More Is Actually Less: Practitioners' Perspective of Unnecessary Medical Testing in Saudi Arabian Emergency Departments.

Background The overuse of medical testing, be it ancillary testing or imaging, has been identified as a problem in all healthcare systems in the world. As the Kingdom of Saudi Arabia marches towards the 2030 vision of healthcare transformation, we have sought to get a perspective on medically unnecessary tests being conducted in Saudi Arabian emergency departments (EDs), the reasons behind this phenomenon, and possible solutions to it. Methods This is a cross-sectional survey among emergency medicine physicians (EMPs) working in Saudi Arabian EDs, taken through a self-filled online questionnaire, about their ordering habits, what they believe to be unnecessary testing in their practice, the practice of their colleagues, and other Saudi EMPs as a whole. Subjects have also been asked about the reasons why such practices are occurring and possible solutions to reduce such overuse of unnecessary tests in Saudi EDs. Results A total of 182 EMPs were surveyed from the different regions of the Kingdom, and CT head for patients presenting with asymptomatic stroke, and asymptomatic TBI were the most overused scans (both 44%). The most overused advanced body imaging was CT kidney-ureters-bladder (KUB) at 41.5%, while the most overused ancillary tests were complete blood count (CBC) and liver transaminases. The most common reason for the practice was found to be fear of medicolegal proceedings (70.9%). Continuous education of EMPs and increasing ED staffing were found to be the most helpful solutions to reduce unnecessary testing in the ED (70.9% and 67%, respectively). Conclusion It is clear from our data that overuse of medical tests and imaging is still a prominent practice. CT head in asymptomatic patients seems to be the most commonly overused imaging in Saudi EDs. Ancillary testing and unnecessary ordering of CBCs and transaminases seem to stem from fear of EMPs from legal consequences. More control over medical test ordering needs to be exercised to reduce these practices.

Trends in Serum Shifts: Unveiling Hyperglycaemia Links PostCOVID-19 Vaccination.

BACKGROUND: Clinical endocrinology has observed emerging endocrine complications following COVID-19 vaccination, amidst successful reductions in COVID-19 hospitalizations and deaths. The Pfizer-BioNTech and Moderna mRNA vaccines have demonstrated efficacy. Reports indicate a potential association between SARS-CoV-2 vaccination and diabetes, exploring interactions with ACE-2 receptors and molecular mimicry. Additionally, altered liver and kidney function tests post-vaccination prompt investigation into their role in predicting type 2 diabetes. This study aims to explore these biochemical abnormalities in a case-control, single-centre prospective study. MATERIALS AND METHODS: This prospective study aimed to evaluate a total of five hundred healthy donors, out of which 203 qualified for final analysis. Participants were selected based on their vaccination status with a COVID-19 vaccine and prior exposure to the SARS-CoV-2 virus. Donors without prior SARS-CoV-2 infection were excluded from the study. Included participants were adults who had received three doses of the COVID-19 vaccine. RESULTS: A total of 203 individuals were included in the study, comprising 104 with type 2 diabetes mellitus (T2DM) and 99 without. Demographic characteristics including age, sex, nationality, Rh factors, ABO blood groups, liver function tests (LFT), kidney function tests (KFT), lactate dehydrogenase (LDH), and mineral ion levels were analysed. Among the participants, the distribution based on HbA1c levels showed 47.8% with HbA1c <7% classified as normal, 38.48% with HbA1c 8-10% classified as high, and 16.64% with HbA1c <10% classified as uncontrolled diabetes. Significant findings included a decrease in magnesium levels to 0.77±0.82 mmol/L (p<0.04*), an increase in LDH levels to 420.70±356.26 µL (p<0.01*), and elevated levels of alkaline phosphatase (143.22 ± 142.62 µL, p<0.001), gamma-glutamyl transferase (GGT) (55.70 ± 32.20 µL, p<0.001), and serum bilirubin (9.23 ± 4.87 µmol/L, p<0.001). Creatinine levels were significantly lower at 116.75 ± 101.94 µmol/L (p#60;0.001), while uric acid levels were significantly elevated at 305.92 ± 145.04 µmol/L (p<0.001) in individuals with uncontrolled HbA1c <10%. A majority of these individuals belonged to the O+ blood group. CONCLUSION: This study underscores significant shifts in serum biomarkers and their complex interplay with mRNA-based SARS-CoV-2 vaccination and diabetes, particularly in uncontrolled cases. The findings suggest potential autoimmune reactions triggered by the self-adjuvant properties of mRNA and polyethylene glycol lipid conjugates. Variations observed among different blood groups may correspond to racial disparities influencing molecular mimicry mechanisms. Despite these insights, the underlying pathophysiological mechanisms remain unclear, highlighting the critical need for further research to validate and expand upon these findings.

