Exploring faculty perception of simulation-based education: Benefits and challenges of using simulation for improving patient safety in cardiovascular diploma program.

Objectives: The study was conducted in a tertiary educational hospital based in Riyadh to explore faculty's perception of using simulation-based teaching as part of the Cardiovascular Diploma Program (CDP) to improve patients' safety. The study, also aimed to identify the benefits and challenges of utilizing simulation. Methods: Researchers used a qualitative approach. Semi-structured interviews were conducted online with ten faculty-members. The interviews were performed between July and September in the year 2019. Authors used convenient sampling techniques for recruitment. Data were transcribed and analyzed using a framework analysis approach. Result: Data analysis showed four emergent themes, i.e., the concept of simulation (it is a risk-free environment for training), simulation for patients' safety (students first learn on the simulators and deal with patients), simulation as a safe learning environment (gives idea basic things about the working environment, knowing the symptoms of the patients, catheterizing the patient, knowing preparations for the procedure and post care), and the challenges of utilizing simulation (identify gaps between the theoretical and practical parts). Conclusion: Faculty has appreciated the role of simulation in improving patients' safety. Simulation was underutilized due to the limited time allotted for simulation and lack of adequate experienced faculty. It is recommended that simulation should be integrated into the CDP curriculum.

Optimal abdominal CT protocol for obese patients.

INTRODUCTION: This study investigated the impact of different protocols on radiation dose and image quality for obese patients undergoing abdominal CT examinations. METHODS: Five abdominal/pelvis CT protocols employed across three scanners from a single manufacturer in a single centre used a variety of parameters (kV: 100/120, reference mAs: 150/190/218/250/300, image reconstruction: filtered back projection (FBP)/iterative (IR)). The routine protocol employed 300 reference mAs and 120 kV. Data sets resulting from obese patient examinations (n = 42) were assessed for image quality using visual grading analysis by three experienced radiologists. Objective assessment (noise, signal/contrast-noise ratios) and radiation dose was compared to determine optimal protocols for prospective testing on a further sample of patients (n = 47) for scanners using FBP and IR techniques. RESULTS: Compared to the routine protocol, mean radiation dose was reduced by 60% when using 100 kV and SAFIRE technique strength 3 (p = 0.001). Reduction of up to 30% in radiation dose was noted for the FBP protocol: 120 kV and 190 reference mAs (p = 0.008). Subjective and objective image quality for both protocols were comparable to that of the routine protocol (p > 0.05). An overall improvement in image quality with increasing strength of SAFIRE was noted. Upon clinical implementation of the optimal dose protocols, local radiology consensus deemed image quality to be acceptable for the participating obese patient cohort. CONCLUSION: Radiation dose for obese patients can be optimised whilst maintaining image quality. Where iterative reconstruction is available relatively low kV and quality reference mAs are also viable for imaging obese patients at 30-60% lower radiation doses.

Sofosbuvir-Based Therapy for Genotype 4 HCV Recurrence Post-Liver Transplant Treatment-Experienced Patients.

Background and Aim. This is an open label prospective cohort study conducted at a tertiary care hospital. The primary endpoint is SVR12 in patients treated with sofosbuvir-based therapy in post-liver transplant patients with genotype 4 HCV recurrence. Methodology. Thirty-six treatment-experienced liver transplant patients with HCV recurrence received sofosbuvir and ribavirin ± peginterferon. Results. We report here safety and efficacy data on 36 patients who completed the follow-up period. Mean age was 56 years, and the cohort included 24 males and one patient had cirrhosis. Mean baseline HCV RNA was 6.2 log10 IU/mL. The majority of patients had ≥ stage 2 fibrosis. Twenty-eight patients were treated with pegylated interferon plus ribavirin in addition to sofosbuvir for 12 weeks and the remaining were treated with sofosbuvir plus ribavirin only for 24 weeks. By week 4, only four (11.1%) patients had detectable HCV RNA. Of the 36 patients, 2 (5.5%) relapsed and one died (2.75%). Conclusion. Our results suggest that sofosbuvir + ribavirin ± pegylated interferon can be utilized successfully to treat liver transplant patients with HCV recurrence.

Serum 25-hydroxyvitamin D status among Saudi children with and without a history of fracture.

