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Sensory overload is the feeling of over-stimulation that may lead to increased anxiety and panic in individuals with psychiatric disorders such as autism, post traumatic stress disorder, etc. Understanding visual processing is crucial to enhancing our treatments for disorders where sensory overload is a symptom. How do changes in internal states such as stress or hunger alter visual processing? This project aims to explore how visual processing is affected by signaling in the hypothalamus, an area of the brain regulating changes in internal states and stress. Preliminary studies revealed there are a number of neurons projecting from the lateral area of the hypothalamus to the visual cortex. We want to understand the specific location, identity, and neural circuits of these neurons. Visual cortex neurons were retrogradely traced to identify which inputs originate from the hypothalamus, and the geographical location of these cells was mapped out. The molecular identities of these projection neurons was further explored using specific RNAScope probes to check if those cells are expressing any of four genes most commonly expressed in the hypothalamus: Gal, Crh, Hcrt, and Pmch. This exploration will help us understand the type of signals communicated from the hypothalamic nuclei to the visual cortex to modulate visual processing.

Purpose The objective of this study was to explore the ambience of professionalism related to academic integrity among undergraduate dental students. Methodology “Dundee Polyprofessionalism Inventory I: Academic Integrity” was used to collect responses from first-year to fifth-year dental students of the College of Dentistry, King Saud University (Response rate = 78%). The participants’ responses (for 34 professionalism lapses) were recorded by using the Dundee Polyprofessionalism Inventory. Statistical analysis included descriptive statistics, Chi-square, and T-tests (P Results The “Ignore” sanction was not opted for any of the 34 professionalism behaviors, and there was unanimous agreement between the participants in considering all 34 behavior statements to be “wrong”. Male and female participants were found to opt for a similar sanction as the median for 16 statements (47%), whereas, for 18 statements (53%), their responses differed with a range of levels 0.5 to 1.5. Preclinical- and clinical-year student responses also showed similarities in their 11 statements (32.3%), and they did differ for 20 statements (58.8%). Interestingly, clinical year respondents were overall on the stricter side of recommending sanctions. Conclusions For the majority of the dental students tested, there was a good understanding of the significance of some lapses of professionalism associated with academic integrity. Some of the disclosures in this study were substantially appreciable because none of the students selected “ignore” sanction for any of the survey statements. We found that using the Dundee Polyprofessionalism Inventory for learning and understanding academic professionalism among dental students is useful.

To develop, validate, and evaluate machine learning (ML) algorithms for predicting mastectomy skin flap necrosis (MSFN).MSFN is a devastating complication that causes significant distress to patients and physicians by prolonging recovery time, compromising surgical outcomes, and delaying adjuvant therapy.We conducted comprehensive review of all consecutive patients who underwent mastectomy and immediate implant-based reconstruction (IBR) from January 2018 to December 2019. Nine supervised ML algorithms were developed to predict MSFN. Patient data were partitioned into training (80%) and testing (20%) sets.We identified 694 mastectomies with immediate IBR in 481 patients. The patients had a mean age of 50 ± 11.5 years, a mean body mass index of 26.7 ± 4.8 kg/m2, and a median follow-up time of 16.1 (range, 11.9-23.2) months. MSFN developed in 6% (n=40) of patients. The random forest model demonstrated the best discriminatory performance (area under curve, 0.70), achieved a mean accuracy of 89% (95% confidence interval [CI], 83-94%), and identified 10 predictors of MSFN. Decision curve analysis demonstrated that ML models have a superior net benefit regardless of the probability threshold. Higher BMI, older age, hypertension, subpectoral device placement, nipple-sparing mastectomy, axillary nodal dissection, and no acellular dermal matrix use were all independently associated with a higher risk of MSFN.Machine learning algorithms trained on readily available perioperative clinical data can accurately predict the occurrence of MSFN and aid in individualized patient counseling, preoperative optimization, and surgical planning to reduce the risk of this devastating complication.

