Search results for: Saudi patients

Authors: Arrate Barrenechea Garro

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Background: Bilingualism has been shown to enhance cognitive reserve and potentially delay the onset of dementia symptoms. This study investigates the impact of bilingualism on cognitive reserve and the age of diagnosis in Parkinson's Disease (PD). Methodology: The study involves 16 non-demented monolingual PD patients and 12 non-demented bilingual PD patients, matched for age, sex, and years of education. All participants are native Spanish speakers, with Spanish as their first language (L1). Cognitive performance is assessed through a neuropsychological examination covering all cognitive domains. Cognitive reserve is measured using the Cognitive Reserve Index Questionnaire (CRIq), while language proficiency is evaluated using the Bilingual Language Profile (BLP). The age at diagnosis is recorded for both monolingual and bilingual patients. Results: Bilingual PD patients demonstrate higher scores on the CRIq compared to monolingual PD patients, with significant differences between the groups. Furthermore, there is a positive correlation between cognitive reserve (CRIq) and the utilization of the second language (L2) as indicated by the BLP. Bilingual PD patients are diagnosed, on average, three years later than monolingual PD patients. Conclusion: Bilingual PD patients exhibit higher levels of cognitive reserve compared to monolingual PD patients, as indicated by the CRIq scores. The utilization of the second language (L2) is positively correlated with cognitive reserve. Bilingual PD patients are diagnosed with PD, on average, three years later than monolingual PD patients. These findings suggest that bilingualism may contribute to cognitive reserve and potentially delay the onset of clinical symptoms associated with PD. This study adds to the existing literature supporting the relationship between bilingualism and cognitive reserve. Further research in this area could provide valuable insights into the potential protective effects of bilingualism in neurodegenerative disorders.

Keywords: bilingualis, cogntiive reserve, diagnosis, parkinson's disease

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Authors: Yong Seong Kim, Seongbin Hong, So Hun Kim, Moonsuk Nam

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Background: Patients who undergo thyroidectomy due to thyroid cancer often complain weight gain, although they are on suppressive thyroid hormone treatment. The aim of this study is to know whether thyroid cancer patients gain the weight after thyroidectomy and weight change is dependent on estrogen state or use of rhTSH. Material and Method: We performed a retrospective chart review of subjects receiving medical care at an academic medical center. Two hundred two patients who underwent total thyroidectomy were included. As a control group, patients with thyroid nodule and euthyroidism were matched for age, gender, menopausal status. The weight changes occurring over first one year and thyroid function were assessed. Results: Mean age was 51±12 years and patients was composed with 38% of premenopausal, 15 % perimenopausal women, 37% of postmenopausal women and 20% of men. Patients with thyroid cancer gained 2.2 kg during the first year. It’ was not significantly different with control. However, weigh change in perimenopausal and post menopausal women gained more weight than control (P <0.05). Age, baseline body weight and weight gain were not correlated. Discussion: Patient who had undergone thyroidectomy gained more weight than their control, especially in peri- and postmenopausal women. Patients in this age should be monitored for their weight carefully.

Keywords: weight gain, thyroidectomy, thyroid cancer, weight chance

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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

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Introduction: Head and neck cancers (HNC) are often associated with the development of non-HNC primaries, as the risk factors that predispose patients to HNC are often risk factors for other cancers. Aim: We sought to evaluate whether there was an increased risk of smoking and alcohol-related cancers and also other cancers in HNC patients and to evaluate whether there is a difference between the rates of non-HNC primaries in Aboriginal compared with non-Aboriginal HNC patients. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single center in Western Australia, identifying 80 Aboriginal and 240 non-Aboriginal patients matched on a 1:3 ratio by sites, histology, rurality, and age. We collected data on the patient characteristics, tumour features, treatments, outcomes, and past and subsequent HNCs and non-HNC primaries. Results: In the overall study population, there were 86 patients (26.9%) with a metachronous or synchronous non-HNC primary. Non-HNC primaries were actually significantly more common in the non-Aboriginal population compared with the Aboriginal population (30% vs. 17.5%, p=0.02); however, half of these were patients with cutaneous squamous or basal cell carcinomas (cSCC/BCC) only. When cSCC/BCCs were excluded, non-Aboriginal patients had a similar rate as Aboriginal patients (16.7% vs. 15%, p=0.73). There were clearly more cSCC/BCCs in non-Aboriginal patients compared with Aboriginal patients (16.7% vs. 2.5%, p=0.001) and more patients with melanoma (2.5% vs. 0%, p value not significant (p=NS). Rates of most cancers were similar between non-Aboriginal and Aboriginal patients, including prostate (2.9% vs. 3.8%), colorectal (2.9% vs. 2.5%), kidney (1.2% vs. 1.2%), and these rates appeared comparable to Australian Age Standardised Incidence Rates (ASIR) in the general community. Oesophageal cancer occurred at double the rate in Aboriginal patients (3.8%) compared with non-Aboriginal patients (1.7%), which was far in excess of ASIRs which estimated a lifetime risk of 0.59% in the general population. Interestingly lung cancer rates did not appear to be significantly increased in our cohort, with 2.5% of Aboriginal patients and 3.3% of non-Aboriginal patients having lung cancer, which is in line with ASIRs which estimates a lifetime risk of 5% (by age 85yo). Interestingly the rate of Glioma in the non-Aboriginal population was higher than the ASIR, with 0.8% of non-Aboriginal patients developing Glioma, with Australian averages predicting a 0.6% lifetime risk in the general population. As these are small numbers, this finding may well be due to chance. Unsurprisingly, second HNCs occurred at an increased incidence in our cohort, in 12.5% of Aboriginal patients and 11.2% of non-Aboriginal patients, compared to an ASIR of 17 cases per 100,000 persons, estimating a lifetime risk of 1.70%. Conclusions: Overall, 26.9% of patients had a non-HNC primary. When cSCC/BCCs were excluded, Aboriginal and non-Aboriginal patients had similar rates of non-HNC primaries, although non-Aboriginal patients had a significantly higher rate of cSCC/BCCs. Aboriginal patients had double the rate of oesophageal primaries; however, this was not statistically significant, possibly due to small case numbers.

