Experienced laparoscopic surgeon, researcher, academia, and administrator. Published more than 140 research articles with multi center profile. Senior educator and editor.
We are highly obliged to Dr. Bindhu Nair, AHIP Deputy and Research Support Librarian at RCSI-MUB ... more We are highly obliged to Dr. Bindhu Nair, AHIP Deputy and Research Support Librarian at RCSI-MUB for providing the technical support for library services.
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid... more There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case repo...
Although there is evidence that vitamin D deficiency leads to the development of several cancers,... more Although there is evidence that vitamin D deficiency leads to the development of several cancers, including colorectal cancer, research has shown gaps in establishing a relationship between hypovitaminosis D and the incidence of colorectal cancer. There are controversial reports and inadequate scientific evidence about the role of age and race-specific dosage of vitamin D supplementation for chemoprevention. This editorial sheds light on the current evidence on the association of vitamin D deficiency and colorectal cancer, the role of vitamin D supplementation, and the future action plans to establish the needs analysis and goal setting about this area of research.
Operative Techniques and Recent Advances in Acute Care and Emergency Surgery, 2019
The advent of virtual reality has transformed the landscape of learning opportunities that envisa... more The advent of virtual reality has transformed the landscape of learning opportunities that envisages to provide specialty training, assessment, and even accreditation and certification. There is a plethora of educational tools and programs that can enhance the professional competence of the learners by enriching their cognitive, meta-cognitive, and psychomotor skills. In the emergency and surgical disciplines, the learners need structured training for precise movement, manual dexterity, teamwork, and decision-making as illustrated by the practicing senior surgeons and emergency physicians. Unfortunately, there are no accredited surgical and emergency training programs that can be applied across the globe. This section lays out an insightful review of the available emergency training programs that can complement the existing curricula. In addition, the state-of-the-art surgical educational tools and a sketch of a comprehensive surgical training program are provided. There is an overa...
Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased ... more Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased cellular iron. Vitamin D exerts some of its anti-cancer effects by regulating the expression of key iron regulatory genes (IRGs). The association between vitamin D and cellular iron content in BRCA remains ambiguous. Herein, we addressed whether vitamin D signaling exerts a role in cellular iron homeostasis thereby affecting survival of breast cancer cells.Methods: Expression profile of IRGs in vitamin D-treated breast cancer cells was analyzed using publicly available transcriptomic datasets. After treatment of BRCA cell lines MCF-7 and MDA-MB-231 with the active form of vitamin D, labile iron content, IRGs protein levels, oxidative stress, and cell survival were evaluated.Results: Bioinformatics analysis revealed several IRGs as well as cellular stress relates genes were differentially expressed in BRCA cells. Vitamin D treatment resulted in cellular iron depletion and differentially a...
Background: The prevalence of type 2 diabetes mellitus (T2DM) and related complications are rapid... more Background: The prevalence of type 2 diabetes mellitus (T2DM) and related complications are rapidly rising worldwide. Diabetic Foot Ulcer (DFU) carries a high risk of proximal or distal amputation. This study explored the correlation of fasting blood glucose levels with the grades of DFUs and the outcome of treatment strategies offered. Materials and methods: The data of all consecutive patients admitted to the surgical unit with DFUs was recorded for demographic information, grades of DFUs, fasting blood glucose, limb vascularity, treatment strategies offered and the outcome of treatment were recoded. Results: Of a total of 252 patients, 144 (57.1%) had fasting blood glucose level of ≥ 220 mg (%) and 14 (5.6%) had values between 80-100 mg (%). Majority of patients (131; 51.9%) presented with grades 4 and 5 DFUs. A total of 123 amputations were performed, however, only 83 (32.9%) improved and 154 (61.1%) did not (p value 0.00). Conclusion: In this study the majority of patients had poorly controlled T2DM with advanced stage of DFUs that necessitated amputations. An interdisciplinary approach with optimal control of fasting blood glucose and an early detection and aggressive treatment of tissue infection can reduce the frequency of lower limb amputations and T2DM-related morbidity.