BACKGROUND: The significance of vitamin D deficiency in the incidence of bone fractures in children has been under investigated. Here, we aimed to associate serum 25-hydroxyvitamin D levels and fractures in Saudi children. MATERIALS AND METHODS: This cross-sectional study was conducted in 1022 Saudi children without fracture history [476 boys (age 14.56 ± 1.81, BMI 22.38 ± 5.81) and 546 girls (age 13.57 ± 1.67, BMI 22.24 ± 4.94)] and 234 Saudi children with a history of fracture [148 boys (age 14.25 ± 1.39, BMI 22.66 ± 6.08) and 86 girls (age 13.76 ± 1.35, BMI 21.33 ± 1.35)]. Anthropometric and fasting serum biochemical data were collected. Serum 25-hydroxyvitamin D level was assessed using electrochemiluminescence. RESULTS: Mean circulating 25-hydroxyvitamin (25OH) D level in subjects with a history of fracture was significantly lower in both boys (p < 0.01) and girls (p < 0.01) than those without, however both groups had low mean 25(OH)D levels. Furthermore, age was positively associated with 25-hydroxyvitamin D in boys (p < 0.05) and negatively in girls (p < 0.05) with a history of fracture. CONCLUSION: In conclusion, vitamin D levels were significantly lower in children with a history of bone fractures in both boys and girls than those without such a history; even in the absence of fracture history, vitamin D status correction is warranted in the general Saudi pediatric population.

A cross-sectional assessment of quality of life of colorectal cancer patients in Saudi Arabia.

OBJECTIVE: In this cross-sectional study, we aimed to describe the quality of life of Saudi colorectal cancer (CRC) patients and identify the factors that may further improve health care for CRC survivors in Saudi Arabia (KSA). METHODS: A total of 106 CRC patients from five different private and public tertiary level hospitals in Saudi Arabia participated in this study. CRC patient was interviewed by a trained researcher between September and December 2014. All respondents answered a three-part questionnaire which includes demographic data and a validated Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life. RESULTS: Participants had a mean score for global health of 67.1 (95 % CI 62.55-71.71). Among the five scales of quality of life, social functioning and functional scales of CRC patients scored the highest [Mean 83.49 (95 % CI 78.64-86.33)] while the lowest scored was emotional scales [66.9 (95 % CI 61.81-71.98)]. Insomnia was considered the most distressing symptom on the symptom scales. Using the disease-specific tool, it was found that sexual interest scored the highest. On the symptom scale, dissatisfaction with stoma care problems scored the highest. CONCLUSION: Factors associated with a major reduction in all domains of quality of life included employment status and tumor location. This study identifies the factors and issues that affect the quality of life of CRC patients in KSA. Addressing these factors and issues may lessen the burden of cancer survivors in the KSA or may prolong their survival.

New Approach of Beauveria bassiana to Control the Red Palm Weevil (Coleoptera: Curculionidae) by Trapping Technique.

This work is the first study to investigate the efficacy of the commercial formulation of Beauveria bassiana (Broadband) to control adults of red palm weevil (Rhynchophorus ferrugineus (Olivier)). This fungus could be applied as one of the biological tactics in controlling red palm weevil. Bioassay experiments for medium lethal concentrate and medium time to cause death of 50% of red palm weevil adults were carried out. The result showed that the LC50 of B. bassiana (Broadband) was 2.19×10(7) and 2.76×10(6) spores/ml at 9 and 23 d of treatment, respectively. The LT50 was 13.95 and 4.15 d for concentration of 1×10(7) and 1×10(8) spores/ml, respectively, whereas 1×10(9) spores/ml caused 100% mortality after 24 h. Additionally, a red palm weevil pheromone trap was designed to attract the adults to be contaminated with spores of Broadband, which was applied to the sackcloth fabric that coated the internal surfaces of the bucket trap. The mating behavior was studied to determine direct and indirect infection of the spores from male to female and vice versa. The results showed a high efficacy of Broadband suspension at 1×10(9) spores/ml; 40 ml of suspension at this concentration treated to cloth in a trap caused death of contaminated adults with B. bassiana spores directly and indirectly. The 100% mortality was obtained even after 13 d of traps treatment with 40 ml of the suspension at 1×10(9) spores/ml.

Prevalence of hepatitis B and C among students of health colleges in Saudi Arabia.

This study determined the prevalence of hepatitis B surface antigen (HB(s)Ag) and antibody to hepatitis C virus (anti-HCV) among students at health colleges in Saudi Arabia from 2000 to 2007. Data were obtained from student records. A total of 16 570 (9852 male and 6718 female) students were included. Their mean age was 21 years and they were divided in 2 age groups of 18-21 and 22-30 years. Residence (rural or urban) was recorded. The prevalence of HB(s)Ag for males and females was 0.17% and 0.78% respectively in the 18-21-year-olds and 0.39% and 0.90% in the 22-30-year-olds. The prevalence of anti-HCV for males and females was 0.03% and 0.07% respectively in the 18-21-year-olds and 0.31% and 0.40% in the 22-30-year-olds. There was a statistically significant relationship between age and rural/urban background and HB(s)Ag and anti-HCV positivity (P < 0.005).

