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Fahd Al Qahtani,1 Adel Abdelaziz2,31Radiology Department, Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia; 2Medical Education Development Unit, Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia; 3Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, EgyptAbstract: Fulfilling the goal of integrating radiology into undergraduate medical curricula is a real challenge due to the enduring faith assuming that traditional medical disciplines are worthy of consuming the available study time. In this manner, radiology is addressed occasionally and with relevance to these traditional disciplines. In Al-Baha University Faculty of Medicine, Al-Baha, Saudi Arabia, efforts have been made to integrate radiology vertically and in a structured manner into the undergraduate curriculum from the first year to the sixth year. For achieving convenient integration of radiology, a triphasic approach to integration is adopted. This approach consists of the integration of radiology foundations into the basic sciences phase, development of a distinct 4-week module in year 4, and finally, integration of clinical applications of radiology in the clinical phase modules. Feedback of students and inferences obtained through assessment and program evaluation are in favor of this approach to integration. Minor reform and some improvement related to time allocated and content balancing are still indicated.Keywords: radiology foundations, radiology module, students assessment

Background: Burnout syndrome (BOS) is a syndrome characterised by high emotional exhaustion with depersonalisation and low professional accomplishment associated with the workplace. It is well known that working in the healthcare industry significantly increases stress and psychological fatigue rates. Objective: To explore the prevalence of BOS and its associated factors among healthcare professionals in Saudi Arabia. Methods: In this cross-sectional study, 385 healthcare professionals out of 809,533 were randomly surveyed. The questionnaire had three components: sociodemographic data, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool to assess BOS, and questions about personal, work-related and health status information. Results: Most of the 450 participating professionals were males and were married (66.2% and 75.8%, respectively). Precisely, 42.4% of the participants had high emotional fatigue, 42.4% experienced high depersonalisation, and 33.8% showed low personal accomplishment. Females, younger age groups, nurses, those with fewer years of experience, those with on-call duties, those with increased daily working hours, those with sleep difficulties, those who are exercising, and those experiencing high discrimination and harassment were associated with the development of burnout syndrome. Conclusion: It is essential to establish multidimensional and diversified therapies to decrease the incidence of BOS syndrome and its effect on healthcare.

Awad Mohammed Al-Qahtani,1 Ibrahim Ahmed Shaikh,2 Mohammed Ashique K Shaikh,3 Basheerahmed Abdulaziz Mannasaheb,4 Faisal Saeed Al-Qahtani5 1Department of Family and Community Medicine, College of Medicine, Najran University, Najran, Saudi Arabia; 2Department of Pharmacology, College of Pharmacy, Najran University, Najran, Saudi Arabia; 3Pharmacy Services Division, Najran University Hospital, Najran, Saudi Arabia; 4Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh, 13713, Saudi Arabia; 5Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Awad Mohammed Al-Qahtani, Department of Family and Community Medicine, College of Medicine, Najran University, Najran, Saudi Arabia, Tel +966 530540450, Email awadresearch17@gmail.comBackground: Self-medication (SM) is a customary practice around the globe. Appropriate SM comes with many advantages, yet irrational SM is a concern and could lead to adverse drug events and poor health outcomes.Methods: This college-based cross-sectional study was carried out from January to March 2021 among Najran University undergraduate medical students to investigate the prevalence and practice of, and attitudes towards SM. Data were collected using a bilingual self-administered online questionnaire, which was categorized into sections, such as socio-demographic details, attitude towards SM, and practice of SM during the last six months, along with students’ opinions and suggestions regarding SM. The three-item scale was used to assess the students’ attitude. IBM SPSS was used to perform the cross-tabulation, chi-squared test, and binary logistic regression.Results: Overall, 205 undergraduate medical students (58.6%) responded to the survey. The overall prevalence of SM was 60%, of which 25% used antibiotics as SM drugs. Headache (65.9%), fever (30.2%), cold/flu (31.2%), and gastric acidity (28.3%) were common illnesses for which SM was sought, using analgesics and NSAIDs (52.7%), antipyretics (13.7%), and antacid (12.7%) medications. Among the reasons for SM, the illness being minor and quick relief were frequently reported. To rationalize and improve the practice of SM, about half (48.3%) of the students suggested spreading awareness and education regarding the implications of SM and dispensing the medications with prescriptions (46.8%).Conclusion: Overall, the attitude towards SM was satisfactory. The prevalence of SM during the last six months was 60%, and antibiotics were used by 25% of students. A significant negative correlation was observed between attitudes towards and practice of SM. Although medical students of Najran University displayed responsible behavior towards SM, efforts should be made to educate them about the adverse consequences of SM, especially with antibiotics.Keywords: self-medication, students, practice, prevalence, Saudi Arabia