Objectives: Research has shown a fall of research productivity of faculty after their promotion t... more Objectives: Research has shown a fall of research productivity of faculty after their promotion to professor rank. This study explores the factors that lead to this decline in research productivity of professors in medical discipline. Methods: A 20-item questionnaire was distributed online to medical professors of a Saudi, Malaysian and a Pakistani medical school. The participants were instructed to select their responses on a 5-point Likert's scale and the collected data was analyzed for quantitative and qualitative results. Results: Of 161, 110 responded; response rate of 68.3%. About 35% professors spent 1-4 hours and 2% spent 19-25 hours per week for research. As many as 7% did not publish a single article and 29% had published 10 or more articles after attaining professor rank. During the last two years, 44% professors had published 5 or more research articles. Majority pointed out a lack of research support and funds, administrative burden and difficulty in data collection as the main obstacles to their research. Conclusions: This research has identified time constraints and insufficient support for research as key barriers to medical professors' research productivity. Financial and technical support and lesser administrative work load are some suggested remedies to foster the professors' research output.
In the recent past, dramatic advances in research have elucidated the prognosis of gallstone dise... more In the recent past, dramatic advances in research have elucidated the prognosis of gallstone disease and have permitted a more selective choice of persons for treatment based on symptom status and projected prognosis. Ultrasound - detected- incidental gallstones are infrequently clinically significant but this finding has prompted the surgeons to have a liberal attitude towards the operative indications for cholelithiasis particularly after the advent of laparoscopy. At the same time, the management of gallstones in the diabetics still remains controversial. Early retrospective studies reported an alarmingly high incidence of gallstones in diabetics as compared with general population and in view of profound morbidity and mortality rates observed in the diabetics, prophylactic cholecystectomy was generally recommended. However, recent evidence-based studies challenged this approach and have concluded that prophylactic cholecystectomy is not justified in diabetic patients with asympt...
Background: There are varying perceptions about professionalism and academic integrity, both bein... more Background: There are varying perceptions about professionalism and academic integrity, both being influenced by regional, cultural, contextual and religious factors worldwide. Very few studies have compared the variations in understanding about academic integrity among medical faculty and students. This study explored the existing understanding of academic integrity in a Saudi and a UK medical school. Methods: The validated Dundee Polyprofessionalism Inventory I: Academic Integrity was administered online to the students and staff of a Saudi and a UK medical school. The data was analysed by SPSS software and a p value of less than 0.05 was considered significant. Results: Of 1005 invitees, 411 completed the survey; response rate of 40.8%. The findings showed significant variations towards opinions of lapses of academic integrity. Mean rank scores showed that faculty of both schools were stricter than students and clinical staff were stricter than non-clinical staff (p < 0.05). The UK students were stricter for 16 and Saudi students were stricter for 10 lapses of academic integrity (p < 0.05). Yearly stratifications of students' recommendations identified a pattern of learning process as indicated by higher sanctions by senior students than their junior counterparts. Conclusion: This study identified some congruence as well as some significant dissimilarities in the sanctions for academic dishonesty. These data can be utilized for standard setting of professionalism that will facilitate the migration of International Medical Graduates by promoting their fitness to practise, especially probity and honesty, as defined by the General Medical Council of UK.
Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative ... more Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative surgery, some patients experience cancer recurrence. However, the pattern, stage, and time of recurrent disease (RD) remain unknown. We aimed to determine the pattern and stage of RD after curative open and laparoscopic surgery for CRC. Databases were searched using selected keywords for clinical studies that analyzed the pattern, stage, and time of RD from CRC. A systematic protocol was used for data extraction, data synthesis, and interpretation of results. Of 455 publications retrieved from databases, 9 clinical studies were selected for this systematic review. There is substantial evidence that pulmonary recurrence is most commonly associated with rectal tumors, and multisite RD appears more frequently with right-sided CRC. RD from colon cancers predominantly appears early in liver, while recurrences from rectal cancer appear late in lungs. Approximately 30% to 50% of RD after curative resection of CRC occurs within the first 2 years; however, median time to recurrence is gradually increasing, particularly for patients with rectal cancers. Advanced primary CRC is significantly correlated with more locoregional and distant RD, with worse disease-free survival. There is a decrease in the 5-year incidence of RD that is associated with prolongation of time of RD for both locoregional and metastatic disease. The duration and design of postoperative follow-up protocols for recurrences from CRC should be tailored to site and stage of primary tumor, as rectal cancers demand longer surveillance times than colon cancer.
