-dermatological-manifestations-of-neurofibromatosis. Methodology: We did a systematic search for Ocular-and-dermatological-manifestations-of-neurofibromatosis using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: ONSMs are considered difficult to diagnose and manage, due to the nature of this lesions, treatment-induced morbidity and the effect of the different lines of treatment on the vision in the affected eye. Given the variable natural history of these lesions, there will always be uncertainty around when and how to initiate treatment. Nevertheless, with earlier detection with improved imaging technology, more accurate radiotherapy delivery, and improved case selection for surgical management, it is hoped that outcomes will continue to improve for these patients. Key words: Ocular, dermatological manifestations, neurofibromatosis.

Introduction: Acute severe headache is always serious and demands care and usually patients present to to the emergency department (ED). There are many medications available, and many hazards to be avoided, both regarding the diagnosis and the management. It represents an agonizingly painful and disturbing event for the patients, families, as well as the medical team. Usually, these patients have done many methods with expert doctors to no benefit. Inpatient assessment and management could be helpful in some patients. The major diagnostic difficulties in diagnosing the cases of severe acute headache in the ED are misdiagnosis of primary headache syndromes and undiagnosed secondary causes of headache. Missing the correct diagnosis will decrease the chances of correct management. Red flags such as meningismus, fever, neurologic signs, and concurrent medical illnesses should raise the attention. Aim of work: In this review, we will discuss the most recent evidence regarding the recent approach to the emergency management of patients with headache. We will also discuss options for the management. Methodology: We did a systematic search for approach to headache in the emergency department using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles. Conclusions: Most cases of headache are evaluated in EDs have migraine, however some of them have other primary and secondary headache disorders that must be excluded. When this is performed, many medications are available to relief of headache, involving parenteral ketorolac, neuroleptic antiemetics, DHE, triptans, and magnesium sulfate. Opioids, while commonly employed, are generally less useful, and may lead to readmission to the ED. Even though most chronic headache problems could be treated in the outpatient setting, inpatient management can offer many benefits, especially in patients who are overusing medications. Intravenous DHE has good evidence for efficacy. Few commonly proposed managements plans for acute headache relief in the ED have been studied in that setting; similarly, most inpatient IV treatment protocols are not clearly established to be effective. Problems to further research include lack of funding and individual differences between refractory headache patients, making comparison studies difficult. Key words: Headache, emergency department, management.

Background: burnout in general is known as the work-related stress and it is now a major concern among health care professionals. Objective: this study aimed to estimate the prevalence of burnout among nurses in King Fahad Hospital - Al-Baha, Saudi Arabia. Methods: this was a cross-sectional study that used a modified version of Copenhagen Burnout Inventory (CBI) questionnaire. We included King Fahad Hospital - Al-Baha, SA. All nurses from all departments were eligible for the study except for ICU nurses. Results: the participated nurses had moderate levels of burnout with percentages as follow: personal burnout (58.0%), work-related burnout (51.7%) and client-related burnout (51.7%). In our sample, the emotional exhaustion was slightly higher among females with a significant P-value (P=0.019). Also, EE was more prevalent in those who were not income-satisfied. Two thirds of the nurses in our sample were satisfied with their income. Conclusion: our study indicated high prevalence of burnout among nurses and high-income satisfaction while, marriage represented a strong protective factor against burnout in nurses. Keywords: Al-Baha, Saudi Arabia, King Fahad Hospital, burnout, nurses, emotional exhaustion, income satisfaction.

Introduction: The eye is a fascinating organ for several reasons. It is not only have a composite structure, however it is considered an immune-privileged organ. The anatomy of the eye is composed of the anterior and posterior parts, the line of division is posterior to the lens. The anterior chamber lies within the anterior segment and is an immuneprivileged anatomical location, this is due to the fact that the T-cell response in this area is suppressed This protects the eye from potentially destructive immune attacks however it also makes defence against infectious agents challenging, particularly where T-cell responses are critical for immunological defence. Viruses could get into the eye by direct inoculation, or through haematogenous or neuronal spread. The diagnoses of viral eye infections are usually clinical one, helped by taking a thorough history and performing ophthalmic examination. But in challenging cases the lab tests are essential. In this review, we will discuss the most recent evidence regarding Causes and management of viral eye infection Aim of work: In this review, we will discuss the most recent evidence regarding Causes and management of viral eye infection Methodology: We did a systematic search for Causes and management of viral eye infection using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: A wide range of of viruses can affect the eye and cause viral eye infections, either as a primary infection or reactivation. Some affect the eye directly while the others indirectly but may still manifest with eye disease. One virus may affect several parts of the eye, while different viruses may cause the same eye disease. This could complicate the clinical diagnosis of viral eye disease, but the lab tests like PCR and antibody tests could assist in challenging cases where there may be diagnostic dilemma. The HIV epidemic has had an huge impact on ophthalmology clinics, this is because the virus can cause different eye diseases, and the associated decrease in cell-mediated immunity makes the person highly susceptible to opportunistic viral eye infections, sometimes with severe morbidity. There could be other viruses that may affect the eye that we did not discuss. Key words: Causes, management, viral eye infection.

