Trends in genitourinary cancer mortality in the United States: analysis of the CDC-WONDER database 1999-2020.

Introduction: Sociodemographic disparities in genitourinary cancer-related mortality have been insufficiently studied, particularly across multiple cancer types. This study aimed to investigate gender, racial, and geographic disparities in mortality rates for the most common genitourinary cancers in the United States. Methods: Mortality data for prostate, bladder, kidney, and testicular cancers were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database between 1999 and 2020. Age-adjusted mortality rates (AAMRs) were analyzed by year, gender, race, urban-rural status, and geographic region using a significance level of p < 0.05. Results: Overall, AAMRs for prostate, bladder, and kidney cancer declined significantly, while testicular cancer-related mortality remained stable. Bladder and kidney cancer AAMRs were 3-4 times higher in males than females. Prostate cancer mortality was highest in black individuals/African Americans and began increasing after 2015. Bladder cancer mortality decreased significantly in White individuals, Black individuals, African Americans, and Asians/Pacific Islanders but remained stable in American Indian/Alaska Natives. Kidney cancer-related mortality was highest in White individuals but declined significantly in other races. Testicular cancer mortality increased significantly in White individuals but remained stable in Black individuals and African Americans. Genitourinary cancer mortality decreased in metropolitan areas but either increased (bladder and testicular cancer) or remained stable (kidney cancer) in non-metropolitan areas. Prostate and kidney cancer mortality was highest in the Midwest, bladder cancer in the South, and testicular cancer in the West. Discussion: Significant sociodemographic disparities exist in the mortality trends of genitourinary cancers in the United States. These findings highlight the need for targeted interventions and further research to address these disparities and improve outcomes for all populations affected by genitourinary cancers.

Pediatric Anesthesia Exposure: Decoding Its Neurodevelopmental Implications and Navigating the Nuances.

General anesthesia is fundamental in pediatric medical interventions, but its potential neurodevelopmental impact on children has raised concerns, necessitating a thorough investigation. This systematic review aimed to assess the association between pediatric anesthesia exposure and neurodevelopmental outcomes, focusing on dosage effects and identifying high-risk groups. The study involved an extensive literature search across PubMed, Medline, and Google Scholar, selecting 40 relevant studies from an initial pool of 2,000, based on inclusion criteria that focused on children under 18 years exposed to anesthesia, excluding those with major comorbidities or perioperative physiological insults. It was observed that while a single exposure to anesthesia had minimal impact on general neurodevelopment, repeated or prolonged exposures posed greater concerns. Despite these findings, the study identified gaps in certain areas like adaptive behavior and sensory cognition due to limited data. The conclusion drawn is that although the evidence on anesthesia-induced neurotoxicity in children remains inconclusive, the implications of pediatric anesthesia exposure are significant enough to warrant careful consideration by healthcare professionals, who should balance the procedural benefits against the risks. This study also calls for future research to standardize methodologies and employ consistent, validated neurodevelopmental measurement tools.

The Risk of Latent Tuberculosis Infection Among Healthcare Workers at a General Hospital in Bisha, the Kingdom of Saudi Arabia.

Background and objective Tuberculosis (TB) is a global health issue, often preceded by a latent tuberculosis infection (LTBI) in individuals. Significant global and local efforts have recently been directed toward this infection, focusing on TB control and eradication. This study aimed to assess the magnitude of LTBI among healthcare workers (HCWs) in the Kingdom of Saudi Arabia, by evaluating its prevalence and associated risk factors. Methods An analytical cross-sectional study was conducted among HCWs at the King Abdullah Hospital (KAH), from January to August 2018, by using two surveys: the first one involved data related to HCW demographics and the tuberculin skin test (TST) readings, and the second involved a questionnaire that assessed LTBI risk factors. Results Out of the total 561 HCWs who participated in the study, 66 had an induration reading of more than 10 mm in TST. Many factors were associated with LTBI cases, but multivariate analysis showed that age, gender, and nationality were statistically significant risk factors. Conclusion Given the nature of their work, HCWs are at a greater risk of TB and LTBI. At the same time, HCWs are uniquely positioned to play a crucial role in halting the spread of TB. Gaps in preventive measures may result in the increased spread of TB. Our study assessed risk factors associated with the increased risk of LTBI and proposed possible ways of addressing them.

The Incidence of Needlestick and Sharps Injuries Among Healthcare Workers in a Tertiary Care Hospital: A Cross-Sectional Study.

