Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review

Objectives

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP.

Data Source

Systematic Review of three electronic databases.

Review Methods

Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs.

Results

A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported.

Conclusion

The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03144-8.

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment

OBJECTIVES

To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials.

METHODS

We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT).

RESULTS

A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014).

CONCLUSION

The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

Burnout, Stress, and Stimulant Abuse among Medical and Dental Students in the Western Region of Saudi Arabia: An Analytical Study

Background

High levels of burnout, stress, and stimulant abuse have been reported among medical and dental students worldwide, with country-specific factors being contributors. The association, risk factors, and predictors of these three variables have not sufficiently been reported from Saudi Arabia, especially from the Western region.

Objective

To determine the prevalence, association, and predictors of burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia.

Methods

This cross-sectional study included all second to sixth year medical and dental students enrolled at Taibah University, Madinah, Saudi Arabia, during the 2019-2020 academic year. A self-administered, closed online questionnaire was administered. Data regarding stress were elicited using Cohen's 10-item Self-Perceived Stress Scale and regarding burnout using the Oldenburg Burnout Inventory Student Version questionnaire. Multiple logistic regression model to identify the risk of burnout was conducted, and univariate and multiple linear regression models were carried out to identify the predictors of stress.

Results

Of 1016 eligible students, 732 responded (medical: 511; dental: 221). About half of the students experienced burnout (51.5%), with both high disengagement (49%) and exhaustion (45%). Most participants (90.3%) experienced moderate levels of stress. Eight (1.1%) respondents had experienced stimulant abuse; there was a no significant association between stimulant abuse and burnout in the multivariate analysis. Stress, age, gender, body mass index, GPA, study field, smoking, family income, and birth order were significant predictors of burnout, while burnout, age, gender, GPA, and physical exercise were significant predictors of stress.

Conclusion

The findings in this study highlight the need for policymakers to devise strategies that target early identification as well as reduction of the high levels of burnout and stress.

Comparison of Two Treatment Modalities in Overactive Bladder: A Rapid Overview

Background

Overactive bladder is a syndrome of urgency with the absence of infection and is usually accompanied by frequency and nocturia. Both sacral neuromodulation (SNM) and intravesical botulinum toxin (BTX) injection are used contentiously in overactive bladder after failure of conservative management.

Objective

We aimed to provide an updated comparative overview of BTX injection versus SNM in the treatment of overactive bladder.

Methods

PubMed and Google scholar databases were explored starting from 2016 to 2022 to obtain relevant articles. English studies on adult population were included.

Results

Six articles included 648 participants were included in the current overview. Both BTX and SNM are comparable for the treatment of overactive bladder, with no major complications were reported. However, the use of SNM for refractory overactive bladder after failure of BTX was more successful and effective and resulted in patient satisfaction compared to the use of BTX after failure of SNM.

Conclusion

Our update provides the latest comparative overview of outcomes of BTX versus SNM in the treatment of overactive bladder.

Growth factors in relation to obesity, food habits, and microbiota among healthy Saudis: preliminary results

OBJECTIVE

 Obesity is a serious problem among Saudis because of the country's affluent lifestyle. Obesity is associated with various metabolic disorders and characterized by low-grade inflammation that leads to the release of pro-inflammatory cytokines, human growth factors (GFs), lipids, aberrant adipokines, and other chemokines from adipose tissue. The objective of this study is to delineate the effects of GFs on microbiota and their relationship to body mass index (BMI) and food habits.

SUBJECTS AND METHODS

In a cross-sectional study, 32 randomly selected participants (16 males and 16 females) were enrolled in a survey covering their sociodemographic information, medical history, lifestyle, and dietary practices. The information on diet, health condition, food and drink intake habits were examined under four distinct BMI categories: normal, underweight, overweight, and obese. The participants' serum samples were analyzed for the various GFs using a human magnetic 30-plex panel multiplex assay. Bioinformatics analysis was performed to investigate which bacterial taxa are enriched and to predict the functional profiles of the samples.

RESULTS

Correlational studies revealed sex-based differences between GFs and microbiota. Females exhibited a significant correlation between epidermal GF (EGF) and Proteobacteria, whereas males showed a significant correlation between fibroblast GF-basic and Actinobacteria. Interestingly, a combined analysis of both sexes showed a significant correlation between EGF and vascular endothelial GF with Firmicutes. The data in the underweight group revealed a correlation between granulocyte colony-stimulating factor (G-CSF) and hepatocyte GF with Firmicutes. In the obese group, a correlation was found between G-CSF and Actinobacteria.

CONCLUSIONS

Our results identified links between GFs, microbiota, and BMI in a Saudi cohort. The insights from this preliminary study will contribute to the predictive diagnosis of obesity. However, further research involving a larger cohort will be necessary to understand the mechanistic aspects of these GFs to provide biomarkers of potential obesity.

