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Mohammed S Almizani,1 Manar A Alotaibi,1 Modhi F Bin Askar,1 Nuha M Albaqami,1 Reema S Alobaishi,1 Mostafa A Arafa,2,3 Mohammad I Jumaa4,5 1College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia; 2Kingdom of Saudi Arabia; 3High Institute of Public Health, Alexandria University, Alexandria, Egypt; 4Anatomy Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia; 5College of Medicine, Al-Azhar University, Assiut, EgyptCorrespondence: Mohammed S Almizani, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), 6889 Ibn Rashiq, King Faisal District, Riyadh, Kingdom of Saudi Arabia, Tel +966 532314692, Email M7mdsajdi@gmail.comBackground: In both the preclinical and clinical sciences, anatomy is considered as the foundation of medical education. Anatomy education serves as a foundation for clinical application and future practice of medicine. Health practitioners and students are interested in the adequacy of anatomical knowledge in clinical years since it has a direct impact on medical education and professional clinical practice.Objective: To examine the opinions and attitudes of medical students and clinicians regarding the preclinical and clinical years’ teaching of anatomy and anatomical knowledge to medical students.Methods: Participants in the study, including clinicians and medical students, were required to answer an 8-question, 5-point Likert scale questionnaire to assess their attitudes regarding anatomical knowledge. The maximum score was 40, and the higher the score, the more the positive attitude towards anatomical knowledge. The difference in the mean attitude score between males and females was investigated using the Independent sample t-test.Results: A total of 327 clinicians and 423 students participated in the study. Clinicians and students showed moderately high positive attitude towards anatomical knowledge. The mean statements score for clinicians’ attitudes was 31.4(± 3.4). There was no significant difference between total attitude score means for clinicians and students, p=0.83. Attitude statements attained a significantly higher percentages and were in favor to clinicians in comparison to students, particularly for clinical significance of anatomical knowledge to students in the clinical years, the importance of anatomical knowledge to surgical and non-surgical specialties, and re-teaching special anatomy for students in the clinical years would improve their clinical background. Both clinicians and students expressed low agreement regarding anatomical educational style and quality of study materials.Conclusion: Teaching anatomy to medical students is a continuous process. Therefore, we recommend reforming the anatomy curriculum by vertical integration of anatomy into the clinical rotations, clerkship, and specialist training.Keywords: anatomy, medical education, clinicians, students, Saudi Arabia

Mohammad I Jumaa,1 Safaa M Hanafy,1 Mostafa A Arafa2,3 1Anatomy Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia; 2The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3High Institute of Public Health, Alexandria University, Alexandria, EgyptCorrespondence: Mohammad I Jumaa, Assistant professor, Anatomy Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), P.O. Box: 7544 – Othman Bin Affan Road Al-Nada, Riyadh 4233-13317, Riyadh, Saudi Arabia, Tel +966542253151, Email migomaa@imamu.edu.saBackground: Due to the COVID-19 pandemic, medical education has gone online. Human anatomy is a three-dimensional subject that requires a clear understanding of the relationships between structures through the study of human cadavers, microscopic samples, and models.Objective: This study aimed to examine the attitudes and perceptions of students regarding teaching anatomy before and after the lockdown period and ways of improving the challenges they faced.Methods: This cross-sectional study was conducted at AL Imam University School of Medicine. Structured surveys were designed to understand students’ attitudes and opinions towards offline versus online teaching of anatomy and suggestions to improve the online teaching process.Results: The mean attitude scores for the conventional lectures, seminars, and practical sessions were significantly higher. Students expressed positive attitudes towards the three teaching modules. Students agreed that themes related to computer skills and technical Internet infrastructure (71.55%) and administrative procedures (61.74%) are essential for improving the online teaching process.Conclusion: Conventional learning is the main target of student learning. Improvements in computer skills, technical Internet infrastructure, learning resources, staff communication, examinations, and development of blended learning will enrich the learning process, especially during the impending challenges.Keywords: online learning, anatomy, COVID-19, challenges

Introduction: Today, effective treatments are increasingly available to cancer patients to improve their survival and quality of life. However, both radiotherapy and chemotherapy are known to damage reproductive organs and compromise patients' fertility. Hence, sperm cryopreservation performed before starting therapy is an attractive option for male patients. The objective of this study was to assess the level of awareness and the views about this option among oncologists from Saudi Arabia.Methods: Oncologists from three different regions of the country were invited to participate in this study, which consisted of a self-administered questionnaire to test their knowledge, perception and referral practices regarding sperm cryopreservation.Results: Survey response was 57%. Only half of the participating oncologists knew about the technique of intracytoplasmic sperm injection, while less than 20% referred their patients to a fertility specialist. On a scale of 1 (not important) to 10 (very important) the oncologists rated sperm cryopreservation to be 7.8 +/- 1.8. Factors that were considered important before recommending this option were: type of cancer, age of patient, number of children, marital status and cost. Surprisingly, religion was not perceived as an important factor.Conclusions: Despite a general lack of knowledge about the available fertility management options for cancer patients, the oncologists appeared to have a favorable attitude towards sperm banking.Implications For Cancer Survivors: Improving awareness among oncologists would lead to more referrals to fertility specialists and thus benefit cancer survivors and their families. [ABSTRACT FROM AUTHOR]

As nursing has been previously identified as a stressful occupation, sources of job stress and levels of job satisfaction were extensively investigated. However, studies addressing issues of nurses' mental health are scarce. This work aims to assess psychological well-being of nurses in different job settings in Alexandria and to identify sociodemographic, psychosocial and workplace predictors. A total sample of 412 nurses represented nurses working in five different health organizations in Alexandria. A self-administered questionnaire was used to collect sociodemographic, occupational and health data, and the Standardized Arabic Version of General Health questionnaire (GHQ-30 items), Job Descriptive Index (JDI), and Social Support Scale (SSS) were also used. Results revealed that 21.67% of nurses recorded moderate to severe psychological symptoms on GHQ. Fewer years of experience, negative family and friend support, and negative total work satisfaction were found to be significant predictors of psychological ill health among nurses in a descending rank order. Implications for nursing intervention will be discussed. [ABSTRACT FROM AUTHOR]

Background: Neuroanatomy is essential to clinical neurosciences and is one of the most difficult components of the anatomy curriculum. Flipped classrooms are one of the pedagogical approaches that have been found to enhance students' abilities and encourage in-depth learning. The current study aims to assess the attitudes and effects of flipped classrooms on neuroanatomy teaching among medical students compared to traditional classrooms., Methods: A quasi-experimental study was carried out during the period January through June 2023. The effectiveness of teaching neuroanatomy in flipped classrooms versus traditional classrooms was assessed using formative assessment and a pre-designed structured questionnaire. The questionnaire was composed of four sections assessing different domains on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree)., Results: The total sample reached 214 students. Most students' attitude statements covering skills, knowledge and learning process, and length of time were significantly in favor of flipped teaching at the expense of traditional teaching. Then mean examination grades were significantly higher for pre-test flipped and post-test flipped in comparison to pre-test and post-test traditional examination., Conclusions: Although the flipped classroom is an effective method of learning neuroanatomy as compared to traditional classes, it faces some challenges in its implementation. Such challenges need awareness and solutions from educational institutions., (© 2024 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Introduction A quasi-experimental study was conducted to assess students' attitudes toward the flipped practical classroom and evaluate its effectiveness in teaching practical anatomy. Methods Two survey questionnaires were developed: the first assessed students' attitudes toward flipped practical classrooms, while the second focused on the obstacles and difficulties students might encounter in this learning environment. Results We found that students rated flipped learning significantly higher compared to other teaching methods, particularly in terms of the quality of learning materials, enhancement of learning skills, engagement and understanding of anatomy topics, and problem-solving abilities. The highest mean examination grades were observed for the pretest flipped modality, followed by the pretest small group discussion (mean scores: 82.72 vs. 54.46, F = 43.2, P = 0.004). Conclusions Students hold positive attitudes toward flipped classrooms and small group discussions compared to traditional classes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of the Faculty of Medicine, Imam Mohammed bin Saud Islamic University issued approval 367/2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jumaa et al.)

