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Background:During the coronavirus disease 2019 (COVID-19) pandemic, the utilization of face masks was made mandatory as a protective tool. However, prolonged use of face masks increases the risk of dry eye, which affects people's visual-based activities. The Al-Baha area is a high-altitude area located in the west of the Kingdom of Saudi Arabia in the Hejaz region. As a result, residents of this region are more likely to suffer from dry eyes because of the extreme environmental conditions. Subsequently, the aim of this study is to determine the prevalence of mask-associated dry eye (MADE) and its associated risk factors among the general population of the Al-Baha area, Saudi Arabia. Materials and Methods:This is a cross-sectional study conducted using an anonymous online questionnaire composed of 56 questions. Data were collected from 480 participants in the Al-Baha area. Results:Theprevalence of MADE among the general population of Al-Baha, Saudi Arabia, was 39.2%, which is higher than the global prevalence. The risk factors for MADE include exposure to dry weather, wind, blepharitis, and ectropion. Moreover, it was determined that females were more likely to develop MADE than males; likewise, people in the age group of 16 to 25 were more likely to have MADE. Conclusion:The study shows that the prevalence of MADE in Al-Baha is comparatively higher than the worldwide prevalence, which is best explained by this area being at a high altitude. Based on the study's findings, some recommendations to guard against MADE are made to patients, the general public, and ophthalmologists.&nbsp

The role of fingerspelling as to its unique features, its use, and its function in the culture and education of the Saudi Deaf population has not been examined. Specifically, this study focuses on ...

Nanotechnology has emerged as the most popular research topic with revolutionary applications across all scientific disciplines. Tin oxide (SnO2) has been gaining considerable attention lately owing to its intriguing features, which can be enhanced by its synthesis in the nanoscale range. The establishment of a cost-efficient and ecologically friendly procedure for its production is the result of growing concerns about human well-being. The novelty and significance of this study lie in the fact that the synthesized SnO2 nanoparticles have been tailored to have specific properties, such as size and morphology. These properties are crucial for their applications. Moreover, this study provides insights into the synthesis process of SnO2 nanoparticles, which can be useful for developing efficient and cost-effective methods for large-scale production. In the current study, green Pluronic-coated SnO2 nanoparticles (NPs) utilizing the root extracts of Polygonum cuspidatum have been formulated and characterized by several methods such as UV–visible, Fourier transform infrared spectroscopy (FTIR), energy dispersive X-ray (EDAX), transmission electron microscope (TEM), field emission-scanning electron microscope (FE-SEM), X-ray diffraction (XRD), photoluminescence (PL), and dynamic light scattering (DLS) studies. The crystallite size of SnO2 NPs was estimated to be 45 nm, and a tetragonal rutile-type crystalline structure was observed. FESEM analysis validated the NPs’ spherical structure. The cytotoxic potential of the NPs against HepG2 cells was assessed using the in vitro MTT assay. The apoptotic efficiency of the NPs was evaluated using a dual-staining approach. The NPs revealed substantial cytotoxic effects against HepG2 cells but failed to exhibit cytotoxicity in different liver cell lines. Furthermore, dual staining and flow cytometry studies revealed higher apoptosis in NP-treated HepG2 cells. Nanoparticle treatment also inhibited the cell cycle at G0/G1 stage. It increased oxidative stress and promoted apoptosis by encouraging pro-apoptotic protein expression in HepG2 cells. NP treatment effectively blocked the PI3K/Akt/mTOR axis in HepG2 cells. Thus, green Pluronic-F-127-coated SnO2 NPs exhibits enormous efficiency to be utilized as an talented anticancer agent.

665 Background: Tyrosine kinase inhibitors remain a corner stone in the management of metastatic clear cell renal cell carcinoma (RCC). The intermittent schedule of sunitinib with 4 weeks on/2 weeks off could result in a rebound angiogenesis and tumor progression in the 2 weeks rest period. We propose the use of bevacizumab to alternate with sunitinib to attain continuous anti-angiogenesis during sunitinib therapy. Methods: This was a phase I/II design. Patients advanced clear cell RCC were recruited. Sunitinib was given as 50 mg daily on 4 weeks on/2 weeks off schedule. Bevacizumab was given on day 29 of each sunitinib cycle. Bevacizumab starting dose was 5 mg/kg and the dose was escalated to 10 mg if no dose limiting toxicity. Primary endpoints were response rate and progression-free survival. Results: Twenty-five patients were recruited. The study was closed prematurely because of poor accrual. No dose limiting toxicity was found on the 5 mg dose level of bevacizumab. One patient achieved complete response and 12 achieved partial response for a response rate of 52%. At a median follow up was 42.2 months (95%, confidence interval (CI) 32.9 to 51.4), the median progression-free survival was 16.5 months (95% CI 4.1-28.8), and the median overall survival was 33.3 months (95% CI 19.4-47.3). Twenty-two patients (88%) had at least one grade 3 or 4 toxicity. The commonest grade 3 or 4 toxicity was thrombocytopenia and lymphopenia each occurring at a rate of 32%, followed by hypertension at a rate of 28% followed by fatigue at a rate of 24%. Conclusions: Continuous angiogenesis blockade by adding bevacizumab to sunitinib 4 weeks on and 2 weeks break regimen in advanced RCC produce significant anti-tumor activity with manageable increased toxicity. Clinical trial information: NCT02919371 .