Knowledge and Awareness of Varicose Veins and Its Risk Factors in Al-Qunfudah, Saudi Arabia.

Background Varicose veins are defined as visibly swollen and twisted veins, surrounded sometimes by patches of flooded capillaries. Varicose veins are a relatively common condition. For many people, they are a family trait. Women are at least twice as likely as men to develop them. Aim This study aims to assess the public knowledge and awareness of varicose veins in Al-Qunfudah, Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people in Al-Qunfudah, Saudi Arabia. An online questionnaire was used for data collection. The data collection sheet included socioeconomic-demographic information. Varicose vein knowledge was assessed in the second portion using three-point ratings. The final section had multiple-choice questions about risk factors and complications, including symptoms, diagnostic techniques, and risk factors for varicose veins. Results Participants were included in the study after excluding individuals aged less than 18 years old, with a majority being males (319; 79.9%). Regarding age distribution, participants aged 36-45 years constituted the largest group (132; 33.1%). Out of 399 participants, 369 (92.5%) had not been diagnosed with varicose veins. Most participants (271, 67.9%) had heard of varicose veins, with the primary sources of information being someone they knew with varicose veins (106, 39.11%). Family history was considered an important factor by 141 (35.3%) of respondents while 217 (54.4%) were unsure. Female gender and old age showed significantly higher knowledge levels (p< 0.05). Conclusion The current study concluded that while there was a fair level of public awareness of varicose veins in general, there was a noticeable lack of knowledge regarding clinical symptoms and diagnostic techniques. Younger females demonstrated noticeably greater awareness and comprehension of the illness.

Evaluation of the Relationship Between Smartphone Addiction and Lower Back Pain and Neck Pain Among Medical Students at Al-Baha University.

Introduction In recent years, the increased use of smartphones has adversely affected students, leading to issues like musculoskeletal pain. Therefore, our objective was to assess the correlation between smartphone addiction and neck and lower back pain. Methodology An observational cross-sectional study was conducted at Al-Baha University, Al-Baha, Saudi Arabia. The Smartphone Addiction Scale Short Version (SAS-SV) was used to measure the level of smartphone addiction while the Nordic Musculoskeletal Questionnaire (NMQ) was utilized to evaluate musculoskeletal pain. Results Smartphone addiction was prevalent in 72% of the participants (n = 293). Significantly, lower back pain was associated with smartphone addiction (p-value = 0.004). However, none of the demographic characteristics were associated with neck or lower back pain (p-value > 0.05). Students in clinical years had a higher risk of neck pain than those in an internship (p-value = 0.048). Conclusion Almost two-thirds of the students were addicted to smartphones, with a significant association with lower back pain. Students addicted to their smartphones had a higher risk of developing lower back pain, while clinical-year students had a higher risk of developing neck pain. It's important to raise awareness about the health and safety dangers linked to smartphones and other devices.

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study.

Background: Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults. Objective: This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults. Methods: A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively. Results: MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling. Conclusion: This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.

Prevalence of Gastroesophageal Reflux Disease and Its Impact on the Quality of Life Among Obese Individuals in Al-Baha Region, Saudi Arabia.