Survival, mortality, and related comorbidities among COVID-19 patients in Saudi Arabia: A hospital-based retrospective cohort study

OBJECTIVES

To assess the survival of COVID-19 patients in Saudi Arabia and to investigate possible mortality predictors.

METHODS

This is a retrospective cohort study involving 248 patients with severe acute respiratory syndrome coronavirus-2 who were admitted to the primary COVID-19 referral hospital in Jeddah between March and June of 2020. Socio-demographic characteristics, comorbidities, laboratory investigations, management protocols, complications, treatment options, and mortality data were extracted from electronic medical records. The time analysis began at the first signs of illness thorough discharge or death.

RESULTS

Our study showed that in-hospital complications including heart failure followed by acute renal failure had the largest effect size on mortality (p<0.001). Elderly patients and those with comorbid asthma had a higher risk of death. Non-survivors presented more commonly with shortness of breath and fever than survivors. High D-Dimer level was a marginally significant indicator of mortality in the studied population (p=0.05). We did not find a significant benefit in relation to any treatment option.

CONCLUSION

Age, asthma, some in-hospital complications are important survival indicators in hospitalized COVID-19 patients. The controllable co-factors should be monitored and managed by healthcare workers to reduce mortality rates in those hospitalized with COVID-19.

Patterns of self-reported recovery from chemosensory dysfunction following SARS-CoV-2 infection: insights after 1 year of the pandemic

BACKGROUND

The coronavirus disease (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes chemosensory dysfunction.

AIMS/OBJECTIVES

To determine the characteristics of chemosensory dysfunction and to identify factors associated with chemosensory complete recovery and time to recovery.

MATERIALS AND METHODS

This cross-sectional study included all patients presenting with chemosensory dysfunction and confirmed SARS-CoV-2 infection from May to August 2020 who underwent telemedicine follow-up after 1 year to assess their chemosensory recovery.

RESULTS

A total of 372 patients were included, of which 53.8% were male. The mean age ± SD was 37.45 ± 13.44. The majority experienced combined (olfactory and gustatory) dysfunction (85.7%), and 315 patients (84.7%) had complete loss of chemosensory function. The independent predictors associated with a low likelihood of complete recovery were parosmia (aOR 0.16, p < .001), upper respiratory tract symptoms (aOR 0.28, p = .001), and dyspnoea (aOR 0.21, p < .001), whereas the factors associated with a long recovery period were parosmia (aOR 12.04, p = .002), headache (aOR 7.19, p = .007), and hypertension (aOR 7.76, p = .039).

CONCLUSIONS

A full recovery outcome was predominant. The presence of parosmia was linked to both an incomplete recovery and a long time to recovery.

SIGNIFICANCE

Parosmia and respiratory symptoms are implicated in the incomplete recuperation of chemosensory function.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Academic and non-academic life stressors and their impact on psychological wellbeing of medical students

Objectives

Among medical students, depression, anxiety, and stress (DAS) are key public wellbeing challenges that require epidemiological research. We aimed to evaluate potential sources of these psychological disturbances and assess the contribution of academic and non-academic life stressors in psychological morbidity among medical students.

Methods

This exploratory questionnaire-based survey was conducted in a Saudi Arabian public sector medical college. A total of 231 medical students were enrolled and completed the depression, anxiety, and stress scale-21 (DASS-21) questionnaire.

Results

More than half of the medical students, 129 (55.8%), had depression, 106 (45.9%) students had anxiety, and 87 (37.7%) students had stress. Academic achievement was the largest explanatory factor for depression and stress, whereas bodily appearance constituted the largest explanatory factor of anxiety among the study sample. Academic and non-academic stressors score was significantly associated with depression (adjusted Odds Ratio, aOR = 1.13, 95% CI 1.07–1.19), anxiety (aOR = 1.07, 95% CI 1.03–1.12), and stress (aOR = 1.12, 95% CI 1.08–1.17).

Conclusions

Medical students have a high incidence of negative emotional states. These negative psychological states were explained by academic achievement and bodily appearance. The studied stressors influenced medical students' psychological wellbeing.

Does Caffeine Intake Increase the Incidence of Tinnitus? A Systematic Review

Introduction  Excessive caffeine intake has been thought to be a contributory factor for tinnitus. However, there has been no systematic review to elucidate the causal relationship between caffeine intake and the incidence of tinnitus.

Objectives  We performed the current review aiming at evaluating the evidence from the current literature for the relationship between caffeine intake and the incidence of tinnitus.