Prevalence of hepatitis B and C among students of health colleges in Saudi Arabia

This study determined the prevalence of hepatitis B surface antigen [HB[s]Ag] and antibody to hepatitis C virus [anti-HCV] among students at health colleges in Saudi Arabia from 2000 to 2007. Data were obtained from student records. A total of 16 570 [9852 male and 6718 female] students were included. Their mean age was 21.years and they were divided in 2 age groups of 18-21 and 22-30 years. Residence [rural or urban] was recorded. The prevalence of HB[s]Ag for males and females was 0.17% and 0.78% respectively in the 18-21-year-olds and 0.39% and 0.90% in the 22-30-year-olds. The prevalence of anti-HCV for males and females was 0.03% and 0.07% respectively in the 18-21-year-olds and 0.31% and 0.40% in the 22-30-year-olds. There was a statistically significant relationship between age and rural/urban background and HB[s]Ag and anti-HCV positivity [P< 0.005]

Dedifferentiated giant cell tumour of bone in the form of low-grade fibroblastic osteogenic sarcoma: case report of a unique presentation with follow-up.

Giant cell tumour (GCT) of bone is a locally aggressive benign tumour. It can, however, undergo dedifferentiation, either de novo or secondarily after local recurrence or radiation. Whether spontaneously occurring or induced by previous irradiation, this malignant transformation is typically defined as a high-grade anaplastic sarcoma devoid of giant cells. Dedifferentiation of GCT into low-grade-appearing sarcoma has not been reported yet. Here, we describe the first case of dedifferentiated GCT in the appearance of low-grade fibroblastic osteogenic sarcoma with distant bone metastases. This disease progression occurred without previous irradiation. We confirm the aggressive behaviour of this tumour despite the deceptively bland appearance of the malignant component. We also alert others to the importance of recognizing this rare histology to avoid underdiagnosis and subsequent undertreatment.

DRR drives brain cancer invasion by regulating cytoskeletal-focal adhesion dynamics.

Malignant glioma invasion is a primary cause of brain cancer treatment failure, yet the molecular mechanisms underlying its regulation remain elusive. We developed a novel functional-screening strategy and identified downregulated in renal cell carcinoma (DRR) as a regulator of invasion. We show that DRR drives invasion in vitro and in vivo. We found that while DRR is not expressed in normal glial cells, it is highly expressed in the invasive component of gliomas. Exploring underlying mechanisms, we show that DRR associates with and organizes the actin and microtubular cytoskeletons and that these associations are essential for focal adhesion (FA) disassembly and cell invasion. These findings identify DRR as a new cytoskeletal crosslinker that regulates FA dynamics and cell movement.

Reticulate acropigmentation of Dohi: a case report of autosomal recessive inheritance.

Reticulate acropigmentation of Dohi is a rare dyschromic disorder that generally has an autosomal dominant pattern of inheritance. Most of the cases have primarily been described from Japan. Only a few similar cases have been described elsewhere. We describe 3 black siblings, one boy and two girls, who had progressive reticulate hyperpigmented and hypopigmented macules over the dorsa of hands and feet, which began in early childhood. There were no palmar pits or breaks of the epidermal rete ridge pattern nor was there a family history of any pigmentary skin diseases. Three skin biopsies were performed on one patient; a biopsy specimen from a hyperpigmented macule showed increased melanin in all epidermal levels tapering towards the surface, a second biopsy specimen from a hypopigmented macule showed much less melanin, but it had a similar distribution. A third specimen from a hyperpigmented macule for electron microscopy showed a moderate number of stage III and IV melanosomes in the cytoplasm of the melanocytes. To our knowledge, these patients are the first cases reported from the Middle East with an autosomal recessive pattern of inheritance, confirming previous reports.

Embryonal rhabdomyosarcoma and chromosomal breakage in a newborn infant with possible Dubowitz syndrome.

We report on a newborn girl with Dubowitz syndrome (DS) and embryonal rhabdomyosarcoma (ERMS), with multiple chromosomal breakage (MCB). The tumor was resected but recurred in a few months, resulting in the infant's death. Malignancy and chromosomal breakage have been reported previously in DS. However, ERMS has not been reported among the malignant tumors diagnosed in DS. To our knowledge, concurrence of DS, ERMS, and MCB has not been reported previously. This is the first observation of DS in the Arab ethnic group.

Purification and characterization of cationic chymotrypsin from the pancreas of the Arabian camel (Camelus dromedarius).