Background Gastroesophageal reflux disease (GERD) is a global gastrointestinal disorder, and obesity is a particular risk factor. Symptoms of GERD, such as heartburn and acid reflux, are caused by abnormal relaxation in the lower esophagus, causing gastric acid reflux. Persistent symptoms can affect the patient's quality of life (QOL) and can cause complications, such as esophageal adenocarcinoma. Management of GERD includes lifestyle changes, antacids, and anti-reflux surgery. Even though GERD is a common disease, few research has been carried out on it in Saudi Arabia. Aim This study aimed to estimate the prevalence of GERD and its associated risk factors among obese individuals in the Al-Baha region population and the effect of GERD on their QOL. Methods A cross-sectional study included 314 obese participants from the Al-Baha region. A questionnaire was filled out to measure the prevalence of GERD, risk factors, and effects on the QOL of the participants. Data were analyzed by the IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). Descriptive statistics and the chi-squared test were applied. Logistic regression analysis was used to determine the factors associated with the incidence of GERD. A p-value of <0.05 was considered statistically significant. Results A total of 314 patients who met our inclusion criteria completed the survey; 42% of them were women, the mean age of all patients was 35.3 ± 12.9 years, and 38.2% of the patients were diagnosed with GERD. Epigastric pain and burning sensation were the most common symptoms (44.9%). Five out of six domains in the QOL questionnaire showed more effects among GERD participants than non-GERD participants, and the results were statistically significant (p = 0.001). Logistic regression analysis showed that men are 1.8 times more likely than women to be diagnosed with GERD, and smokers have 2.6 times the risk of being diagnosed with GERD than non-smokers. Conclusion The present study showed a high prevalence of GERD among obese patients in the Al-Baha region, negatively affecting their QOL. Major risk factors included gender, smoking, dyslipidemia, and hypertension. Public health programs to raise awareness of these risk factors and lifestyle habits are necessary to improve QOL and prevent complications.

Evaluation of Allergic Conjunctivitis Prevalence and Attitude Toward Prevention and Control in Saudi Arabia.

BACKGROUND: Allergic conjunctivitis (AC) is a prevalent ocular condition with a substantial impact on individuals' quality of life. This study aimed to explore the demographic patterns, prevalence, symptoms, awareness, and attitudes associated with AC, while also examining potential associations with gender, age, and region of residence in Saudi Arabia. METHODS: A cross-sectional study was conducted involving 487 participants. Data was collected through a self-administered questionnaire that included demographic information about AC prevalence, symptoms, attitudes, and awareness levels. Statistical analyses, including chi-square tests, were employed to examine associations between variables. RESULTS: The study revealed a prevalence of AC (89, 18.3%) with common symptoms being eye redness (73, 82%) and itching (73, 82%). Participants displayed diverse awareness levels, with (376, 77.2%) correctly defining AC. The majority demonstrated either a good (230, 47.2%) or insufficient (196, 40.2%) attitude, while 54 (11.1%) had a sufficient attitude, and 7 (1.4%) exhibited an excellent attitude and awareness. Significant regional disparities were observed, impacting both prevalence and attitudes. While no gender differences were noted, the age group of 31-40 displayed a higher prevalence. CONCLUSION: In this study, among 487 participants, the prevalence of AC was found to be 89 (18.3%). Meanwhile, attitude levels varied, with the majority demonstrating either a good or insufficient attitude. This provides valuable insights into the prevalence, symptoms, and awareness of AC in our population. The regional disparities underscore the need for tailored interventions addressing specific geographical contexts. The findings contribute to the broader understanding of AC, emphasizing the importance of targeted education and regional considerations in managing and preventing this condition.

Gait Compensation among Children with Non-Operative Legg-Calvé-Perthes Disease: A Systematic Review.

Perthes disease is a condition that affects walking patterns in young children due to poor blood circulation in the hip joint. Understanding the gait strategies of affected children is of great importance for an objective assessment and better management of this condition. The aim of this systematic review was to evaluate the current literature to identify gait compensation patterns in non-operative children with Perthes disease. METHODS: A systematic electronic search was performed using MEDLINE, CINAHL, Embase, BIOSIS, and the Cochrane Library to identify studies published from inception up until December 2023. An adapted Downs and Black checklist was utilised to assess methodological quality and project risk of bias. Percentage agreement and nominal kappa statistics with bootstrapped bias-corrected 95% confidence intervals (CIs) were used. RESULT: A comprehensive literature search revealed 277 citations for review, of which 210 studies entered full-text screening. In total, eight studies met the inclusion criteria for quality assessment by two independent reviewers. The results revealed variations in data quality, with scores ranging from 12 to 17 due to missing information related to subject characteristics, biomechanical model, and power calculation. CONCLUSIONS: This review reveals common compensation strategies associated with walking among non-operative children with Perthes disease such as Trendelenburg gait due to weakness of the hip abductor muscle.

