bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Optimizers and their Performance in Autosegmenting Lung Tumors
Authors: Ramachandran Prabhakar , Eswarlal Tamma , Lehman Margot , Colbert Zachery
Published: September 2024

Purpose:

Optimizers are widely utilized across various domains to enhance desired outcomes by either maximizing or minimizing objective functions. In the context of deep learning, they help to minimize the loss function and improve model’s performance. This study aims to evaluate the accuracy of different optimizers employed for autosegmentation of non-small cell lung cancer (NSCLC) target volumes on thoracic computed tomography images utilized in oncology.

Materials and Methods:

The study utilized 112 patients, comprising 92 patients from “The Cancer Imaging Archive” (TCIA) and 20 of our local clinical patients, to evaluate the efficacy of various optimizers. The gross tumor volume was selected as the foreground mask for training and testing the models. Of the 92 TCIA patients, 57 were used for training and validation, and the remaining 35 for testing using nnU-Net. The performance of the final model was further evaluated on the 20 local clinical patient datasets. Six different optimizers, namely AdaDelta, AdaGrad, Adam, NAdam, RMSprop, and stochastic gradient descent (SGD), were investigated. To assess the agreement between the predicted volume and the ground truth, several metrics including Dice similarity coefficient (DSC), Jaccard index, sensitivity, precision, Hausdorff distance (HD), 95th percentile Hausdorff distance (HD95), and average symmetric surface distance (ASSD) were utilized.

Results:

The DSC values for AdaDelta, AdaGrad, Adam, NAdam, RMSprop, and SGD were 0.75, 0.84, 0.85, 0.84, 0.83, and 0.81, respectively, for the TCIA test data. However, when the model trained on TCIA datasets was applied to the clinical datasets, the DSC, HD, HD95, and ASSD metrics showed a statistically significant decrease in performance compared to the TCIA test datasets, indicating the presence of image and/or mask heterogeneity between the data sources.

Conclusion:

The choice of optimizer in deep learning is a critical factor that can significantly impact the performance of autosegmentation models. However, it is worth noting that the behavior of optimizers may vary when applied to new clinical datasets, which can lead to changes in models’ performance. Therefore, selecting the appropriate optimizer for a specific task is essential to ensure optimal performance and generalizability of the model to different datasets.
Application of a Comprehensive Treatment Planning Test for Credentialing Intensity-Modulated Radiotherapy and RapidArc in a TrueBeam Linear Accelerator Setup
Authors: Roy Soumya , Sarkar Biplab , Pradhan Anirudh
Published: September 2024

An extended version of task group report (TG)-119 dosimetric tests was introduced and tested on the TrueBeam linear accelerator setup. Treatment plan results and quality assurance (QA) results of RapidArc (RA) and intensity-modulated radiotherapy (IMRT) were compared to understand the limitation and efficacy of the RA and IMRT system of the linear accelerator. Test structure sets were drawn on OCTAVIUS four-dimensional (4D) phantom computed tomography scan data for this study. We generated treatment plans based on the specified goal in the Eclipse™ treatment planning system using RA and IMRT in the study phantom. We used the same planning objectives for RA and IMRT techniques. Planar dose verification was performed using electronic portal imaging device and OCTAVIUS 4D phantom. The treatment log file was further analyzed using Pylinac (V2.4.0 (Open Source Code library available on Github, runs under Python programming language)) to compare the dosimetric outcome of RA and IMRT. Dose to the planning target volume (PTV) 1–5 and organ at risk (OAR) were analyzed in this study for the efficiency comparison of RA and IMRT. The primary objective was accomplished by adhering to the dose constraints associated with PTV 2 and the OAR. RA and IMRT also met the secondary objective. The tertiary goal of dose delivery to PTV 4 was met with RA but not IMRT. This study can be utilized to compare different institutions’ planning and patient-specific QA (PSQA) procedures. The findings of this study were in line with the published works of the literature. A multi-institutional planning and delivery accuracy audit can be built using this structure and set of planning objectives having similar PSQA phantom. The TG-119 report incorporated test challenges that were combined in a single study set and a single plan. This reduces the complexity of performing the original TG-119 tests, whereas keeping the challenges as introduced in the TG-119 report. This study’s planning and dosimetric results could be further utilized for dosimetry audit with any institute having a linear accelerator and OCTAVIUS 4D phantom for PSQA.
Multiple Brain Metastases Radiosurgery with CyberKnife Device: Dosimetric Comparison between Fixed/Iris and Multileaf Collimator Plans
Authors: Ianiro Anna , Infusino Erminia , D’Andrea Marco , Marucci Laura , Farneti Alessia , Sperati Francesca , Cassano Bartolomeo , Ungania Sara , Soriani Antonella
Published: September 2024

Purpose:

In our institution, stereotactic radiosurgery of multiple brain metastases is performed with the CyberKnife® (CK) device, using fixed/Iris collimators. In this study, nineteen fixed/Iris plans were recalculated with the multileaf collimator (MLC), to assess if it is possible to produce plans with comparable dosimetric overall quality.

Materials and Methods:

For consistent comparisons, MLC plans were re-optimized and re-normalized in order to achieve the same minimum dose for the total planning target volume (PTVtot). Conformation number (CN), homogeneity index (HI) and dose gradient index (DGI) metrics were evaluated. The dose to the brain was evaluated as the volume receiving 12 Gy (V12) and as the integral dose (ID). The normal tissue complication probability (NTCP) for brain radionecrosis was calculated as a function of V12.

