Medical students' perception of the reformed medical curriculum at King Saud University

Objectives: To evaluate the King Saud University [KSU] medical students' perceptions of the educational programmes' quality

Materials and Methods: A total of 289 medical students at KSU, College of Medicine were selected randomly from year 1 through year 5 and were invited to participate in a descriptive cross-sectional study design. A questionnaire was distributed to the students and collected on completion. The questionnaire measured the students' perceptions of the educational programmes and their competence, as well as their overall satisfaction with the training delivered and the feedback system

Results: About 60.5% of the students declared that the educational programmes provided them with the necessary knowledge while only 48.5% of students believed that it provided them with the necessary skills required. Only 34% of students stated that the intended learning objectives were known to them at the beginning of the courses. About half of the students indicated that the programmes actively involved them in the problem-solving process. Half of the students believed that the amount of basic science knowledge provided was enough; however, 39.5% of students [in their clinical years] believed that the amount of knowledge delivered in the basic science courses was inadequate. Only 18.4% of students considered that the basic science courses prepared them for a clinical clerkship. 17.7% of the students declared that the research activities improved their research skills. 47.3% believed that the research activities helped them in understanding community characteristics, 57.6% asserted learning the basics of medical statistics, 44.6% believed it helped them in using the available resources in solving community problems and 49.5% believed it helped them in learning as well as acquiring project management skills. 34% of the students participated in planning educational activities while 53.7% participated in evaluating these educational activities. 36.1% of students gave frequent feedback to the college. Only 30.2% of the students were satisfied with the overall quality of the educational programmes

Conclusion: The students' perception of the educational programmes was illustrated and important aspects were highlighted which needed to be addressed and revised in order to improve the quality of the curriculum

Vanishing bile duct syndrome in a Hodgkin's lymphoma patient with fatal outcome despite lymphoma remission

Vanishing bile duct syndrome [VBDS] is a condition resulting from severe bile duct injury, progressive destruction, and disappearance of intrahepatic bile ducts [ductopenia] leading to cholestasis, biliary cirrhosis, and liver failure. VBDS can be associated with a variety of disorders, including Hodgkin's lymphoma [HL]. We describe a 33-year-old male patient who presented with lymphadenopathy and jaundice, and was diagnosed to have HL. Serum bilirubin worsened progressively despite chemotherapy, with a cholestatic pattern of liver enzymes. Diagnosis of VBDS was established on liver biopsy. Although remission from HL was achieved, the patient died of liver failure. Presence of jaundice in HL patients should raise the possibility of VBDS. This report discusses the difficulties of delivering chemotherapy in patients with liver dysfunction. HL-associated VBDS carries a high mortality but lymphoma remission can be achieved in some patients. Therefore, liver transplantation should be considered early in these patients.

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Knowledge of the predictors of sustained viral response [SVR] to pegylated interferon [PEG-INF] alfa-2a and ribavirin [RBV] therapy in patients with hepatitis C genotype-4 [HCV-4] is crucial for selecting patients who would benefit most from therapy. We assessed the predictors of SVR to this combination therapy in Saudi patients with chronic HCV-4 infection. This retrospective study included 148 patients with HCV-4 infection who underwwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks posttreatment. Of the 148 patients, 90 [60.8%] were males. Mean [SD] for age was 48.5 [12.7] years and BMI was 27.9 [7.5] kg/m[2]. Seventy-nine of 148 [60.1%] patients were treatment naive and 110 [74.3%] underwent pre-treatment liver biopsy. Eighteen [12.2%] patients did not complete therapy because of side effects or they were lost to follow up. Early virological response was achieved in 84 of 91 [92.3%] patients. In the 130 [87.8%] patients who completed therapy, 34 [26.2%] were non-responders and 96 [63.8%] achieved end-of-treatment virological response [ETVR]. SVR and virological relapse [24 weeks after ETVR] occurred in 66/130 [50.7%] and 30/130 [31.2%] patients, resspectively. Compared to relapsers, sustained responders were significantly younger [P = .005], non-diabetic [P = .005], had higher serum albumin [P = .028], lower alpha-fetoprotein level [P = .026], lower aspartate aminotransferase [AST] [P = .04] levels, and were treatment-naive [P = .008]. In a multivariate regression analysis, the independent predictors of SVR were younger age [P = .016], lower serum AST [P = .012], and being treatment na‹ve [P = .021]. Approximately half of HCV-4 patients who complete the course of combination therapy achieve an SVR, especially if they are young, treatment naive and have lower AST levels