Optimal distribution grid allocation of reactive power with a focus on the particle swarm optimization technique and voltage stability.

A structured approach to managing reactive power is imperative within the context of power systems. Among the restructuring initiatives in the electrical sector, power systems have undergone delineation into three principal categories: generation, transmission, and distribution entities, each of which is overseen by an independent system operator. Notably, active power emerges as the predominant commodity transacted within the electrical market, with the autonomous grid operator assuming the responsibility of ensuring conducive conditions for the execution of energy contracts across the transmission infrastructure. Ancillary services, comprising essential frameworks for energy generation and delivery to end-users, encompass reactive power services pivotal in the regulation of bus voltage. Of particular significance among the array of ancillary services requisite in a competitive market milieu is the provision of adequate reactive power to uphold grid safety and voltage stability. A salient impediment to the realization of energy contracts lies in the inadequacy of reactive power within the grid, which poses potential risks to its operational safety and voltage equilibrium. The optimal allocation of the reactive power load is predicated upon presumptions of consistent outcomes within the active power market. Under this conceptual framework, generators are afforded continual compensation for the provision of reactive power indispensable for sustaining their active energy production endeavors.

Art or Artifact: Evaluating the Accuracy, Appeal, and Educational Value of AI-Generated Imagery in DALL·E 3 for Illustrating Congenital Heart Diseases.

Artificial Intelligence (AI), particularly AI-Generated Imagery, has the potential to impact medical and patient education. This research explores the use of AI-generated imagery, from text-to-images, in medical education, focusing on congenital heart diseases (CHD). Utilizing ChatGPT's DALL·E 3, the research aims to assess the accuracy and educational value of AI-created images for 20 common CHDs. In this study, we utilized DALL·E 3 to generate a comprehensive set of 110 images, comprising ten images depicting the normal human heart and five images for each of the 20 common CHDs. The generated images were evaluated by a diverse group of 33 healthcare professionals. This cohort included cardiology experts, pediatricians, non-pediatric faculty members, trainees (medical students, interns, pediatric residents), and pediatric nurses. Utilizing a structured framework, these professionals assessed each image for anatomical accuracy, the usefulness of in-picture text, its appeal to medical professionals, and the image's potential applicability in medical presentations. Each item was assessed on a Likert scale of three. The assessments produced a total of 3630 images' assessments. Most AI-generated cardiac images were rated poorly as follows: 80.8% of images were rated as anatomically incorrect or fabricated, 85.2% rated to have incorrect text labels, 78.1% rated as not usable for medical education. The nurses and medical interns were found to have a more positive perception about the AI-generated cardiac images compared to the faculty members, pediatricians, and cardiology experts. Complex congenital anomalies were found to be significantly more predicted to anatomical fabrication compared to simple cardiac anomalies. There were significant challenges identified in image generation. Based on our findings, we recommend a vigilant approach towards the use of AI-generated imagery in medical education at present, underscoring the imperative for thorough validation and the importance of collaboration across disciplines. While we advise against its immediate integration until further validations are conducted, the study advocates for future AI-models to be fine-tuned with accurate medical data, enhancing their reliability and educational utility.

Awareness of inflammatory bowel disease among the general population of Al-Baha region, Saudi Arabia.

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder that encompasses Crohn's disease (CD) and ulcerative colitis (UC). IBD can be debilitating and has severe effects on the quality of life of the affected individuals. However, despite the increasing frequency of IBD around the world, the general population lacks knowledge and comprehension of this illness. The aim of this study was to determine the level of knowledge and awareness of IBD among the general population in Al-Baha region, Saudi Arabia. We carried out a cross-sectional study using an online self-administered validated questionnaire. The questionnaire included demographic questions, as well as questions regarding knowledge and awareness of IBD. The study included 473 participants selected by convenience random sampling with equal chance of selection. Approximately 61% of the participants had never heard about IBD, and for those who did, social media was the most common source of information (40.6%). Also, the majority of participants had limited knowledge about the different types of IBD (74%), their symptoms, and long-term effects. Women had a significantly higher level of adequate knowledge (12.1%) compared to men (4.8%) (P = 0.011). The study demonstrated a substantial lack of understanding and awareness of IBD among the general population in Al-Baha region, notably regarding the different types of IBD, their symptoms, and their long-term effects. The study underscores the need for further educational initiatives and resources to raise public knowledge and comprehension of IBD globally.