Acute poisoning in children is a major public health problem worldwide. Children poisoning ranks among the top unintentional injuries in children aged less than four years. This paper aimed to describe the pattern and characteristics of acute poisoning incidents, estimate the percentage of medication poisoning among those children and highlight the possible risk factors. All children aged below 10 years admitted to Alexandria Poison Centre (APC) with acute poisoning from the July 1, 2022, to December 31, 2022, were included in the study. A pre-designed structured interviewing questionnaire was used to collect data: socio-demographic data of the poisoned child and his/her caregiver, medical history of the poisoned child and family members, history of previous poisoning incidents in the family, details of the poisoning incident including causative agent, route of poisoning, scene of poisoning, time interval to reach APC and the first aid done.  350 children admitted to APC were included in our study, of which 59% (n=208) of poisoned children were males with mean age 3.14 ± 2.28 years. The types of poisoning found were 46.6% chemical compounds, 31.4% medication, 18% household and 4% food poisoning. Most of the children were poisoned orally. High education of caregiver, urban residence and the presence of chronic disease within a family member were significantly associated with medication poisoning while low education of caregiver, drug addiction, having chronic disease among a family member and the presence of previous poisoning accident in the family were significantly associated with poisoning with chemical compounds. The study found that acute poisoning is more common among young male children in Alexandria; the chemical compounds came first as the main source of poisoning followed by the medication poisoning., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the High Institute of Public Health issued approval 28622. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abd El-Aziz et al.)

Objectives: The aims of the study were to construct a new prognostic prediction model for detecting prostate cancer (PCa) patients using machine-learning (ML) techniques and to compare those models across systematic and target biopsy detection techniques., Methods: The records of the two main hospitals in Riyadh, Saudi Arabia, were analyzed for data on diagnosed PCa from 2019 to 2023. Four ML algorithms were utilized for the prediction and classification of PCa., Results: A total of 528 patients with prostate-specific antigen (PSA) greater than 3.5 ng/mL who had undergone transrectal ultrasound-guided prostate biopsy were evaluated. The total number of confirmed PCa cases was 234. Age, prostate volume, PSA, body mass index (BMI), multiparametric magnetic resonance imaging (mpMRI) score, number of regions of interest detected in MRI, and the diameter of the largest size lesion were significantly associated with PCa. Random Forest (RF) and XGBoost (XGB) (ML algorithms) accurately predicted PCa. Yet, their performance for classification and prediction of PCa was higher and more accurate for cases detected by targeted and combined biopsy (systematic and targeted together) compared to systematic biopsy alone. F1, the area under the curve (AUC), and the accuracy of XGB and RF models for targeted biopsy and combined biopsy ranged from 0.94 to 0.97 compared to the AUC of systematic biopsy for RF and XGB algorithms, respectively., Conclusions: The RF model generated and presented an excellent prediction capability for the risk of PCa detected by targeted and combined biopsy compared to systematic biopsy alone. ML models can prevent missed PCa diagnoses by serving as a screening tool., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background: Accurately identifying aggressive prostate tumors and studying them as a separate outcome are urgently needed. Nomogram is a predictive tool using an algorithm, it has been widely applied in clinical practice to predict prognosis. We aimed to develop and internally validate a nomogram predicting clinically significant prostate cancer (csPCa)., Methods: Data were retrieved from the records of the two main hospitals in Riyadh, during the period 2019-2022. Significant variables associated with csPCa cases were used to develop and internally validate a novel nomogram, utilizing the C index, and calibration curves. Decision curve analysis (DCA) was used to assess its clinical utility., Results: Prostate imaging reporting and data system (PI-RADS), smaller prostate volume, and prostate-specific antigen (PSA) > 10 ng/mL were significantly associated with the risk csPCa, respectively. The model developed by the nomogram showed an excellent accuracy for csPCa discrimination, as indicated by area under the curve (0.83), and calibration curves. DCA showed that our model was superior and surpassed all other models with a larger net benefit for various threshold probabilities. Based on our model, at a probability threshold of 30%, biopsying patients is the equivalent of a strategy that led to an absolute 5% reduction in the number of biopsies without missing any csPCa., Conclusion: The developed nomogram consisting of PI-RAD, total PSA, and prostate volume showed a robust predictive capacity for csPCa before prostate biopsy that may be valuable for clinical judgment to prevent needless biopsy. Yet, the small percentage (5%) of yielded unnecessary biopsies that could be saved by using such a model, cast an important question on its merit and clinical applicability., (© 2023 Wiley Periodicals LLC.)

Infectious diseases trigger fear and anxiety among patients leading to disturbance in psychological health of patients. Psychological symptoms were found during SARS-COV-1 epidemic which raise the curiosity about their presence with SARS-COV-2 infection. The current study aimed to estimate the prevalence and severity of psychiatric disorders (depression, anxiety, and stress) among COVID-19 patients and their associated significant predictors. A cross-sectional study was conducted among 382 patients infected with COVID-19 in South Sinai governorate, Egypt, during the period June 2021 through January 2022. Patients with positive PCR test for COVID-19 were included if no more than 6 months have passed after being isolated in the hospital or at home. The patients were being contacted after being cured from COVID-19. The Arabic version of the Depression Anxiety Stress was used to assess the psychological status of patients. Multivariate linear regression analysis was done to detect the predictors of psychiatric symptoms among patients. A total of 382 participants with mean age of 41.5 ± 15.0 years old, of whom 72.5% were males were included in the study. 91.6% of participants had all the three studied psychological disorders; depression, anxiety and stress with most of participants had either severe or extremely severe conditions (13.9 and 75.7 for anxiety, 22.8 and 46.3% for depression, 38.5 and % 19.6 for stress, respectively). Healthcare workers had higher prevalence rates of depression, anxiety and stress. In bivariate analysis, educational level, HCWs and visiting healthcare facility were significantly affecting DASS scores. In linear regression analysis, hospital admission was the main predictor of the three psychological disorders. In Conclusion, majority of patients affected with COVID-19 suffered from symptoms of anxiety, depression and stress within six months after being infected. Hospital admission was found to be the main predictor of the presence of psychiatric disorders with prolonged recovery time from COVID-19 infection. More attention should be paid to COVID-19 patient's mental health as psychological care and presence of psychiatric in the isolation hospitals should be considered., (© 2023. The Author(s).)