BACKGROUND Although the use of social networking sites (SNSs) for fun is increasing, educational ... more BACKGROUND Although the use of social networking sites (SNSs) for fun is increasing, educational use of SNSs by students is low. Additionally, there is limited data about SNSs use by students from different faculties. OBJECTIVE This study compared patterns of SNSs use among medical and non-medical university students. METHODS It is a single-stage cross-sectional study conducted at university students (n=2350) from Saudi Arabia and China. A 21-statement questionnaire was administered to medical students of Taibah and Imam Abdulrahman AlFaisal University, Saudi Arabia, and non-medical students of the Beijing Institute of Technology and the University of International Business and Economics, China. The data about nature of SNSs use and strategies for sharing knowledge were analyzed. RESULTS Comparative data regarding use of SNSs between medical and non-medical students were obtained. Of 2350 respondents; 92% students did and 8% did not use SNSs for any reason. Overall, 624 (26.6%) stud...
BACKGROUND Literature has shown that aberrantly expressed microRNAs may have implications in cert... more BACKGROUND Literature has shown that aberrantly expressed microRNAs may have implications in certain cancers. A wealth of studies signal potential prognostic role of microRNA-21 in GIT cancers. This meta-analysis quantitatively determines prognostic significance of circulating microRNA-21 in esophageal squamous cell carcinoma (ESCC), pancreatic ductal adenocarcinoma (PDAC) and colorectal carcinoma (CRC). METHODS Databases of Medline, Wiley online library, Cochrane library, Taylor and Francis Online, CINAHL, Springer, Proquest, ISI Web of knowledge, ScienceDirect, and Emerald were searched using MeSH terms serum/tissue microRNA-21, prognosis, esophagus squamous cell carcinoma, pancreatic ductal adenocarcinoma, colorectal cancer. A systematic algorithm was used that selected 15 relevant studies. Meta-analysis was conducted using forest plot and a summary effect model was employed. RESULTS This meta-analysis reports significant prognostic value of miR-21 in predicting worse overall survival (OS) in ESCC, PDAC, and CRC with pooled hazard ratio (HR) of 3.49 (95% CI 2.58-4.71, p-value < 0.01). Subgroup analysis for ESCC showed a pooled HR of 3.46 (95% CI 1.88-635, p value of <0.01), worse overall survival (OS) with the pooled HR of 3.14 (95% CI 2.22-4.43, p value < 0.01) for CRC and a pooled HR of 3.77 (95% CI 1.63-8.73, p value < 0.01) for PDAC. CONCLUSION This research infers that microRNA-21 expression is a powerful prognostic tool. Expression of micro-RNA-21 is associated with poor OS and poorer disease-free survival in ESCC, PDAC and CRC.
ynchronous bilateral breast cancer is uncommon (1-2.6% of all patients with breast cancer) but it... more ynchronous bilateral breast cancer is uncommon (1-2.6% of all patients with breast cancer) but its incidence is likely to rise due to earlier detection by mammography and longer survival rates of patients with unilateral breast cancer. The striking feature of the disease is reflected by the worse histological grade which necessitates an urgent risk-reduction multi disciplinary approach for such patients. The incidence of synchronous bilateral breast cancer (SBBC) ranges from 0.8-3%.1 Patients with an index breast cancer have an increased risk of the development of a second breast cancer. The calculated average risk of development of a second breast cancer is approximately 0.7% per year and the cumulative incidence of bilateral breast cancer (BBC), synchronous and metachronous, has been reported to be 4-26%.2 There is no general consensus of the optimal treatment for SBBC which is defined as cancer diagnosed in both breasts simultaneously or within 3 months of the diagnosis of the first tumor.3 The patients are often treated with bilateral mastectomy rather than breast conservation and the prognosis is worse than a unilateral breast cancer. We managed a 42-year-old Filipino lady at King Khalid University Hospital Riyadh, Kingdom of Saudi Arabia, admitted with the history of a palpable lump in her left breast found accidentally at approximately 3 months back. The patient had 3 children and she breast-fed all of them. Her family history was unremarkable of breast cancer, and she did not take contraceptive pills in the past. Examination of the left breast revealed a 5x6 cm firm; non-tender mass in upper and inner quadrants of the breast with ill defined edges. At the same time, on physician’s examination, the patient’s right breast also demonstrated a 4x3 cm hard lump with irregular borders in upper and outer quadrants. There was no associated nipple retraction, skin tethering, muscular attachment or axillary lymphadenopathy on both sides. The mammographic findings of both breasts are illustrated in Figures 1 and 2. Fine needle aspiration cytology (FNAC) reported infiltrating ductal carcinoma of the left breast and suspicious dysplastic cells in the right breast. Radionuclide bone scan, computerized tomography scan of the chest and abdomen were unremarkable and her serum CA 153 was found to be 34.6 (normal is 0-22). The patient underwent left mastectomy with
To explore the usefulness of an online inventory for tracking medical students&amp;amp;amp;am... more To explore the usefulness of an online inventory for tracking medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; understanding of the importance of lapses in academic integrity. Respondents were asked to recommend sanctions for lapses as a proxy of their understanding of the importance of the 34 types of poor professionalism. The data suggest that while there is congruence, there are also substantial differences between ratings of the importance of poor professionalism, particularly in relation to data integrity, between a cohort in Saudi Arabia and one in the UK. This resource may be useful both for teaching and learning in individual schools, and particularly for the induction of doctors into organisational environments different from the one they were trained in.