Data Synthesis  Databases including PubMed, Scopus, and Google scholar were searched for relevant articles. A total of 142 studies were screened for eligibility, of which four articles met our inclusion criteria: two were prospective cohorts and two were cross-sectional studies. Although one study found no association between caffeine consumption and the incidence of tinnitus, an inverse relationship was reported by two population-based studies. Concerning patients with preexisting tinnitus, reduction of caffeine intake in a subset who consumed 150 ml to 300 ml/day of coffee yielded a favorable outcome in tinnitus severity. However, those with higher dose intake were less prone to have improvement in the severity of tinnitus.

Conclusion  Although the current review was inconclusive, it appears that the incidence of tinnitus in previously unaffected individuals might be prevented by a high dose of caffeine intake. However, in preexisting tinnitus, a high dose of caffeine may adversely interfere with the efficacy of caffeine reduction.

Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study

Objectives:

To quantify the extent and variation of depression, anxiety and stress among medical and non-medical Saudi Arabian students.

Methods:

In this cross-sectional study, students from Umm Al-Qura University, Makkah, Saudi Arabia, were recruited. The Faculty of Education was randomly selected to represent the non-medical colleges. The depression, anxiety and stress scale-21 items (DASS-21) was used to estimate the study outcomes.

Results:

Of the 465 undergraduates recruited in this study, 49.68% (n=231) were medical students and 50.32% (n=234) were non-medical students. Approximately 54%, 53%, and 38% of the participants were found to be suffering from depression, anxiety, and stress, respectively. The analyses showed that the two groups did not differ significantly with respect to stress and depression (p=0.934 and 0.423, respectively). However, the non-medical students exhibited a significantly higher anxiety score compared to the medical students (p=0.002). Family conflicts was a common risk factor for the studied psychological disturbances. Female gender and travel time from home to university were significant predictors of depression and anxiety, whereas a positive history of a psychological condition increased the likelihood of depression and stress.

Conclusion:

There was a high prevalence of anxiety, stress, and depression among the students, with a significantly higher anxiety levels among the non-medical students.

Outcomes of microdebrider-assisted versus radiofrequency-assisted inferior turbinate reduction surgery: a systematic review and meta-analysis of interventional randomised studies

BACKGROUND

The microdebrider technique was introduced in clinical practice to provide a better outcome in nasal obstruction caused by inferior turbinate hypertrophy. We conducted this systematic review to evaluate the effectiveness of this technique, by comparison with the radiofrequency-assisted modality.

METHODOLOGY

PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched to retrieve relevant randomised studies published prior to November 2019. Randomised Trials in English that studied the difference between the two techniques among adult patients were eligible for the current review. Data extraction and study inclusion were guided by PRISMA guidelines. The outcome measures were visual analogue scale (VAS, 0-10) for nasal obstruction, anterior active rhinomanometry, and acoustic rhinometry. A meta-analysis was carried out to quantify the difference between the two techni- ques, for each measured outcome.

RESULTS

Seven randomised trials were included and quantitatively analysed in this meta-analysis. Our analysis revealed that the microdebrider-assisted technique demonstrated significantly better VAS (0-10) for nasal obstruction scores in early and late posto- perative follow-up. Whilst no difference was noted using the objective measurements (rhinomanometry and acoustic rhinometry) at early follow-up, microdebrider-assisted technique showed superior results in long-term follow-up, as evidenced using anterior active rhinomanometry.

CONCLUSIONS

The microdebrider-assisted technique results in a better outcome, particularly in long-term follow-up, when compa- red with radiofrequency.

Depression and Anxiety Among Medical Students: A Brief Overview

Depression and anxiety are highly prevalent conditions worldwide. This article reviews the extent of depression and anxiety among medical students and elucidates associated potential risk factors. In comparison to other countries, students from Middle East countries have a higher prevalence of depression. Females suffer from these conditions more commonly than males. Factors associated with these morbidities can be divided into academic and non-academic factors. There is an inconclusiveness of whether medical students experience these symptoms more commonly than their counterparts. The present review provided a cross-sectional picture of the students' psychological well-being, which is crucial to formulate a health policy for preventive and therapeutic purposes.

Predictors of misconceptions, knowledge, attitudes, and practices of COVID-19 pandemic among a sample of Saudi population

