Knowledge, Attitude, and Practice of Diagnostic Radiology Among Clinical Year Medical Students.

Background Nowadays, radiology is considered one of the most important disciplines of medicine as it guides physicians to reach the proper diagnosis by using many types of medical imaging modalities, such as x-ray radiography, computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). These modalities are used to create dynamic images of different parts of the human body, which are being used to accurately diagnose and follow up on a variety of medical conditions. Moreover, in recent decades, radiology has experienced substantial growth and transformation, establishing itself not just in diagnostics but also in the domain of medical interventions, which includes the increasingly recognized discipline of interventional radiology. Methodology A descriptive cross-sectional study was conducted at Umm Al-Qura University (UQU) in Makkah from October 2022 to April 2023. The population size of medical students from the fourth to sixth year at Umm Al-Qura University is about 820 students. Results The total number of participants was 359, but two did not fill out properly. Hence, data was analyzed for (n=357), whereas more than half of them were female, 195 (54.6%). About 133 (37%) of the students were in their sixth year, while 106 (29%) were in their fourth year. Regarding their grade point average (GPA), 209 (58%) had >3.5, and 119 (33%) had 3.0-3.5. The maximum number of females 77 (57.9%) students were in the sixth year. Regarding knowledge, 291 (81.5%) had heard about interventional radiology before, while 66 (18.5%) had never heard about interventional radiology before. Moreover, 270 (75.6%) believe that the years in radiology residency are the same as other specialties. Regarding perceived knowledge about radiology, 183 (51.3%) said it is adequate. Conclusion This study showed that medical students at Umm Al-Qura University have a positive attitude towards radiology. However, the majority of the students do not have adequate knowledge regarding radiology as well as radiation hazards. We can improve this by increasing radiology experience in our institutions. Also, courses should be designed and incorporated into the curriculum to increase the knowledge of medical students about ionizing radiation.

Uterine Lipoleiomyoma: A Case Report and Review of the Literature.

Uterine leiomyomas are the most common benign neoplasms found in women of reproductive age. Lipoleiomyoma, a rare variant of leiomyomas, is composed of intermixed smooth muscle cells and mature adipocytes. These neoplasms are usually discovered incidentally in obese, perimenopausal, or postmenopausal women. In this report, we present a case of lipoleiomyoma in a postmenopausal woman who presented with vaginal bleeding and back pain.

A Pathology Experience of Posttransplant Lymphoproliferative Disorder From One Tertiary Hospital: Pathology Concepts and Diagnostic Approach.

BACKGROUND: Solid organ transplantation and bone marrow/hematologic stem cell transplantation recipients face a heightened risk of developing malignancies or cancer as a result of immunosuppression. Posttransplant lymphoproliferative disorders (PTLD) are a range of disorders from benign lymphoid growth to lymphoma found post-transplant. Risk factors for PTLD include high immunosuppressive use and oncogenic effects of Epstein-Barr virus (EBV). There is a lack of comprehensive clinical and pathological documentation of PTLD cases among Saudi patients, and the available data are limited to a few case reports. As a result, a deeper understanding of this disease requires more clinicopathological information. MATERIAL AND METHOD: In this review, we share our insights on cases diagnosed with PTLD at King Faisal Specialist Hospital and Research Center, a prominent tertiary center in the western region of Saudi Arabia, from 2005-2023. RESULT: We have diagnosed a total of 14 cases of PTLD in our department, with an age range spanning from 3 to 62 years. These diagnoses were made based on biopsies or tumor resection procedures. The survival rate of patients is believed to be influenced by multiple factors, including histology, tumorigenesis, disease biology, and clinical stage. Additionally, Kaplan-Meier curve analysis indicates that female patients tend to have a higher estimated survival rate compared to males. CONCLUSION: PTLD diagnosis and therapy have greatly improved in the past 20 years. PTLD is treated with reduced immunosuppression, rituximab, chemotherapy, adoptive therapy, surgery, antiviral therapy, and radiotherapy. In this study, we present our experience from a large tertiary center in the western region of Saudi Arabia. Moreover, we will go through etiology, clinical features, and pathologic morphology along with the corresponding genetics, prevention, and valid treatment options.

Preferred Mode of Therapy Among Patients in Rheumatoid Arthritis Saudi Database: A Cross-Sectional Study.

