Preliminary experience with laparoscopic common bile duct exploration.

BACKGROUND: Herein we present our experience with laparoscopic common bile duct exploration (LCBDE) in managing common bile duct stones. METHODS: Data of 129 consecutive patients who underwent laparoscopic cholecystectomy (LC) and LCBDE done at our institutes from April 2011 through June 2016 were prospectively recorded and retrospectively reviewed. RESULTS: Since 2011, 3012 laparoscopic cholecystectomy were performed at our institutes, intraoperative cholangiogram (IOC) was done in 295 (9.8%) patients which detected choledocholithiasis in 129 (4.3%) of them. LCBDE was successful to clear the common bile duct (CBD) in 123/129 (95.4%). Six patients underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) because of incomplete CBD clearance (4 cases), symptomatic stenosed papilla (2 cases). LCBDE was performed in 103 patients via trans-cystic approach and choledochotomy one in 26 patients. In the choledochotomy group, seven patients had primary closure of the CBD, CBD was closed over T-tube in nine patients whereas the remaining 10 patients the CBD was closed over antegrade inserted stent. The median time of hospital stay was 4 (range; 1-15) days. No patients showed retained CBD stones with mean follow up was 9 ± 3.4 months. CONCLUSION: LCBDE is a safe and cost effective option for CBD stones in short-term outcome and can be performed provided proper laparoscopic expertise and facilities are available.

Opioid Control for Patients With Sickle Cell Anemia in Emergency Departments in the Western Region of Saudi Arabia.

Introduction Sickle cell anemia (SCA) affects the Saudi Arabian population significantly, with 4.2% carriers and 0.26% affected. Vaso-occlusive crises cause severe pain due to blood vessel blockage by sickled cells, leading to frequent emergency visits, where treatment includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), oxygen, and opioids. This study examines opioid use in managing SCA crises in Saudi emergency departments. Method A retrospective cross-sectional study in western Saudi Arabia surveyed board-certified emergency physicians (consultants, fellows, specialists) via the Sickle Cell Disease Implementation Consortium (SCDIC). Non-board-certified physicians and general practitioners were excluded. Data were gathered through structured surveys and supplemented by interviews. Results The study included 53 emergency physicians, mostly specialists (60.4%), with one to three years' experience, primarily from King Abdul Aziz University Hospital (28.3%) and King Abdullah Medical Complex (22.6%). While more than half of the participants felt adequately trained for SCA management, 20.8% faced challenges referring patients to case management programs. Major barriers included department overcrowding and the opioid epidemic. Conclusion The study reveals challenges in managing SCA in Saudi emergency departments, particularly with opioid use. Despite physician training, gaps in administrative support, medication access, and follow-up care persist. Institutional policies and opioid epidemic concerns restrict Schedule-II opioid prescriptions. Implementing a comprehensive opioid administration tracking system and standardizing protocols are crucial for enhancing patient outcomes. Future efforts should focus on improving resources and inter-institutional collaboration.

Understanding the effects of COVID-19 on patients with diabetic nephropathy: a systematic review.

Background: Diabetic nephropathy is one of the consequences of diabetes mellitus that causes a continuous decline in the eGFR. After the COVID-19 pandemic, studies have shown that patients with diabetic nephropathy who had contracted COVID-19 have higher rates of morbidity and disease progression. The aim of this study was to systematically review the literature to determine and understand the effects and complications of SARS-CoV-2 on patients with diabetic nephropathy. Materials and methods: The authors' research protocol encompassed the study selection process, search strategy, inclusion/exclusion criteria, and a data extraction plan. A systematic review was conducted by a team of five reviewers, with an additional reviewer assigned to address any discrepancies. To ensure comprehensive coverage, the authors employed multiple search engines including PubMed, ResearchGate, ScienceDirect, SDL, Ovid, and Google Scholar. Results: A total of 14 articles meeting the inclusion criteria revealed that COVID-19 directly affects the kidneys by utilizing ACE2 receptors for cell entry, which is significant because ACE2 receptors are widely expressed in the kidney. Conclusion: COVID-19 affects kidney health, especially in individuals with diabetic nephropathy. The mechanisms include direct viral infection and immune-mediated injury. Early recognition and management are vital for improving the outcomes.