This study intends to explore the predictors of misconceptions, knowledge, attitudes, and practices concerning the COVID-19 pandemic among a sample of the Saudi population and we also assessed their approaches toward its overall impact. This online cross-sectional survey was conducted at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU) in Jeddah, Saudi Arabia (SA). Participants were approached via social media (SM), and 2006 participants (953 [47.5%] females and 1053 [52.5%] males) were included in this study. SM was the leading source of information for 43.9% of the study participants. Most of the participants had various misconceptions such as “females are more vulnerable to develop this infection, rinsing the nose with saline and sipping water every 15 minutes protects against Coronavirus, flu and pneumonia vaccines protect against this virus.” About one-third of participants (31.7%) had self-reported disturbed social, mental, and psychological wellbeing due to the pandemic. Many participants became more religious during this pandemic. Two-thirds of the study participants (68.1%) had good knowledge scores. Attitudes were highly positive in 93.1%, and practice scores were adequate in 97.7% of the participants. Participants’ educational status was a predictor of high knowledge scores. Male gender and divorced status were predictors of low practice scores, and aged 51–61 years, private-sector jobs, and student status were predictors of high practice scores. Being Saudi was a predictor of a positive attitude, while the male gender and divorced status were predictors of a negative attitude. Higher education was a predictor of good concepts, while the older age and businessmen were predictors of misconceptions. Overall, our study participants had good knowledge, positive attitudes, and good practices, but several myths were also prevalent. Being a PhD and a Saudi national predicted high knowledge scores and positive attitudes, respectively. A higher education level was a predictor of good concepts, and students, private-sector jobs, and aged 51–61 years were predictors of high practice scores. Study participants had good understanding of the effects of this pandemic.

First report of pulmonary disease associated with Nicoletella semolina in a horse in New Zealand

Case history: A 9-year-old warmblood gelding with a history of chronic intermittent tachypnoea and dyspnoea was presented for evaluation and removal of a mass on the left side of the neck. A fibrous mass adherent to the left jugular vein developed and was removed surgically 6 weeks later, at which time the owner requested an evaluation of the cause of the persistent respiratory signs first noted on primary admission. Clinical findings and treatment: Clinical findings included coarse lung sounds on thoracic auscultation, tracheal wheeze, and an abnormal trans-tracheal aspirate. These findings, in addition to the results of ultrasonographic imaging of the thorax and transtracheal cytology, were suggestive of bacterial bronchopneumonia. Initial antimicrobial therapy included I/M 22 mg/kg procaine penicillin every 12 hours and I/V 6.6 mg/kg gentamicin sulphate every 24 hours. The horse's clinical signs improved within 36 hours. It was discharged after 6 days, and at the owner's request antimicrobial therapy was changed to 25 mg/kg trimethoprim/sulphadimidine to be given orally every 12 hours for 10 days. One month later, the horse had recovered and there were no further complications reported by the owner except for an occasional cough while grazing Laboratory findings: Bacterial culture of transtracheal wash fluid resulted in the isolation of Nicoletella semolina as the sole organism, later confirmed by genotyping. Attempts to subculture the organism for antimicrobial susceptibility testing were unsuccessful. Diagnosis: Infectious bronchopneumonia associated with Nicoletella semolina Clinical relevance: Further work is required to determine whether N. semolina is acting as an opportunistic commensal of the equine respiratory tract or a primary pathogen. However, this article reports the first instance in New Zealand of an association between the presence of this organism and respiratory disease in a horse.

Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review

Objective

Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients.

Data sources

PubMed, Embase and Cochrane Library.

Study selection

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated.

Data extraction

Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported.

Main findings

Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia.

Conclusion

Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.

Evaluation of the Diagnostic and Predicative Values of 8-Iso-Prostaglandin F2α as a Biomarker of Breast Cancer

BACKGROUND

Breast cancer (BC) is a commonly reported cancer that is widely prevalent among women. Its early detection improves patient survival and results in better outcomes. For diagnosis and follow-up care, tumor markers are one of the feasible investigations to be ordered. 8-Iso-prostaglandin F2α (8-iso-PGF2α) serves as a serum marker reflecting oxidative stress and subsequent damaging of DNA. In the present study, we aimed to evaluate both diagnostic and predictive values of 8-iso-PGF2α in BC patients.

MATERIALS AND METHODS

Serum levels of 8-iso-PGF2α were assessed for 66 women with benign breast tumors and 65 women who had malignant BC. To compare the patients who had breast tumors with healthy individuals, 63 women free of breast diseases were selected as controls.

RESULTS

The serum level of 8-iso-PGF2α in the BC patients (57.92 pg/mL) was significantly higher compared to those with benign tumors (18.89 pg/mL) (p < 0.001). In addition, individuals with no breast diseases had less 8-iso-PGF2α (4.02 pg/mL) compared to those who had developed a tumor (p < 0.001). Serum 8-iso-PGF2α was found to be positively correlated with both carcinoembryonic antigen (r = 0.74, p < 0.001) and cancer antigen 15-3 (r = 0.80, p < 0.001). Furthermore, serum 8-iso-PGF2α showed high diagnostic performance in BC (AUC = 0.999, sensitivity = 100%, specificity = 99.2% at a cutoff value of 36.18 pg/mL).

CONCLUSIONS

Our study found that the high level of serum 8-iso-PGF2α helps to provide a non-invasive indicator to detect BC. Future work with a larger sample size and various phases of BC can confirm the current results which provide insights into the early detection of cancer.

The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis

OBJECTIVES

The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature.

DATA SOURCE

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials).