AIMS AND OBJECTIVES: Current knowledge of patients' preferences for rheumatoid arthritis (RA) treatment is limited. Our goal was to determine the most favorable mode of therapy and the reasons behind choosing each route among RA patients in the Rheumatoid Arthritis Saudi Database (RASD). MATERIALS AND METHODS: In this cross-sectional, nationwide, qualitative study, we conducted interviews with 308 RA patients to assess their preferred mode of therapy (oral, subcutaneous (SC) injection, or intravenous (IV) infusion) and to determine the reasons behind their choice. The determining factors behind patients' preferred mode of therapy were evaluated using a 10-point allocation system (1 = least important, 10 = most important). RESULTS: We interviewed 308 RA patients (83.4% females, mean age, 48 years). Among all administration modes, the oral route was identified as the most preferred mode among our patients, with a percentage of 73.3%, followed by SC injection and IV infusion at 19.5% and 7.3%, respectively. Ease of drug administration was the most reported reason for patients who chose the oral route over the injection route (63.2%). Difficulty remembering to take the drug and finding it hard to swallow the pills were the highest-scored reasons for avoiding the oral route (24.9%). CONCLUSION: Our study demonstrates and emphasizes the importance of shared decision-making between patients and their physicians. The oral route of therapy is, by far, the most preferred mode among our cohort of RA patients.

Incidental Appendiceal Basidiobolomycosis in a Clinical Setting of Intestinal Intussusception in a Five-Year-Old Patient: A Case Report.

Gastrointestinal basidiobolomycosis (GIB) is a rare, critical fungal infection caused by Basidiobolus ranarum, an environmental saprophyte with a wide geographical distribution. It usually affects the immunocompetent host and presents with nonspecific clinical signs and symptoms, posing a diagnostic and therapeutic challenge. The coexistence of GIB and intussusception is rare, and it is far more unusual for appendiceal basidiobolomycosis and intussusception to coexist. Herein, we report a case of a five-year-old male who presented to the emergency department with a clinical and radiological picture of intestinal intussusception, for which he underwent laparoscopic exploration and reduction. The appendix was observed to be partially invaginated through the cecum and was difficult to be reduced. Subsequent histopathological examination of the laparoscopically resected appendix demonstrated fungal organisms morphologically consistent with basidiobolomycosis. The patient achieved full recovery with a combination of surgery and prolonged antifungal therapy.

Rhinoseptoplasty in a Blind Patient: A Case Report.

Vision seems to be the first to recognize a potential threat, subconsciously recording and processing the image. Visual discrimination happens at a subcortical level after an environmental image is recorded in midbrain tissues. Aesthetics and beauty have been found to be decoded subconsciously in the amygdala, similar to a frightening threat. Therefore, blind patients can detect beauty by embodied primal senses other than vision. It could be processed without conscious thought, in the same way, that an immediate threat is. Here, we present a case of a 55-year-old male who has had bilateral blindness for 15 years and came to a rhinoplasty clinic seeking help for nasal obstruction and difficulty breathing due to an old history of trauma since adolescence, causing nasal deviation. He asked for both aesthetic and functional corrections. Rhinoseptoplasty was done successfully, significantly impacting the quality of life and psychosocial distress.

Adrenal Cortical Rests in the Fallopian Tube: A Case Report and Review of the Literature.

Ectopic adrenal rest is a rare phenomenon usually discovered incidentally during microscopic evaluation. The most common site reported in the literature is the genitourinary system and pelvis. Ectopic adrenal rest is more common in male than in female children. The documented site for females is mainly along the broad ligament. However, only two cases of ectopic adrenal rest in the fallopian tube have been reported in the literature, showing that they are extremely rare. In this article, we outline a case of adrenal cortical rest that was discovered incidentally during a microscopic examination of the left fallopian tube after a total hysterectomy with a left salpingo-oophorectomy specimen from a 49-year-old female patient who was complaining of severe bleeding related to severe adenomyosis.

Determinants of Post-COVID-19 Conditions among SARS-CoV-2-Infected Patients in Saudi Arabia: A Web-Based Cross-Sectional Study.

Background: Large numbers of people infected with COVID-19 developed acute symptoms. Post-COVID-19 conditions have been reported after recovery or discharge from the hospital. However, little is known about the prevalence and possible risk factors of post-COVID-19 conditions in the Saudi community. Here, we describe the incidence of post-COVID-19 conditions among the general population of Saudi Arabia. Methods: We conducted a cross-sectional, nationwide study using an online survey in Saudi Arabia from 1 September 2021 to 28 February 2022. The survey was distributed using social media platforms, such as Twitter, WhatsApp, and Facebook. Patients with SARS-CoV-2 infection were included in the questionnaire adapted from published studies. Result: The study enrolled 7520 individuals who were previously infected with SARS-CoV-2. Most patients in our study were symptomatic and their acute symptoms may persist for more than six days. On the other hand, long-term complications may develop and continue for an extended period (post-COVID-19 conditions). Most of these complications are respiratory, neurological, psychological, or skin related. The proportion of long-term complications reported in this study is 36% among SARS-CoV-2-infected individuals. In addition, being female, old age, number of chronic complications, long-term medication, length of stay in hospital and intensive care unit, and duration of acute symptoms may be significant predictors of post-COVID-19 symptoms. Conclusion: In conclusion, the incidence of post-COVID-19 conditions among the Saudi population was high, which urges further investigation into the risk factors associated with post-COVID-19 symptoms.