Keywords: head and neck cancer, synchronous and metachronous primaries, other primaries, Aboriginal

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Authors: Mostafa El Khashab

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Our experience with 50 patients with metastatic tumors located in different locations of the brain by a stereotactic-guided craniotomy and total microsurgical resection. Patients ranged in age from 36 to 73 years. There were 28 women and 22 men. Thirty-four patients presented with hemiparesis and 6 with aphasia and the remaining presented with psychological manifestations and memory issues. Gross total resection was accomplished in all cases, with postoperative imaging confirmation of complete removal. Forty patients were subjected to whole brain irradiation. One patient developed a stroke postoperatively and another one had a flap infection. 4 patients developed different postoperative but unrelated morbidities, including pneumonia and DVT. No mortality was encountered. We believe that with the assistance of stereotactic localization, metastases in vital regions of the brain can be removed with very low neurologic morbidity and that, in comparison to other modalities, they fare better regarding their long-term outcome.

Keywords: stereotactic, craniotomy, radiosurgery, patient

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Authors: Rahimah Abdulrahman, A. Eardle, Wilfred Alan, Abdel Hamid Soliman

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With the rapid development in technology, and advances in learning technologies, m-learning has begun to occupy a great part of our lives. The pace of the life getting together with the need for learning started mobile learning (m-learning) concept. In 2008, Saudi Arabia requested a national plan for the adoption of information technology (IT) across the country. Part of the recommendations of this plan concerns the implementation of mobile learning (m-learning) as well as their prospective applications to higher education within the Kingdom of Saudi Arabia. The overall aim of the research is to explore the main issues that impact the deployment of m-learning in nursing institutes in Saudi Arabia, at the Armed Force Hospitals (AFH), Alhada. This is in order to be able to develop a generic model to enable and assist the educational policy makers and implementers of m-learning, to comprehend and treat those issues effectively. Specifically, the research will explore the concept of m-learning; identify and analyse the main organisational; technological and cultural issue, that relate to the adoption of m-learning; develop a model of m-learning; investigate the perception of the students of the Nursing Institutes to the use of m-learning technologies for their nursing diploma programmes based on their experiences; conduct a validation of the m-learning model with the use of the nursing Institute of the AFH, Alhada in Saudi Arabia, and evaluate the research project as a learning experience and as a contribution to the body of knowledge. Activity Theory (AT) will be adopted for the study due to the fact that it provides a conceptual framework that engenders an understanding of the structure, development and the context of computer-supported activities. The study will be adopt a set of data collection methods which engage nursing students in a quantitative survey, while nurse teachers are engaged through in depth qualitative studies to get first-hand information about the organisational, technological and cultural issues that impact on the deployment of m-learning. The original contribution will be a model for developing m-learning material for classroom-based learning in the nursing institute that can have a general application.

Keywords: activity theory (at), mobile learning (m-learning), nursing institute, Saudi Arabia (sa)

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Authors: Mohammad Hossein Harirchian, Siavash Babaie, Nika keshtkaran, Sama Bitarafan

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Background: Fatigue is a common complaint of multiple sclerosis (MS) patients, adversely affecting their quality of life. There is a lot of evidence showing that Carnitine deficiency is linked to fatigue development and severity in some conditions. This study aimed to compare the levels of Free L-Carnitine (FLC) between MS patients and healthy people and evaluate its association with the severity of fatigue. Methods: This case-control study included 30 patients with relapsing-remitting MS (RRMS) in 2 sex-matched equal-number groups according to the presence or absence of fatigue and 30 sex-matched healthy people in the control group. In addition, between two patient groups, we compared Serum level of FLC between the patient and healthy group. Fatigue was scored using two valid questionnaires of fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). In addition, association between Serum level of FLC and fatigue severity was evaluated in MS patients. Results: There was no significant difference in serum levels of FLC between MS patients and healthy people. The patients with fatigue had a significantly lower FLC (mg/dl) value than patients without fatigue (22.53 ± 15.84 vs. 75.36 ± 51.98, P < 0.001). The mean value of FSS and MFIS in patients with fatigue were 48.80±8.55 and 62.87 ± 13.63, respectively, which was nearly two-fold higher than group without fatigue (P < 0.001). There was a negative correlation between the serum level of FLC and fatigue severity scales (Spearman rank correlation= 0.76, P < 0.001). Conclusion: We showed healthy people and MS patients were not different in levels of FLC. In addition, patients with lower serum levels of FLC might experience more severe fatigue. Therefore, this could clarify that supplementation with L-Carnitine might be considered as a complementary treatment for MS-related fatigue.