Background Needlestick injuries (NSIs) and sharps injuries (SIs) remain significant hazards in most healthcare facilities that expose healthcare workers (HCWs) to blood-borne pathogens (e.g., HIV, hepatitis B, and hepatitis C). This study aims to review the incidence of NSIs and SIs in King Fahad Medical City (KFMC) and correlate this incidence with several parameters related to the event, including age, sex, length of work experience, type of injury, type of instrument causing the injury, type of activity during which the injury happened, nature of the job of the HCWs, and location within the hospital where the injury happened. Methodology This cross-sectional study involves all self-reported documents related to needlestick and sharp injuries among HCWs at King Fahad Medical City (KFMC) in Riyadh, Kingdom of Saudi Arabia, from January 2017 to December 2020. The data of 389 reports of needlestick and sharp injuries detailing incidence and site, shift, type, and instrument related to the incidents were reported to the infection control department for coding and analysis using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics, Armonk, NY, USA). Results Our data showed that NSIs/SIs could be caused by a wide range of objects used by healthcare workers, including needles, suture needles, scalpels, and sharp devices. Remarkably, the most common cause of NSIs was handling the sharp object (38.8%), followed by disposing of the sharp object (19.3%). Furthermore, nurses were found to be the highest at-risk category of HCWs experiencing NSIs (49.9%), while medical waste handlers (1.5%) and dentists (1.3%) were least likely to incur injuries. Conclusion This study sheds some light on the incidence rates of NCIs and SIs at KFMC and correlates these rates with several demographical, occupational, and experiential parameters related to these events.

Comparative Analysis of Effectiveness Between Flipped Classroom and Lecture-Based Classroom in Undergraduate Medical Education at Alfaisal University.

Objective The effectiveness of the flipped classroom is currently debated due to conflicting results from different studies. It is therefore important to evaluate its usefulness each time it is applied in a new setting. Thus, this study was conducted with the objective of evaluating the effectiveness and acceptability of the flipped classroom in undergraduate medical education at the College of Medicine, Alfaisal University. Methods This was a quasi-experimental study consisting of development and administration of a flipped classroom with one group of students receiving the flipped classroom (FG) and the other group with the traditional lecture-based teaching (LG). We compared the pre-university enrolment Cumulative Grade Point Average (CGPA), preceding progress test results and previous semester performance for the two groups, which showed no statistical difference. Results Since the FG had received the video lecture while the LG had not, there was a clear statistical difference between the groups with FG showing better performance in pre-test scores. The post-test performances were marginally not statistically different between FG and LG groups. Conclusion Our results did not show any long-term benefit of a flipped classroom in terms of retention of knowledge as manifested by grades obtained in midterm and final examinations. It was also not received positively by the students.

Applying integrated video assisted learning approaches for medical clerkship - potential adaptations in the post-COVID-19 era.

Lockdowns and social distancing measures due to the ongoing COVID-19 pandemic have forced the delivery and assessment of educational material to be performed via online and virtual educational tools. Such disruption has greatly affected hands-on training programs essential to acquire clinical competencies, particularly modes requiring physical patient encounters. While most educational content has successfully been shifted to predominantly web-conferencing platforms, the essential clinical teaching at affiliated hospitals for undergraduate medicine clerkship years has been severely disrupted due to barring of students from hospital premises to minimise spread of COVID-19, presenting a problem requiring unique solutions to ensure that quality of education and subsequent healthcare is kept sufficiently high. To this degree, technological advances increasingly present several elegant solutions which may provide the required levels of educational delivery. In this article, we briefly discuss the number of options that could be deployed to aid in acquisition of requisite skills during the clerkship years, with a focus on wearable technologies and video recording/broadcasting. Given the ongoing pandemic, application of technological advances could provide, with some global coordination, the medical education community with numerous proactive solutions rather than just educational luxuries or novelties.

Vitamin D and intestinal homeostasis: Barrier, microbiota, and immune modulation.

Vitamin D plays a pivotal role in intestinal homeostasis. Vitamin D can impact the function of virtually every cell in the gut by binding to its intracellular receptor (VDR) and subsequently transcribing relevant genes. In the lumen, the mucus layer and the underlying epithelium serve to keep resident microbiota at bay. Vitamin D ensures an appropriate level of antimicrobial peptides in the mucus and maintains epithelial integrity by reinforcing intercellular junctions. Should bacteria penetrate the epithelial layer and enter the interstitium, immune sentinel cells (e.g. macrophages, dendritic cells, and innate lymphoid cells) elicit inflammation and trigger the adaptive immune response by activating Th1/Th17 cells. Vitamin D/VDR signaling in these cells ensures clearance of the bacteria. Subsequently, vitamin D also quiets the adaptive immune system by suppressing the Th1/Th17 cells and favoring Treg cells. The importance of vitamin D/VDR signaling in intestinal homeostasis is evidenced by the development of a chronic inflammatory state (e.g. IBD) when this signaling system is disrupted.

The pathogenesis of congenital radial head dislocation/subluxation.