Effect of the COVID-19 Pandemic on Medical Students at the University of Jeddah, Saudi Arabia.

Background This study aims to identify the coronavirus disease 2019 (COVID-19) pandemic impact on the academic, financial, psychological, and hygienic aspects of medical students at the University of Jeddah. Methodology Three hundred fifty medical students from the University of Jeddah were sent an online questionnaire using a simple consecutive type of sampling for this cross-sectional study. Students from the preclinical and clinical years were included. The survey consisted of 39 items: four questions were for the demographic domain, 14 items were for the academic domain, another 14 were for hygienic, psychological, and financial aspects, and seven items assessed the effect on elective. A P-value of less than 0.05 was regarded as significant during the statistical analysis, which was conducted using Statistical Package for Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY, USA). Results There were 333 responses, 174 (52.3%) of them were males. The commonest age group was 21-23 years (n=237, 71.2%). Most of the participants were living in Jeddah (n=307, 92.2%). The majority (54%, n=180) agreed or strongly agreed that "Fluctuations in lecture timing is one of the downsides of online teaching" and "The hands-on experience has suffered greatly" and 42% (n=140) strongly agreed on "Technical issues like poor WiFi connection and lack of computer or mobile devices make online teaching difficult". One hundred five (31.5%) of the participants had an elective during the pandemic, of which 41 (39%) did not have it in training centers. In terms of the mental aspect, 154 (46.2%) students were impacted by the COVID-19 pandemic, and 111 (72.1% of them) developed anxiety or depression. Social media (n=150, 45%) was the most preferable source of information during the pandemic.". Conclusion The COVID-19 pandemic affected the academic advancement of medical students, particularly during the years of their clinical training at the University of Jeddah. Our findings also showed that the COVID-19 pandemic had an impact on the students' financial, hygienic, and mental health, which led to increased depression and concern about visiting hospitals and providing care for patients, which ultimately prevented them from acquiring the necessary clinical skills.

Intermittent Fasting: Benefits, Side Effects, Quality of Life, and Knowledge of the Saudi Population.

Introduction Intermittent fasting (IF) is an eating pattern that alternates between periods of fasting and eating. IF has shown many benefits for people who are obese and are trying to lose weight and attain a healthy lifestyle. The aim of our study was to evaluate the efficacy of IF and how it can be used as a daily lifestyle as well as to measure the knowledge of the IF diet among the Saudi population about its benefits, side effects, and life quality. Method For this retrospective cross-sectional study, data about the common side effects, benefits, and the measurement of the quality of life were collected by a survey distributed using Google Forms. Microsoft Excel was used for the data analysis, with the data and results being mainly expressed as numbers and percentages. Results Among the 147 individuals practicing the IF plan who were surveyed, male participants were more than females (53.7% vs 46.3%). The highest percentage of respondents were in the age group 18-35 years old, and 88 individuals (59.9%) had a high body mass index (BMI). Duration of fasting varied from less than a month to three months in 70.8%, and 71.4% of participants had undertaken IF several times. Side effects were headache (61.3%), lethargy (68%), mood swings (57.8%), and lastly dizziness and polyuria (55.8% and 46.2%, respectively). Slightly more females expressed happiness than males (86.8% vs 83.6%). Conclusion The IF diet is an efficient dietary plan for those aiming at a weight loss journey over a short duration, ranging from less than a month up to three months. Minimal side effects were found during fasting, being of different intensities, which did not need surgical or medical treatment. All in all, most of our respondents were pleased with their experience and saw excellent weight loss results using the IF diet.

Awareness of and Attitude to Breast Self-Examination and Breast Cancer Among Females in Jeddah, Saudi Arabia.