Results:

The reoptimized plans were reviewed by the radiation oncologist and were found clinically acceptable according to the The American Association of Physicists in Medicine (AAPM) Task Group-101 protocol. However, fixed/Iris plans provided significantly higher CN (+8.6%), HI (+2.2%), and DGI (+44.0%) values, and significantly lower ID values (−35.9%). For PTVtot less than the median value of 2.58cc, fixed/Iris plans provided significantly lower NTCP values. On the other side, MLC plans provided significantly lower treatment times (−18.4%), number of monitor units (−33.3%), beams (−46.0%) and nodes (−21.3%).

Conclusions:

CK-MLC plans for the stereotactic treatment of brain multi metastases could provide an important advantage in terms of treatment duration. However, to contain the increased risk for brain radionecrosis, it could be useful to calculate MLC plans only for patients with large PTVtot.
Benchmarking a New Circular Cone-based Radiosurgery System against Clinically Tested Radiosurgery System on the same Novel Digital Linear Accelerator Platform
Authors: Sharma Dayananda Shamurailatpam , Shaju P , Sawant Mayur B , Kaushik Suryakant
Published: September 2024

Objective:

To examine the dosimetric characteristics of circular cones, the accuracy of dose modeling and overall treatment delivery of two radiosurgery systems integrated on a linear accelerator (Linac).

Materials and Methods:

The dosimetric characteristics of circular cones (4-17.5 mm) from Varian (VC) and BrainLAB (BLC) were measured for 6 MV flattening filter free beam from Edge linac using stereotactic field diode and 0.65 cc ionization chamber following established protocols. The Eclipse and iPlan modeled dose distribution for VCs and BLCs were validated with EBT3-film measurement. End-to-end tests were performed using stereotactic phantom having PTW 60008 diode connected to a Dose-1 electrometer.

Results:

The depth at dose maximum,

JOURNAL/jomp/04.03/00660230-202348020-00001/111FF07/v/2023-07-11T195429Z/r/image-tiff

and dose at 10cm depth of the same size VC and BLC agree within ± 0.7 mm, ± 0.71% and ± 0.81% respectively. Full width at half maximum (FWHM) of any cone beyond 15 mm depth increases at 1% of nominal cone size per 10 mm depth. The penumbra of 4mm and 17.5mm VC at 15 mm depth was 1.1 mm and 1.50 mm. At 300 mm depth, penumbra increased by around 0.4 mm for 4 mm cone and up to 1 mm for cone size ≥12.5 mm. The VCs penumbra values were within ±1mm of the corresponding BLCs. Scatter factors for VCs varies from 0.609 to 0.841 and were within ± 1.0% of corresponding values of BLCs. Agreement between the Eclipse and iPlan computed dose fluence and the EBT3-film measured dose fluence was >98% (γ: 1%@1 mm), and the absolute dose difference was ≤ 2.2%, except for the 4 mm cone in which it was >96% and ≤4.83%. Target localization using cone-beam computed tomography was accurate within ± 0.8 mm and ± 0.3° in translation and rotation. The end-to-end dose delivery accuracy for both radiosurgery systems was within ± 3.62%.

Conclusion:

The dosimetric characteristics of Varian and BLC cones of same diameter was comparable. Both Eclipse and iPlan cone planning system modeled dose fluences agree well with the EBT3 film measurement. The end-to-end tests revealed an excellent target localization accuracy of Edge linac with satisfactory and comparable absolute dose agreement between Varian and BLC radiosurgery systems and hence these can be interchanged on edge linac.
Cartilage Ear Piercing Probable Infections among Females between 18 and 28 Years Old in Riyadh
Authors: Binkhamis Khalifa , Habib Hanan A. , Alkahtani Mashel K. , Alrasheed Dana A. , Barakeh Maha M. , Alohali Lina Mohammed , Aloqayfi Sumayah I.
Published: September 2024

Background:

The prevalence of ear piercings is 8%−32%. Complications can be due to the factors such as the amount of tissue blood supply, the location of the piercing, the extent of hygiene techniques, and much more.

Materials and Methods:

A total of 586 females (age, 18–28 years) in Riyadh, Saudi Arabia, with at least one ear piercing were included in this analytical cross-sectional study by convenience sampling from September 2019 to April 2020. A link to an Arabic web-based questionnaire was distributed through social media (WhatsApp, Twitter, and Snapchat). It included questions related to both earlobe and ear cartilage piercings. Bivariate statistical tests were carried out.

Results:

The prevalence of a probable ear piercing-related infection for ear cartilage piercings was found to be significantly higher than for earlobe piercings (41.4% vs. 29.6%) (P = 0.0004) (confidence interval [CI] = 0.443–0.795). A significant association between piercing type (3.3% of earlobe piercings and 8.1% of ear cartilage piercings) and scar formation was observed (P = 0.0002) (CI = 0.209–0.722). The prevalence of ear piercing complications among participants who used piercing needles was lower for both earlobe piercings and ear cartilage piercings (3.65%, 8.75%) (P = 0.0015) than among those who used piercing guns (37.9%, 43.4%) (P = 0.114).