This study reports on the purification and characterization of a cationic enzyme with chymotryptic activity from camel pancreas. The enzyme was purified 52-fold in a 48% yield by a three-step chromatographic procedure consisting of anion-exchange, cation-exchange and affinity chromatographies. The purified enzyme was homogeneous on gel isoelectric focusing and on SDS gel electrophoresis. Its isoelectric point was estimated to be 7.3 and its molecular mass was found to be 23,600 Da. The enzyme was identified as a cationic chymotrypsin according to its physiochemical properties, substrate specificity and susceptibility to inhibition. It was active towards esters of aromatic amino acids but much less active towards a leucine ester. In all cases, the k(cat) values of the camel enzyme were less than the corresponding values of bovine chymotrypsin A. It also showed a lower level of kininase activity. Camel chymotrypsin was more susceptible than its bovine equivalent to inhibition by soybean trypsin inhibitor and aprotinin. It showed the same pH optimum as bovine chymotrypsin A for its esterolytic activity, but was more dependent on CaCl2 for long-term stability.

Purification and some properties of camel carboxypeptidase B.

A carboxypeptidase B-like enzyme was purified 116-fold with a recovery of activity of 29% from a crude extract of camel pancreas by a four-step procedure consisting of two anion exchange chromatographies in succession, gel filtration and hydrophobic interaction chromatography. The enzyme was homogeneous on SDS and non-denaturing gel electrophoresis and on gel isoelectric focusing. Its molecular mass was found to be 31.5 kDa and its isoelectric point was estimated as 6.1. It was active towards a number of substrates that are cleaved by carboxypeptidases B from other species and was also susceptible to inhibition by inhibitors of such enzymes. The camel enzyme showed a pH optimum of 8.0 and it was seen to be a relatively potent kininase in vitro. The enzyme purified in this study was very similar to carboxypeptidases B isolated from other species in size, charge, substrate specificity and susceptibility to inhibition and thus it can be identified as camel carboxypeptidase B.

Fine-needle aspiration cytology of primary Kaposi's sarcoma of lymph nodes in an immunocompetent man.

This case report describes the fine-needle aspiration (FNA) findings of primary lymphadenopathic Kaposi's sarcoma (KS) in a 44-year-old African heterosexual male who is immunocompetent and has no clinical or serological evidence of the acquired immunodeficiency syndrome (AIDS) or the endemic form of KS. The cytological findings emphasize the role of FNA in the diagnosis of KS and draw the attention to the fact that a diagnosis of KS in an African man is not synonymous with the diagnosis of AIDS or endemic/African KS. A description of other spindle cell intranodal lesions which may mimick KS is given with a discussion of the differential diagnoses that should be considered in such cases by the cytopathologist.

Purification and partial characterization of camel anionic chymotrypsin.

An anionic chymotrypsin-like enzyme was isolated from a crude extract of camel pancreas by a three-step procedure consisting of anion-exchange chromatography, gel filtration, and hydrophobic interaction chromatography. The purified enzyme was homogeneous on native and SDS gel electrophoresis and on gel isoelectric focusing. Its molecular mass was estimated as 28.5 kDa and its isoelectric point was found to be 4.4. The enzyme differed markedly from bovine chymotrypsin A in its substrate specificity, showing considerably lower values of the specificity constant for its action on tyrosine, tryptophan, and phenylalanine esters. Its pH optimum was found to be 7.8. It showed lower kininase activity and was more susceptible to inhibition by a number of inhibitors than the bovine cationic chymotrypsin. On the other hand, the camel enzyme showed a much greater hydrolytic activity than the bovine enzyme toward a leucine ester. In terms of its size, charge, and substrate specificity the camel enzyme was very similar to anionic chymotrypsins that have been isolated from other species and thus appears to be a camel anionic chymotrypsin.

Purification and some properties of low molecular weight crystallins from camel lens (Camelus dromedarius).

1. The use of an Ultrogel AcA 54 gel-filtration column separates camel lens cortex low molecular weight proteins into four peaks containing beta s-, gamma 1-, gamma 2- and gamma 3-crystallins. 2. The molecular weight of beta s-crystallin corresponded to 29 kDa on SDS-PAGE and showed three major bands between pH 5.85 and 8.45 on isoelectric focusing. In addition, as compared to gamma-crystallins it has a lower degree of homology in amino acid composition, a low sulfhydryl content and a blocked N-terminal amino acid. 3. gamma 1-, gamma 2- and gamma 3-crystallins appeared homogenous on SDS-PAGE and their molecular weights were recorded as 23, 22 and 21 kDa. The isoelectric points of the gamma-crystallin fractions ranged from pH 6.55 to 8.60 and they were found to have an unmodified glycine at the N-terminal end. 4. The three camel gamma-crystallin fractions were similar in molecular weight, isoelectric points, amino acid composition, sulfhydryl concentration and N-terminal amino acid.