OBJECTIVE: The aim of this study was to investigate the prevalence of metabolic syndrome (MS) among dentists in Riyadh, Saudi Arabia. The study also explored the causes of occupational stress among the participating dentists. MATERIALS & METHODS: The participants included a conveniently selected sample of dentists (N = 126; Males = 65; Females = 61). The participants’ anthropometric measurements/blood sample analysis were carried out and they completed a self-administered questionnaire. Data analysis included demographics, gender/age wise comparison using SPSS (p 0.05) were observed for cholesterol, triglycerides and HDL. However, significant difference (p = 0.00) was found for the fasting glucose level (Males = 5.69±1.49; Females = 4.94±0.42). Overall mean scoring (3.00±1.11) for the stress showed that the participants fall into the average/moderate level of stress category (Males = 3.16±1.02; Females = 2.83±1.08). Almost two third (68.26%) of the participant’s responded that they were under some kind of stress. CONCLUSIONS: MS was found to be less frequent among the dentists working in the city of Riyadh. Overall, the dentists were under moderate level of occupational stress, with male dentists being more prone to work related stress.

Objective: Deterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related. Methods: A prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months. Results: LVEF decreased from 62 ± 5% at baseline to 58 ± 7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF

Objective: The use of Electronic Nicotine Delivery Systems (ENDS) is increasing rapidly. However, its discoloring effect on dental restorations is not known. This study aimed to evaluate the effect of ENDS aerosol when compared to conventional cigarette smoke (CS) on the color stability of dental ceramic (DC) and resin composite (RC). Methods: This research project was conducted from November 2018 to May 2019. In this study 30 discs each for DC and RC materials were fabricated to be equally divided into groups of exposure to CS, ENDS aerosol and storage in distilled water (No smoke; NS) respectively (n=10). Specimens were exposed for a total of 7 days, with a rate of 10 cycles per day, each cycle represented 10 puffs. The color change was assessed using the CIELAB color space, by calculating ΔE. Data was analysed using ANOVA and multiple comparisons test. Results: Ceramic specimens in CS (2.422 ± 0.771) and ENDS (2.396 ± 0.396) groups showed comparable ΔE (color change) (p=0.992). Similarly, composite specimens in CS (42.871 ± 2.442) and ENDS (46.866 ± 3.64) groups showed comparable ΔE (p>0.05). NS specimens in both composite and ceramic samples showed lower ΔE than CS and ENDS specimens respectively. Conclusions: Aerosol from Electronic nicotine delivery systems (ENDS) showed similar discoloration levels as cigarette smoking (CS). The level of discoloration for ceramic samples for both ENDS and CS was below clinically perceptible levels (Mean ΔE < 2.5). Discoloration of composite resin due to CS and ENDS was visually perceptible (Mean ΔE > 4.0). doi: https://doi.org/10.12669/pjms.36.5.2303 How to cite this:Vohra F, Andejani AF, Alamri O, Alshehri A, Al-Hamdan RS, Almohareb T, et al. Influence of electronic nicotine delivery systems (ENDS) in comparison to conventional cigarette on color stability of dental restorative materials. Pak J Med Sci. 2020;36(5):993-998. doi: https://doi.org/10.12669/pjms.36.5.2303 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Summary:. Preserving a dynamic abdominal wall is the premise behind the evolution of TRAM flaps into deep inferior epigastric perforators (DIEPs). Performing a true DIEP flap requires a highly refined surgical technique and often times involves a tedious intramuscular dissection which may account for the slow, albeit steady adaptation of DIEPs in breast reconstruction. This article intends to address a scenario in which an additional perforator from a different row is needed. Based on our current knowledge of the abdominal wall and its embryology, we propose splitting the rectus abdominis muscle through the intersections while recruiting a second perforator instead of converting the procedure into MS-TRAM or performing a second anastomosis through the perforator exchange technique, APEX. This potentially saves time and simplifies the procedure while maintaining the integrity of the abdominal wall.