Background Breast cancer is the most common of all female cancers worldwide. A large percentage are diagnosed at a late stage, which can be related to awareness and knowledge deficiency. We aimed to assess the level of knowledge of and attitude to breast cancer and breast self-examination in Jeddah, Saudi Arabia. Methodology A descriptive cross-sectional study was carried out among 392 women in Jeddah, Saudi Arabia. Using a non-probability sampling technique, a self-administered validated questionnaire was distributed via social media. Inclusion criteria were ages above 18 years old of all educational levels. Results Out of 392 participants, there were 146 in the age group of 19-25 (37.2%). Most of the participants are aware of breast cancer (94.9%). The mean knowledge score was 6.9 ± 3.36. Ninety-two percent (92%) of participants had poor knowledge. Most respondents reported that the main risk factor for breast cancer was family history (83.7%). About 37% believed that the purpose of the breast self-examination practice is advice from a health care professional followed by routine examination (37.3%). About 97% agreed that early detection of breast cancer increases the chance of recovery. Conclusion There is a lack of knowledge and awareness about the risk factors and symptoms of breast cancer. Despite a positive attitude toward breast self-examination, it is poorly practiced.

Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review.

The benefits of laparoscopic surgery (LS) include a speedy recovery, shorter duration of hospital stay, minimal postoperative pain, discomfort and disabilities, and better cosmetic outcomes (less scarring) that help an individual to resume normal daily activities and return to work. A comprehensive literature search on laparoscopic surgeries was conducted using different Internet-based search engines and databases from August 2021 to October 2021. The search was limited to articles published in the English language and those published between years 2005 and 2021. A total of 126 articles were initially identified. Two independent reviewers thoroughly examined the quality and content of the articles. Articles with duplicate data were excluded, and the remaining articles were screened and assessed by the titles and abstracts. After a vigorous assessment, we included data from 49 articles for this review process. Bibliographic management was done using the software "EndNote" (Thomson Reuters, New York, NY, USA). It was concluded that LS has become the technique of choice for virtually every kind of abdominal surgery, evident by numerous scholarly publications in this field. Level I evidence demonstrating the advantage of LS over open surgery has been reported for numerous operations, including fundoplication for gastroesophageal regurgitation disease, bariatric surgery for weight loss, and cancer resection. Advanced LS has subsequently been expanded to include hepatectomy, pancreatectomy, urology, and gynecology. Patients who are at risk of having elevated abdominal pressure during LS, however, should proceed with care. Recent advances in natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, and robot-assisted laparoscopic surgery are promising.

Perception, Academic Performance, Gender Judgment and Barriers among Surgeons' Career Progression in Jeddah, Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: Gender discrimination continues to be an issue in different surgical subspecialties, especially in Saudi Arabia, where no studies have been conducted so far on female surgeons in academia, on gender discrimination, and on job satisfaction. Considering the increasing number of women enrolling for surgery programs in Jeddah, Saudi Arabia, this study aims to examine their perceptions about and equity in working as surgeons. METHODS: Following the STROCSS criteria, cross-sectional analyses were conducted of survey data from a multicentric online questionnaire in 2019/2020. A representative sample of medical interns and surgeons (n = 100) from Saudi Arabia responded out of 400 from the 4th iteration. RESULTS: Females were 53%; most participants were less than 40 years. Women ranked assistant professors were fewer than men (2% vs. 11%). The number of publications by females vs. males was 2.58 +/- 2.68 vs. 11.37 +/- 20.53 (p = 0.002). Surgery was not considered a profession conducive to family life according to more than half the women citing lack of flexible/part-time training or work (26/53, or 49%). However, only 1/5, or 9/47 (19.1%), of men thought there was gender attitude/bias; men also had more variety in surgical career choices. Further, most patients preferred male surgeons ( p = 0.026). Both females (30/53 or 56.6%) and males (25/47 or 53.2%) agreed that the best response to an offensive question was to ignore it. Decision in choosing their specialty was influenced mostly by career and promotion prospects, enthusiasm, and commitment (females: 31/53 or 58.5% and males: 17/47 or 36.2%) with p = 0.026. CONCLUSIONS: The findings reveal the persisting discrepancies based on gender in the surgical field in Saudi Arabia. A nationwide movement limiting working hours, encouraging medical students to enter surgery, and upholding women in leadership positions can help in overcoming this situation.