Conclusion:

Probable external ear infections were more common among those with cartilage ear piercings than those with earlobe piercings. Future studies should include participants of a broader age category and in different locations in Saudi Arabia.
The Contributions of Islam and Muslim Scholars to Infection Control
Authors: BaHammam Ahmed S.
Published: September 2024

Islam's teachings emphasize maintaining personal hygiene and isolating sick people, both of which are crucial in the present COVID-19 pandemic. Between the 7th and 15th centuries, Islamic and Arab civilizations produced significant advancements in science and medicine. These discoveries laid the groundwork for the development of the European Renaissance. In Islam, maintaining one's personal cleanliness and hygiene is a duty that Muslims have to do to worship Allah (God). In universal outbreaks such as plague pandemics, Islam recognized the risks and mandated precautions, prevention, and hygienic isolation. Islam took the lead in pioneering several health protection practices, such as the quarantine rule. If a contagious sickness manifests in a certain area or town, Prophet Muhammad instructed to forbid entry or exit to the affected town, now known as quarantine. The first documented application of quarantine, as we currently know, it was implemented by the Muslim scholar Avicenna (ibn Sina). According to Islam, protecting living creatures' lives equals protecting the faith. Therefore, all needed measures to reduce the risk of infection, including vaccines, should be rigorously applied in Islam. In this viewpoint, we discuss Islamic beliefs, the Prophet's practices and teachings, and Muslim scholars' contributions to lowering infections and putting specific regulations in place during pandemics that supplemented the development of infection control rules as we know them in modern medical practices through using the best available evidence.
Prevalence of Constipation among Peritoneal Dialysis Patients in Saudi Arabia
Authors: Tarakji Ahmad Raed , Alorabi Hussam Zaid , Alhusainy Yazeed Abdullah , Alhowaish Nasser Yousef , Alsebti Abdullah Abdulaziz , Aljutaili Hamad Sulaiman
Published: September 2024

Objectives:

Constipation among peritoneal dialysis (PD) patients can lead to serious complications and impair the quality of life. The aim of this study was to determine the prevalence of constipation and its associated factors among PD patients in our center.

Methods:

A quantitative, cross-sectional study was conducted on PD patients at King Khaled University Hospital in Riyadh, Saudi Arabia, from November 2016 to January 2017.

Results:

A total of 36 PD patients were included; the male to female ratio was 1. Based on a self-reporting questionnaire, 15 PD patients (41.7%) reported suffering from constipation. However, the prevalence was the same using at least one of Rome III criteria (41.7%) and much lower using Bristol stool form Scale (11%). No significant difference was detected between PD patients with and without constipation in terms of dietary fiber intake, use of calcium and iron supplements, water intake, presence of diabetes and hypertension, or demographic profiles.

Conclusion:

The high prevalence of constipation among PD patients seen in our population is comparable to those seen in other studies.
Renal-dose Dopamine Postcardiac Surgery in Patients with Acute Kidney Injury
Authors: Albacker TB , Alqumaizi F , Alqazlan A , Alghamdi FK , Arafat AA
Published: September 2024

Background:

Many studies have investigated the prophylactic use of dopamine in cardiac or critically ill patients with controversial results. However, only very few studies investigated the therapeutic use of low-dose dopamine in cardiac surgery patients after the development of acute kidney injury (AKI). Therefore, the aim of our study was to investigate the effect of postoperative use of low-dose dopamine in patients who develop AKI postcardiac surgery on improvement in renal function.

Methods:

This is a retrospective cohort study that included all adult patients who underwent cardiac surgery with the use of cardiopulmonary bypass and developed AKI between January 2017 and December 2020. Ninety-six patients were enrolled in the study and were divided into two groups; the first group who did not receive postoperative renal-dose dopamine (39 patients) and the second group who received dopamine (57 patients). The outcomes of interest were the improvement in renal function as indicated by the serum creatinine level, the requirement for dialysis, and the 30-day mortality.

Results:

The dopamine group had higher postoperative peak creatinine levels (205 vs. 164, P < 0.001) and higher requirements for dialysis (22.81% vs. 2.56%, P = 0.01) compared to the nondopamine group. In addition, the dopamine group had longer duration of intubation (24 h vs. 21 h, P = 0.01), longer requirement for inotropic support (4 days vs. 3 days, P < 0.001), and higher rate of re-exploration for bleeding or tamponade (21.05% vs. 2.56%, P = 0.01). Multivariate regression analysis showed that time from surgery was the only factor associated with an increase in creatinine level while dopamine use was not associated with an increase or decrease in postoperative creatinine level.

Conclusion:

The use of low-dose dopamine was not effective as a therapeutic agent in improving renal function or eliminating the need for dialysis in patients who develop AKI postcardiac surgery.
Air Pollution Impact on the Coronavirus Disease 2019, Transmission, and Mortality among Asian Countries: A Systematic Review
Authors: Tandarto Kevin , Pratama Kevin Gracia , Hengky Antoninus
Published: September 2024