REVIEW METHODS

All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

RESULTS

Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31; P = .01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78-6.88; P < .001).

CONCLUSION

Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.

Patterns of emergency department visits during Hajj period: Towards healthcare optimization in view of Saudi Arabia's vision 2030

Objective:

This study aimed to examine the pattern of emergency department (ED) visits by Hajj patients and determine the urgency of emergency visits at an advanced healthcare center.

Methods:

A retrospective review of medical records of Hajj patients visiting the ED at King Abdullah Medical City Makkah from September 1 to October 5, 2015 was conducted.

Results:

We considered 233 visits by 199 Hajj patients. Most diseases were cardiovascular related. Approximately half of the ED visits led to hospital admission, which were largely during the evening and nighttime. Potentially avoidable visits were significantly encountered during the daytime. Average bed occupation time in the ED was similar for both cases: those admitted to inpatient care and discharged from ED. Results from the Canadian Triage and Acuity Scale revealed that most patients were triaged with a score of III (48.4%) followed by a clinically better score of IV (32%); however, scores did not change significantly throughout the Hajj day.

Conclusions:

During Hajj, a significant proportion of patients who visited the ED at the ultimate healthcare facility were discharged within 24 hours, with a higher rate in the morning-afternoon period. Both admitted and discharged cases required equal levels of care. Therefore, an extension in working days at primary care centers and optimization of advanced healthcare facilities during Hajj is currently warranted.

8-Hydroxy-2'-deoxyguanosine as a Discriminatory Biomarker for Early Detection of Breast Cancer

BACKGROUND

Breast cancer (BC) is one of the most prevalent and reported cancers among Saudi women. Detection of BC in the early invasive stage (stages I, II) has an advantage in treating patients over detection in the late invasive stage (stages III, IV). Tumor markers are used to aid in diagnosis, treatment monitoring, and recurrence detection of malignant tumors. 8-hydroxy-2'-deoxyguanosine (8-OHdG) is a marker of nucleic damage owing to oxidative stress.

PATIENTS AND METHODS

We studied the blood levels of 8-OHdG in 50 women with benign breast tumors, 50 women with BC, and 50 healthy women as a control group.

RESULTS

The concentrations of 8-OHdG were significantly increased in the BC group (55.2 ng/dL) compared with the benign tumor group (30.2 ng/dL) and with the healthy control group (9.08 ng/dL). The same pattern was observed with other diagnostic markers, including carcinoembryonic antigen and cancer antigen 15-3. Significant positive correlations between 8-OHdG and both carcinoembryonic antigen (r = 0.63; P < .001) and cancer antigen 15-3 (r = 0.51; P < .001) were noticed. The levels of 8-OHdG were significantly higher in stage I (81 ng/dL) compared with stage II (51 ng/dL; P < .05), stage III (38 ng/dL; P < .01), and stage IV (19 ng/dL; P < .001). In addition, serum 8-OHdG had a high diagnostic performance in BC (area under the curve, 0.86; sensitivity = 82%; specificity = 80% at cutoff value 21.4 ng/mL). 8-OHdG is associated with BC risk according to logistic regression analysis.

CONCLUSION

We concluded that the significant increase of serum levels of 8-OHdG in patients with BC can be used as a potential noninvasive biomarker for early detection of BC. However, large sample sizes from different stages and types of BC should be included in any future study to confirm the present findings before translating the findings into routine clinical application.

Patterns of Inpatient Admissions during Hajj: Clinical conditions, length of stay and patient outcomes at an advanced care centre in Makkah, Saudi Arabia

Objectives:

This study aimed to describe inpatient clinical conditions at an advanced care facility in Saudi Arabia during the annual Hajj pilgrimage and to determine factors correlating with length of stay (LOS).

Methods:

This retrospective study was conducted at the King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, and included all inpatients admitted during the annual Hajj pilgrimage between August and October 2015. Demographic, administrative and clinical data were collected from patient charts and analysed.

Results:

A total of 296 inpatients were included in the study, of which the majority were male (73.6%) and ≥55 years old (77%). Walk-in admissions occurred less frequently than referrals (38.9% versus 61.1%). Most patients (41.6%) were admitted during the peak Hajj period (the 8-13^th days of Dhu al-Hijjah). Acute coronary syndrome was the most prevalent provisional diagnosis (65.2%). In terms of outcomes, 89.2% of the inpatients were discharged in a stable condition, with 37.5% discharged within ≤24 hours of admission. However, 39.9% required admission to the Intensive Care Unit (ICU). Overall, LOS was significantly associated with various factors, including the mode of admission, admission period, admitting department, number of comorbidities and ICU admission (P <0.050 each).

Conclusion:

Most of admissions were referrals, and the main Hajj period witnessed the majority of admissions. The vast majority of inpatients eventually discharged in a stable condition. Determinants of the length of hospital stay were the mode of admission, admission period, admitting department, number of comorbidities and ICU admission.