Background: Prostate cancer screening with prostate-specific antigen (PSA) can result in unnecessary biopsies and overdiagnosis. Alternately, PSA density (PSAD) calculation may help support biopsy decisions; however, evidence of its usefulness is not concrete., Objective: To evaluate the predictive value of PSAD for clinically significant prostate cancer detection by systematic and MRI-targeted biopsies., Methods: This prospective study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2018 and November 2021. Patients suspected of prostate cancer were subjected to multi-parametric MRI, and for those with positive findings, systematic and targeted biopsies were performed. Clinically non-significant and significant prostate cancer cases were classified based on histopathology-defined ISUP grade or Gleason score. The PSAD was measured using the prostate volume determined by the MRI and categorized into ≤0.15, 0.16-0.20, and >0.20 ng/ml 2 subgroups., Results: Systematic and targeted biopsies were carried out for 284 patients. The discriminant ability of PSAD is higher in MRI-targeted biopsy compared with systematic biopsy (AUC: 0.77 vs. 0.73). The highest sensitivity (97%) and specificity (87%) were detected at 0.07 ng/ml 2 in targeted biopsy. More than half of the clinically significant cases were detected in the >0.2 ng/ml 2 PSAD category (systematic: 52.4%; targeted: 51.1%). The CHAID methodology found that the probability of having clinically significant cancer (CSC) in patients with PSAD >0.15 ng/ml 2 was more than threefold than that in patients with PSAD ≤0.15 ng/ml 2 (64% vs. 20.2%). When considered by age, in PSAD ≤0.15 ng/ml 2 subgroup, the percentage of CSC detection rate increased from 20.2% to 24.6% in patients aged ≥60 years., Conclusion: PSAD has good discriminant power for predicting clinically significant prostate cancer. A cutoff of 0.07 ng/ml 2 should be adopted, but should be interpreted with caution and by considering other parameters such as age., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Saudi Journal of Medicine & Medical Sciences.)

Introduction: The current practice of offering fertility preservation (FP) counseling and treatment has become one of the focal points in patient care throughout cancer treatment. The turning point was the approval of the Council of Senior Religious Scholars four years ago to freeze tissues from the ovarian membrane, the entire ovary, and the eggs for later use in reproduction to preserve the offspring. Thus, we aimed to assess any development in oncologists' knowledge, attitude, and referral practices regarding FP in Saudi Arabia., Methods: This is a cross-sectional survey using a self-administered questionnaire. We assessed oncologists' opinions on the importance of FP, their perception of the patient's preferences, and factors to consider when discussing the subject. Then, we assessed the knowledge and referral practices, including the timing of referral before starting cancer treatment., Results: Most oncologists showed good knowledge and positive attitudes toward FP; however, their referral practices could be better. Most were familiar with FP options. The most significant factors influencing the oncologist-patient FP discussion were the number of existing children, marital status, cost, and type of cancer (96.6%, 76.7%, 65.7%, and 58.9%, respectively)., Conclusions: There is a significant improvement in the knowledge and attitude of oncologists toward FP. However, patients' counseling and referral to fertility services still need to be improved. There is a shortfall in the clinical practice guidelines for FP in cancer patients in Saudi Arabia. The implementation of clinical practice guidelines would enhance FP. However, patients' counseling and referral to fertility services still need to be improved. The lack of proper guidelines on FP is affecting oncologists' practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Arafa et al.)

Objectives: To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia., Method: The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24., Results: Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively., Conclusions: Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.

Objectives: To evaluate Hem-o-Lok polymer clips' feasibility, safety and cost-effectiveness in controlling the splenic pedicle during paediatric laparoscopic splenectomy., Method: The prospective study was conducted from May 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised children of either gender aged <18 years who had benign haematological diseases and were indicated for laparoscopic splenectomy. During the procedure, Hem-o-Lok clips were used for controlling the splenic pedicle. Patients were encouraged to ambulate the same day, and the drain was removed 24hours postoperatively. The cases were followed up for three months postoperatively., Results: Of the 23 subjects, 11(47.8%) were boys and 12(52.2%) were girls. The overall mean age was 8.74±3.44 years (range: 4-15 years). There were 6(26%) cases of spherocytosis, 1(4.3%) immune thrombocytopenic purpura and 16(69.6%) with thalassemia major. The mean operative time was 93.43±29.87 minutes(range: 65-180 minutes). There was no conversion to open splenectomy and no mortality. There were 2(8.7%) cases of minor and 1(4.3%) of major intraoperative bleeding. All the 3(100%) cases were controlled laparoscopically. No postoperative bleeding occurred and no cases required postoperative blood transfusion., Conclusions: Controlling both the splenic artery and vein using Hem-o-Lok clips was found to be feasible, safe and cost-effective.

Background: Diabetes represents a chronic disease characterized by hyperglycemia. Several changes in the renal functions had been detected in diabetic patients., Aim of the Work: This study was conducted to compare the possible ameliorative role of both ginger and Echinacea either alone or in combination upon experimentally induced diabetic nephropathy., Materials and Methods: Sixty adult male albino rats were used in this study. Rats were divided into three groups. Control (group I) included 20 rats. Diabetic group (group II) included 10 rats. Group III included 30 rats subdivided into three subgroups 10 animals each: Subgroup IIIa diabetic treated with 100 mg/kg Echinacea for 30 days. Subgroup IIIb diabetic treated with 400 mg/kg ginger for 30 days orally. Subgroup IIIc diabetic treated with both 100 mg/kg Echinacea and 400 mg/kg ginger for 30 days orally. Hemotoxylin and eosin staining, Periodic acid Schiff and Masson trichrome were done. Ultrastructural examination was done. Immunohistochemical markers used were caspase-3 for apoptosis and CD68 for macrophages. Morphometric and statistical analyses were done., Results: Diabetes caused a significant increase in collagen fibers in the renal cortex, the caspase-3 expression as well as the number of macrophages. Ultrastructurally, there was an irregularly thickened glomerular basement membrane and effacement of podocytes. Ginger treatment alone or in combination with Echinacea exhibited more pronounced improvement of diabetes-induced degenerative changes and a significant decrease in collagen fibers, the caspase-3 expression as well as the number of macrophages compared to Echinacea alone., Conclusion: Ginger treatment alone or in combination with Echinacea exhibited more pronounced improvement in diabetes nephropathy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Microscopy and Ultrastructure.)

Background: False-positive (FP) multiparametric magnetic resonance imaging (MPMRI) obscures and swift needless biopsies in men with a high prostate-specific antigen., Materials and Methods: This was a retrospective study, in which all patients who had been exposed to consecutive MP-MRI of the prostate combined with transrectal ultrasound-guided-magnetic resonance imaging fusion-guided prostate biopsy between 2017 and 2020 were involved in the study. The FP was measured as the number of biopsies that did not encompass prostate cancer divided by the whole number of biopsies., Results: The percentage of FP cases was 51.1%, the highest percentage was found in Prostate Imaging-Reporting and Data System (PI-RADs) 3 (37.7%) and the lowest was detected in PI-RAD 5 (14.5%). Those with FP biopsies are younger, and their total prostate antigen (PSA) and PSA density (PSAD) are significantly lesser. The area under the curve PSAD, age, and total PSA are 0.76, 0.74, and 0.69, respectively. An optimum PSAD value of 0.135 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 68% and 69%, respectively., Conclusion: FP results of mpMRI were detected in more than half of our sample, more than one-third were presented in Pi-RAD3, improved imaging techniques to decrease FP rates are highly needed., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Urology Annals.)

Despite the relatively increased cancer incidence in the last few years in the Arab countries, it is still far from the figures reported from Western countries. Several mechanisms have been adopted to explain the significant decreased incidence of cancer in the Arab countries, among them fasting, food full of special recipes filled with spices, significant lower rates of smoking and alcohol drinking, and genetic predisposition. Clinical trials are warranted on a large population scales to study, discuss, and verify such mechanisms., (© 2022. The Author(s).)