The viral illness known as coronavirus disease 2019 (COVID-19) is characterized by acute severe respiratory syndrome. Recent research has conducted investigations on the impact of weather conditions on the transmission of COVID-19 in various regions worldwide, including the United States, Iran, Spain, Norway, Turkey, China, and other countries. The purpose of this systematic review study is to assess the influence of air pollution on COVID-19 transmission and fatality in Asian nations. This research aims to qualitatively synthesize articles obtained from databases and search engines such as MEDLINE, EBSCOhost, and ProQuest. The inclusion criteria for this study involve full-text articles written in English and Indonesian, published between 2020 and 2022, focusing on Asian countries, and examining the relationship between air pollution, transmission, and mortality of COVID-19 infection. Exclusion criteria encompass articles written in languages other than English, case reports, letters to the editor, and review articles. Given the worldwide impact of the COVID-19 pandemic and concerns about air pollution, particulate matter (PM) has been implicated in the transmission of the disease. Reports from various Asian countries have demonstrated significant associations between PM2.5 and PM10 levels and COVID-19 infections. Prolonged exposure to air pollution is linked to higher mortality rates in the general population. Moreover, air pollution exhibits correlations with the contagiousness of COVID-19, as observed in the majority of Asian countries investigated in this study. However, it is important to note that other meteorological factors have also played a role in the transmission dynamics of COVID-19.
An Assessment of Learning Styles of Undergraduate Medical Students in Three Different Types of Curriculum
Authors: Alfawzan Abdulrahman , Mahzari Moeber , Agha Sajida , Omair Aamir , Alfawzan Omar , Alessa Reema , Alturki Abdulaziz , Alshiha Kholoud
Published: September 2024

Background:

Research in academia suggests that types of school may have an impact on learning styles. The study is aimed to examine the learning styles of students from medical institutions using different types of curriculum.

Methods:

This descriptive cross-sectional study was conducted in the three largest public-sector medical colleges using conventional, hybrid, and a problem-based learning-based curriculum in Saudi Arabia. By using convenient sampling, we collected 316 responses. The questionnaire consisted of sociodemographic data and index of learning style instrument. The categorical data were presented as percentages and descriptive data were analyzed using the Chi-square test. Value of P < 0.05 level was considered statistically significant.

Results:

Of the 316 participants, the male-to-female ratio was 1:1. Gender was associated with a significant difference in the visual/verbal dimension (P = 0.034). Irrespective of college, most of the participants are primarily balanced in active/reflective (67.2%), visual (51.1%), and sequential (68.8%) with slight shift toward sensing (47.6%). Significant differences between colleges were found in sensing/intuitive (P = 0.005) and sequential/global (P = 0.012) dimensions. There was no significant association between academic years with learning styles in the three medical colleges from public sector universities.

Conclusion:

Irrespective of college, most of the participants' preferred style was visual illustrations supported by hands-on teaching in a stepwise process. Although, medical students in different universities possessed different learning styles. It has also been shown that students in a single university tend to develop the same learning styles as they advance through the years. The collaboration between institutions using different types of the curriculum may increase the quality of education by developing effective teaching and learning methods that correspond with the learning styles of students.
Effectiveness of Online Peer-Assisted Learning Session in Fostering the Knowledge on Breast Cancer and Breast Self-Examination among Undergraduate Medical Students
Authors: Ranganath R , Simon MA , Shah YA , AlAbduwani FI , Al Mubarak H , Al-Shamsi FA
Published: September 2024

Introduction:

Peer-assisted learning (PAL) is a student-centered active learning process which provides a flexible approach for students to prepare and organize their learning prospectus and gives opportunity for collaboration among peers.

Aims:

The purpose of this study was to assess the effectiveness and impact of online PAL session in enhancing the knowledge of breast cancer and breast self-examination (BSE) among medical students.

Settings and Design:

This was a cross-sectional, quasi-experimental study done using mixed-method design.

Subjects and Methods:

Online PAL session was conducted for premedical and preclinical students by the peer tutors for 93 medical students in March 2020. Knowledge of breast cancer and BSE was compared with the pretest and posttest scores. Feedback survey from tutees, tutors, and faculties was taken to evaluate conduct and satisfaction of the workshop for improvements in future.

Statistical Analysis Used:

Data were analyzed using SPSS 22. Descriptive data were presented as frequency and percentage. Continuous data were presented as mean and standard deviation. Paired sample t-test was applied for statistical significance of pretest and posttest data.

Results:

Significant improvements were observed in the posttest scores of knowledge on breast cancer and BSE. The mean satisfaction score was high among the tutees, tutors, and faculties, indicating that PAL session had significant impact on students.

Conclusions:

PAL sessions can be a dynamic tool to create a safe and successful learning environment for students to learn on sensitive health issues such as breast cancer and BSE.
Type B Aortic Dissection Presenting as a Left-Sided Hemothorax in a Patient with a Low-Risk Probability
Authors: Alramyan Abduluah , Alkhalifah Fahd
Published: September 2024

The differential diagnosis of isolated pleural effusion is very wide. Unilateral hemothorax carry the same wide differentials. Taking systematic approach can lead to diagnosis in the majority of cases. We presented a case of unilateral hemothroax in a gentleman with minimal symptoms and unhelpful clinical exam. Despite his low risk, he turned to have type B aortic dissection presenting as left sided hemothorax, which is a rare presentation. We presented the clinical course the patient went through and finished with brief discussion on thoracic aortic dissection and its relation to hemothorax.
Colorectal Cancer Surveillance after Resection
Authors: Aloun Abdulrahman A. , Alnafisah Khaled A. , Azzam Nahla , Aljebreen Abdulrahman , Alotaibi Egab , Alkhathami Mohammad , Mahrous Waleed K. , Alghamdi Abdullah A. , Alhujairy Bandar A. , Al Badr Eldin , Obeidalah Ibrahim , Almadi Majid Abdulrahman
Published: September 2024

Background:

Multiple guidelines have recommended performing surveillance colonoscopies after resection of colorectal cancer. However, there has been debate about the optimal frequency of endoscopic surveillance and its yield.