Prevalence of Acute Tonsillitis and Its Association With Oral Hygiene Among the Population of Taif City, Saudi Arabia.

Introduction  Dental surfaces have dense bacterial deposits, and poor oral hygiene can exacerbate bacterial infections, causing acute tonsillitis. The study aims to quantify acute tonsillitis prevalence and assess its association with oral hygiene practices. Methods  A descriptive cross-sectional study aimed to assess the prevalence of acute tonsillitis and its association with oral hygiene was conducted among adults aged 20 and above in Taif City, Saudi Arabia. Illiterates and those unwilling to participate were excluded. We employed an Arabic online self-administered questionnaire that was disseminated conveniently via Google Forms to social media assessing oral hygiene such as last dental visit, age at starting dental care, number of toothbrushes per day, frequency of toothbrush change, and duration of brushing teeth, and acute tonsillitis characteristics of the participants. Results About 393 participated in the study. Of them, 54% were aged 20-30, 53% were males, and 70% had a university education. The prevalence of acute tonsillitis was 64%. Approximately 28% reported dental clinic visits within three months, and 21% initiated oral hygiene practices at age 20. Among participants, 43% brushed twice daily, with 33% spending one minute and 43% two minutes. About 31% replaced toothbrushes every three months, while 23% acknowledged having bad breath. Experiencing bad breath, changing toothbrushes every three months, and having dental visits within less than three months were associated with having acute tonsillitis (p<0.05). However, regression analysis revealed that experiencing bad breath (OR: 2.11, 95% CI: 1.23, 3.70) was associated with a higher risk of acute tonsillitis, while less frequent toothbrush changes correlated with a lower risk (OR: 0.54, 95% CI: 0.30, 0.94). Conclusion  This study revealed a substantial prevalence of acute tonsillitis among adults in Taif City. Oral care practices need improvement. There are significant associations between oral hygiene practices, bad breath, and the occurrence of acute tonsillitis. Addressing oral hygiene practices could be a key focus for preventative measures.

Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia.

Background Cancer patients suffer from variable degrees of distress. The distress thermometer (DT) is a valuable tool for screening those patients for distress. Few studies have addressed the utility of DT in screening cancer patients in Saudi Arabia. We aimed to measure the distress level of adult cancer patients utilizing the DT and identify the appropriate measures and interventions required to improve this population's well-being. Methods This cross-sectional study was carried out at the oncology center of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Enrollment criteria were Saudi adults (≥14 years old), with a diagnosis of cancer, who gave informed consent. They were screened for distress using the DT and its associated problem list (PL). A workflow for a psycho-oncology supportive program was suggested. Results Using DT at a cut-off score of ≥4, 22% of patients had significant distress. The most frequent problems reported were loss/change of physical activity, swelling/edema, change in eating, family health problems, and child care. The multivariable binary regression analysis showed that sadness, depression, worry/anxiety, fear, loss of interest, change in appearance, taking care of myself, swelling/edema, and memory/concentration problems were independent factors for significant distress in our cohort. The suggested workflow could effectively be implemented among cancer patients. Conclusion The current study's findings support previous reports concerning the utility of DT in screening cancer patients for distress. A considerable number of Saudi cancer patients suffered from significant distress, which was significantly related to the emotional, spiritual, social, and religious aspects of their problems. We suggested a workflow by which cancer centers can implement DT screening after developing a plan for timely distress evaluation, with further proper management and referrals accordingly. Additional studies are warranted.

The effect of school size and class size on school preparedness.

The purpose of the present study was to understand students' school readiness as a function of student and teacher behaviors but also school size and class size using both linear and non-linear analytical approaches. Data came from 21,903 schools distributed across 80 countries as per the 2018 cohort of the PISA database. Results pointed to a preference for the Cusp model in that the relationship between school and class sizes with achievement proved to be best described by the non-linearity of the Cusp catastrophe model. The critical benchmarks were a school size of 801 students and a class size of 27 students for which increases beyond those thresholds were linked to nonlinearity and unpredictability in school readiness. For this reason, we suggest using the cusp catastrophe model from Nonlinear Dynamical Systems Theory (NDST) to understand more fully such complex phenomena.