Background: Helicobacter pylori (H.pylori) plays an important role in gastroduodenal disease. However, there are few data concerning the epidemiology of H.pylori in patients with chronic renal failure and on hemodialysis (HD) treatment. Aim of the study: This study is aimed to determine the epidemiology of H.pylori infection in patients with end stage renal disease (ESRD) on Hemodialysis (HD). Patients and Methods: Ninety-six patients with dyspeptic complaints were included in the study. They were divided into two groups; group one consisted of 46 patients with ESRD on HD and group two (control) of 50 patients without renal disease. All patients were subjected to upper gastrointestinal endoscopies, and gastric biopsies were obtained for histological evidence of H. pylori infection. Results: The mean age of both groups was similar. The prevalence of H.pylori among the two groups was not significantly different (45.7%Vs48%=p>0.05). The prevalence of duodenal ulcers was significantly higher in H.pylori positive than in H.pylori negative ESRD patients (p< 0.05). GERD was significantly lower in H.pylori positive patients in both groups (p< 0.001 and p< 0.01 respectively). Conclusion: This study showed a similar prevalence of H.pylori infection in both groups. H.pylori infection in patients with ESRD is probably associated with increased risk of gastroduodenal lesions

Transcatheter pulmonary valve implantation (TPVI) is a surgical alternative for correcting dysfunctional right ventricular outflow tract in previously operated patients. MyVal transcatheter heart valve (THV) (Meril Life Sciences, India), a new transcatheter valve designed for aortic position has recently been reported to be implanted in pulmonary position. Myval transcatheter valve were implanted in patients with stenosed dysfunctional conduits, severe regurgitation from transannular patch or dysfunctional surgical pulmonary valves (Bioprosthesis). Procedural details and post-TPVI follow-up were analysed. Myval TPVI was used in Fifty three patients with median age of 15 years (IQR 12-19.5 years). Almost sixty percent of the patients were male, with a median weight of 50 kg (31-63 kg). Prestenting was used in more than 80 percent of patients (n = 45 patients), while 6 patients had a prior surgical valve implantation. After Myval TPVI implantation, the peak instantaneous gradient across the RVOT decreased from a median of 23.5 mmHg (IQR 10-53 mmHg) pre-procedure to 10 mmHg (IQR 5-16 mmHg) post-procedure. The median fluoroscopy time for the procedure was 35 min (IQR 23.5-44 min). The large sizes-mainly the 29-mm and 32 mm Myval (Navigator, Meril Life Sciences Pvt Ltd, India), were the most used size in 40% (n = 22) of the cases each. The median contrast volume used during the procedure was 247 mL (IQR 120-300 mL). Patients were followed for a median period of 360 days (IQR 164-525 days). At the last clinic follow-up, there was no tricuspid valve regurgitation. Moderate neo-pulmonary valve regurgitation was reported in three cases. Early experience of TPVI with MyVal is encouraging with procedural success in all patients and acceptable mid-term outcomes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Traumatic brain injuries (TBIs) associated with maxillofacial fractures (MFFs) are a public health concern worldwide, especially among adult-aged males. There is an urgent need for early detection of associated TBIs in patients with MFFs during the initial assessment and treatment stage to reduce morbidity and mortality. The objective of the present study was to systematically review the literature to determine specific MFF situations associated with TBIs and to identify the factors associated with TBIs in patients with MFFs. The protocol was developed in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020155912. Overall, of 26,774 patients recorded, 13,667 patients (51.04%) sustained MFFs with an associated TBI. The male to female ratio was 4.8:1. RTA was the most common cause. The most common TBIs were concussions, contusions, and closed brain injuries. Within the limits of this study, it was concluded that TBI-related MFFs should be suspected whenever maxillary or mandibular bone fractures occur, especially among adults, males, and people with injuries caused by RTAs and assaults. There is a need to increase the awareness of maxillofacial surgeons on the possible associations of combined maxillofacial trauma and brain injuries., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There are no studies that have assessed advanced glycation end products (AGEs) and interleukin 17A (IL-17A) levels in whole saliva (WS) of patients with dental implants. The aim was to compare levels of AGEs and IL-17A in WS and peri-implant clinical and radiographic status of patients with and without osteoporosis at 6-years' follow-up., Methods: Osteoporotic (Group-1) and systemically healthy controls (Group-2) having undergone dental implant therapy at least 5 years ago were included. A questionnaire was used to collect information about age, gender, duration and treatment of osteoporosis, number and duration of implants in function, and frequencies of toothbrushing, flossing and hygiene visits. Modified bleeding and plaque indies (mBI and mPI), peri-implant probing depth (PD) and crestal bone loss (CBL) were recorded. WS was collected and levels of AGEs and IL-17A were determined using enzyme linked immunosorbent assay. Sample-size estimation was done and statistical analyses were doing using the independent t- and Wilcoxon rank-sum tests. Statistical significance was marked for P-values that were below 0.01., Results: In patients with (n = 24) and without (n = 27) osteoporosis, implants were in function for 6.3 ± 0.27 and 6.6 ± 0.5 years, respectively. There was no significant difference in peri-implant mBI, PD, mPI and CBL in both groups. Levels of AGE in patients with (119.6 ± 26.5 μg/ml) and without (91.5 ± 14.6 μg/ml) osteoporosis were comparable. Levels of whole salivary IL-17A in patients without and with osteoporosis were 4.6 ± 0.3 and 5.1 ± 0.8 pg/ml, respectively. Flossing of full mouth interproximal spaces once and twice daily toothbrushing daily was reported by 100% patients with osteoporosis. Among patients with osteoporosis 75% and 25% individuals were receiving professional dental prophylaxis every 4 and 6 months, respectively., Conclusion: Within the limitations of the present study osteoporotic patients are not at an increased risk of peri-implant diseases and can demonstrate salivary AGE and IL-17A levels comparable to non-osteoporotic individuals as long as oral hygiene is stringently maintained., (© 2022. The Author(s).)