Objective:

The objective of this study was to explore the adherence and the yield of surveillance colonoscopy in our population.

Design:

This was a retrospective cohort study.

Setting:

This study was carried out in two tertiary care centers in Riyadh of all patients who were found to have colon cancer on colonoscopy.

Patients and Methods:

All patients who were found to have colon cancer on colonoscopy at one center from January 2016 to July 2019 and the second center from April 2012 to April 2019 were included in the study. The main outcome measures were as follows: rate of adherence to surveillance colonoscopies as well as the rate of synchronous and metachronous tumors identified. The sample size was not calculated.

Results:

A total of 280 patients were identified with a mean age of 64.5 years (standard deviation: 13.1), 61.4% were male, and the majority (72%) of the original cancers were left sided (rectum – 25.45%, rectosigmoid – 13.45%, sigmoid – 25.82%, and descending colon – 7.27%). Surveillance was performed in 55.7%, 17.9% did not attend their scheduled procedures, 2.1% refused, while there was no clear reason in 8.9%. Surveillance was not applicable to 15.3% of the study population. Over the course of three rounds of surveillance, the timing of the procedures was in line with recommendations in 66.8% in the first round while it was 20% in the second and third rounds. The procedures were normal in 69%, 71.9%, and 90% of the first, second, and third rounds, respectively. Metachronous adenocarcinoma was seen in 2.6% and synchronous adenocarcinoma in 0.6% during the first round. Adenocarcinoma was found in 5 out of 75 patients in the second round and 1 out of 10 in the third round.

Conclusion:

The attrition rate and deviation from timing suggested by guidelines are high. Furthermore, the yield of surveillance colonoscopies for important findings is clinically relevant. The limitations of this study were as follows: retrospective, probability of unmeasured confounders, as well possibility of attrition bias.
Shear Bond Strength of Ceramics to Chlorhexidine versus Pomegranate Peel Extract – Pretreated Dentin: A Randomized Control Study
Authors: Zaghloul Samaa A. , Gabal Zahraa A. , Abdul-Rahman Fatma Al-Zahraa M.
Published: September 2024

Background:

Durable tooth bonding is the hallmark of successful minimally invasive all-ceramic restorations.

Aim:

The aim of this study was to assess the shear bond of ceramics to pretreated dentin with chlorhexidine (CHX) or pomegranate peel extract (PPE), compared to no pretreatment (control), after thermocycling.

Materials and Methods:

Thirty extracted sound human premolars were enrolled and mounted in autopolymerized acrylic blocks. Occlusal 3 mms were removed to obtain the flat dentin surfaces. Teeth were randomly distributed among three equal groups (n = 10) according to dentin pretreatment; (group I: No pretreatment (control), group II: 2% CHX, and group III: PPE pretreatments). Ceramic discs (4 mm × 4 mm × 1.5 mm) were milled from zirconia-reinforced lithium silicate (ZLS) blocks (Celtra Duo, Dentsply), and cemented to prepared teeth with self-adhesive cement (RelyX Unicem, 3M). All samples were thermocycled for 2500 cycles at 5°C–55°C. Shear bond strengths (SBSs) were assessed followed by statistical analysis using one-way ANOVA, followed by Tukey’s post hoc test. The significance level was set at P ≤ 0.05 in all tests.

Results:

CHX-pretreated group showed the best SBS (18.40 ± 1.27 MPa) after thermocycling, compared to control (12.24 ± 1.20 MPa) and PPE-pretreated groups (5.89 ± 0.24 MPa) with a statistically significant difference among all groups (P ≤ 0.05).

Conclusions:

In contrary to PPE, CHX-dentin pretreatment kept better SBS to ceramics after thermocycling, providing an access to minimally invasive, yet durable esthetic restoration.
Polycystic Ovarian Syndrome and Diabetes Mellitus
Authors: Nasr Mohammed Y. , Alhuqayl Talal A. , Alshammari Hassan A. , Alkhudhayri Hamad H. , Alzin Majed B. , Sulimani Riad A.
Published: September 2024

Polycystic ovarian syndrome (PCOS) is an important public health problem. In addition to its gynecologic and hyperandrogenic manifestations, it has been associated with an increased incidence of prediabetic state, gestational diabetes mellitus (GDM), and diabetes mellitus. The pathogenesis of PCOS, as well as its metabolic consequences, is complex. The two main causative factors are intrinsic insulin resistance and impaired β cell function. Obesity has frequently been reported in PCOS; however, it is not entirely responsible for the insulin resistance in this population. PCOS should be managed with lifestyle modifications and appropriate dietary measures. In addition, treatment with insulin sensitizers is usually needed. PCOS provides a unique opportunity for the screening and early diagnosis of diabetes and its management.
Contemporary Trends and Ethical Concerns in Clinical Photography in Saudi Arabia
Authors: Jamal Amr , Al Ghamdi Khalid M. , Tharkar Shabana , Al-Rabiah Ibrahhem , Al-Shehri Mohammed , Al-Sahaf Abdulmalik , Al-Baz Mohammed , Al-Rowailey Abdullah , Al-Fowzan Abdulrahman
Published: September 2024

Objectives:

Medical photography is imperative for maintaining documentation of patient records and aiding in diagnosis and management, research, education, and training. Smartphones have replaced conventional photography due to their ease of availability, accessibility, and storage; however, their use raises privacy and ethical concerns. The objective of the present study was to determine the current trends in clinical photography and to assess the ethical issues involved in this field.