The current study investigated the impact of different doses of Nigella sativa seeds on the symptoms, the cluster of differentiation profile group, and inflammatory markers of mild COVID-19 cases., Methods: The study was a double-blind placebo-controlled clinical trial. Patients with mild and asymptomatic SARS-CoV-2 infection patients were randomly subdivided into seven subgroups: Group (GP) 1: received charcoal capsules as a control group, and GP 2: received three capsules of whole Nigella sativa seeds daily, two capsules in the morning and one in the evening; GP 3: received three capsules of whole Nigella sativa seeds every 12 h, GP 4: received five capsules in the morning and four capsules of whole Nigella sativa seeds in the evening, GP 5: received one capsule of Nigella sativa powder every 12 h; GP 6: received two capsules of Nigella sativa powder every 12 h; GP 7: received three capsules of Nigella sativa powder every 12 h; all treatment course was for ten days. Inflammatory parameters were assessed before and after interventions., Results: 262 subjects were included in the final analysis. No significant difference was detected regarding age, gender, and nationality. No significant differences were detected between the inflammatory marker in all groups. The WBCs showed a significant difference between before and after the intervention. While for procalcitonin, a significant difference was demonstrated in groups 1,4, and 6., Conclusions: The current randomized clinical trial did not reveal a significant effect of ten days of treatment with various doses of Nigella sativa on symptoms, differentiation profile, and inflammatory markers of patients with COVID-19. As a natural product, the effect of Nigella sativa on disease requires weeks to manifest itself.

Objectives: Natural products are often efficacious and safe alternatives to synthetic drugs. This study explored secondary leaves and bark metabolites profiles in extracts of a new Egyptian hybrid, Annona cherimola × Annona squamosa, known as Abdel Razek. This hybrid exhibited 100% similarity with A. cherimola as evidenced by random amplified polymorphic DNA (RAPD) and inter-simple sequence repeat (ISSR) analyses., Methods: Primary constituents in methanol extracts of different plant organs were identified. Extracts richest in alkaloids and polyphenolics were assessed for in vitro antioxidant activity and the most potent were further studied in vivo for treating gastric ulcer in rats. The latter activity was assessed histopathologically., Results: Structural analysis with HPLC/ESI-MS n , and UPLC/HESI-MS/MS identified 63 metabolites, including seven amino acids, 20 alkaloids, 16 flavonoids, eight phenolics and other compounds. Severe stomach alteration was observed after ethanol induction in rats. Ulcer score, oxidative stress biomarkers, cell organelles biomarker enzymes, and gastrointestinal histological features improved to variable degrees after treatment with Annona Abdel Razek hybrid leaves and bark methanol extracts., Conclusion: Extracts of Annona Abdel Razek had showed in vitro antioxidant effect and may be promising for the treatment of gastric ulcers., (© 2022. The Author(s).)

Objectives: To explore the cancer prevention-related nutrition knowledge of primary health care physicians towards nutrition and its relation to the development of cancer., Materials and Methods: a cross-sectional study was conducted among family physicians in Riyadh, between November 2019 and April 2020. The participants in the current study were surveyed using a self-administered questionnaire. The questionnaire included socio-economic data and data related to the association between nutrition and cancer., Results: The mean correct knowledge score for physicians is good but less than expected (26.5+5.8) 73.6%. Multiple regression revealed that age, position, and nationality to be significantly associated with knowledge of cancer prevention (P<0.05) among physicians., Conclusions: Primary care physicians have good knowledge about the relation between nutrition and cancer but not sufficient, they should have continuous nutrition educational training programs to ensure safe and sound nutritional advice to patients and for the public about the relation of nutrition and cancer.

Background: To date, the cytokine profile in children and adolescent with novel coronavirus disease 2019 (COVID-19) has not been reported., Objectives: We investigated serum levels of a panel of key cytokines in children and adolescent with COVID-19 pneumonia with a primary focus on "cytokine storm" cytokines such as interleukin (IL)-1β, IL-6, IL-17, IL-2, IL-4, IL-10, interferon (IFN-γ), tumor necrosis factor (TNF)-α, and two chemokines interferon-inducible protein-10 (IP-10) and IL-8. We also studied whether these cytokines could be potential markers for illness severity in COVID-19 pneumonia., Methods: Ninety-two symptomatic patients aged less than 18 years with confirmed COVID-19 pneumonia and 100 well-matched healthy controls were included in this multi-center study. For all patients, the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory fluid specimens was detected by real-time reverse-transcriptase polymerase chain reaction. We measured serum concentrations of studied cytokines by using flow cytometry., Results: Patients with COVID-19 had significantly higher median IL-1β, IL-6, IL-8, IL-10, IL-17, TNF-α, and IP-10 serum levels than did control children (all p < 0.01). Patients with severe COVID-19 pneumonia had significantly higher median IL-1β, IL-6, and IP-10 serum levels as compared with those with moderate COVID-19 pneumonia; all p < 0.01. ROC analysis revealed that three of the studied markers (IL-6, IL-1β, and IP-10) could predict severe COVID-19 pneumonia cases with the largest AUC for IL-6 of 0.893 (95% confidence interval: 0.84-0.98; p < 0.01)., Conclusion: Our study shows that pediatric patients with COVID-19 pneumonia have markedly elevated serum IL-1β, IL-6, IL-8, IL-10, IL-17, TNF-α, and IP-10 levels at the initial phase of the illness indicating a cytokine storm following SARS-CoV-2 infection. Moreover, serum IL-6, IL-1β, and IP-10 concentrations were independent predictors for severe COVID-19 pneumonia., (© 2021 Wiley Periodicals LLC.)

Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis. Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP > 24 mmHg, IAP > 20 cmH 2 O (15 mmHg), APP <50 mmHg, and CVP > 15cmH 2 O. Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49-52 mmHg. The range of IAP (IVP) was 15-20 cmH 2 O (11-15 mmHg), the range of PIP was 22-25 cmH 2 O, the range of CVP was 13-15 cmH 2 O, and the range of urine output was 1-1.5 ml/kg/h. Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH 2 O (15 mmHg), APP > 50 mmHg, and CVP ≤ 15cmH 2 O., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Arafa, Elshimy, Shehata, Elbatarny, Almetaher and Seleim.)

Background: Some men are subjected to multiple repeated biopsies because of ongoing suspicion of prostate cancer, which might subject them to complications. The aim of the study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI)/target fusion-guided biopsy in comparison with systematic biopsy in our low prevalence prostate cancer population, in terms of validity measure, case detection rate, and detection of clinically significant cancer., Methods: This is a retrospective cohort study. All consecutive patients who met the inclusion criteria (all men with persistent high prostate-specific antigen levels >4 ng/ml and/or subnormal finding in direct rectal examination, with suspicious regions identified on prebiopsy MRI) were subjected to transrectal MRI/ultrasound fusion-guided biopsy., Results: A total of 165 cases met the inclusion criteria and were included in the study. The cancer detection rate (CDR) of target biopsy was significantly higher than that of standard biopsy (27.9% vs 14%, respectively), and 25 cases (52%) were missed by standard strategy and correctly classified by multiparametric MRI with targeted biopsy (MRI-TB). On the other hand, only 2 cases (4.3%) were misclassified by MRI-TB, and one of them was clinically significant. There was an exact agreement between the 2 strategies in 15 (31%) cases. Targeted biopsy diagnosed 41.5% more high-risk cancers vs systematic biopsy (41.6% vs 6.2%, P < .001). The difference between sensitivity, specificity, and negative predictive value of MRI-TG varies between 80% and 98%., Conclusion: The CDR of prostate cancer in general and clinically significant cancer, in specific, is significantly higher with MRI-TG modality than with systematic modality. Yet, MRI-TG biopsy still misses some men with clinically significant prostate cancer. Hence, the addition of a 12-core biopsy is required to evade missing cases of clinically significant and insignificant cancer., Competing Interests: The authors declare that they have no conflict of interest., (© 2021 Asian Pacific Prostate Society. Published by Elsevier B.V.)