The pathogenesis of congenital radial head dislocation/subluxation is unknown and has not been previously investigated. In this review, we explore the pathogenesis and define five different primary insults: collagen abnormalities, abnormal endochondral ossification of the developing growth plate, abnormalities of forearm ossification outside the growth plate, disproportionate growth of the radius and ulna, and altered HOX D expression/activity. Finally, the clinical relevance of our review is discussed.

Perceived barriers towards participation in undergraduate research activities among medical students at Alfaisal University-College of Medicine: A Saudi Arabian perspective.

BACKGROUND: The importance of undergraduate research (UR) to students is well acknowledged in literature; however, little is known about its perceived barriers. The aim of study is to explore the perceived barriers toward participation in UR activities among students at Alfaisal University-College of Medicine, Saudi Arabia. METHODS: An online, anonymous, cross-sectional, self-rating survey was administered. A two-tailed Mann-Whitney U-test was used to compare the average five-point Likert scale responses between male and female students. RESULTS: Two-hundred and twenty-one students (n = 221/350) participated in the survey with a 63.1% response rate. The percentage of participation in UR significantly differed by gender (males vs. females: 68.6% vs. 45.4%; p < 0.0005, Chi-square test). The top three barriers toward participation in UR were "lack of time" (77.4%), "lack of formal UR courses in curriculum" (76%) and "lack of UR mentors" (70.1%). Statistically significant differences of means were identified between male and female students regarding the following statements: "lack of supervising research mentors" (p < 0.01), "lack of interest in research" (p < 0.04), "lack of finding same-gender research mentor" (p < 0.00) and "lack of UR opportunities" (p < 0.00). CONCLUSION: Our results were fairly comparable to the Western studies. Medical educators should carefully look into all UR barriers and consider implementing applicable solutions.

Perceived influential factors toward participation in undergraduate research activities among medical students at Alfaisal University-College of Medicine: A Saudi Arabian perspective.

AIMS: (1) To explore correlations between medical students' participation in undergraduate research (UR) activities and their characteristics, and (2) to explore students' perceived influential factors toward participation in UR activities at Alfaisal University-College of Medicine, Saudi Arabia. METHODS: An online, anonymous, cross-sectional, self-rating survey was administered. Chi-square test was used to correlate between participation in UR activities and students' characteristics (age, academic year and grade point average [GPA]). Two-tailed Mann-Whitney U-test was used to compare the mean 5-point Likert scale responses between students with and without previous UR activities. RESULTS: About 218 students participated in the survey (n = 218/350; response rate: 62.3%). The top three influential factors to undertake UR activities were "facilitate entry into competitive residency programs," (88.1%) "improve curriculum vitae" (81.2%) and "publish in peer-reviewed journals" (79.8%). Percentage of participation in previous UR activities significantly differed by gender (p < 0.03825), academic year (p < 0.000003) and GPA (p < 0.02627). Students who had previous UR activities were more positively influenced to participate in future UR activities than those who did not (p < 0.0488). CONCLUSION: Students demonstrated positive attitudes toward UR activities. The relationships between participation in UR activities and male gender, increased number of years spent at medical college and higher GPA were directly proportional.

Dual-degree MBBS-PhD programs in Saudi Arabia: A call for implementation.

Engaging medical students in scholarly research activities and producing clinically competent and research-oriented medical workforces are essential demands, particularly in developing countries. Dual-degree MD-PhD programs offer simultaneous rigorous education in medicine and research, and train its graduates (physician-scientists) to successfully catalyze translational research evolutions. Literature fundamentally identifies dual-degree MD-PhD programs as the single most important, well-established, popular and influential programs toward commencing physician-scientist professions. While the physician-scientist population is alarmingly vanishing in the West with ongoing efforts to reverse this undesired trend, such population is largely nonexisting, unfortunately to start with, in Saudi Arabia. This is simply because no single dual-degree MBBS-PhD program is yet established in Saudi Arabia. Herein, we call on the Saudi Higher Education bodies to implement dual-degree MBBS-PhD programs with anticipated generation of competent physician-scientists in Saudi Arabia. To the best of our knowledge, this is the first ever report to call for such innovative implementation.

The pathogenesis of the clinical features of oral-facial-digital syndrome type I.

Oral-facial-digital syndrome type I (OFDI) is an X-linked syndrome, which has several craniofacial and limb features; and hence, patients frequently present to craniofacial and plastic surgeons. Oral-facial-digital syndrome type I is caused by mutations in the CXORF5 gene. The gene product is one of the basal body proteins of a slim microtubule-based organelle called the "primary cilium". Most of the clinical features of OFDI patients are related to dysfunctions of the primary cilium leading to abnormal Hedgehog signal transduction, depressed planar cell polarity pathway, and errors in cell cycle control.