Methods:

A cross-sectional survey was used to interview physicians registered at the Saudi Commission for Health Specialties. Data collection was performed using the SurveyMonkey platform, and the final sample included complete responses from 210 participants.

Results:

A total of 147 physicians (70%) reported taking clinical photographs. Personal smartphones were the most common device used by 116 (79%) physicians, and 43 (29.3%) reported also using hospital cameras for photographing their patients. Patient visit follow-ups and medical education/training were the most popular reasons for clinical photography. Access to these devices was not well secured, with only 42 (28.6%) physicians reporting storing them in a separate folder with a password. Furthermore, no significant differences were observed in consent-taking practices between male and female patients and in the cross-analysis between physicians' and patients' genders. However, significant differences were obtained in the method of consent for identifiable and nonidentifiable photographs, with written consent preferred over verbal in identifiable photographs (P = 0.025). Common misuses included not obtaining proper consent before taking and while sharing the photographs, which raises serious privacy concerns. Patients' refusal to be photographed was the most common barrier reported by 55 (26.2%) physicians.

Conclusions:

Physicians mostly resorted to personal smartphones for capturing and storing patient photographs. This study identified a widespread prevalence of inadvertent practices related to inadequate consent, photograph sharing, and unsecured storage, which increases the risk of a breach of confidentiality. There is an urgent need to enforce standard guidelines and regulations addressing patients' privacy and ethical concerns involving digital photography in clinical practice.
Driving Distance and Glycemic Control in Patients with Insulin-Treated Diabetes Mellitus
Authors: Almigbal Turky H.
Published: September 2024

Context:

Driving distance to health-care facilities has been associated with suboptimal glycemic control in patients with diabetes. The data pertaining to the driving burden on patients with diabetes in Saudi Arabia is lacking.

Aims:

This study aims to assess the driving distance to healthcare facilities and the glycemic control of patients with insulin-treated diabetes mellitus (ITDM) in Saudi Arabia.

Setting and Design:

This study is part of the diabetes and driving study–a cross-sectional project conducted on individuals with ITDM in Saudi Arabia.

Materials and Methods:

Data collection was performed from August 2016 to February 2017 from the designated clinics every alternate day, for 4-h intervals. We included men aged more than 18 years, with at least 1 year of follow-up with the clinic, and using a car as the main mode of transportation.

Results:

A total of 429 individuals were included in the study, they were mostly from Riyadh (95.3%, n = 409) with an average age of 49.54 ± 15.20 years. The distance driven was on average 32.09 ± 115.23 km. The average duration of diabetes was 14.36 ± 8.44 years. Most (80.4%; n = 345) had uncontrolled diabetes and were almost equally distributed between those driving <10 km (55.48% n = 238) and more. We found statistically significant associations between driving for more than 10 km to access healthcare (odds ratio [OR] = 1.47; confidence interval [CI] 1.127–1.92); P = 0.004) and lower age (OR = 0.97; CI = 0.949, 1.00; P = 0.029) with uncontrolled diabetes.

Conclusion:

Patients with ITDM in Saudi Arabia have a driving burden if the healthcare facilities located far, which also might be associated with poor glycemic control. A thorough study of healthcare facilities and location of diabetes centers needs to be implemented on a national level.
Studying the Anthropometric Indices of University Students at a Nigerian University
Authors: Ugbenyen Anthony Moses , Ajayi Olulope Olufemi
Published: September 2024

Background:

Measurement of an individual’s anthropometric indices is one of the many methods for determining physical health status. This study was designed to test the reliability of some anthropometric indices in predicting central obesity among undergraduate students in Edo State, Nigeria.

Materials and Methods:

Random sampling was used in recruiting 843 undergraduate students aged 15–31 years old from Edo State University, Uzairue, Edo State, into this cross-sectional study. Traditional and new Anthropometric indices were determined by standard methods, and the area under the curve (AUC) was calculated. Data were analyzed using Student’s t-test, Chi-square, and Mann–Whitney test, and correlations were determined and were deemed statistically significant at P < 0.05.

Results:

The majority of males (52.5%) and females (50.7%) were aged 19–22 years. Weight, height, waist circumference (WC), and mid-upper arm circumference (MUAC) were significantly higher in males than females (P < 0.05). Conversely, body mass index (BMI), body roundness index (BRI), and body adiposity index (BAI) were significantly higher in females compared to males (P < 0.05). The female participants had significantly higher pulse rates, oxygen saturation, and pulse pressure than the males (P < 0.05). The AUC constructed showed WC and Waist–height ratio predicted central obesity in both genders (AUC ≥ 0.9). A significant positive correlation of WHtRatio with MUAC was observed in female participants, while a significant inverse correlation was observed between BAI and a body shape index in male participants in this study.

Conclusion:

Determining cutoff values for these indices, particularly in adolescents in sub-Saharan Africa, is imperative.
Understanding the Residents’ Practice of Cause of Death when Completing Death Certificates in Saudi Arabia
Authors: Aljerian Khaldoon , AlHogail Norah Salah , Alsuhaibani Adel Abdulaziz , Alhamidi Razan Ali
Published: September 2024

Background:

A death certificate is an official certificate signed by a doctor that states the cause of a person’s death. In most teaching hospitals, resident physicians complete the filling out of death certificates.