Background: Allergic rhinitis (AR) is an inflammatory state categorized by a disturbance of immunoregulatory mechanisms. MicroRNA-155 (miRNA-155) has an essential role in regulating gene expression and can mediate the allergic TH2 process., Objective: In this study, we aimed to evaluate the role of miR-155 as a biomarker in AR and correlate its level with the total nasal symptom score (TNSS) and the levels of serum interleukin-4 (IL-4)., Methods: This study included 90 children: 45 with pollen-induced AR and 45 healthy controls. Serum miR-155 expression levels were measured using quantitative real-time PCR. Human IL-4 ELIZA kits were used for the semiquantitative detection of the serum levels of IL-4. Receiver operating characteristic (ROC) curves were used to determine the best cutoff values for the studied parameters for the diagnosis of AR., Results: The demographic characteristics of the two groups were matched with respect to age and sex. The AR case group included 23 (51.1%) males and 22 (48.9%) females, while the control group included 24 (53.3%) males and 21 (46.7%) females. The miR-155 level was increased in the serum of children with pollen-induced AR compared with controls (mean difference = 2.8, p < 0.001). A significant positive correlation between the serum expression level of miR-155 and TNSS in children with AR was detected ( r  = 0.494, p < 0.001). However, no significant correlation was identified between the expression of miR-155 and that of IL-4. At a cutoff value of 1.09, the sensitivity of miR-155 as a biomarker for AR was 100%, and the specificity was 71.1%., Conclusion: MiR-155 expression levels were elevated in the serum of AR children. Therefore, miR-155 could be used as a biomarker in AR diagnosis., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Noha M. Hammad et al.)

Background: The advancements of technologies have developed anatomical education into a new era. The study aims to assess medical students' performance and overall satisfaction who used the anatomage table and plastinated specimens for the teaching and learning anatomy courses., Methods: A cross-sectional study was conducted on students of the first-year college of medicine at Imam Mohammad Ibn Saud Islamic University (IMSIU). Students were randomly distributed equally into three groups A, B, and C. All groups were taken two sessions of lectures for one hour each. Each lecture was followed by a practical session of two hours. Group A learned with the "Anatomage" table and Group B learned the same topics on plastinated specimens. Group C was learning on both plastinated specimens and the "Anatomage" table. The objective structured practical examination was given to all students immediately after the practical sessions. A structured questionnaire was given to each group to determine the students' views on the educational methods., Results: There was a statistically significant difference between the means of the total scale scores for the three teaching methods, where students expressed a higher attitude towards both strategies for teaching in comparison to the anatomage table and plastinated models for teaching, where the means were 18±4.4, 18.3±4.6, 20.4±5.6, respectively, F=12.6 and P=0.0001. There were higher and positive students' attitudes regarding the five statements in favor of both models teaching compared to anatomage table and plastinated model teaching alone., Conclusion: The first-year medical students have valued the combination of anatomage table and plastinated prosections in learning and assessing anatomy education at the undergraduate level. The advantages outweigh the limitation of these educational tools., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Bin Abdulrahman et al.)

Objectives: To explore the attitude and perception of undergraduate medical students and their staff towards the educational methods (conventional versus online) and to assess their performance accordingly., Methods: It was a comparative cross sectional study, conducted at the Faculty of Medicine, Al- Imam University, Riyadh, Saudi Arabia on May 30, 2020. A structured questionnaire was designed to collect the data from students and staff about conventional teaching, online teaching, conventional examination and online examination. It was in the form of 5-point Likert-type scale ranging from 5-strongly agree, to 1-strongly disagree, in addition to age and gender. The results of conventional and online examination were recorded., Results: The total sample reached 230 students and 20 staff. Mean scores for conventional teaching and examination were significantly higher than online. The mean values for grades of online final examination was significantly higher than those of midterm conventional examination. Most of the statements related to conventional teaching and examination attained a good response where students and their staff conveyed a negative perception pertinent to online examination. Students and staff showed a higher percentage of agreement in favor of online examination allowing immediate feedback., Conclusion: Conventional teaching was perceived as more effective, accessible, less technical difficulties and less fraud and cheating. Online learning, should be allowed in undergraduate medical education, by combining it with conventional learning, and students should be prepared to it., (Copyright: © Saudi Medical Journal.)

Background: Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors., Objectives: To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening practices among Saudi men., Methods: This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed., Results: In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate examination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing., Conclusion: Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process., (© 2020 Amin HS et al.)

Objective: Beta vulgaris L. (beetroot) is a vegetable plant rich in phytochemical compounds such as phenolic acids, carotenoids and flavonoids. The objective of the current study is the development and optimization of self-nanoemulsifying drug delivery systems (SNEDDSs) to enhance the hepatoprotective activity of beet leaf (BL) extract., Methods: Total flavonoids content was estimated in the BL extract and its solubility was evaluated in various vehicles to select proper component combinations. Pseudo-ternary phase diagrams were constructed employing olive, linseed, castor and sesame oils (oil phase), Tween ® 20 (Tw20) and Tween ® 80 (Tw80) (surfactants (SAs)) as well as dimethyl sulfoxide (DMSO) and propylene glycol (PG) (co-surfactants (Co-SAs)). Optimization of formulations from the phase diagrams took place through testing their thermodynamic stability, dispersibility and robustness to dilution., Results: Four optimized BL-SNEDDS formulations, comprising linseed oil or olive oil, Tw80 and DMSO at two SA/Co-SA ratios (2:1 or 3:1) were chosen. They exhibited high cloud point and percentage transmittance values with spherical morphology of mean droplet sizes ranging from 14.67 to 16.06 nm and monodisperse distribution with negatively charged zeta potential < -9.51 mV. The in vitro release profiles of the optimized formulations in pH 1.2 and 6.8 were nearly similar, with a non-Fickian release mechanism. In vivo evaluation of BL-SNEDDSs hepatoprotective activity in a thioacetamide-induced hepatotoxicity rat model depicted promoted liver functions, inflammatory markers and histopathological findings, most prominently in the group treated by F7., Conclusion: The results indicate that SNEDDS, as a nanocarrier system, has potential to improve the hepatoprotective activity of the BL extract.

Aim: The aim of the study was to identify factors that influence urology physicians for choosing subspecialty and to know the most competitive urology subspecialty among residents., Methodology: An online questionnaire was sent to all Saudi Urology residents, registrars, and fellows all over Saudi Arabia, during February 2019-June 2019. The survey included demographic data, level and location of training, a subspecialty of interest, as well as 15 influencing factors that could affect physicians' choice in the form of Likert scale, ranging from strongly disagree = 0 to strongly agree = 4., Results: Of the 193 urology Saudi physicians, 85 replied (44.1%). Their mean age was 29 + 3.2 years. The majority of them were male (98.8%). There were 66 (77.6%) residents, 12 (14.1%) were fellows, and 7 (8.2%) were registrars. Four factors were found to be significantly different across positions, i.e., personal interest in the subspecialty, patient's prognosis, potential to join a private hospital, and family/friend advice. Among residents, the highest score means of the impact factors were the patient's prognosis, potential to join a private hospital and family/friend advice. The most prominent factors that influence urology physicians to select their subspecialty were personal interest in the specialty (88.2%), followed by the patient prognosis and lifestyle (84.7%, 78.8%). About 28.2% of the participants have a desire of endourology, followed by infertility and pediatric urology (23.5% and 20%, respectively)., Conclusion: The most influencing factors among urology physicians for choosing their subspecialty are the patient's prognosis and personal interest. Female medical graduates should be encouraged to join a urology residency., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Urology Annals.)