Genomic aberrations in non- small cell lung cancer and their impact on treatment outcome

The therapeutic options of nonsmall cell lung cancer (NSCLC) therapy has been changed since the first discovery of activating epidermal growth factor receptor (EGFR) mutations and the development of specific EGFR tyrosine kinase inhibitors, which resulted in the evolution of "personalized medicine." There are a considerable number of genomic aberrations in NSCLC serving as potential predictive biomarkers and drug targets and still more. We summarized the molecular pathways, potential targets, and possible impact on disease outcome in NSCLC.

Foreign body mimicking malignancy in acquired dacryocystocele

A featured malignant‐like granulation tissue can be the only preoperative clinical clue of a concealed foreign body in the nasal cavity. Thus, endoscopic Dacryocystorhinostomy (DCR) should be completed with intraoperative nasal exploration to reveal non‐apparent foreign bodies that might be the underlying etiology of chronic dacryocystocele.

Comparison of two approaches to lateral nasal osteotomy in Saudi patients

BACKGROUND

Nasal deformity is an abnormality in the appearance of the nose due to either congenital defect or trauma. In traumatic cases, patients often present with combined functional and cosmetic complaints. Therefore, otolaryngologists take into account both breathing and aesthetic nasal issues.

OBJECTIVES

To evaluate the changes in the nasal dorsum and base; compare breathing and aesthetic satisfaction scores between two approaches to lateral nasal osteotomy: low-to-low and low-to-high.

DESIGN

Comparative observational; data gathered retrospectively and prospectively.

SETTING

Head and Neck and Skull Base Center, King Abdullah Medical City, Makkah, Saudi Arabia.

PATIENTS AND METHODS

Patients who received hump reduction rhinoplasty from 2013 to 2016 met the inclusion criteria.

MAIN OUTCOME MEASURE(S)

The differences in dorsal (DW) and ventral (VW) widths with a fixed interpupillary distance (IPD). Satisfaction scores for both cosmetic perspective and breathing functionality.

RESULTS

We included 46 patients; 28 patients underwent low-to-low osteotomy and 18 patients underwent low-to-high osteotomy. With both approaches, there were statistically decreases from preoperative to postoperative ratios of VW/IPD and DW/IPD. However, differences in DW/IPD ratio and VW/IPD ratio (pre- versus post-op) were significantly higher in the low-to-low group (P < .0001). All showed breathing satisfaction postoperatively regardless of the operative approach. Patients with a low satisfaction level for aesthetic sensibility (neutral and dissatisfied) underwent low-to-high osteotomy.

CONCLUSION

Both types of osteotomy showed a satisfactory outcome in both objective and subjective measures. However, low-to-low osteotomy was superior in pre- to post-operative differences in DW/IPD and VW/IPD ratios.

LIMITATIONS

Sampling was by convenience. The study was conducted in a single tertiary center and was a small sample.

Urinary Bladder Cancer: Biomarkers and Target Therapy, New Era for More Attention

Currently, bladder cancer (BCa) evaluation depends mainly on traditional clinicopathological parameters encompassing tumor stage and grade, which will not reflect the behavior of the disease. Diverse molecular alterations are responsible for the heterogeneous course. The differences in molecular pathogenesis between non-invasive BCa and invasive BCa have been recognized. Molecular biomarkers are promising to predict progression and survival. The management of advanced BCa remains somewhat primitive in comparison with other more common malignancies. This topic will discuss the molecular pathways, biomarkers and potential targets that may improve the outcome in BCa.

Abstracts from the 5th International Conference for Healthcare and Medical Students (ICHAMS)

O1: Assessing the protective effect of dexrazoxane against doxorubicin-induced toxicity in HL-1 cardiomyocytes

Yvonne Sweeney, Hugh O’Neill, Garry Duffy

O2: Role of KCNQ1 in epithelial barrier repair

Daniel Creegan, Viviana Bustos, Brian J. Harvey

O3: The suitability of non-small cell lung cancer cytology preparations for the analysis of anaplastic lymphoma kinase gene rearrangements

Alexander Dalphy, Anthony O’Grady, Elaine Kay

O4: Penetrating keratoplasty and descemet’s stripping automated endothelial keratoplasty may lead to deterioration in glaucoma management

Katarzyna Samelska, Justyna Izdebska, Anna Kurowska

O5: The effect of Resolvin D1 on normal and cystic fibrosis human bronchial epithelium

Rena Al-Zubaidy, Magdalena Mroz, Brian Harvey

O6: Validity of clinical assessment compared with plantar fascia thickness on ultrasound for plantar fasciitis: a cross-sectional study

Ryan Fagan, Helen French, Vanessa Cuddy, Jennifer Ashton, Michelle Clarke

P1: Undergraduate medical research in Gulf Cooperation Council (GCC) countries: A descriptive study of students’ views

Zaid Sayedalamin, Mukhtiar Baig, Osama Almutairi, Hassan Allam, Taher F. Halawa, Hazem M. Atta

P2: Positive fluid balance as a prognostic factor in children with sepsis during first 3 hours of resuscitation in intensive care unit

Linda Sirone, Renars Erts, Jana Pavare

P3: Patients on aspirin: Too little or too much?