Materials and Methods:

In this research study, we conducted a cross-sectional study on 300 resident physicians from subspecialties, such as internal medicine, emergency medicine, and surgery, at King Khalid University Hospital, Riyadh, Saudi Arabia. The residents responded to a self-administered questionnaire. Both male and female physicians voluntarily participated in the study upon providing electronic consent. The Statistical Package for the Social Sciences(SPSS) version 25 was used to measure the statistical significance of the retrieved responses.

Results:

The study conveys that in the last 12 months, 8% of the study participants had not filled out any death certificates. Moreover, in the last 3 years, 74.6% of the resident doctor participants had filled out a significant number of death certificates, while only 4.3% had not dealt with this document. Only 16% of the doctors filled out a death certificate for patients for whom they were the primary caregivers in most of the cases.

Conclusion:

The data generated through this study indicated the reasons why some inaccuracies occur in the process of filling out death certificates, which are based on the reasons accepted by the system, the language barrier, and the training received by the residents on the matter. Given these study results, we have made various recommendations for a training program based on the documented challenges and inaccuracies in filling out death certificates, irrespective of any prior training in the subject.
Can Vitamin D Level Influence the Academic Performance of Medical Students?
Authors: Oommen Anitha , Alzahrani Wala Ibrahim
Published: September 2024

Vitamin D deficiency is common in many Western countries and also in Saudi Arabia. The cognitive effect of Vitamin D has been a subject of debate over the years. Studies in elderly people who had low levels of Vitamin D showed a cognitive decline over 6 years. Even though there is awareness about Vitamin D deficiency among medical students, only few of them are serious about taking care of it. Medical students are known to have excessive stress, which can affect their cognitive function. Researchers have reported that Vitamin D administration has improved cognitive function in the elderly. Sixty articles were collected from PubMed, Google Scholar, Directory of Open Access, and Research Gate relating to Vitamin D, of which 30 relevant articles were chosen to study the possible role of Vitamin D in neuroprotection and cognitive function.
A Nationwide Online Survey on Comparative Preference of Face-To-Face Lecture, Online Synchronous, and Asynchronous Learning in Indian Undergraduate Medical Students
Authors: Mondal Himel , Mondal Shaikat , Swain Sharada Mayee
Published: September 2024

Background:

During the coronavirus disease-2019 pandemic, learning activity via the digital medium has suddenly increased. Medical teachers quickly adapted with synchronous (i.e., online classes), and asynchronous (i.e., video-and other materials-based learning) method of delivering the content to the students.

Aim:

We aimed to explore the comparative preference of face-to-face lecture, synchronous, and asynchronous learning among Indian undergraduate medical students.

Materials and Methods:

We conducted a cross-sectional nation-wide online survey in July–August 2020 with a snowball sampling technique. We collected response from undergraduate medical students who had attended both online classes and video-and other materials-based learning. Preference on the three modes of learning (namely, face-to-face lecture, online synchronous, and asynchronous) was recorded in a 10 point Likert-type scale. Obtained responses were statistically compared by analysis of variance with a P < 0.05 to be statistically significant.

Results:

A total of 695 (female = 304 (43.74%), male = 391 (56.26%)) entries were analyzed. Overall, traditional face-to-face lecture class was the most preferred method (8.68 ± 1.49) followed by asynchronous (6.33 ± 2.22) learning and then online classes (5.22 ± 2.55, P < 0.0001). Perceived attention, interest, scope of learning, and possibility of interaction with the teachers were highest in face-to-face lecture. The scope of taking notes from all three modes was equal but the scope of formative assessment was highest with synchronous learning. The distraction was highest with asynchronous learning.

Conclusion:

Undergraduate medical students in India prefer to learn by face-to-face lecture while compared with distance delivery via the digital media. Postpandemic blended learning may be planned with the following sequence of importance: Face-to-face lecture >asynchronous >synchronous learning.
Preparing a Teaching Hospital and University Campus for the COVID-19 Pandemic
Authors: Al-Assaf Wajdan , Al-Raye Mohammed , Joseph Mercy , Al-Anazi Ahmed , Jumat Sabarina , Al-Zughibi Hisham , Allam Aseem , Al-Suwaida Abdulkareem
Published: September 2024

Objectives:

To outline the preparation conducted by King Abdullah Bin Abdulaziz University hospital, And princess Nourah Bint Abdulrahman university to deal with COVID-19 pandemic. This experience may assist other healthcare facilities (especially academic hospitals) in pandemic-related disaster planning and management.

Methods:

A descriptive study outlining the process of disaster preparedness and functional implication of this preparedness for a university campus and its related academic hospital to cope with the merging COVID-19 pandemic for the period from February 2020-October 2020.

Results:

The implemented measures in both the university and hospital helped in decreasing the rate of COVID-19 cross-infections between healthcare workers, admitted patients and university personnel. Resources were evenly distributed, and clear line of management, reporting and communication was established between the hospital and university.