Background: The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges., Consensus Panel: A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy., Consensus Findings: Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference., Conclusion: Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia., Competing Interests: Conflict of interest None declared., (© 2022 Saudi Heart Association.)

Objectives: The transition of patients from one setting to another increases the risk of medication errors (MEs). This study aims to assess the implementation of pharmacy intern-led transition of care (TOC) service and to demonstrate its impact on the quality of patient care., Method: A prospective interventional pilot study was carried out from August 2020 to April 2021 at an academic hospital in Saudi Arabia. The TOC team consisted of three pharmacy interns and one pharmacist-in-charge. Daily activities included medication reconciliation, discharge counseling, and follow-up call after 3 days of discharge. The identified discrepancies were categorized according to the National Coordinating Council for Medication Error Reporting Program., Key Findings: A total of 182 patients were included in the analysis. During medication reconciliation, 102 discrepancies were detected, with an average of 0.7 discrepancy per patient. The most common discrepancy at admission and discharge was omission (41.7% and 70%, respectively). Category B was the most frequent and accounted for 46% at admission and 93% at discharge. Around 39% of TOC beneficiaries received a follow-up call, and all reported a high level of satisfaction with the service., Conclusion: Involving the pharmacy team in TOC activities was effective in identifying discrepancies and resolving MEs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Disclosure. All authors have approved the final article and declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Kawasaki disease is an idiopathic medium-sized vasculitis that occurs primarily in infants and children younger than 5 years of age. Atypical Kawasaki disease applies to patients who do not fulfill the complete criteria of fever of 5 days or more with at least four of five features: bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, extremity changes, and polymorphous rash. Acute kidney injury is defined as a sudden decline in kidney function within hours, including structural injuries and loss of function. Acute kidney injury is extremely common in hospitalized pediatric patients. However, it is rarely documented in Kawasaki disease. Acute kidney injury is underestimated in Kawasaki disease due to the lack of a clear definition of age-specific normal serum creatinine levels and routine renal functions. This report describes a case who presented with clinical features suggestive of atypical Kawasaki disease and developed acute kidney injury., Case Presentation: A 2-year-old Saudi girl had a history of high-grade fever for 5 days, moderate dehydration, dry cracked lips, poor appetite, and generalized erythematous rash; therefore, she was diagnosed to have incomplete Kawasaki disease. Laboratory investigations revealed normochromic normocytic anemia, leukocytosis, thrombocytosis, high inflammatory markers, and acute kidney injury stage III. An echocardiogram showed a 4-mm dilatation on the left main coronary artery and a 3-mm dilatation on the right. A renal biopsy was not performed to identify the cause of the injury as it showed improvements after the start of the specific therapy for Kawasaki disease; intravenous immune globulin at a dose of 2 g/kg, aspirin at a high dosage of 80 mg/kg/day, and prednisolone at 2 mg/kg. In addition to the acute kidney injury management, normal saline boluses were followed by furosemide at a 2 mg/kg dose. Her urine output increased, and her renal functions normalized. She was discharged in good condition after 10 days., Conclusions: It is valuable to check renal function tests in a confirmed case of Kawasaki disease to reduce the negative consequences of late acute kidney injury discovery. Early detection and intervention make a substantial difference in acute kidney injury management., (© 2022. The Author(s).)