The decision whether to operate for diverticular disease and the appropriate selection of right c... more The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated episode of acute diverticulitis remains controversial. Although both the impact of symptomatic disease and occurrence of its complications are extensively studied, there is no consensus about the role of elective colonic resection in the management of symptomatic recurrent diverticulitis. In this study, the database of ERIC, the Web of Science, EMBASE, and MEDLINE were searched for the English-language published articles about the functional outcomes and symptomatic improvement in patients after elective surgery for diverticular disease. A majority of clinical trials showed that elective surgery following a successful conservative treatment of acute diverticulitis resulted in significantly better social and functional well-being. In addition, elective surgery greatly reduces the potential events of disease recurrence, thus decreasing financial burden on the national health services. However, to obtain the best functional outcome surgical intervention must be individualized and tailored to meet every single patient&amp;amp;#39;s specific indigenous symptomatology.
To report the incidence of cholesterolosis in the surgically removed gallbladders, its associatio... more To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment. This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy. The study group was comprised of 549 patients and out of which, 74 (13.4%) had cholesterolosis of the gallbladder. There were 59 (79.9%) female and 15 (20.1%) male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three (85.1%) cases were reported to have abnormally high fasting serum cholesterol levels (&amp;amp;amp;amp;amp;amp;gt;=5.5 mmol/L), whereas 11 (14.9%) had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 (63.3%) patients while 27 (36.5%) subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 (95.9%) individuals, whereas 3 patients ended up with open cholecystectomy (conversion rate of 4.2%). There were no postoperative complications. Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis.
Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer du... more Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer due to their rapid nutritional disturbances and difficult surgical management. This case report details a 23-year-old female who presented with diarrhea, anorexia, weight loss, anemia and abdominal pain. A series of examinations showed a transverse colon carcinoma with a malignant duodenocolic fistula and direct infiltration of the right lobe of the liver. The patient underwent extended right hemicolectomy with wide local excision of the duodenum and segmental hepatic resection. Postoperative recovery was uneventful. The analysis of other similar cases from the literature treated with this procedure or less frequently, with right hemicolectomy and pancreaticoduodenectomy, allows us to discuss the indications and results of radical surgery. Whenever feasible, resection offers the best treatment as lesser techniques such as bypass and exclusion result only in minimal palliation. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long term survival are realistic goals and prognostically justifiable.
