Awareness of the General Population Toward Constipation and Its Complications in the Western Region, Saudi Arabia.

Background and aim Constipation can be defined as unsatisfying defecation characterized by difficult stool passage, infrequent stools, or both. Complications include hemorrhoids, anal fissures, and prolapse of pelvic organs. Unfortunately, there needs to be more data available regarding awareness on this subject. Thus, in this study, we aim to measure the level of understanding of constipation and its complications in the western region of Saudi Arabia. Methods In this cross-sectional study, a valid and reliable questionnaire was used in data collection. In addition, SPSS (IBM Corp., Armonk, NY) was used for the analysis of collected data. Results The present study included a total of 778 participants from the general public, 75.6% of whom were female and 24.4% of whom were male. We found that 70% of participants had an overall good awareness of constipation, with significant variation in levels of awareness among different groups; levels of awareness increased with age (P-value < 0.001), higher education also positively affected the level of understanding (P-value = 0.04), and participants who reported personal experience had higher levels of awareness than participants who did not have personal experience (P-value​​​​​​​ = 0.002). There was no significant association between the level of awareness and gender or city of residence. Conclusion Much of our population was well aware of constipation and its complications, with significant variation in awareness among different age groups, educational levels, and personal experiences.

Program Directors' Selection Criteria for General Surgery and Internal Medicine Residency Programs: A Cross-Sectional Study.

Background and aims General surgery is a specialty that calls for a variety of abilities such as strong hand-eye coordination, the ability to function well under pressure, and the ability to make quick, informed decisions. On the other hand, internal medicine focuses on diagnosing, treating, and preventing adult non-surgical disorders. The present study aims to investigate the commonly used selection criteria employed by program directors (PDs) for general surgery and internal medicine residency programs. It also identifies how PDs value those criteria in the western and central regions of Saudi Arabia. Methods A retrospective cross-sectional study was conducted using a questionnaire adopted from the literature and modified following expert opinion. It was distributed to PDs in both the central and the western regions of Saudi Arabia. Results In total, 34 PDs completed the questionnaire, of which 32 (94.1%) were men. The mean age of participants was 42.53 ± 5.05 years; 21 (61.8%) PDs were general surgeons, and 47.1% were from the Jeddah region. Conclusion The study showed that the most selected criterion for both specialties was communication skills followed by clinical rotation in the same hospital; leadership skills were also highly considered by PDs.

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift.

OBJECTIVE: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients. METHODS: We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center. RESULTS: After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance. CONCLUSION: The old surgical adage "the solution to pollution is dilution" is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation. (Trial registration number: ISRCTN66454589).

Congenital cataract and congenital chloride diarrhoea-a unique combination and antenatal diagnosis.

Congenital chloride diarrhoea (CCD) is a serious inherited defect of intestinal electrolyte absorption transmitted in an autosomal recessive way. The molecular pathology involves an epithelial Cl(-)/HCO(3)(-) exchanger protein, encoded by the solute carrier family 26 member 3 gene (SLC26A3) and known DRA (down regulated in adenomas) in the distal ileum and colon. Polyhydramnios, premature birth, ileus without meconium passage, hypochloremia, and hyponatremia are typical features of CCD in the neonate followed by chronic metabolic alkalosis, hypokalemia, hypochloremia, retarded growth and renal impairment in older children and adults if the disease is not adequately treated. Antenatal diagnosis if made on the basis of findings on ultrasonography-a non-invasive diagnostic test-can help in early management of the disorder immediately after birth and, thus, prevent the sequelae. We present an interesting case of CCD diagnosed antenatally and found to have congenital cataract, which is a unique occurrence not reported in literature so far.

Chest wall swelling: unusual presentation of an aggressive mediastinal tumour.

The majority of patients with primary mediastinal lymphoma are symptomatic at the time of diagnosis and commonly have fever, weight loss and/or night sweats. Symptoms due to compression of adjacent mediastinal structures are infrequent, but may include pain, dyspnoea, stridor, or superior vena cava syndrome. Local infiltration into the chest wall, pleura and pericardium is not uncommon.In the present report, two interesting cases of chest wall swellings that in fact were extensions of primary mediastinal lymphoma are given. Histopathology of the tumour was large B cell lymphoma (CD20+). The first case was in a 23-year-old woman, with dramatic onset but a good outcome. The second was in a 34-year-old Pakistani woman, with insidious onset and poor outcome due to extent and invasion by the tumour. Interesting CT images are presented showing chest wall and left supraclavicular swelling.