Competing Interests: There are no conflicts of interest.

Background: Familial hypercholesterolemia (FH) is a lipid disorder caused by pathogenic mutations in LDLRAP1 gene. The present study has aimed to deepen our understanding about the pathogenicity predictions of FH causative genetic mutations, as well as their relationship to phenotype changes in LDLRAP1 protein, by utilizing multidirectional computational analysis., Methods: FH linked LDLRAP1 mutations were mined from databases, and the prediction ability of several pathogenicity classifiers against these clinical variants, was assessed through different statistical measures. Furthermore, these mutations were 3D modelled in protein structures to assess their impact on protein phenotype changes., Results: Our findings suggest that Polyphen-2, when compared with SIFT, M-CAP and CADD tools, can make better pathogenicity predictions for FH causative LDLRAP1 mutations. Through, 3D simulation and superimposition analysis of LDLRAP1 protein structures, it was found that missense mutations do not create any gross changes in the protein structure, although they could induce subtle structural changes at the level of amino acid residues. Near native molecular dynamic analysis revealed that missense mutations could induce variable degrees of fluctuation differences guiding the protein flexibility. Stability analysis showed that most missense mutations shifts the free energy equilibrium and hence they destabilize the protein. Molecular docking analysis demonstrates the molecular shifts in hydrogen and ionic bonds and Van der waals bonding properties, which further cause differences in the binding energy of LDLR-LDLRAP1 proteins., Conclusions: The diverse computational approaches used in the present study may provide a new dimension for exploring the structure-function relationship of the novel and deleterious LDLRAP1 mutations linked to FH., (© 2020 John Wiley & Sons, Ltd.)

Thalassemia (Thal) is an inherited blood disorder endemic to the Mediterranean and Middle East (e.g., KSA and UAE). This disease is caused by defects in the synthesis of one or more hemoglobin chains in red blood cells (RBCs). Alpha (α) Thal is caused by a reduced or absent alpha globin segment. Similarly, beta (β) Thal is caused by a defect in the beta globin segment. We divided the diseases into four groups: α Thal trait, α Thal disease, β Thal trait, and β Thal disease. The α or β Thal traits are milder variants of these diseases and do not require treatment; but β Thal disease (and to a lesser extent, α Thal) causes hemolytic anemia, splenomegaly, and bone deformities and requires repeated lifelong blood transfusions. This paper presents results regarding the identification of Thal variants using fluorescence spectroscopy of blood biomolecules and atomic force microscopy analysis of the morphologic features of red blood cells. The combined results provide new insights into the characteristics of these diseases. Furthermore, this study shows why β Thal disease subjects are often transfusion-dependent, and α Thal disease subjects are only occasionally transfusion dependent., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Diabetes mellitus (DM) is a common metabolic disease indicated by high sugar levels in the blood over a prolonged period. When left untreated, it can lead to long-term complications, such as cardiovascular disease, stroke, and diabetic retinopathy or foot ulcers. Approximately 415 million people (about 8.3% of the world's population) had diabetes worldwide in 2015, with 90% of the cases classified as Type 2 DM, which is caused by insulin resistance that arises mostly from being overweight and from a lack of exercise. DM affects every part of the body, including the erythrocytes. The aim of the present report is to gain insight into the damage done to the erythrocytes of patients classified with pre-diabetes and diabetes (plenty are found in the Kingdom of Saudi Arabia, a country where young people encompass a large segment of the population). The study presents results on the morphological analysis of erythrocytes by atomic force microscopy (AFM) and molecular investigations by fluorescence spectroscopy (FS). Our results indicate significant differences (in the morphology, size, and hemolytic end products) between the erythrocytes of diabetic patients (HbA1C, glycated hemoglobin, levels of 8⁻10%) and normal controls. It is well-known that DM and smoking are two major contributory factors for cardiovascular diseases (CVDs), and our observations presented in this study suggest that diabetes plays a relatively less damaging role than smoking for CVD.