Keywords: fatigue, multiple sclerosis, L-carnitine, modified fatigue impact scale

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Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Objectives. The age of the disease onset could have an impact on the effect of therapy in systemic sclerosis(SSc). Late-age onset in SSc could have a more severe course of the disease and worse clinical effects on therapy. The aim of our study was to evaluate changes in skin fibrosis on rituximab(RTX) therapy in patients with SSc and different ages of the disease onset. Methods. 151 patients with SSc were included in this study. Patients were divided into groups depending on the age of the disease onset: group 1 - younger than 30 years (40 patients(26%), group 2 - 31-59 years (90 patients(60%) and group 3 – more than 60 years (21 patients(14%). The mean follow-up period was 13±2.3month. The mean age was 48±13years, female-83% of patients, and the diffuse cutaneous subset of the disease had 52% of patients. The mean disease duration was 6.4±5years. The cumulative mean dose of RTX was 1.5±0.6grams. Patients received RTX as a therapy for interstitial lung disease. All patients received prednisone at a dose of 11.6±4.8mg/day, immunosuppressants received 48% of them. The results at baseline and at the end of the follow-up are presented in the form of mean values. Results. There was a significant decrease of modified Rodnan skin score(mRss) in all groups: in group 1 - from 10.2±8 to 7.7±6.5(p=0.01); in group 2 - from 9±7.2 to 6.2±4.7(p=0.0001); in group 3 - from 20.5±14.1 to 10.8±9.4(p=0.001). There was a significant decrease of the activity index (EScSG-AI): in group 1 from 2.5±1.8 to 1.3±1.1; in group 2 – from 3.2±1.6 to 1.5±1.2; in group 3 – from 4.2±2.1 to 1.3±1. Conclusion. There was a significant improvement in skin fibrosis in a year after initiation of RTX therapy regardless of the age of the disease onset. The improvement was more pronounced in the group with late-age onset of the disease, but these data require further investigations.

Keywords: skin fibrosis, systemic sclerosis, rituximab, disease onset

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Authors: Kholod J. Alotaibi, Andrew M. Gravell

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A study was conducted in which 212 software developers in higher education institutions in Saudi Arabia were surveyed to gather an indication of their understanding of the concept of usability, their acceptance of its importance, and to see how well its principles are applied. Interviews were then held with 20 of these developers, and a demonstration of Usage-Centred Design was attempted, a highly usability focused software development methodology, at one select institution for its redesign of an e-learning exam system interface during the requirements gathering phase. The study confirms the need to raise awareness of usability and its importance, and for Usage-Centred Design to be applied in its entirety, also need to encourage greater consultation with potential end-users of software and collaborative practices. The demonstration of Usage-Centred Design confirmed its ability to capture usability requirements more completely and precisely than would otherwise be the case, and hence its usefulness for developers concerned with improving software usability. The concluding discussion delves on the challenges for promoting usability and Usage-Centred Design in light of the research results and findings and recommendations are made for the same.

Keywords: usability, usage-centred, applying principles of usage-centred, Saudi Arabia

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Authors: Sushma Tejwani, Shoruba Dinakaran, Kushal Kacha, K. Bhujang Shetty

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Introduction and aim: It is not unusual to find patients with glaucomatous damage and normal intraocular pressure, and to label a patient as Normal tension glaucoma (NTG) majority of clinicians depend on office Intraocular pressures (IOP) recordings; hence, the concern is that whether we are missing the late night or early morning spikes in this group of patients. Also, ischemia to the optic nerve is one of the presumed causes of damage in these patients, however demonstrating the same has been a challenge. The aim of this study was to evaluate IOP variations and patterns in a series of patients with open angles, glaucomatous discs or fields but normal office IOP, and in addition to identify ischemic factors for true NTG patients. Materials & Methods: This was an observational cross- sectional study from a tertiary care centre. The patients that underwent full day DVT from Jan 2012 to April 2014 were studied. All patients underwent IOP measurement on Goldmann applanation tonometry every 3 hours for 24 hours along with a recording of the blood pressure (BP). Further patients with normal IOP throughout the 24- hour period were evaluated with a cardiologist for echocardiography and carotid Doppler. Results: There were 47 patients and a maximum number of patients studied was in the age group of 50-70 years. A biphasic IOP peak was noted for almost all the patients. Out of the 47 patients, 2 were excluded from analysis as they were on treatment.20 patients (42%) were diagnosed on DVT to have an IOP spike and were then diagnosed as open angle glaucoma and another 25 (55%) were diagnosed to have normal tension glaucoma and were subsequently advised a carotid Doppler and a cardiologists consult. Another interesting finding was that 9 patients had a nocturnal dip in their BP and 3 were found to have carotid artery stenosis. Conclusion: A continuous 24-hour monitoring of the IOP and BP is a very useful albeit mildly cumbersome tool which provides a wealth of information in cases of glaucoma presenting with normal office pressures. It is of great value in differentiating between normal tension glaucoma patients & open angle glaucoma patients. It also helps in timely diagnosis & possible intervention due to referral to a cardiologist in cases of carotid artery stenosis.