Knowledge, perception and attitudes toward epilepsy among medical students at King Abdulaziz University.

INTRODUCTION: Epilepsy is a chronic neurological disorder characterized by repetitive seizures which could occur in different forms depending on the site of brain disturbance. It has both psychological as well as social effects resulting in stigmatization and isolation of epileptic patients. Even though medical students are considered a role model of well-educated communities, previous studies showed that students lack the satisfactory knowledge and attitudes toward epilepsy, so it is important to evaluate the concept of epilepsy and to measure awareness and attitudes toward epileptic patients among medical students of King Abdulaziz University. The aim of this study is to determine knowledge, perception and attitudes toward epilepsy among medical students at King Abdulaziz University. METHODS: An observational cross-sectional study was conducted on 455 medical students from Faculty of medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Western region) through a web-based survey in July 2018. The survey is composed of many sections (demographic variables, knowledge, attitudes and practices toward epilepsy). The survey was applied as a Google form and the data were analyzed by IBM-SPSS for Windows, version 21.0. The chi-square test of independence was used for data analysis. RESULTS: Four hundred thirty-six out of 455 students (98.5%) were aware about epilepsy. However, the level of knowledge varies depending on the educational level of these students, because 88.5% of the students responded that brain injury is the most common cause and 57.3% said it is a genetic disease, while 3.7% stated that it was due to evil spirit. As a treatment method, medication and God's help were chosen by 95.8% and 57.8%, respectively. Objection to marry an epileptic patient was the most common negative attitude toward epileptics among the participants. Nonetheless, the overall attitude was found to be positive. CONCLUSION: King Abdulaziz University medical students have had some misunderstandings regarding causes, manifestations and treatment of epilepsy which could affect their attitudes toward epileptic individuals. Educational programs which include more clinical exposure to such common diseases are required to improve students' impressions of these diseases.

The association of stress with sleep quality among medical students at King Abdulaziz University.

OBJECTIVE: This study aims to determine the prevalence and the association of stress with sleep quality among medical students at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. METHODS: A cross-sectional study was done among 326 medical students of KAU using a stratified random sampling technique. An electronic self-administered questionnaire was used. Kessler Psychological Distress Scale (K10) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the stress and sleep quality, respectively. RESULTS: The overall students who experienced stress were 65%. The prevalence of poor sleep quality (total PSQI score ≥5) was 76.4%. There was a strong association between stress and poor sleep quality (value of Cramer's V = 0.371, P < 0.001), and it showed that the increase in stress level is a significant predictor of poor sleep quality. CONCLUSION: A high prevalence of stress and poor sleep quality was found among the students and the study confirms a strong association between them. We recommend establishing courses focusing on educating the students about proper sleep hygiene and how to deal with the stressful environment.

The Perception of Medical Students at King Abdulaziz University Hospital Regarding the Liver Transplant Allocation System.

BACKGROUND: The benefit of liver transplantation is not only to increase the patient's lifetime but also for persistent relief of pain and anxiety. Shortage of the organ is the main hindrance of transplantation around the world, leading authorities to pass a general law for the reasonable distribution of organs and come up with the Model for End-Stage Liver Disease (MELD) system which scores the severity of liver disease and risk of mortality in order to detect the mechanism of allocation.  Objective: This study aims to assess medical students' perception of the liver transplant and allocation system. METHODS:  A cross-sectional survey was carried out among 402 medical students at King Abdulaziz University in Jeddah, Saudi Arabia. RESULTS:  The majority of the medical students (84.4%) believed that a successful liver transplant improves both lifetime and quality of life. Most of the students also saw that the minimum survival rate should be five years after transplantation and that the patient should recover to be at least ambulatory, even if restricted by strenuous physical activity. When asked whether urgency or prospect of success defined a successful transplant, most of the students who chose urgency were preclinical (50.7%), while the prospect of success was the dominant answer chosen by students in their clinical years of study (66.1%). CONCLUSION:  The criteria determining the success of a liver transplant include a gain in both lifetime and quality of life. The majority of respondents wanted the capacity to benefit to be considered in the liver allocation system.