Impact of COVID-19 Pandemic on Medical Education: A Cross-Sectional Study in the Western Region of Saudi Arabia.

Background: As the Coronavirus Disease 2019 (COVID-19) outbreak has made a tremendous impact on medical education and healthcare institutions, we aimed to measure effects of online classes on medical students' comprehension in comparison with attending campus classes during the COVID-19 pandemic. Methods: A cross-sectional survey has been conducted between September 2020 and June 2021 in the western region of Saudi Arabia. The Convenience sampling technique was conducted to collect the data from medical students in their basic and clinical years, using a questionnaire that involved 45 multiple-choice and multiple-answer questions. Results: Out of 3700 questionnaires, 922 completed the questionnaires from 11 different medical schools. Umm AL-Qura University had the highest response rate with 232 responses (25.2%), followed by King Abdulaziz University with 186 responses (20.2%). The majority of institutions preferred Blackboard and Zoom as platforms for e-learning. A total of 355 (38.5%) believed that it resulted in higher academic achievement, whereas 555 (60.2%) of students believed the limitation of clinical access was one of the biggest disadvantages of e-learning. Overall, 518 (56.2%) of students did not want to continue using e-learning on its own in the future. Whereas 668 (72.5%) wished to keep using e-learning in combination with traditional learning. Conclusion: According to our findings, advantages of e-learning vary among students. Most of the students thought e-learning to be an interactive system that provides a learning opportunity. In contrast, many of the students believed that there were many disadvantages regarding online teaching methods.

Trends in the Incidence of Nasopharyngeal Cancer in Saudi Arabia Across One Decade (2007 to 2016).

Background Cancer is an ongoing global health concern; it is the greatest cause of mortality in the industrialized world and the second-highest cause of death in the developing world. This study aims to assess the incidence and geographic distribution of nasopharyngeal cancer between 2007 and 2016 in Saudi Arabia. Methods Data between 2007 and 2016 from Saudi Cancer Registry reports were collected in this study. These reports provide information on all cancer cases, including the age, sex, geographic location, and year of diagnosis for each patient. Result Between 2007 and 2016, the Saudi Cancer Registry identified 110,075 cancer cases in total. The mean age-standardized rate of all cancer types for women was 51.7 compared with 48.2 for men. The percentage of cases of nasopharyngeal cancers was 1.2% for women and 2.2% for men in 2007. This percentage decreased to 0.8% for women and increased to 2.7% for men in 2016 in comparison to all cancer cases. The curve for nasopharyngeal cancer of all cancer types for men and women correlated with rises and drops in men over the study period, and a minor decrease in women over time, until another rise in 2016. A positive correlation was observed between nasopharyngeal cancer incidence and age. The age-standardized rate data for nasopharyngeal cancer cases demonstrated a wide variation across Saudi regions. The age-standardized rate per 100,000 people from 2007 to 2016 ranged from 0.39 in Jazan to 1.92 in Qassim, with a national average of 1.06. Conclusion From 2007 to 2016, the overall trend of the age-standardized rate for men fluctuated while the female rate slightly dropped before rising again. On the contrary, the incidence of nasopharyngeal cancer varies by region in Saudi Arabia. Further study of this variation would help focus awareness campaigns on the most susceptible regions.

Primary Pulmonary Alveolar Rhabdomyosarcoma in a Pediatric Patient: A Case Report With Literature Review.

Rhabdomyosarcoma (RMS) is a rare soft tissue tumor originating from skeletal muscle that is mostly reported in children. The most common sites of involvement are the head, neck, and extremities. The 2020 WHO classification divide RMS into four types: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing. Reports of RMS with primary lung origin are rare. We present a case of RMS in a 16-month-old boy who presented with a lung mass and microscopic examination with fluorescence in situ hybridization confirmed the diagnosis of alveolar RMS. In conclusion, RMS should be considered in the differential diagnosis of any lung mass with small round blue cell morphology in the microscopic evaluation and should be distinguished from metastatic RMS of other sites, pleuropulmonary blastoma, lymphoma, neuroblastoma, primitive neuroectodermal tumor (PNET)/EWING, and malignant peripheral nerve sheet tumors (MPNST).

Leiomyoadenomatoid Tumors of the Uterus: A Case Report and Literature Review.