Keywords: carotid artery disease in NTG, diurnal variation of IOP, ischemia in glaucoma, normal tension glaucoma

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Authors: Behcet Al, Mehmet Murat Oktay, Suat Zengin, Mustafa Sabak, Cuma Yildirim

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Objective: Th Recognition of arrest patients and application of basic life support (BLS) by bystanders in the field and the activation of emergency serves were evaluated in present study. Methodology: The present study was carried out by Emergency Department of Medicine Faculty of Gaziantep University at 33 of Emergency Health center in Gaziantep between December 2012- April 2014 prospectively. Of 539 arrested patients, 171 patients were included in study. Results: 118 (69%) male, and 53 31(%) female with a totlay of 171 patients were included in this study. Of patients, 32.2% had syncope and 24% had shorth breathing just befor being arrested. The majority of arrest cases had occured at home (61.4%) and rural area (11.7%) respectively. Of asking help, %48.5 were constructed by family members. Of announcement, only 15.2% occured within first minute of arrest. The BLS ratio that was applied by bystanders was 22.2%. Of bystanders, 47.4% had a course experience of BLS. The emergency serve had reached to the field with a mean of 8.43 min. Of cases, 55% (n=94) were evaluated as exitus firstly bu emergency staff. The most noticed rythim was asystol (73.1%). BLS and advanced life support (ALS) were applied to 98.8% and 60% respectively at the field. 10.5% (n=18) of cases were defibrilated, and 45 (26.3%) were intubated endotrecealy. The majority (48.5%) of staff who applied BLS and ALS at the fied were emergency medicine technicians. CPR was performed to 86.5% (n=148) cases in ambulance while they were transported. The mean arrival time to mergency department was 9.13 min. When the patients arrived to ED 15.2% needed defirlitation. 91.2% (n =156) of patients resulted in exitus in ED. 15 (8.8%) patients were discharged (9 with recovery, six patients with damage). Conclusion: The ratio of inntervention for arrest patients by bystanders is still low. To optain a high percentage of survival, BLS training should be widened among the puplic especiallyamong the caregivers.

Keywords: arrest patients, cardiopulmonary resuscitation, bystanders, chest compressions, prehospital

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Authors: Taerim Kim, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim

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Object: Reversible cerebral vasospasm syndrome (RCVS) remains an underrated cause of thunderclap headache which shares similar history of the ‘worst-ever’ headache with subarachnoid hemorrhage (SAH) to the emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS so that the physicians could raise the high index of suspicion to detect RCVS in more patients with thunderclap headache before having life-threatening complications. Methods: The electric medical records of 18 patients with diagnostic criteria of RCVS at the emergency department (ED) between January 2013 and December 2014 were retrospective reviewed. Results: The mean age was 50.7 years, and 80% were women. Patients with RCVS visit an average of 4.7 physicians before receiving an accurate diagnosis and mean duration of symptom until diagnosis is 9.3 days. All patients except one experienced severe headache, from 8 to 10 pain intensity on a numerical rating scale (NRS). 44% of patients had nausea as an associated symptom, 66% of patients experienced worsening of headache while gagging, leaning forward, defecating, urinating or having sex. The most frequently affected vessels are middle cerebral arteries demonstrating the characteristic diffuse “string of beads” appearance. Four patients had SAH as a complication. Conclusion: Patients with RCVS have a unique set of clinical and imaging features. Emergency physicians should raise the high index of suspicion to detect RCVS in more patients with thunderclap headache before life-threatening complications.

Keywords: headache, thunderclap, subarachnoid haemorrhage, stroke

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Authors: Mohua Chatterjee, Rajib De

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Introduction: Bone Marrow Transplant (BMT) is often performed to treat patients with various types of leukemia. A majority of these patients develop complications like chronic musculoskeletal GVHD post-BMT where patients get scleroderma, pain and restricted range of motion of joints of hand. If not treated early, it may cause permanent deformity of hand. This study was done to find the effectiveness of physiotherapy in hand dysfunction caused due to chronic musculoskeletal GVHD of leukemia patients after BMT. Methodology: 23 patients diagnosed with leukemia and having musculoskeletal GVHD were treated with a set of exercises including active exercises and stretching. The outcome was measured by Cochin Hand Function Scale (CHFS) at baseline and after four weeks of intervention. Results: Two patients were not able to carry out exercises beyond two weeks due to relapse of disease and one patient defaulted. It was found that all the patients who received physiotherapy had significant improvement in hand function. Mean CHFS decreased from 63.67 to 27.43 (P value < 0.001) indicating improvement in hand function after four weeks of physiotherapy. Conclusion: Early intervention of physiotherapy is effective in reducing hand dysfunction of leukemia patients with musculoskeletal GVHD post-BMT.

Keywords: bone marrow transplant, hand dysfunction, leukemia, musculoskeletal graft versus host disease, physiotherapy

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Authors: Hafsa Raheel

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Objectives: Secondary school girls, ages 15–19 years old were surveyed to find out the coping strategies they used when stressed. Adolescents, who are affected with stress and depression early in life, suffer from depression throughout their lives, especially if they are utilizing improper ways to cope with it. Methods: A cross-sectional school-based survey among 1028 adolescent girls was conducted among the secondary schools in Riyadh city, Kingdom of Saudi Arabia. Results: About 25% stated that they cry, 19% listen to music, 15% start eating a lot, 12% sit alone/isolate themselves, 11% pray/read the Quran, 10% get into a verbal argument or a fight. Only a few, 3% exercise, and 2% stated that they find someone to discuss and talk to. Conclusion: The majority of the adolescent girls in our survey rely on emotion-related coping mechanisms rather than problem-solving mechanisms. This can cause long-term implications in these adolescents as there is an increased probability to develop depression later on in life. Policy makers need to implement strategies for early identification of stress and depression. Talking to friends and family can serve as an effective way to cope with stress.