Conclusion :

Integration between all stake holders in academic hospital and university leadership is the corner stone in pandemic and disaster management.
Prevalence of Self-Esteem and Imposter Syndrome and Their Associated Factors among King Saud University Medical Students
Authors: Alsaleem Lara , Alyousef Nada , Alkaff Zaina , Alzaid Lujane , Alotaibi Reema , Shaik Shaffi Ahamed
Published: September 2024

Objectives:

Our objectives are to estimate the prevalence of self-esteem and imposter syndrome, to compare their prevalence between genders and different academic years, and to determine their associated factors among King Saud University (KSU) medical students.

Methods:

Our study is a quantitative analytical cross-sectional study. Data were collected on the KSU campus. Participants in this research are KSU medical students including males and females from 1st to 5th year, with a sample size of 502. A stratified random sampling design was used. Data were collected through a self-administered questionnaire that includes the Young imposter scale, Rosenberg self-esteem scale, and sociodemographic factors.

Results:

The prevalence of low self-esteem and positive imposter syndrome is 23.6% and 42.1% (n = 573), respectively. There is a positive correlation between low self-esteem and positive imposter syndrome. There is a significant association between self-esteem and gender, mother's education, and Grade Point Average (GPA). Imposter syndrome is significantly associated with gender.

Conclusion:

Low self-esteem and positive imposter syndrome are prevalent among medical students, especially in the first few years and particularly in female students. These issues affect the mental health of medical students and thus need to be addressed to possibly improve the educational system.
Utility of the Single-Balloon Enteroscopy in a Patient with Small Bowel Tuberculosis
Authors: Altuwaijri Mansour , Alkhudhayri Hamad , Alhuqayl Talal , Aljebreen Abdulrahman
Published: September 2024

With the changing epidemiology of Crohn’s disease (CD) and intestinal tuberculosis (ITB), discriminating the two diseases has become increasingly challenging for physicians and delayed diagnosis or misdiagnosis resulted in higher morbidity and mortality. We describe the case of ITB in a 14-year-old boy who presented with chief complaints of lower abdominal pain, high swinging fever, and weight loss over the past 12 months. He had visited different clinics, diagnosed with ileal CD. He received 5-aminosalicylic acid, prednisone, and azathioprine followed by three doses of infliximab, with no response. Abdominal computed tomography revealed terminal ileal stricture with no evidence of an intra-abdominal abscess. Colonoscopy with ileoscopy up to 25 cm from the ileocecal valve showed normal mucosa; retrograde single-balloon enteroscopy was used to delineate multiple transverse ulcers with mild stenosis at 40 cm of the terminal ileum from the ileocecal valve. Pathologic findings revealed mucosal granuloma. The patient was empirically started on four anti-TB medications, and he responded very well within the 1st week of therapy. At the 6-month follow-up, he was still receiving anti-TB treatment, however became asymptomatic, gained weight and on the way to full recovery.
Approach for Zygomatic Implant Placement in Atrophic Maxilla: A Review of the Literature
Authors: Fatani Bader , Alabood Abdulaziz Abdullah
Published: September 2024

Zygomatic implants are considered one of the main treatments for severe atrophic maxilla showing a favorable alternative approach compared to bone grafting while exhibiting higher survival rates, fewer complications, shorter repair period, lower costs, shorter time, large bone graft avoidance, and few prosthodontic procedures. Zygomatic implants are mainly used for posterior maxillary support in a completely edentulous patient with severe alveolar ridge resorption and major sinus pneumatization. Previous clinical studies discussed the survival and complication rates of zygomatic implants in the atrophic maxilla; these studies have demonstrated different survival rates of these implants. Our study aims to review the approach for zygomatic implant placement in the atrophic maxilla while reviewing the surgical approach, success rate, and complications of these implants.
Parents' Knowledge, Attitude, and Practice Toward Seasonal Influenza Vaccination of Primary School Children in Buraidah City, Qassim in 2018–2019
Authors: Alqarzai Rahaf Khalid , Almaghyuli Leen Majed , Alolyan Sharouq Ali , Alharbi Fai Mutlaq , Aljehani Ebtehal Khalid , Mohamed Dalia A. , Kamal Manal Mohamed
Published: September 2024

Introduction:

Influenza viruses cause seasonal influenza which is an acute respiratory infection. The WHO reported that annually, there are about 290,000–650,000 deaths worldwide due to seasonal influenza. Vaccination is one of the most effective ways to prevent seasonal influenza and despite the high recommendation and the proven effectiveness of seasonal influenza vaccines in children, still, there is hesitancy and refuse among children's parents.

Objective:

This study assesses the parents' knowledge, attitude, and practice toward children's seasonal influenza vaccines (knowledge, attitude and practices). In addition, it aims to figures out solutions to increase awareness toward seasonal influenza vaccines.

Methods:

This study targets the parents of primary school children aged from 7 to 12 years who live in Buraidah. On 800 sample size, we used cluster random sampling. Self-administer hard copy questionnaire has been distributed.

Results:

The result shows that there is a significant association between the gender and receiving of flu vaccine P = 0.006, and the most common barrier prevents patents to vaccinate their children was because of their thoughts about its potential side effects 20.2%. Furthermore, there is no relationship between the educational level and the knowledge about seasonal influenza vaccination benefits P = 0.483614. In addition, a great proportion of our participants trust the information given to them by the Saudi Ministry of health and by their doctors 95.5% and 94.2%, respectively.

Conclusions:

We suggest increasing the effort in awareness campaigns and find a solution to correct the misconception and limits the rumors to increase the number of influenza vaccine uptake.