Background: In the last three eras, the incidence of renal cell carcinoma (RCC) has increased, due to increased radiological studies. The expected 5-year survival rate has become better, associated with the identification of small size renal masses. However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies. Objectives: The objective was to report the trends of clinical presentation, peri-operative, oncological outcomes, and surgical management trends for RCCs over the period. Methods: After Institutional Review Board approval, a retrospective study for adult patients was conducted, who presented with renal mass and were managed between 2008 and 2019. Variables, including demographics, perioperative and pathological outcomes analyzed using descriptive statistics for continuous variables reported as mean ± standard deviation and categorical variables values compared by Chi-square test. Survival Analysis calculated using the Kaplan-Meier method. The level of significance is set at P-value < 0.05. Results: A total of 588 patients underwent surgical treatment for kidney cancer from January 2008 to January 2019. 237 (40.30%) were females and 351 (59.69%) males. The clinical presentation was higher as an incidental diagnosis of 58.67%. 71.25% of patients were from outside Riyadh city. Pathology was mostly clear cell RCC 61.22% and grade 2 (57.48%). Tumor size, surgery time, and length of hospital stay showed a significant difference between the three periods (both P > 0.05). Robotic surgery performed more than open (P < 0.0001). There was no significant difference in the survival time, when compared to patients by the regions and when compared by the primary tumors (Log-Rank P = 0.4821). Patients from the Riyadh region (median = 54.0) had a significantly higher recurrence time (Log-Rank P < 0.0001). Conclusion: There was a rising trend in the incidence of RCC associated with comorbidities and incidental diagnosis. In our study period we found increase in the trend of minimal invasive approach. The size of the tumor, blood loss and operative time decreases over the period of time. The Robotic assisted nephrectomy approach has become increased over the period of time duration in present study.

Highlights • Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia is extremely rare. • The diagnosis of Neuroendocrine tumor in a such emergency situation is a real challenge. • Treatment of the hernia defect in a such condition is interesting., Amyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported. We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5 cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip. An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition.

Background: The goal of this study was identification signaling molecules mediated the formation of AGEs in brain of rats injected with CdCl2 and the role of camel whey proteins and Brassicaceae extract on formation of AGEs in brain. Methods: Ninety male rats were randomly grouped into five groups; Normal control (GpI) and the other rats (groups II-V) were received a single dose of cadmium chloride i.p (5 μg/kg/b.w) for induction of neurodegeneration. Rats in groups III-V were treated daily with whey protein (1g/kg b.w) or Brassicaceae extract (1mg/kg b.w) or combined respectively for 12 weeks. Results: It was found that whey protein combined with Brassicaceae extract prevented the formation of AGEs and enhance the antioxidant activity compared with untreated group (p

Cervical thymic cysts (CTCs) are unusual lesions, representing only 1% of cystic cervical masses. Diagnosis of this condition in adults is even rarer. We report a 34-year-old female who presented with asymptomatic progressively growing left-sided neck swelling. Neck ultrasound (US) showed a large cystic lesion with septation, compressing the ipsilateral vessels. Magnetic resonance imaging (MRI) confirmed the US findings. Surgical excision was performed which subsequently showed findings consistent with CTC. CTC in adult is extremely rare, with few reported cases identified in the literature. Thymic gland anomalies in the neck are the consequences of an arrest in the descent of the gland, sequestration of the thymic tissue, or failure of involution. The diagnosis of this condition is rarely done prior to surgical excision. The clinical presentation, radiologic imaging, surgical findings, and histologic appearance are all essential components to make the correct diagnosis of this very rare differential diagnosis of cystic lateral neck swelling.