Keywords: adolescents, stress, Saudi Arabia, mental health

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Authors: Shaya Alshahrani

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Perceived risks play a major role in consumer intentions, behaviors, attitudes, and decisions about online shopping in the KSA. This paper investigates the influence of six perceived risk dimensions on Saudi consumers: product risk, information risk, financial risk, privacy and security risk, delivery risk, and terms and conditions risk empirically. To ensure the success of this study, a random survey was distributed to reflect the consumers’ perceived risk and to enable the generalization of the results. Data were collected from 323 respondents in the Kingdom of Saudi Arabia (KSA): 50 who had never shopped online and 273 who had done so. The results indicated that all six risks influenced the respondents’ perceptions of online shopping. The non-online shoppers perceived financial and delivery risks as the most significant barriers to online shopping. This was followed closely by performance, information, and privacy and security risks. Terms and conditions were perceived as less significant. The online consumers considered delivery and performance risks to be the most significant influences on internet shopping. This was followed closely by information and terms and conditions. Financial and privacy and security risks were perceived as less significant. This paper argues that introducing adequate legal solutions to addressing related problems arising from this study is an urgent need. This may enhance consumer trust in the KSA online market, increase consumers’ intentions regarding online shopping, and improve consumer protection.

Keywords: perceived risk, online contracts, Saudi Arabia, consumer protection

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Authors: Tarek Abdel Azim Ahmed, Eman Sarhan Shaker

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This research aims to explore how well the extended model of internet commerce adoption (eMICA) model is often used to determine the extent of internet commerce adoption in the travel agencies sector in both Egypt and Kingdom of Saudi Arabia (KSA). The web content analysis method was used to analyze the level of adoption of Egyptian travel agencies and Saudi travel agencies according to data immensely available on their websites. Therefore, each site was categorized according to the phases and levels proposed. In order to achieve this, 120 websites were evaluated by the two authors over a three-month period, from August to October 2020, and then categorized according to the phases and levels of (eMICA). The results show that there are deficiencies in the application of the eMICA model by both KSA and Egyptian travel agencies, generally, updating their websites, the absence of quality certification, offering secure online payment, virtual tours, and videos using Flash animation. In general, the Egyptian companies slightly outperformed the KSA ones in applying eMICA model.

Keywords: e-commerce, internet marketing, eMICA, travel agencies, websites

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Authors: Ibrahim Alshalan

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The Islamic Republic of Iran is one of the greatest and most powerful countries, not only in the Arabian Gulf but in the entire Middle East region. However, the Iranian regime, which came to power as a result of the 1979 revolution that resulted in overthrowing the Shah Mohammad Reza Pahlavi, has been the biggest source of threat to the stability of the Middle East since the revolution until this day. It has ambitions to dominate the neighboring Arab countries, especially Iraq, Syria, Lebanon, Yemen and Bahrain. Iran has bad relationships with countries of the Gulf Cooperation Council (GCC), which includes Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Oman and Bahrain. The main objective of this paper is to shed light on the deteriorating political relations between the Iranian regime on one hand and the GCC on the other, especially Saudi Arabia which is witnessing more challenges as a result of Iran's determination to develop its nuclear program. Another important objective of this paper is to identify the Iranian role in the creation of the hotbeds of conflict in addition to its responsibility for some of the region's problems. It also aims to answer the question; why does Iran insist on developing its controversial nuclear program?

Keywords: Iran, GCC, Gulf, Saudi Arabia

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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

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Introduction: It is well known that patients with Head and Neck Cancer (HNC) are at increased risk of subsequent head and neck cancers due to various aetiologies. Aim: We sought to determine the factors contributing to an increased risk of subsequent HNC primaries, and also to evaluate whether Aboriginal patients are at increased risk. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. We collected patient data including smoking and alcohol consumption, tumour and treatment data, and data on subsequent HNC primaries. Results: A subsequent HNC primary was seen in 37 patients (11.6%) overall. There was no significant difference in the rate of second primary HNCs between Aboriginal patients (12.5%) and nonAboriginal patients (11.2%) (p=0.408). Subsequent HNCs, were strongly associated with smoking and alcohol consumption however, with 95% of patients with a second primary being ever-smokers, and 54% of patients with a second primary having a history of excessive alcohol consumption. In the 37 patients with multiple HNC primaries, there were a total of 57 HNCs, with 29 patients having two primaries, six patients having 3 HNC primaries, one patient with four, and one with six. 54 out of the 57 cancers were in ever smokers (94.7%). There were only two multiple HNC primaries in a never smoker, non-drinker, and these cases were of unknown etiology with HPV/p16 status unknown in both cases. In the whole study population, there were 32 HPV-positive HNCs, and 67 p16-positive HNCs, with only two 2 nd HNCs in a p16-positive case, giving a rate of 3% in the p16+ population, which is actually much lower than the rate of second primaries seen in the overall population (11.6%), and was highest in the p16-negative population (15.7%). This suggests that p16-positivity is not a strong risk factor for subsequent primaries, and in fact p16-negativity appeared to be associated with increased risk, however this data is limited by the large number of patients without documented p16 status (45.3% overall, 12% for oropharyngeal, and 59.6% for oral cavity primaries had unknown p16 status). Summary: Subsequent HNC primaries were strongly associated with smoking and alcohol excess. Second and later HNC primaries did not appear to occur at increased rates in Aboriginal patients compared with non-Aboriginal patients, and p16-positivity did not predict increased risk, however p16-negativity was associated with an increased risk of subsequent HNCs.