Louis Richter, Joseph Morris, Irene Oglesby, Eimear Dunne, Dermot Kenny

P4: Beta catenin/TCF4 activation reduces KCNQ1 current in colonic monolayers

Ibrahim Mohammed Mahdi Khayyat, Viviana Bustos Salgado, Brian J. Harvey

P5: Size Matters. Abdominal aortic aneurysm: adherence to surveillance imaging guidelines

Jonavan Tan, Daragh Moneley, Austin Leahy, Patricia Fitzgerald

P6: Endoscopic retrograde cholangiopancreatography in the west of Ireland: Procedural outcomes and peri-procedural complications

Evelyn Fennelly, Grace Harkin, John Lee

P7: The effect of the extracellular redox environment on polyamine-platelet interactions

Erica O’Sullivan, Brian Kirby, Sarah O’Neill

P8: Functionalized gold nanoparticles: preliminary data on in vitro toxicity and comparative photothermal effect

Diana Gonciar, Teodora Mocan, Cristian Matea, Lucian Mocan, Cornel Iancu

P9: Imaging proteasomal inhibition after seizures in the brain: A study into cellular activity in the hippocampus of epileptic transgenic mice

Chloe Doran, Sarah Hoolahan, Tobias Engel

P10: Investigating the ability of the Olfactory epithelial stem cells to differentiate into glial cells by assessing cell morphology and marker expression

Maha Alkhattab, Tijna Alekseeva, William Lackington, Fergal O’Brien

P11: Beaumont Hospital cystic fibrosis service audit and annual report

Nabeehah Moollan, Chloe Doran, Noel Gerry McElvaney, Cedric Gunaratnam

P12: Quick cognitive screening: the 6-item cognitive impairment test and the temporal orientation score

Lorraine Scanlon, Noeleen Brady, Suzanne Timmons

P13: Granular analysis of causes of peritoneal dialysis technique failure in the first six months of therapy

Richard Bresler, Zita Abreu, Stefan Trohonel, Joanne Bargman

P14: Job satisfaction of surgeons working in hajj pilgrimage: a multicenter study

Ahmad A. Mirza, Ahmed Badrek-Amoudi, Rakan H. Aun, Hussam A. Senan, Abdulrahim A. Mirza, Mohammed S. Binsaad, Mian U. Farooq

P15: Investigation of the role of Bok using wild-type, bax-, bok-, and bax/bok-double-deficient mice

Saheli Nandi, Beatrice D’Orsi, Jochen Prehn

P16: Is it possible to predict resistance of an organism to stress based on the level of corticosterone?

Mariia Zharova, Pavel Umrukhin

P17: Investigating the strength model of self-regulation (ego depletion) and medical decision making and error in medical students

Wendy Evans-Uhegbu, Frank Doyle, Hope Kudryashova, Derek Dorris, Anthony Cummins

P18: Does bladder drainage with intermittent catheterisation preserve kidney function in boys with posterior urethral valves?

Jemma Doheny-Shanley, Mark Woodward, Wesley Hayes

P19: Investigating the role of Stonin 2, a Clathrin Mediated Endocytosis adaptor protein, in altered hippocampal synaptic transmission characterized in schizophrenia

Marina Yostos, David Cotter, Melanie Focking

P20: Predicting complications after colon resection

Samantha Stancu, Florin Iordache, Bogdan A. Popescu

P21: Knowledge, attitude and practice of the methods of primary and secondary prevention of cervical cancer among NYSC members in Lagos state, Nigeria

Muhammad-Mujtaba A. Akanmu, Alero A. Robert, Ezekiel O. Oridota

P22: Incidental glucose and lipid metabolisms disorders among office workers: a cross sectional study

Ahmad A. Mirza, Ali K. Alzahrani, Omar Alfarhan, Essam Nour Eldin

P23: Differentiating clinically significant spinal injuries; a review of emergency department presentations

Bronagh MacManus, Owen Keane, Patrick Hillery, James Lee, Hugh O’Reilly, Niamh Collins

P24: Pattern of renal colic occurrence due to urinary stones during Ramadan and other months of the year at King Abdulaziz Medical City, Riyadh, KSA

Ibrahim Abu saq, Abdullah Al Mufarrih, Muath Jaafari, Abdullah Al Mahayni, Amen Bawazir, Sultan Alkhateeb