BACKGROUND An adenomatoid tumor is a benign neoplasm that originates in the mesothelial lining, commonly present in the male and female genital tracts. The lieomyoadenomatoid tumor (LMAT) is rare and considered an adenomatoid variant, characterized microscopically by prominent smooth muscle proliferation within an adenomatoid tumor. Areas of pseudo-glandular infiltration and tubular and slit-like spaces can mimic metastatic carcinoma or malignant tumors. Most cases of LMAT were incidentally discovered microscopically after an impression of leiomyoma. Eighteen cases have been reported in studies published in English. CASE REPORT We present a case of a 35-year-old woman who experienced recurrent vaginal bleeding and underwent a myomectomy. Microscopically, the mass showed smooth muscle proliferation in fascicles with areas of tubular, slit-like spaces, and gland-like areas, which showed reactivity for Wilms tumor-1 and calretinin by an immunohistochemistry study. The final pathology examination showed a 9-cm LMAT, which is the largest size ever reported to the best of our knowledge. There was no recurrence or other symptoms at the 2-year follow-up. CONCLUSIONS An LMAT should be considered in the differential diagnosis of leiomyomas that present areas of pseudo-infiltrative glands and slit-like spaces, which can lead to misdiagnosis as a malignant tumor.

Concurrent Urinary Bladder Paraganglioma and Adrenal Phaeochromocytoma With Succinate Dehydrogenase-B Mutation.

Phaeochromocytoma (PHEO) is a neoplasm that arises from chromaffin cells present in the adrenal medulla. The counterpart of the PHEO extra-adrenal is termed paraganglioma (PGL). The urinary bladder PGL is a rare tumour, and it accounts for less than 0.06% of all bladder tumours. In this report, we discuss a case of a young female who presented with symptoms of headache, dizziness, palpitations, and high blood pressure. After workup, she was diagnosed with concurrent urinary bladder PGL and adrenal PHEO, and the genetic study of the whole exon sequence indicated the presence of succinate dehydrogenase-B (SDHB) mutation. Both tumours were treated surgically; however, the patient ultimately developed recurrence, rapid progression, and metastasis. All secondary modalities were unsuccessful, and the patient was referred for palliative treatment and eventually lost to follow-up. PGL should be included in the differential diagnosis of bladder tumours, and testing for SDHB gene mutations should be considered in all urinary PGLs. Therefore, these patients need follow-up and genetic counselling.

Comparison of performance of medical students between two teaching modalities "Flip the classroom" and traditional lectures: A single center educational interventional study.

OBJECTIVES: This study aims to compare the students' performance in Obstetrics and Gynecology by using two teaching modalities, i.e., Flip the classroom (FTC) compared to Traditional lectures (TL) among final year medical students and assessment of the students' satisfaction towards FTC as learning modality. METHODS: An educational interventional study was conducted on 136 females final year medical students at Umm Al-Qura University, Makkah, Saudi Arabia from September to December; 2017. Out of 40 core topics of Obstetrics and Gynecology, eight were chosen for FTC and eight for TL. The performance in each teaching modality was assessed by comparing the score of the students in multiple choice question (MCQ) and objective structured clinical examination (OSCE) in the final examination. The final performance was compared between the FTC and TL selected topics. The data was analyzed by using SPSS version 16 (SPSS Inc., Chicago, IL, USA). RESULTS: MCQ and OSCE grades of students (n=136) were significantly higher in FTC versus TL topics, i.e., mean ± standard deviation (13.4 ± 2.7 vs. 12.3 ± 2.4; p < 0.001) and (33.9 ± 4.3 vs. 30.4 ± 4.7; p < 0.001), respectively. Almost 60% of the students expressed their satisfaction with FTC modality. CONCLUSION: Scores were significantly high for Flip the classroom topics compared to Traditional lectures.

Collision Glial Neoplasms Arising in an Ovarian Mature Cystic Teratoma: A Rare Event.

Germ cell neoplasms represent around 20% of all ovarian tumors. They most frequently affect children and young adults. Mature cystic teratoma is a common benign ovarian neoplasm comprising about 95% and is made up of all three germ cell embryonic layers. By definition, mature cystic teratoma may be derived from any of the three germ cell lines. On the other hand, immature teratomas contain primitive neuroepithelial elements. However, it is quite uncommon in the English literature to have a neuroepithelial glial neoplasm arising in a mature cystic teratoma of an adolescent. Interestingly enough, all published cases described a single type of glial neoplasm arising in mature ovarian teratoma. Herein, the authors discuss a unique case of concomitant occurrence of two different glial neoplasms, namely pilocytic astrocytoma and subependymoma arising in an ovarian mature cystic teratoma. To the best of our knowledge, this is the first reported case with such a distinctive histopathologic finding.