Keywords: head and neck cancer, multiple primaries, aboriginal, p16 status, smoking, alcohol

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Authors: Mochammad Indra Permana, Andhiani Sharfina Arnellya, Dika Pramita Destiani, Budhi Prihartanto

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Cardiovascular disease is the cause of the highest mortality rates in the world. The number of cardiovascular disease patients is increasing every year. Data obtained from World Health Organization (WHO) that 17,5 million people died from this disease. The condition of cardiovascular diseases such as atrial fibrillation, myocardial infarction, venous thromboembolism, and several other conditions need anticoagulant therapy. Results of the anticoagulant therapy are measured not only by the effectiveness of International Normalized Ratio (INR) value but also by the quality of life of the patients. The purpose of this study was to determine the quality of life of patients on oral anticoagulant therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This is a cross-sectional study with collecting data from the quality of life questionnaire and medical record of the patients. The results of this study showed that 28 patients (46,7%) had a good quality of life, 30 patients (50%) had a moderate quality of life, and 2 patients (3,3%) had a poor quality of life with no significant differences in quality of life based on age, gender, diagnosis, and duration of drug use.

Keywords: anticoagulant, cardiovascular diseases, INR, quality of life

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Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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Authors: Hamad Aldosari

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The purpose of this study is to investigate the status of sexism, or gender discrepancies, in current pedagogical and curricular practices in EFL learning higher education settings. Qualitative and quantitative analyses of both course contents and pedagogies in Saudi higher education institutions are to be discussed with reference to female/male topic presentation in dialogs and reading passages, sex-based activity types, stereotyped sex roles and the masculine generic conceptions of male superiority subliminally related in EFL curriculum and pedagogical practices, as well as the causes and effects of segregated language education practices in Saudi Arabia from a holistic vantage point of analysis. Analysis findings show that language educational practices including educational settings and segregation are gender-biased in attitude, but with regard to curriculum, sexism has not been traced. Findings also show that sexism is rampant due to socio-cultural aspects of language education rather than to religious reasons: a finding that seems to mirror the institutionalized unfair sex discrimination to the disadvantage of women in the Arabian societies at large.

Keywords: genderism, sex segregation, Saudi Arabia, EFL

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Authors: Alireza Pirkhaefi

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Background: Multiple sclerosis (MS) is one of the most common diseases of the central nervous system (brain and spinal cord). Given the importance of cognitive disorders in patients with multiple sclerosis, the present study was in order to compare cognitive functions (Working memory, Attention and Centralization, and Visual-spatial perception) in patients with relapsing- remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). Method: Present study was performed as a retrospective study. This research was conducted with Ex-Post Facto method. The samples of research consisted of 60 patients with multiple sclerosis (30 patients relapsing-retrograde and 30 patients secondary progressive), who were selected from Tehran Community of MS Patients Supported as convenience sampling. 30 normal persons were also selected as a comparison group. Montreal Cognitive Assessment (MOCA) was used to assess cognitive functions. Data were analyzed using multivariate analysis of variance. Results: The results showed that there were significant differences among cognitive functioning in patients with RRMS, SPMS, and normal individuals. There were not significant differences in working memory between two groups of patients with RRMS and SPMS; while significant differences in these variables were seen between the two groups and normal individuals. Also, results showed significant differences in attention and centralization and visual-spatial perception among three groups. Conclusions: Results showed that there are differences between cognitive functions of RRMS and SPMS patients so that the functions of RRMS patients are better than SPMS patients. These results have a critical role in improvement of cognitive functions; reduce the factors causing disability due to cognitive impairment, and especially overall health of society.

Keywords: multiple sclerosis, cognitive function, secondary-progressive, normal subjects

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Authors: Ghada M. R. Koura, Ahmed M. F. El Shiwi

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Background: structural scoliosis is a twisting deformity in the curve of vertebral column to the lateral side with simultaneous rotation of the vertebrae, which occurs during the growing years from 10 years to the puberty. Purpose: Studies investigating balance problems specific to scoliotic patients showed that those patients reveal variable balance abnormalities. In this study we evaluated the difference in postural stability responses between female patients (students, office worker and shish weapon players) with structural scoliosis and normal subjects. Methods: sixty subjects participated in this study. Thirty female patients with structural scoliosis with a mean age of (19.5 ± 3.26) years, with Cobb's angle ranged from 20º to 40° in the major curves, and thirty healthy female subjects with a mean age of (19.36 ± 2.41) years. Postural stability of both groups were evaluated by the Biodex Stability System. Results: There was no significant difference between both groups in dynamic balance test. Interpretation/Conclusion: As there was no significant difference between both groups in balance response, it is not recommended to add balance training as an extra physical therapy program for AIS female patients.