Introduction: Dorsal inlay graft urethroplasty using inner-face preputial graft was described as an adjunct method to the classic tubularized incised plate (TIP) urethroplasty, aiming at reducing the risk of neourethral stenosis., Objectives: To evaluate the impact of dorsal inlay grafting of preservable narrow plates, in relation to native plate width., Methods: Consecutive children with penile hypospadias with narrow plate (width < 8 mm) were evaluated prospectively between Jan 2014 and Jun 2018. Included cases were stratified into two groups: group A (plate width: 4 to <8 mm) and group B (plate width: < 4 mm). All cases were approached by TIP urethroplasty, with dorsal inlay grafting (inner-face prepuce). Cases with significant chordee (non-preservable plates), circumcised cases, and redo cases were excluded., Results: A total of 104 hypospadias cases with narrow plates were included in this study. Among group A (n = 81), the need for postrepair urethral dilations was reported in two cases (2.5%) vs seven cases (30%) in group B (n = 23) (P-value < 0.001). Another two cases (2.5%) in group A developed urethrocutaneous fistulae vs three cases (13%) in group B (P-value = 0.0624). Surgical repair of the reported five cases with fistulae, revealed an ample neourethral wall; disclosing well-taken grafts in both groups., Discussion: Few published studies evaluated grafting the incised plate in penile hypospadias. To the authors knowledge, this is the first study that selectively evaluated the impact of grafting narrow plates in relation to its native pre-incision width., Conclusions: According to the presented authors' experience, 4 mm width is the border line of clinical relevance that defines poor urethral plate. Grafting that plate failed to compensate for its native poor characteristics; however, it offered a valuable neourethral wall that proved indispensable when redo surgery deemed necessary, without adding grafting-related problems. Nevertheless, further extended comparative studies came across as a necessity to verify the long-term outcomes of grafting the incised poor plates., (Copyright © 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of the study is to assess the awareness of family medicine residents about influenza and pneumococcal vaccination for high-risk patients and to verify the most significant variables that might affect residents' knowledge and the tools needed to enhance their practice., Materials and Methods: This cross-sectional study was conducted at four major hospitals in Riyadh, Saudi Arabia, during the period, October through December 2017. A pretested self-administered questionnaire was handed to 180 family residents. Descriptive statistics were used to analyze the study data. The Chi-square test was used to compare categorical variables data. The One-way ANOVA test was used to detect the significant difference., Results: The overall knowledge of physicians about influenza and pneumococcal vaccines was inadequate and was more toward pneumococcal vaccine, in spite their respectable knowledge about the target population. The main reasons for non- prescribing of vaccines were forgetfulness (59.4%), the availability of vaccines (33.9%), and the patients' refusal (23.3%). The tools that might help for prescribing were the need for the presence of electronic reminder (69.4%) and the patients should follow a regular family physician (47.2%)., Conclusion: Knowledge and practice of influenza and pneumococcal vaccination are inadequate. This is mainly because of forgetfulness owing to minimal guideline awareness, lack of vaccine availability, and patients' refusal. The important recommendations to enhance vaccination practice among physicians are the implementation of electronic reminders, regular follow-up with the same physician in addition to educational programs during residency, and patient education about the importance of vaccinations as a means of disease prevention., Competing Interests: There are no conflicts of interest.

Introduction: Laparoscopic splenectomy (LS) became the standard choice for splenectomy in children with benign hematological disease. There are few reports about pancreatic injury during LS. The purpose of this study is to spot on factors increasing the risk of pancreatic injury during LS in children., Patients and Methods: A total of 140 children had LS for benign causes. Children were categorized into A and B groups. LigaSure™ was used to control pedicle in Group A, while endoscopic staplers were used in Group B. Preoperative levels of amylase, lipase, and lactate dehydrogenase (LDH) were obtained. The mean of pancreatic enzymes and LDH values was calculated on the 3 postoperative successive days., Results: A total of 71 boys and 69 girls had LS. The mean splenic size was 13.50 cm in Group A and 12.51 cm in Group B. The mean operative time in Group A was 41.91 min and in Group B was 56.36 min. The mean level of amylase was 42.99 IU/ml in Group A and 75.70 IU/ml in Group B ( P = 0.001). The mean level of lipase was 37 IU/ml in Group A and 76.66 IU/ml in Group B ( P = 0.001)., Conclusion: Pancreatic injury during LS is a rare complication usually presented on biochemical level. We believe that it is a hemostatic-dependent complication rather than splenic size or nature of disease., Competing Interests: There are no conflicts of interest.

Background: Vitamin-D deficiency is a universal health problem caused primarily by inadequate exposure to sunlight. This study aimed to assess the vitamin D status and investigate the factors affecting vitamin D distribution among Saudi males., Methods: A cross-sectional study was conducted at the King Saud University Medical City from December 2015 to August 2016. Saudi males attending the outpatient primary health care clinics were invited to participate in the study. Data were collected on the current and past health status along with biochemical investigations for total 25-hydroxyvitamin D (25OHD), blood sugar, and cholesterol., Results: Majority of the participants (76.1%) had vitamin D deficiency. Blood sugar level, age, and cholesterol level were the most significant factors associated with vitamin D status. The highest percentage of deficiency was observed in the youngest age group (30-40 years). With increasing age, the percentage of deficiency decreased significantly. Those with normal blood sugar and cholesterol level had higher serum vitamin D levels compared to those with diabetes and hypercholesterolemia., Conclusions: Vitamin D deficiency is still endemic in Saudi Arabia, particularly among younger males and those with diabetes and hypercholesterolemia. Vitamin D screening, supplementations, and vitamin D-fortified foods should be provided especially for these groups.

Objective: To describe the reference ranges of serum prostate-specific antigen (PSA) in Saudi men. Materials/Subjects and Methods: Saudi males, aged 30 and above, were invited to participate in the study. Blood samples were taken from each subject to determine serum levels of PSA. Blood sugar levels, lipid profile, and anthropometric measurements were also obtained., Results: Our cohort consisted of 7,814 men; their mean PSA level was 1.24 ng/mL. The majority (90.5%) had PSA values between 0 and 2.5 ng/mL. The median PSA and the 95th percentile increased steadily with age. There was a sharp increase in the 95th percentile, from 3.8 ng/mL in men between 60 and 70 years old to 6.9 ng/mL in men over 71 years old. The 95th percentiles of PSA serum levels were lower in Saudi men than in the general population., Conclusions: PSA serum levels in Saudi men are lower than in other communities. Creating age-specific reference ranges could improve the sensitivity of the PSA tests by allowing the detection of treatable tumors in younger men if the threshold of 4.0 ng/mL is lowered. Furthermore, unnecessary biopsies among older men may be avoided if the threshold is increased., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Incidence rate for prostate cancer in the Arab World is significantly lower than United States and Europe, it ranges from 5.5% to 39.2%. However, the incidence and the number of deaths is expected to increase. In Saudi Arabia, the crude incidence rate and age standardized incidence rate of prostate cancer are reported to be steadily increasing in between 2001-2008. Only two screening trials were attempted in 2001 and 2009 which yielded an incidence rate of 1.17% and 2.5% respectively. Men in the Arab world are sharing a common characteristic of poor knowledge and poor attitude towards prostate cancer examination and screening practices. They are ill-informed about the PSA test's strengths and drawbacks because the doctors are not talking to them about the importance of counselling. Men should be encouraged to do PSA testing before the age of 50 and till the age of 70 years. This could be achieved by enhancing their attitude and enriching the knowledge of the physicians towards PSA testing, harms and benefits, through shared decision making, which would increase men's knowledge scores, reduced their decisional conflict and promote greater involvement in decision making., Competing Interests: Conflict-of-interest statement: The authors declares no conflict of interest related to this publication.