Objectives To evaluate the changing management of sporadic renal angiomyolipoma and renal angiomyolipoma associated with the tuberous sclerosis complex (TSC) during the past 16 years. Methods We retrospectively reviewed the charts of 60 patients with angiomyolipoma seen at our institutions. Results The median age at presentation was 45 years (range 7-78). The presentation was pain in 30 patients and hematuria in 13; it was incidentally discovered in 17 patients. Of the 60 patients, 43 were females. TSC was present in 14 patients. The median tumor size was 4 cm (range 0.3-40, mean 6.5 ± 1.1). Of the 60 patients, 31 were followed up expectantly. Surgery or intervention was needed for 29 patients to control hemorrhage or relieve pain or because of the suspicion of malignancy. Of these 29 patients, 12 underwent nephrectomy, 11 partial nephrectomy, and 6 embolization. The patients treated for hemorrhage had a median tumor diameter of 11 cm (range 2-21). Patients were followed up for a mean of 39.3 ± 5.4 months. The lesions grew an average of 4.7 ± 3.4 cm for TSC tumors and 0.6 ± 0.2 cm for sporadic angiomyolipoma tumors. None of the patients developed renal impairment. Patients with TSC presented at a younger age, had larger and bilateral lesions, and were more symptomatic during follow-up. In the past 6 years, a significant trend was seen toward finding tumors in asymptomatic patients and toward the use of conservative or interventional (embolization) treatment. Conclusions Renal angiomyolipoma has a slow growth rate. The preservation of renal function was noted in all our patients. A recent shift was noted toward finding smaller tumors in asymptomatic patients and the use of conservative and interventional treatment.

Patient Female, 68 FINAL DIAGNOSIS: Gallbladder agenesis with situs inversus totalis Symptoms: Epigastric pain • jaundice Medication - Clinical Procedure: - Specialty: Surgery. Objective Rare disease. Background Situs inversus totalis is an inherited condition characterized by the mirror-image transposition of thoracic and abdominal organs. Gallbladder agenesis, which has normal bile ducts, is a rare congenital condition that occurs in 13 to 65 people out of 100 000. A common bile duct (CBD) stone or choledocholithiasis in patients with gallbladder agenesis is even rarer. Case report We report the case of a 68-year-old woman who presented with epigastric pain and jaundice. She was not known to have situs inversus totalis. Abdominal ultrasound showed a large stone in the CBD, which could not be extracted by endoscopic retrograde cholangiopancreatography (ERCP), necessitating exploration. The gall-bladder and cystic duct were found to be absent. Incisional exploration of the CBD was performed, and a large stone was removed. A choledochoscope was used to identify the remnants and exclude the presence of ectopic gallbladder, and a T-tube was placed into the CBD. Conclusions Gallbladder agenesis in a patient with situs inversus totalis is extremely rare, with no single reported case identified in the literature. In addition, our case showed a rare complication of ERCP - a failure to extract the CBD stone - and illustrates a way to overcome this complication.

Background: Road traffic accidents (RTAs) are not frequently because of ignorance but are because of carelessness, thoughtlessness, and overconfidence, and it can lead to permanent disability. Hence, it is very important to determine the students’ attitude and knowledge toward the road traffic regulation in Saudi Arabia. Objectives: The objectives of this study were to assess the knowledge, attitudes, and practices of male students at the Health Science College in Taif University, Taif, KSA, toward road traffic regulations. Materials and Methods: This study was performed during the second semester of the academic year 2013 among the students studying at the Health Science College for Boys in Taif University, Taif, KSA. A questionnaire of 18 different questions was distributed to all available students and asked to respond under the direct supervision of the heads of the four departments of the college. The questionnaire consisted of three main parts: the first was about the sociodemographic and scientific data of the students; the second on the knowledge of road traffic regulations; and the third dealt with the attitudes of driving and the use of seat belts. Results: One hundred twenty students participated in this study. The mean age of the participants was 21 years; 30% lived in cities, and 60% and 100% had cars and driving licenses, respectively. More than half of the students had been involved in RTAs; 83.3% of these had been injured in these RTAs and 41.6% admitted to hospital for an average of 11 ± 1.3 days. High speed was the main cause of their RTAs. The percentage of knowledge of road traffic regulation was moderate in more than 90% of the students, while more than 85% of them believed in the importance of the use of seat belts. Conclusion: This study revealed that many students had been involved in RTAs as a result of driving at high speed. Most of the students had good attitude toward the use of seat belts.