P25: Proteomic analysis reveals novel AIB1 co-factors that may contribute to acquired endocrine resistance in breast cancer

Amenah Dhannoon, Damir Vareslija, Arnold Hill, Leonie Young

P26: Improving sedation practice in general ICU in Beaumont Hospital

Declan Donoghue, Criona Walsh, Aileen McCabe, John Pope, Saturnino Pasco, Caroline Fallon, Don Solanki, Fiona Kiernan, Sinead Galvin, Jquan Mucvimicc, Johanna Mulvihill

P27: Diagnosis and control of hypertension as indicators of the level of awareness among relatives of medical students

Ahmad A. Mirza, Soha A. Elmosry

P28: Evaluation of the antitumor potential from extracts of endemic plants of Brazilian caatinga against melanoma and hepatocarcinoma

Lorenza Andres Ameida De Souza, Yuri de Oliveira, Diego Menezes, Alene Vanessa Santos

P29: The role of Chromogranin A as a biomarker in drug resistant neuroblastoma

Ahmad Zaki Asraf, Raymond Stallings, Olga Piskareva, Ross Conlon

P30: Membrane sweep at term gestation in CUMH; a case-control study

Siún Sweeney-Landers, Cathy Burke

P31: Study of the variability of glucose levels in patients with diabetes undergoing continuous glucose monitoring

Paraic Behan, Seamus Sreenan

P32: Inflammatory cytokine response to decreased plasma alpha-1 antitrypsin levels in individuals with the MZ genotype

Ahmed Organjee, Tatsiana Crosbie-Staunton, Emer Reeves, Noel McElvaney

P33: Analysing the role of SRC-1 in breast cancer stem cell formation and activity

Crystal Mieres, Leonie Young, Sara Charmsaz

P34: Screening Streptococcus pneumoniae isolates for virulence genes

Aya Al-Jalamdeh, Mary Corcoran, Martha McElligott, Niall Stevens, Hilary Humphreys

P35: Assessment of the relevance of admission clerking criteria taught to medical students at King Abdulaziz University to real hospital practice

Rashid Barnawi, Abdulaziz Ghurab, Sultan Alfaer, Hassan Balubaid, Kamal Hanbazazah, Mohammed Bukhari

P36: Pattern of emergency department visits during Hajj period

Mohammed Alsakkaf, Ahmad Mirza, Amrallah Mohammed

P37: Anti-Dengue activity of Aspergillus terreus (sulochrin); An in vitro study

Anastasia Pratanata, Maria Nathania, Tsabita Annisa, Beti Dewi

P38: The comorbidome in alpha-1 antitrypsin deficiency

Kuok Zhen Lee, Tomas P. Carroll, Laura Fee, Noel G. McElvaney

P39: MLO-Y4 cells behave more like osteocytes in response to mechanical stimulation when cultured in 3D

Rachel C. White, Robert T Brady, Fergal O’Brien

Diagnosis and Control of Hypertension as Indicators of the Level of Awareness Among Relatives of Medical Students in Saudi Arabia

INTRODUCTION

Patients' awareness plays an important role in the early diagnosis and control of many diseases including hypertension.

AIM

To estimate the level of awareness among relatives of medical students by assessing the prevalence of undiagnosed and uncontrolled hypertension.

METHODS

A predefined group of medical students were recruited and properly instructed in order to conduct this cross-sectional study among their respective first-degree adult relatives whom their sociodemographic and medical history were obtained along with their blood pressure readings. According to the absence or presence of hypertension in their history, relatives with high blood pressure were considered as undiagnosed or uncontrolled hypertension, respectively; while those who had normal blood pressure were considered as normal or controlled hypertension, respectively. Comparative analysis of different parameters was carried out between these subgroups.

RESULTS

We included 770 relatives of 82 (57.7 %) total students' participations. The prevalence of undiagnosed hypertension among the total study population was 14.4 % (111 cases). Among participants with previously diagnosed hypertension, 61.9 % were uncontrolled at the time of the study. Predictors for undiagnosed hypertension were age below 40 years, working at the present time in either governmental or private sectors, current smoking, absence of diabetes and cardiac diseases. None of the investigated factors showed to be a significant predictor for uncontrolled hypertension.

CONCLUSIONS

There is insufficient level of awareness among family members of clinically oriented medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The most frequent profile associated with the lowest awareness level is that of the young smoking employee with no history of diabetes or cardiac disease.

WITHDRAWN: Molecular classification of colorectal cancer: Current perspectives and controversies

This article has been withdrawn at the request of the editor. The authors have plagiarized part of a paper that had already appeared in ASCO EDUCATIONAL BOOK (2014), 91-99 (http://meetinglibrary.asco.org/content/114000091-144). One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents an abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).