Background: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. Methods: We searched the medical records for cases of QFE at our cardiac center from 2009–2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. Results: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. Conclusion: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. Key points: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases. Keywords: Q fever endocarditis, Congenital heart disease, Jugular vein, Middle East

Aljohara S Almeneessier,1,2 Nada A AlYousefi,1,2 Lemmese F AlWatban,1,2 Abdulaziz A Alodhayani,1,2 Ahmed M Alzahrani,1,2 Saleh I Alwalan,1 Samaher Z AlSaad,1 Anas F Alonezan1 1Department of Family and Community Medicine, College of Medicine, King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia; 2King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Aljohara S AlmeneessierDepartment of Family and Community Medicine, College of Medicine, King Saud University (KSU), Riyadh, Kingdom of Saudi ArabiaTel +96611505274489Email aljoharas@yahoo.comBackground/Objectives: Practicing independently in an ambulatory care setting demands mastering the knowledge and skills of commonly performed minor procedures. Educational hands-on activities are one way to ensure competent family medicine practitioners. This study aims to evaluate a minor procedure workshop for family medicine trainees using the Kirkpatrick model for short- and long-term workshop effectiveness and to identify facilitators and obstacles faced by the trainees during their practices to gain procedural skills.Methods: A cross-sectional study was conducted in four-time intervals: during the workshop (pre- and post-workshop), 12 weeks after the workshop to evaluate the short-term effectiveness and change of behavior, and 12 months after the workshop to evaluate the long-term effectiveness of the workshop. Statistical Package for Social Sciences 22 was used for data analysis.Results: Forty postgraduate trainees (R1-R4) attended the workshop and participated in the survey. Overall, the workshop was accepted and highly perceived by the trainees, and the pre-workshop confidence level was lower than the post-workshop confidence level. The workshop met the expectation of 100% in obstetric and gynecological procedures workshop with 97% satisfaction rate, followed by dermatology (97.5%, 90%), orthopedic (95%, 87%), general surgery (97.5%, 84%), combined ophthalmology and otorhinolaryngology workshop (82.5%, 74%). At 12 weeks, 24 postgraduate trainees (R2–R4) responded to the survey, and low competency occurred with uncommon procedures in practice. At 12 months only 16 trainees (R3–R4) responded to the survey. Learning effect was higher as post-workshop and varied with the passage of time. Changes in the competency level were noticed, with the number of procedures performed being not statistically significant (P> 0.05).Conclusion: Practicing family medicine in an ambulatory health-care setting safely needs the mastering of minor office procedure skills. Evaluating educational workshops is important to ensure effective outcomes and identify the factors of trainees, supervisors, institutions, and patients that influence or hinder the performance of minor procedures in a family medicine clinic.Keywords: educational activity, evaluation, family practice, minor procedures, simulation

Colon cancer is one of the common cancers and a major reason for cancer-related deaths with reported metastasis to the lungs and liver. Metastasis to inguinal lymph nodes from the adenocarcinoma of the colon is very rare and needs to be managed distinctly. We present a case of moderately differentiated adenocarcinoma of colon confirmed pathologically in an elderly male patient with locally extensive malignancy with involvement of the right-sided inguinal lymph nodes.

A 38-year-old male was diagnosed with unrepaired ventricular septal defect associated with severe pulmonary arterial hypertension, cyanosis, and significant exercise intolerance. His echocardiogram showed right ventricular dysfunction and moderate pericardial effusion with no signs of cardiac tamponade. He was treated with an intensive course of inhaled iloprost and sildenafil. He showed a dramatic clinical response; his saturation went up from 60% on admission to 90% on minimal oxygen with significant improvement in his symptoms and signs of heart failure and total resolution of pericardial effusion. On follow up 3 and 6 weeks later, he was stable and could walk 360 meters in a 6 minutes walk test with disappearance of pericardial effusion. With unavailability of intravenous prostacyclin, we have shown in this case that intensive administration of inhaled iloprost could be used intensively as a rescue therapy in severe cases of pulmonary arterial hypertension with excellent results.

Objectives: Chest pain (CP) is a common cause of referral the children to Hospital. The objective of this study is to describe current magnitude, causes, rate of cardiac chest pain, associated risk factors, and what is the ideal approach for this group of patients in pediatric emergency department and cardiology unit in. Patients and methods: this is prospective hospital based cross sectional study done in Pediatric Department, King Fahad Hospital Albaha Kingdom of Saudi Arabia from Jan 2010 till Jan 2013. The patients are aged from 5 to 12 year. A chest pain protocol was performed by Pediatrician on every patient, including a detailed history, full physical examination, complete blood count, ESR, blood sugar, electrolytes, (ECG) electrocardiogram, and Echocardiography. EEG had done only for patients with positive family history of seizure disorder.?Holter ECG done for pts with significant cardiac signs, and stress ECG done only for 2 pts. Patients with sickle cell anemia, CNS diseases, trauma associated chest pain, and syndromic pts, with chest pain are excluded. Statistical analysis was performed using the Odds, Odd-ratio and 95% CI. Results: 225 patients were seen in this study. 126 pts are male (56%) and 99 female (44%). Electrocardiography (ECG) and Echocardiography were done to all pts. Holter ECG monitoring done in 10 pts (4%). Idiopathic Chest Pain is the most common cause diagnosed in 125 patients (56%), it is more common in elder pts >10 yr and it is a diagnosis of exclusion. Musculoskeletal causes account for (16 %. Pulmonary causes account for 13%. Cardiac causes, account for 15 pts. (7%), Gastrointestinal causes account for 4%. Psychological causes account for 10 pts (4%), school and family related problems are the most common psychological problems.. Conclusion: Idiopathic chest pain is the most common in children and slightly more common in males. Cardiac causes are rare. Detailed history, full clinical examination, CXR, and ECG can diagnose the majority causes. Echocardiography, Holter ECG, and EEG reserved for some cases when associated with significant cardiac or neurological symptoms and signs.