Keywords: structural scoliosis, postural stability, female patients, evaluation

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Authors: Titap Yazicioglu

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Purpose: To determine the etiological factors responsible for the eye removal surgery and to evaluate our surgical results. Material and Methods: Medical records of 226 patients, who underwent eye removal surgery, were analyzed retrospectively. Demographic information, clinical history, surgical procedure, and histopathological data were all collected. Evisceration surgery was performed under general anesthesia in all patients except tumor cases and one patient with rhino-orbital mucormycosis. The patients were followed for an average of 16.46±10.78 months and checked for the possible complications, cosmesis, and functional results.Results: 144 men, and 82 women,with a mean age of 41.78±22.6 years, were underwent enucleation (n=15) or evisceration (n=211) due to traumatic (n=169) and non-traumatic (n=57) causes. In the traumatic group, 79.8% of 169 patients were injured by penetrating and 14.2% by blunt trauma.3.6% of the patients were injured in a traffic accident, and 2.4% of them were injured by explosives. In the non-traumatic group, 40% of 25 patients had post-traumatic endophthalmitis, 32% had endophthalmitis due to corneal ulceration and melting, and 24% had endophthalmitis after cataract surgery. One patient had panophthalmitis due to rhino-orbital mucormycosis. Another cause in the non-traumatic group was glaucoma, of which 92.3% had neovascular glaucoma, and 8.7% had congenital glaucoma. Of the 14 patients who were enucleated for tumor, 35.7% had retinoblastoma, 14.3% had medulloepithelioma, 42.9% had uveal melanoma, and 7.1% had metastatic tumor from paranasal sinuses.The most common complaint in the follow-up period was discharging, seen in all prosthesis-wearing patients. 13.3% of the patients had itching due to ocular prosthesis. 4.4% of the patients were complaining about deep superior sulcus. 4.4% had pyogenic granuloma, and 17.8% had implant exposure. Conclusion: Etiological factors should be carefully evaluated, and precautions should be taken in order to reduce the devastating effect of the physical loss of the eye.

Keywords: enucleation, evisceration, ocular injury, etiology, frequency

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Authors: Mona Almanasef, Dalia Almaghaslah, Geetha Kandasamy, Rajalakshimi Vasudevan, Sadia Batool

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Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide and their services are used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers to the provision of these services in Saudi Arabia. Materials and Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in the Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services and barriers to practicing public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counseling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunization. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in the Asir region have varying levels of involvement in public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Keywords: community pharmacist, public health, Asir region, Saudi Arabia

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Authors: Hamad Albadr

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With a rapid influence to sustain the needs for global trends that had arisen for the increasing complexities in health-care provision, the increasing number of health professionals at different levels, and the need to assure more equitable access to health care, the great variation in the levels of initial education for health care professional around the world had been assign bachelor's degree as the minimum point of entry to the health professions. This intent had affected all the health care professions including biomedical engineering. In Saudi Arabia, these challenges add more pressure to retain the global trends for associate degree graduates to upgrade their education to the bachelor's degree or called birding. This paper is to review the reality of biomedical technology programs that offered in Saudi Arabia by Technical Colleges or Community Colleges nationwide and the challenges that face these colleges to run such bridging program to achieve the Bachelor's degree in biomedical engineering and the official requirements by the Ministry of Higher Education and to maintain the international standards. The author will use strategic planning methodology for designing the biomedical engineering bridging of bachelor's program by reviewing the responsibilities of the biomedical engineers in hospitals through their job descriptions to determine the job assessment needs in advance to Developing a Curriculum (DACUM) through Instructional System Design (ISD) approach via five steps: Analysis, Design, Development, Implement, Evaluate (ADDIE).

Keywords: bachelor's degree bridging, biomedical engineering program, Saudi Arabia, Riyadh College of Technology

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Authors: Yadav R. K., Baral S.

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Introduction: Nepal is one of the world’s least developed countries and has a high incidence of tuberculosis (TB). The TB prevalence survey in 2019 showed 69,000 Nepalese is developing TB and 4,000 die every year. Given its disproportionate impact on the impoverished segments of society, TB often thrusts patients into extreme poverty or exacerbates their existing economic struggles. Consequently, not only the patients but also their families suffer from the loss of livelihood. This study aims to assess the support of nutritional allowance on treatment compliance among retreatment tuberculosis patients in Nepal. This is a secondary analysis of data from HMIS (Health Management Information System) to investigate treatment compliance among tuberculosis patients and its association with nutritional allowance. The study population consisted of all individuals (N=2972) who had received services from July 16, 2021, to December 14, 2022. The SPSS 21version was used to conduct descriptive and bivariate analysis. Out of the total TB patients (n=2972), a third-fourth (65.9%) of TB patients were male. More than one-tenth (12.3%) of respondents received a nutrition support allowance. The TB treatment compliance rate was more (89.91%) in the nutrition support allowance group compared to the non-nutritional support group (87.98%). TB patients who received the nutritional support allowance were nearly twice as likely to have a higher TB treatment compliance rate compared to those who did not receive the nutritional support allowance. Providing nutritional allowance support to tuberculosis (TB) patients can play a significant role in improving treatment compliance and outcomes. Age and the type of TB are important factors that have shown statistical significance in relation to treatment compliance. Therefore, it is recommended to provide nutritional allowance support to both new and retreatment TB patients. To enhance treatment compliance among TB patients, it is beneficial to provide timely nutrition allowances and arrange home visits by TB focal persons.