Factors Influencing Saudi Medical Student's Decision Towards Cardiothoracic Surgery as a Future Career, a Cross Sectional Study.

INTRODUCTION: There has been a progressive decline in students' interest to consider cardiothoracic surgery as future career in the distant regions in the world. There are many factors could explain declining interest in cardiothoracic surgery including diminished caseloads due to the expansive growth of interventional cardiology; length of training programs that influences medical student's perception. King Abdulaziz University student's interest to join the speciality explored in our study. We determined some factors that influence their decision making toward their cardiothoracic career. AIM: We aimed to estimate the current interests of medical students at King Abdulaziz University to pursue a career in Cardiothoracic surgery and to determine the factors that positively or negatively affect their decision. MATERIAL AND METHODS: A self-administered online survey designed on Google form was distributed through email to fourth, fifth, and sixth-year medical students. Five domains; demographics, current career intentions, previous exposure to surgery, experiences and perceptions of cardiothoracic surgery were covered in the questionnaire to identify factors affecting student decision to choose cardiothoracic surgery as a future career. RESULTS: Among 486 students at our institution, 179 (36, 83%) medical students completed the questionnaire more than half of them 91 (50.8%) were males. The percentage of students who considered cardiothoracic surgery as a future career was (4.5%); when asked if they were serious in pursuing a career in cardiothoracic surgery, (14.5%) of the student were affirmative. Of those participated in the survey, Twenty-four students believed they had adequate introduction to the cardiothoracic surgery during their undergraduate program. CONCLUSION: cardiothoracic surgery is falling away behind other specialties as career of choice for many future physicians. It is believed mainly related to inadequate introduction to the field. Increasing exposure and close mentorship is needed to attract more students to pursue a career in cardiothoracic surgery.

Negative Appendectomy Rate and Risk Factors That Influence Improper Diagnosis at King Abdulaziz University Hospital.

INTRODUCTION: Acute Appendicitis is the most common emergent abdominal surgery worldwide. diagnosis based on clinical assessment, laboratory and radiological investigations and appendectomy is the treatment of choice. Removing a normal appendix is a relatively common surgical issue, defined as negative appendectomy (NA). Multiple risk factors contribute to NA; female gender, normal WBC, normal CRP count, and CT scan unavailability. However, recently NA is decreasing in incidence after CT scan and Alvarado scoring. AIM: We aimed to estimate the rate of negative appendectomy, and determine possible risk factors among King Abdulaziz University Hospital. PATIENTS AND METHODS: Article has a retrospective character and included non-incidental 441 patients who undergo an appendectomy, during period 2008 to 2018. RESULTS: Negative Appendectomy incidence (9.5%) was higher among females at (64.3%). Gynecological complaints were seen in (22.2%) of cases with a sign for Negative Appendectomy. Surgery reports documented (29.6%) of female ovarian cyst diseases. Alvarado scoring at presentation was less than 7 in (69%) of cases with statistical significance value. Normal WBC count (50%), for automated neutrophil (45.2%) was high, and same number were recorded with the normal neutrophil count, all of them have statically significant relation with NA. CONCLUSION: Proper clinical evaluation involves documenting Alvarado score, using CRP, efficient radiological utilization. Also, considering more referrals to gynecological specialists of similar presentation especially females at reproductive age. Investing in time and equipment for proper clinical assessment can avoid the unnecessary burden and save our resources for better use.