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. Reduction in mortality rates in some countries worldwide are most likely ascribed to CRC screening and/or improved treatments. We reviewed the most relevant articles which discuss the cost-effectiveness of colorectal cancer screening procedures, in particular, the recent ones through the last eight years. The effectiveness of screening estimated by discounted life years gained (LYGs) compared to no screening, differed considerably between the studies. Despite these differences, all studies consistently emphasized that screening for CRC was cost-effective compared with no screening for each of the recognized screening strategies. Newer technologies for colorectal cancer screening, including computed tomographic colonography (CTC), faecal DNA test, and Pillcam Colon are less invasive and accurate, however, they are not cost-effective, as their cost was higher than all other established screening strategies. When compliance and adherence to such new techniques are increased more than the established strategies they would be more cost-effective particularly CTC., (Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Objectives: To embrace a national screening program for prostate cancer, putting into consideration the cost, and the attitude of the general population towards such screening., Methods: Men aged greater than 45 and less than 70 years were invited to participate in the current prospective study conducted at  King Saud University Medical City, Riyadh, Saudi Arabia between December 2014 and July 2015. Those with confirmed high prostate-specific antigen (PSA) (≥4 ng/ml) were referred to the urology clinic, then subjected to magnetic resonance imaging., Results:   The total cohort screened were 2898, we  found 118 cases with high PSA (≥4 ng/ml). Fifty-two cases (60.4%) were confirmed high PSA. All of them were subjected to MRI and biopsy. The confirmed prostate cancer were 7 cases (0.24%). The age of confirmed prostate cancer cases ranged from 49 years to 68 years, Gleason score for 4 cases was low grade (3+3), while it was 3+4 for 2 cases, and only one case had advanced cancer (3+5). Approximately 12% of cases with high PSA did not show up for confirmation of their results for further examination., Conclusions:   The present study recommends against mass screening among Saudi population; however, men before 50 years of age should start PSA blood testing until before 70 years after discussing the benefits and harms of such screening through shared decision making.

This study was designed to find out the optimized energy delivery strategy in Shock Wave Lithotripsy (SWL) that yield to the best stone-free rate (SFR). In this clinical trial, 150 consecutive patients were randomized into three groups: (a) Dose escalation, 1500 SW at 18 kV, followed by 1500 SW at 20 kV then 1500 SW at 22 kV. (b) Constant dose, 4500 SW at 20 kV. All patients undergo plain X-ray film of the urinary tract at day 1, 14, and 90 to assess stone-free rate (SFR) which was defined as no stones or painless fragments less than 4 mm. (c) Dose reduction, 1500 SW at 22 kV, followed by 1500 SW at 20 kV and then 1500 SW at 18 kV. The three treatment groups were comparable in terms of age, sex, stone size and distribution of the kidneys, and the need for Double J stent use. On day 90, the SFR achieved was 82, 90, and 84 % in the escalating, constant, and reduction energy groups, respectively. However, this rate was not statistically significant (x 2  = 1.38, p level = 0.28). At a slow rate of 60 shocks, there was no difference in stone-free rate between different voltages at 1, 14, and 90 days. Our randomized clinical trial showed no statistically significant difference in SFR between the three groups while using the slow SWL rate. Our trial is the first randomized trial comparing the three strategies. As such, a dose adjustment strategy while delivering SWL in slow rate was not recommended.

Objective: To investigate the level of knowledge and awareness of the cost of the currently used blood investigations, imaging studies, admission cost, and surgical instrument among surgeons in Saudi Arabia., Design: It was a cross-section study conducted in Riyadh city, the capital of Saudi Arabia., Setting: Multihealth centers including main University hospital, Military hospitals, and Ministry of health hospitals. All surgeons in the health facilities were invited to participate in the study. A questionnaire has been formulated, and distributed to all participants. It was composed of 3 sections such as: demographic data, awareness about the cost, and physicians' perception about the cost and the attitude of their institution toward cost practice., Result: Totally, 296 participants were enrolled in the study. More than half of the respondents were females (53.3%). Nearly two-thirds were in the young age group (30-40 years), 41.2% were residents. Only 4.4%, 3.4%, 8.4%, and 3.7% of the surgeons were fully aware of the cost of blood investigations, imaging studies, surgical instruments/prosthesis, and the medication that they prescribe, respectively. Most of them mentioned that their institute neither encourages them to consider a cost-effective practice (86.9%) nor monitor how cost effective is their practice (86.2%)., Conclusion: Surgeon's knowledge and awareness about the cost of different medical procedures were insufficient. Surgeons' knowledge and attitudes about costs of care can be improved through the use of audit and feedback with patient cost and charge data, which could be attained through the inclusion of audit and feedback as part of a curriculum teaching., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective/background: Tuberculosis (TB) is a major health problem. The aim of this study was to examine the pattern of TB in Aswan Chest Hospital, Aswan, Egypt., Methods: This cross-sectional study was carried out using medical records from the TB registry in Aswan Chest Hospital. The investigated variables included demographic characteristics, type of TB infection, and affected organs. All data were coded and statistically analyzed., Results: The average age of the 557 patients infected with TB was 40.31±18.87years; 58.2% of the cases were men and 41.8% were women. In both sexes, the highest number of TB patients was from the reproductive age groups. During the 5-year study period, the highest percentage of cases were new cases and the highest frequency of cases was during 2011 and the lowest frequency was during 2015. Pulmonary TB cases showed a sharp decline; however, there was a decrease in extrapulmonary TB cases during 2012 and 2013, with a slight rise in 2014 and 2015. Of the pulmonary TB cases, 82.5% were smear-positive TB., Conclusion: There was a decline in the total number of TB cases across the studied years and the most studied cases were pulmonary smear-positive and new cases. Younger people represented a large percentage of reported cases., (Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

Introduction . Early diagnosis and treatment of neonatal sepsis may help decrease neonatal mortality. Aim of the Study . To evaluate the role of pancreatic stone protein as a marker for early onset neonatal sepsis. Methods . A hospital-based prospective study was conducted on 104 (52 uninfected and 52 infected neonates) admitted to the Neonatal Intensive Care Unit (NICU) of Zagazig University hospitals during the period from April 2014 to April 2015. All newborns were subjected to full history taking, careful neonatal assessment, blood, C-reactive protein (CRP), and serum pancreatic stone protein. Results . Serum PSP levels were significantly higher in the infected group than in the uninfected group. At a cutoff level of PSP 12.96 ng/mL, the sensitivity was 96.2%, the specificity was 88.5%, positive predictive value was 95.8%, negative predictive value was 89.3%, and area under the curve was 0.87. A significant positive correlation between CRP and PSP was found in infected group. Conclusion . The high negative predictive value of PSP (89.3%) indicates that the serum PSP level is a good marker for diagnosis of early onset neonatal sepsis and can be used to limit hospital stay and antibiotic use in neonates treated for suspected sepsis.