Dear Sir, Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neop... more Dear Sir, Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neoplasms with the age-adjusted incidence of 0.12 case per 1,000,000 people per year [1]. Owing to its vague and bizarre presentations, primary appendiceal cancer cannot be diagnosed preoperatively and is diagnosed in only 0.9%–1.4% of appendectomy specimens. Carcinoid tumours have been reported to be the most frequent primary tumours of appendix, accounting for 32%-85% of all appendiceal tumours, followed by adenocarcinomas that comprise further 4%-6% of tumours [2]. Appendiceal adenocarcinomas are extremely aggressive tumours behaving similar to that of colonic adenocarcinomas, requiring right hemicolectomy for curative intent. A retrospective study showed 10 cases of adenocarcinoma of the appendix from a total of 9323 appendectomies [Table/Fig-1] (0.1%: 8 men and 2 women with a mean age of 53.1 years) [3]. Akbulut et al., reported unusual histological findings in 54 of 5462 (1%) appendectomy specimens; 37 enterobiasis, 6 carcinoids, 4 mucinous cystadenomas, 2 eosinophilic infiltrations, 2 mucoceles, 2 tuberculosis, and 1 neurogenic hyperplasia [4]. An examination of 4545 appendectomy specimens, performed for acute appendicitis, showed 44 (0.97%) unexpected tumours of appendix including an adenocarcinoma and a primary lymphoma of the appendix [5]. Another series analysed histological reports of 324 appendectomy specimens and reported 8 unexpected lesions [6]. The study concluded that surgeons should bear in mind the possibility of unusual pathologies justifying the need for the routine histopathological examination of appendices. Meticulous attention to the gross operative findings such as abnormally hard part of appendix, grossly visible/palpable lymph nodes in peri-appendiceal region, and the arrangements for frozen-section during surgery can help identify the tumours at an earlier stage. [Table/Fig-1]: A well-differentiated adenocarcinoma of the appendix showing the glands with severe hyperchromatism and the stroma surrounded by lymphocytes Although fecoliths and lymphoid hyperplasia are the common aetiologies of acute appendicitis, some rare but vitally fatal lesions may also cause appendicitis. On the same note, intraoperative observations alone are not enough to identify the unexpected disease. The most frequent unusual findings in appendectomy specimens are parasites and benign or malignant tumours. Although the routine histological examination of appendectomy specimens poses a burden on the financial and technical resources, current research strongly justifies this practice. There is a need for routine histopathologic examination of the appendectomy specimens. The histologic examination is valuable in identifying unexpected conditions which may require further management depending on the nature of the disease process. Specimens from patients with suspected acute appendicitis may exhibit a myriad of histological variations including cancerous growths [7]. With increasing emphasis on cost-effectiveness in surgery, routine pathological examination of appendectomy specimens, although expensive and labourintensive, still holds a valuable promise in diagnosing unexpected appendiceal lesions.
World journal of gastrointestinal surgery, Jan 27, 2012
To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pan... more To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pancreatic injuries in children. We conducted a retrospective study to review medical files of children admitted with blunt pancreatic injuries to the Maternity and Children Hospital Al-Madina Al-Munawwarah, Kingdom of Saudi Arabia. The demographic details and mechanisms of injury were recorded. From the database of the Picture Archiving and Communication System of the radiology department, multidetector computed tomography (MDCT) images of the pancreatic injuries, severity, type of injuries and grading of pancreatic injuries were established. Seven patients were recruited in this study over a period of 5 years; 5 males and 2 females with a mean age of 7 years (age range 5-12 years). Fall from height was the most frequent mechanism of injury, reported in 5 (71%), followed by road traffic accident (1 patient, 14%) and cycle handlebar (1 patient, 14%) injuries. According to the American Assoc...
We are highly obliged to Dr. Bindhu Nair, AHIP Deputy and Research Support Librarian at RCSI-MUB ... more We are highly obliged to Dr. Bindhu Nair, AHIP Deputy and Research Support Librarian at RCSI-MUB for providing the technical support for library services.
There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid... more There is a recent proliferation of clinical studies about the minimally invasive scarless thyroid surgery. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) carries a great potential for being scarless surgery via a short dissection flap. However, TOETVA has limitations in extracting larger thyroid tumours via the transoral vestibular incision and due to its potential damage to the branches of the mental nerve. The rapidly evolving surgical innovations have now introduced transoral and submental thyroidectomy (TOaST) approach that allows extraction of large thyroid tumours with less flap dissection and minimal postoperative pain. We present a 39-year-old man with a large multinodular goitre. The patient was euthyroid with moderate to severe compression symptoms of difficulty in breathing and swallowing. We performed a TOaST procedure using intraoperative neuromonitoring and indocyanin green fluorescence imaging with an uneventful recovery. This is a first case repo...