Frontal sinus enlargement has been classified into hypersinus, pneumosinus dilatans and pneumocele. A young male presented with aesthetic concerns regarding his forehead swelling. The patient had no functional disturbances. Radiographic assessment proved expansion of the frontal sinus with extreme thinning of the frontal bone. The causes of frontal sinus expansion have been listed along with a proposed management plan for each type. If blockage is suspected, functional endoscopic sinus surgery can alleviate the blockage. Open surgery is indicated when the element presents as an aesthetic concern. Obliteration of the sinus is indicated with NF obstruction. And reshaping of the anterior table is the mainstay to correct the enlargement. Frontal sinus enlargement regardless of the cause can be tackled using well known principles. We believe that every plastic surgeon should have a basic understanding of frontal sinus enlargement and its management. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Highlights • Triceps nerve-to-deltoid nerve transfer requires the identification of the axillary nerve. • We describe a new technique of identification of the axillary nerve. • Anatomical landmarks are used first. • The ultrasound probe then identifies the cutaneous branch of axillary nerve. • During surgery, the cutaneous branch is followed to the axillary nerve., Introduction Triceps nerve-to-deltoid nerve transfer requires the identification of the axillary nerve in the quadrilateral space. This may be difficult especially for residents-in-training. The senior author is a Professor of Hand Surgery at a teaching institution and has devised a new technique of identification of the axillary nerve and its cutaneous branch using surface land-marks and on-table ultrasonography. Case report The axillary nerve and the quadrilateral space is first identified using anatomical landmarks. The ultrasound probe is the used to identify the quadrilateral space and the axillary nerve which appears as hyper-echoic oval-shaped structure. The ultrasound probe is then moved to scan the cutaneous branch of the axillary nerve as it branches-off the main nerve trunk. Finally, the cutaneous branch is traced superficially till it becomes subcutaneous. This point is marked and the skin incision is made along this marked point. During surgery, the cutaneous branch is followed retrograde to the axillary nerve in the quadrilateral space. Discussion Ultrasound guidance for localization of various nerves is now routinely done by anesthetists in the Operating Room. This localization is used for nerve blocks and in patients with brachial plexus injuries. Hence, the ultrasound machine and the expertise are already available in the operating room; and no special arrangements with the Radiology Department are needed. Conclusion A technique of identification of the cutaneous branch of the axillary nerve using anatomical landmarks and ultrasonography is described. The localization is accurate and is of help in patients undergoing triceps nerve-to-deltoid nerve transfer.

Background Van Den Ende-Gupta Syndrome (VDEGS) is an extremely rare autosomal recessive syndrome with less than 20 reported families (approximately 40 patients) in the worldwide literature. Case presentation We have assessed one consanguineous Saudi family with typical features of VDEGS. Two siblings were affected with almost identical features; including blepharophimosis, arachnodactyly, flexion contractures of the elbows, camptodactyly, slender ribs, hooked lateral clavicular ends, and bilateral radial head dislocations. Both patients had several unusual features; including joint laxity, flat feet, recurrent patellar dislocations, and bilateral short distal ulnae. Full sequencing of SCARF2 revealed a homozygous mutation c.773G > A (p. Cys258Tyr) in both affected children. The parents (both with no abnormalities) were heterozygous for the same mutation. Conclusion Joint laxity, recurrent patellar dislocations, and short distal ulnae should be included as part of the clinical spectrum of VDEGS.

Background:. A literature review did not reveal any study investigating the prevalence of depression among plastic surgery residents. Methods:. We conducted a cross-sectional mail survey and included all Saudi Plastic Surgery residents in our local program in Saudi Arabia. The Beck Depression Inventory II was used. Results:. The inventory showed that mild, moderate, and severe depressive symptoms were prevalent in 20.6%, 38.2%, and 11.8%, respectively. Junior residents were more prone to depression. Conclusions:. The high prevalence rate of depression among plastic surgery residents is alarming, and further studies are warranted. The problem has received no attention in the plastic surgery literature.