Acute kidney injury (AKI) is a complication in children with solid tumors undergoing chemotherapy, as it may prevent the use of therapy protocols and also hinder the supportive and diagnostic procedures. Thus, there is an urgent requirement for early predictive biomarkers of AKI. The most promising novel AKI biomarker is neutrophil gelatinase-associated lipocalin (NGAL). The aim of the present study was to compare the predictability of NGAL as a biomarker of AKI with creatinine as a traditional biomarker in children with solid tumors under chemotherapy. The study was performed on 30 patients with different types of solid tumors (reuroblastoma, Wilms tumor, medulloblastoma, rhabdomyosarcoma and Ewing sarcoma) and 20 control subjects. Urinary NGAL (uNGAL) and serum creatinine samples were taken three times: Baseline before the beginning of the treatment, one week after chemotherapy and at the end of the chemotherapy protocol. AKI is defined as a change in creatinine level by >50% of the baseline. The creatinine level only rises to this level in the third sample, while uNGAL increases significantly in the second and third samples with percentage of change 376.8 and 698.2%, respectively, which is highly significant (P<0.001). When comparing the predictive value of serum creatinine for AKI depending on the receiver operating characteristic curve with that of uNGAL, the area under the curve (AUC) for creatinine was 0.60 with a standard error (SE) of 0.086 and 95% confidence interval (CI) between 0.432 and 0.768, while that of uNGAL was highly predictive with an AUC of 0.847, SE 0.55 and 95% CI between 0.739 and 0.955. Depending only on the creatinine level for detecting the AKI will markedly delay the diagnosis; however, uNGAL is detected earlier, and is easier and more reliable as a marker for AKI in children with solid tumors undergoing chemotherapy.

Two similar words, effectiveness and efficacy, have comparable insight and nearly describe analogous meaning for a screening test, yet clear understanding and perception of their diverse meanings will help clarify the basis of the differing conclusions about whether screening tests for different cancers reduce morbidity and mortality. Screening test may not be effective even when it sounds to be efficacious, on the other hand it should be efficacious when the test is effective.

Background: Ventilator-associated pneumonia (VAP) is a serious health care-associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed in preventing ventilator-associated pneumonia in developing countries are rarely reported. In this study we tried to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rate in our neonatal intensive care unit (NICU)., Method: This prospective before-and-after study was conducted at university hospital NICU, all neonates who had mechanical ventilation for ≥ 48 h were eligible. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of comprehensive preventive measures specifically designed by our infection control team., Results: Of 143 mechanically ventilated neonates, 73 patients developed VAP (51%) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8% (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2% (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95% confidence interval 0.408-0.782, p = 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in post-intervention period (21.50 ± 7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p = 0.000). There were a trend toward reduction in NICU length of stay (23.9 ± 10.3 versus 22.8 ± 9.6 days, p = 0.56) and overall mortality (25% versus 17.3%, p = 0.215) between the two phases but didn't reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5%) particularly Klebsilla pneumonia (55/66, 83.4%)., Conclusion: Implementation of multifaceted infection control bundle resulted in reduction of VAP rate, length of stay in our NICU.

The mechanism of breath-holding spells (BHS) is not fully understood and most probably multifactorial; so, this study was designed to clarify the pathophysiology of BHS through assessing some laboratory parameters and electrocardiographic (ECG) changes which might be contributing to the occurrence of the attacks. Another aim of the study was to evaluate the differences in the pathophysiology between pallid and cyanotic types of BHS. This was a prospective study performed in Zagazig University Hospitals. Seventy-six children diagnosed with BHS were included as follows: 32 children with cyanotic BHS, 14 children with pallid BHS, and 30 healthy children as a control group. All children were subjected to the following: full history taking, clinical examination, and laboratory work up in the form of CBC, serum iron, ferritin, and zinc levels. Twenty-four hours ambulatory ECG (Holter) recording was also performed. No significant statistical difference was found between cyanotic and pallid groups regarding family history of BHS, severity, and precipitating factors of the attacks. Frequent runs of respiratory sinus arrhythmia (RSA) during 24  hours ECG were significantly higher in children with BHS; the frequency of RSA was significantly correlated with the frequency (severity) of the attacks. Low serum ferritin was significantly associated with BHS groups but not correlated with the severity of the attacks. Autonomic dysregulation evidenced by frequent RSA is considered to be an important cause of BHS in children and is correlated with the frequency of the attacks. Low serum ferritin is additional factor in the pathophysiology. Both pallid and cyanotic BHS are suggested to be types of the same disease sharing the same pathophysiology.

Integrons are genetic units characterized by the ability to capture and incorporate gene cassettes, thus can contribute to the emergence and transfer of antibiotic resistance. The objectives of this study were: (1) to investigate the presence and distribution of class I and class II integrons and the characteristics of the gene cassettes they carry in Enterobacteriaceae isolated from nosocomial infections at Zagzig University Hospital in Egypt, (2) to determine their impact on resistance, and (3) to identify risk factors for the existence of integrons. Relevant samples and full clinical history were collected from 118 inpatients. Samples were processed; isolated microbes were identified and tested for antibiotic susceptibilities. Integrons were detected by polymerase chain reaction (PCR) and were characterized into class I or II by restriction fragment length polymorphism (RFLP). Integron-positive isolates were subjected to another PCR to detect gene cassette, followed by gene cassette sequencing. Risk factors were analyzed by logistic regression analysis. Seventy-six Enterobacteriaceae isolates were recognized, 41 of them (53.9%) were integron-positive; 39 strains carried class I and 2 strains carried class II integrons. Integrons had gene cassettes encoding different combinations and types of resistance determinants. Interestingly, blaOXA129 gene was found and ereA gene was carried on class I integrons. The same determinants were carried within isolates of the same species as well as isolates of different species. The presence of integrons was significantly associated with multidrug resistance (MDR). No risk factors were associated for integron carriage. We conclude that integrons carrying gene cassettes encoding antibiotic resistance are significantly present among Enterobacteriaceae causing nosocomial infection in our hospital. Risk factors for acquisition remain to be identified.

Background: The diagnosis of epilepsy should be made as early as possible to give a child the best chance for treatment success and also to decrease complications such as learning difficulties and social and behavioral problems. In this study, we aimed to assess the ability of magnetic resonance spectroscopy (MRS) in detecting the lateralization side in patients with Temporal lobe epilepsy (TLE) in correlation with EEG and MRI findings., Methods: This was a case-control study including 40 patients diagnosed (clinically and by EEG) as having temporal lobe epilepsy aged 8 to 14 years (mean, 10.4 years) and 20 healthy children with comparable age and gender as the control group. All patients were subjected to clinical examination, interictal electroencephalography and magnetic resonance imaging (MRI). Proton magnetic resonance spectroscopic examination (MRS) was performed to the patients and the controls., Results: According to the findings of electroencephalography, our patients were classified to three groups: Group 1 included 20 patients with unitemporal (lateralized) epileptic focus, group 2 included 12 patients with bitemporal (non-lateralized) epileptic focus and group 3 included 8 patients with normal electroencephalography. Magnetic resonance spectroscopy could lateralize the epileptic focus in 19 patients in group 1, nine patients in group2 and five patients in group 3 with overall lateralization of (82.5%), while electroencephalography was able to lateralize the focus in (50%) of patients and magnetic resonance imaging detected lateralization of mesial temporal sclerosis in (57.5%) of patients., Conclusion: Magnetic resonance spectroscopy is a promising tool in evaluating patients with epilepsy and offers increased sensitivity to detect temporal pathology that is not obvious on structural MRI imaging.