Keywords: nutrition, support, treatment compliance, TB, Nepal

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Diabetes is a chronic health problem and a major risk factor of stroke. A number of therapeutic modalities exist for diabetes management. It’s still unknown whether the different oral hypoglycemic agents would ameliorate the detrimental effect of diabetes on stroke severity. The objective of this work is to assess the effect of pretreatment with oral hypoglycemic agents, insulin and their combination on stroke severity at presentation. Patients and Methods: Patients admitted to the King Abdullah University Hospital (KAUH)-Jordan with ischemic stroke between January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were documented. Stroke severity was compared for non-diabetic patients and diabetic patients treated with different antidiabetic agents. Results: Data from 324 patients with acute stroke was documented. The median age of participants was 69 years. Diabetes was documented in about 50% of the patients. Multinomial regression analysis identified diabetes treatment status as an independent predictor of neurological severity of stroke (p=0.032). Patients treated with oral hypoglycemic agents had a significantly lower NIHSS as compared to nondiabetic patients and insulin treated patients (p < 0.02). The positive effect of oral hypoglycemic agents was blunted by insulin co-treatment. Insulin did not alter the severity of stroke as compared to non-diabetics. Conclusion: Oral hypoglycemic agents may reduce the severity of neurologic deficit of ischemic stroke and may have neuroprotective effect.

Keywords: diabetes, stroke, neuroprotection, oral hypoglycemic agents

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Authors: Monisha Edirisooriya, Wilma Jack, Dominique Twelves, Jennifer Royds, Fiona Scott, Nicola Mason, Arran Turnbull, J. Michael Dixon

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Introduction: Excision biopsy has been the investigation of choice for patients presenting with pathological axillary lymphadenopathy without a breast abnormality. Core biopsy of nodes can provide sufficient tissue for diagnosis and has advantages in terms of morbidity and speed of diagnosis. This study evaluates the diagnostic accuracy of core biopsy in patients presenting with axillary lymphadenopathy. Methods: Between 2009 and 2019, 165 patients referred to the Edinburgh Breast Unit had a total of 179 axillary lymph node core biopsies. Results: 152 (92%) of the 165 initial core biopsies were deemed to contain adequate nodal tissue. Core biopsy correctly established malignancy in 75 of the 78 patients with haematological malignancy (96%) and in all 28 patients with metastatic carcinoma (100%) and correctly diagnosed benign changes in 49 of 57 (86%) patients with benign conditions. There were no false positives and no false negatives. In 67 (85.9%) of the 78 patients with hematological malignancy, there was sufficient material in the first core biopsy to allow the pathologist to make an actionable diagnosis and not ask for more tissue sampling prior to treatment. There were no complications of core biopsy. On follow up, none of the patients with benign cores has been shown to have malignancy in the axilla and none with lymphoma had their initial disease incorrectly classified. Conclusions: This study shows that core biopsy is now the investigation of choice for patients presenting with axillary lymphadenopathy even in those suspected as having lymphoma.

Keywords: core biopsy, excision biopsy, axillary lymphadenopathy, non-breast malignancy

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Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari

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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.

Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients

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Authors: Ruqayya Naheed Khan, Awais Amjad Malik, Awais Naeem, Amina Khan, Asad Parvaiz

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Introduction: Axillary nodal status in breast cancer patients is a paramount prognosticator, next to primary tumor size and grade. It has been well established that patients with negative sentinel lymph node biopsy can safely avoid axillary lymph node dissection. A positive sentinel lymph node has traditionally required subsequent axillary dissection. According to ACOSOG Z11 trial, patients who underwent axillary dissection with 3 or more positive sentinel nodes or opted for observation in case of negative sentinel lymph node, did not find any difference in Overall Survival (OS) and Disease Free Survival (DFS). The Z11 trial included patients who underwent breast conserving surgery and excluded patients with mastectomies. The purpose of this study is to determine whether Z0011 can be applied to mastectomy patients as well in 1-3 positive sentinel lymph nodes and avoid unnecessary ALND. Methods: A retrospective review was conducted at Shaukat Khanam Memorial Cancer Hospital Pakistan from Jan 2015 to Dec 2017 including patients who were treated for invasive breast cancer and required upfront mastectomy. They were clinically node negative, so sentinel lymph node biopsy was performed. Patients underwent ALND with positive sentinel lymph node. A total of 156 breast cancer patients with mastectomies were reviewed. Results: 95% of the patients were female while 3% were male. Average age was 44 years. There was no difference in race, comorbidities, histology, T stage, N stage, and overall stage, use of adjuvant chemotherapy and radiation therapy. 64 patients underwent ALND for positive lymph node while 92 patients were spared of axillary dissection due to negative sentinel lymph node biopsy. Out of 64 patients, 38 patients (59%) had only 1 lymph node positive which was the sentinel node. 18 patients (28%) had 2 lymph nodes positive including the sentinel node while only 8 patients (13%) had 3 or more positive nodes. Conclusion: Keeping in mind the complications related to ALND, above results clearly show that ALND could have been avoided in 87% of patients in the setting of adjuvant radiation, possibly avoiding the morbidity associated with axillary lymphadenectomy although a prospective randomized trial needs to confirm these results.

Keywords: mastectomy, sentinel lymph node biopsy, axillary lymph node dissection, breast cancer

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