Knowledge of Back Pain and Spinal Disorders Among the General Population in the Western Region of Saudi Arabia.

Introduction  Low back pain (LBP) is one of the most common global health problems and the second most common reason for seeking medical advice. However, most LBP does not indicate a serious disorder. Over half of the Saudi Arabian population experiences LBP at least once in their lives. Therefore, it is important to assess and understand how people manage this health problem. This study assessed back pain and spinal disorder knowledge among the general population in Saudi Arabia's western region. Methods This was a cross-sectional study of the general population in western Saudi Arabia. The data were collected using an online, self-administered, Arabic version of the validated questionnaire about LBP. A statistical analysis of the collected data was performed using a software program. Results A total of 754 eligible participants completed the questionnaire. Less than half of the participants could correctly define acute and chronic LBP and sciatica. Only 19.2% of participants were aware that medical history and clinical examinations are used to diagnose LBP. Young participants, university graduates, and unmarried participants had good LBP knowledge. Conclusion This study showed that the general population of Saudi Arabia in the Western region needs more knowledge about the definitions of acute and chronic LBP. However, they had fair knowledge about the aggravating factors and triggers of LBP. Young participants had better knowledge about LBP. Awareness campaigns with brochures and flyers can be used to increase the population's knowledge.

Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis.

BACKGROUND: Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery. METHODS: A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively. RESULTS: 11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD -3.704, 95% CI -5.122 to -2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema. CONCLUSION: Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient's blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes.

L1 Cell Adhesion Molecule (L1CAM) Expression and Molecular Alterations Distinguish Low-Grade Oncocytic Tumor From Eosinophilic Chromophobe Renal Cell Carcinoma.

Renal low-grade oncocytic tumor (LOT) is a recently recognized renal cell neoplasm designated within the "other oncocytic tumors" category in the 2022 World Health Organization classification system. Although the clinicopathologic, immunohistochemical, and molecular features reported for LOT have been largely consistent, the data are relatively limited. The morphologic overlap between LOT and other low-grade oncocytic neoplasms, particularly eosinophilic chromophobe renal cell carcinoma (E-chRCC), remains a controversial area in renal tumor classification. To address this uncertainty, we characterized and compared large cohorts of LOT (n = 67) and E-chRCC (n = 69) and revealed notable differences between the 2 entities. Clinically, LOT predominantly affected women, whereas E-chRCC showed a male predilection. Histologically, although almost all LOTs were dominated by a small-nested pattern, E-chRCC mainly showed solid and tubular architectures. Molecular analysis revealed that 87% of LOT cases harbored mutations in the tuberous sclerosis complex (TSC)-mTOR complex 1 (mTORC1) pathway, most frequently in MTOR and RHEB genes; a subset of LOT cases had chromosomal 7 and 19q gains. In contrast, E-chRCC lacked mTORC1 mutations, and 60% of cases displayed chromosomal losses characteristic of chRCC. We also explored the cell of origin for LOT and identified L1 cell adhesion molecule (L1CAM), a collecting duct and connecting tubule principal cell marker, as a highly sensitive and specific ancillary test for differentiating LOT from E-chRCC. This distinctive L1CAM immunohistochemical labeling suggests the principal cells as the cell of origin for LOT, unlike the intercalated cell origin of E-chRCC and oncocytoma. The ultrastructural analysis of LOT showed normal-appearing mitochondria and intracytoplasmic lumina with microvilli, different from what has been described for chRCC. Our study further supports LOT as a unique entity with a benign clinical course. Based on the likely cell of origin and its clinicopathologic characteristics, we propose that changing the nomenclature of LOT to "Oncocytic Principal Cell Adenoma of the Kidney" may be a better way to define and describe this entity.

The impact of science teaching strategies in the Arabic-speaking countries: A multilevel analysis of TIMSS 2019 data.

This paper analyses teaching strategies in relation to the science achievement of 4th-grade students using TIMSS 2019 data. It focuses on seven Arabic-speaking countries, which share similar cultures and distinct features of their societies and school systems. It applies multilevel modeling with student- and classroom-level information to decompose variance and understand relationships at these two levels. Overall, the results show the importance of analysis at the classroom level, as half of the science achievement variance is associated with differences between classrooms. Our results indicate that in the Arabic-speaking countries, emphasis on academic success and more active instruction are positively related to student achievement. On the other hand, science investigation methods such as planning and running experiments are negatively related to achievement, although the effects are small in magnitude. Moreover, the results from multilevel models with random coefficients for home resources suggest that higher emphasis on academic success increases differences in student achievement depending on their socioeconomic background.