Brugada syndrome is a rare arrhythmogenic disease with characteristic electrocardiogram (ECG) findings. Fever represents an important triggering factor. We report the case of a 4-year-old Saudi boy who was diagnosed with Lemierre syndrome and subsequently developed Brugada syndrome.

Transcatheter aortic valve replacement (TAVR) emerged as a promising alternative to surgical aortic valve replacement (SAVR) in extreme-aged patients with severe aortic stenosis (AS). Data on the outcomes of TAVR or SAVR in nonagenarians are limited. The Nationwide Inpatient Sample was used to identify patients aged 90 years or older who underwent TAVR or SAVR from 2004 to 2013. In-hospital morbidity and mortality were assessed. From 2004 to 2013, 9,066 (national estimate) nonagenarians underwent aortic valve replacement. After the introduction of TAVR, most nonagenarians were treated with TAVR (76%) compared with SAVR (24%). A total of 1,847 nonagenarians who underwent SAVR (n = 1,152) or TAVR (n = 695) were included in the analysis. In-hospital mortality was similar between patients who underwent SAVR (6.4%) compared with TAVR (6.5%; p = 0.29). Vascular complications were more common after TAVR (11.9% vs 6.3%, p <0.001), whereas blood transfusion (46.2% vs 33.7%, p <0.001), and acute kidney injury (25.8% vs 20.4%, p = 0.009) were more common after SAVR. Pacemaker implantation and stroke rates were similar between the 2 groups. In a propensity-matched analysis of 630 patients who underwent isolated TAVR (n = 315) or SAVR (n = 315), in-hospital mortality was similar for (6.0% for SAVR vs 7.9% for TAVR, p = 0.35). SAVR was associated with higher rates of acute kidney injury (24.1% vs 16.8%, p = 0.02) and blood transfusion (46.0% vs 35.2%, p = 0.001), whereas TAVR was associated with increased rates of vascular complications (10.2% vs 6.0%, p = 0.07). Stroke (4.1% vs 4.1%, p = 0.99) and pacemaker implantation rates were also similar (13.0% vs 9.2%, p = 0.12) between the TAVR and SAVR groups, respectively. In conclusion, in nonagenarians, both SAVR and TAVR can be performed with acceptable in-hospital outcomes. Referral for aortic valve replacement in these patients should not be precluded based on age alone., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Usher syndrome (USH) is an autosomal recessive disorder divided into three distinct clinical subtypes based on the severity of the hearing loss, manifestation of vestibular dysfunction, and the age of onset of retinitis pigmentosa and visual symptoms. To date, mutations in seven different genes have been reported to cause USH type 1 (USH1), the most severe form. Patients diagnosed with USH1 are known to be ideal candidates to benefit from cochlear implantation., Methods: Genome-wide linkage analysis using Affymetrix GeneChip Human Mapping 10K arrays were performed in three cochlear implanted Saudi siblings born from a consanguineous marriage, clinically diagnosed with USH1 by comprehensive clinical, audiological, and ophthalmological examinations. From the linkage results, the USH1G gene was screened for mutations by direct sequencing of the coding exons., Results: We report the identification of a novel p.S243X truncating mutation in USH1G that segregated with the disease phenotype and was not present in 300 ethnically matched normal controls. We also report on the novel retinal findings and the outcome of cochlear implantation in the affected individuals., Conclusions: In addition to reporting a novel truncating mutation, this report expands the retinal phenotype in USH1G and presents the first report of successful cochlear implants in this disease.