To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS).Data were collected prospectively in an observational study through evaluations at two tertiary academic institutions, i.e. St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada, and King Fahd Medical City, Riyadh, Saudi Arabia, from December 2006 to December 2009. A 2-page evaluation form was developed in conjunction with the Objective Assessment of Technical Skills Surgery (OSATS) evaluation form developed by Reznick et al in Toronto to assess residents' surgical skills. A Likert scale (1-5 where 5 = excellent) was used for evaluations. The Global Rating of Endoscopic Surgical Skills (GRESS) evaluation instrument was designed with input from academic otolaryngologists, fellowship-trained rhinologists, and experts in medical education. The experts' comments were incorporated, establishing face and content validity. Residents from various levels of training were assessed objectively using this instrument. Internal consistency was evaluated using Cronbach's alpha. Test-retest and inter-rater reliability was measured using intra-class correlation.A total of 31 assessments were completed by 15 residents. GRESS showed high reliability in the context of internal consistency (alpha = 0.99), test-retest (0.95, CI = 0.83-0.98), and inter-rater reliability (0.86, CI = 0.31-0.98).This pilot study demonstrated that GRESS is a valid and reliable assessment tool for operating room performance.

Background: Tie-over dressing is an established method of fixation of skin grafts in areas of body where immobilization is difficult toprevent hematoma and seroma formationin addition to avoid shearing motion of the graft. Traditionally, using multiple silk sutures does this. This is a one-time procedure and refixation is difficult if we need to repeat the procedure. Methods: We assessed our initial experience with a repeated tie-over dressing method using cap and collar of normal saline bottles used for irrigation and silk suture threads infourpatients over the anterior chest wall. These patients underwent recurrent keloid excision with reconstruction by skin graft and postoperative radiotherapy. After the graft is applied on the floor, tie-over stitches are taken and paraffin gauze is applied over with adequate padding; the tie-over sutures are passed through the collar and the cap is tightened over it to complete the dressing. The cap can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. Results: The skin graft take in all the patients was complete without any seroma or hematoma. An innovative tie-over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation, is reported here.

The age standardized rate of head and neck cancer in the Kingdom of Saudi Arabia (KSA) is 5.7% with nasopharyngeal cancer (NPC) accounting for40% of all head and neck cancers. This study intends to compare age specific incidence of NPC in KSA and other countries.Data from the National Cancer Registry for KSA during the period 1994 through to 1996 was compared with data from the World Health Organization International Agency for Research on Cancer (ARC) in Singapore, China, Kuwait and Canada.There were 373 diagnosed Saudi patients with NPC with high incidence among the young population, with 42/373 (22 males/20 females) patients in the first 20 years of life, showing a sharp increase both in boys and girls until the ages of 12-14 years. From that point the incidence curve for both males and females separates. In females the incidence flattens without an identifiable zenith from the age of 12-14 years and above, compared with their male counterpart where they have another peak in the fifth decade.Our study indicates a definite early onset of this malignancy in KSA and a similar pattern to that of China and Singapore. Definite increased incidence, at a young age among both sexes, suggests a possible underlying genetic susceptibility in Saudis.

A diagnosis of cancer can be devastating for patients and their loved ones. We compared the intensity of anxiety and depression for 30 terminally ill cancer patients and 30 chronically ill patients and the quality of life of their most attendant caregivers. Hamilton depression and anxiety scales were used with the patients and the quality of life scale [family] was used with the caregivers. Cancer patients and their caregivers had significantly higher scores on these scales and suffered more from depression and anxiety than chronically ill patients and caregivers. Cancer patient caregivers also had poorer quality of life than did caregivers of the chronically ill.