Efficacy of Chemotherapy Rechallenge Versus Regorafenib or Trifluridine/Tipiracil in Third-Line Setting of Metastatic Colorectal Cancer: A Multicenter Retrospective Comparative Study.

PURPOSE: Metastatic colorectal cancer (mCRC) is a significant global health burden. This retrospective study compared the effectiveness of trifluridine/tipiracil (FTD/TPI), regorafenib, and chemotherapy rechallenge for third-line mCRC treatment. MATERIALS AND METHODS: We reviewed the medical records of 132 patients with mCRC treated with regorafenib, FTD/TPI, or a rechallenge with the initial chemotherapy regimen in a third-line setting from four different institutions. The primary end point was progression-free survival (PFS). Secondary end points were objective response rate and overall survival (OS) across the three treatment approaches. RESULTS: Twenty-nine patients received chemotherapy rechallenge, and 103 received FTD/TPI or regorafenib. Patients' characteristics were comparable, except for a lower number of left-sided primaries and KRAS wild-type tumors in the FTD/TPI-regorafenib group. The median PFS for the entire group was 3.0 months, and the median OS was 13.7 months. Chemotherapy rechallenge has resulted in a median PFS of 3.1 months and a median OS of 21.2 months, compared with 2.9 months (PFS) and 12.6 months (OS) for the FTD/TPI-regorafenib group. Multivariate analyses identified male sex and an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1 as independent prognostic factors for better PFS, whereas chemotherapy rechallenge, localized stage at diagnosis, and an ECOG PS of 0-1 were significant prognostic factors for better OS. CONCLUSION: This study suggests that chemotherapy rechallenge may provide a survival benefit in the third-line treatment of mCRC. However, patient characteristics, such as sex and ECOG PS, should also be considered in treatment decisions. Further prospective studies are required to confirm our findings.

Evaluating the Knowledge, Attitudes, and Practices of Saudi Arabian Parents Regarding Red Flags in Developmental Milestones.

Background Parents serve a fundamental role in monitoring developmental milestones and identifying potential delays during early childhood, enabling timely interventions. However, previous studies in Saudi Arabia have shown limited awareness among parents regarding age-specific norms and red flags across developmental domains. This knowledge gap can severely impact the detection and management of abnormalities. Hence, a comprehensive understanding of Saudi parental knowledge, attitudes, and practices concerning childhood developmental trajectories is imperative.  Methodology This cross-sectional study assessed developmental milestone awareness, beliefs, and behaviors among Saudi parents. A sample of 1,052 parents completed a validated 38-item questionnaire covering knowledge, attitudes, practices, and demographics. Knowledge was assessed across developmental domains using 22 multiple-choice questions, with scores categorized as excellent (≥75%), good (50%-75%), fair (40%-50%), or poor (≤39%). Attitudes and practices were captured on five-point Likert scales. Descriptive and chi-square analyses were conducted using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, NY).  Results The majority of participants were females (844, 80.2%), with a mean age of 38.8 years. Serious knowledge inadequacies existed regarding developmental timelines across domains, especially motor milestones like crawling (93, 29.4% correct), sitting unsupported (45, 27.6%), pointing at objects (278, 26.4%), and responding to names (440, 41.8%). Overall, 2 (0.2%) participants showed excellent and 281 (26.7%) showed good understanding, while 490 (46.6%) had poor knowledge. Significant sociodemographic variations were observed, with women and experienced parents demonstrating greater awareness (P < 0.001). Despite knowledge gaps, 542 (51.5%) actively sought developmental information themselves, and over 50% trusted pediatric guidance. Most participants expressed a willingness to undergo screenings if risk factors existed and reported spending a considerable amount of daily interaction time with their children, focusing on developmental needs. Conclusions Critical developmental milestone knowledge shortfalls and selective attitudes persist among Saudi parents, warranting public education and physician-parent communication that enhance interventions to enable impactful developmental monitoring and prompt responses to abnormalities in a timely manner.