Although there is evidence that vitamin D deficiency leads to the development of several cancers,... more Although there is evidence that vitamin D deficiency leads to the development of several cancers, including colorectal cancer, research has shown gaps in establishing a relationship between hypovitaminosis D and the incidence of colorectal cancer. There are controversial reports and inadequate scientific evidence about the role of age and race-specific dosage of vitamin D supplementation for chemoprevention. This editorial sheds light on the current evidence on the association of vitamin D deficiency and colorectal cancer, the role of vitamin D supplementation, and the future action plans to establish the needs analysis and goal setting about this area of research.
Operative Techniques and Recent Advances in Acute Care and Emergency Surgery, 2019
The advent of virtual reality has transformed the landscape of learning opportunities that envisa... more The advent of virtual reality has transformed the landscape of learning opportunities that envisages to provide specialty training, assessment, and even accreditation and certification. There is a plethora of educational tools and programs that can enhance the professional competence of the learners by enriching their cognitive, meta-cognitive, and psychomotor skills. In the emergency and surgical disciplines, the learners need structured training for precise movement, manual dexterity, teamwork, and decision-making as illustrated by the practicing senior surgeons and emergency physicians. Unfortunately, there are no accredited surgical and emergency training programs that can be applied across the globe. This section lays out an insightful review of the available emergency training programs that can complement the existing curricula. In addition, the state-of-the-art surgical educational tools and a sketch of a comprehensive surgical training program are provided. There is an overa...
Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased ... more Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased cellular iron. Vitamin D exerts some of its anti-cancer effects by regulating the expression of key iron regulatory genes (IRGs). The association between vitamin D and cellular iron content in BRCA remains ambiguous. Herein, we addressed whether vitamin D signaling exerts a role in cellular iron homeostasis thereby affecting survival of breast cancer cells.Methods: Expression profile of IRGs in vitamin D-treated breast cancer cells was analyzed using publicly available transcriptomic datasets. After treatment of BRCA cell lines MCF-7 and MDA-MB-231 with the active form of vitamin D, labile iron content, IRGs protein levels, oxidative stress, and cell survival were evaluated.Results: Bioinformatics analysis revealed several IRGs as well as cellular stress relates genes were differentially expressed in BRCA cells. Vitamin D treatment resulted in cellular iron depletion and differentially a...
Background: The prevalence of type 2 diabetes mellitus (T2DM) and related complications are rapid... more Background: The prevalence of type 2 diabetes mellitus (T2DM) and related complications are rapidly rising worldwide. Diabetic Foot Ulcer (DFU) carries a high risk of proximal or distal amputation. This study explored the correlation of fasting blood glucose levels with the grades of DFUs and the outcome of treatment strategies offered. Materials and methods: The data of all consecutive patients admitted to the surgical unit with DFUs was recorded for demographic information, grades of DFUs, fasting blood glucose, limb vascularity, treatment strategies offered and the outcome of treatment were recoded. Results: Of a total of 252 patients, 144 (57.1%) had fasting blood glucose level of ≥ 220 mg (%) and 14 (5.6%) had values between 80-100 mg (%). Majority of patients (131; 51.9%) presented with grades 4 and 5 DFUs. A total of 123 amputations were performed, however, only 83 (32.9%) improved and 154 (61.1%) did not (p value 0.00). Conclusion: In this study the majority of patients had poorly controlled T2DM with advanced stage of DFUs that necessitated amputations. An interdisciplinary approach with optimal control of fasting blood glucose and an early detection and aggressive treatment of tissue infection can reduce the frequency of lower limb amputations and T2DM-related morbidity.
Objectives: Research has shown a fall of research productivity of faculty after their promotion t... more Objectives: Research has shown a fall of research productivity of faculty after their promotion to professor rank. This study explores the factors that lead to this decline in research productivity of professors in medical discipline. Methods: A 20-item questionnaire was distributed online to medical professors of a Saudi, Malaysian and a Pakistani medical school. The participants were instructed to select their responses on a 5-point Likert's scale and the collected data was analyzed for quantitative and qualitative results. Results: Of 161, 110 responded; response rate of 68.3%. About 35% professors spent 1-4 hours and 2% spent 19-25 hours per week for research. As many as 7% did not publish a single article and 29% had published 10 or more articles after attaining professor rank. During the last two years, 44% professors had published 5 or more research articles. Majority pointed out a lack of research support and funds, administrative burden and difficulty in data collection as the main obstacles to their research. Conclusions: This research has identified time constraints and insufficient support for research as key barriers to medical professors' research productivity. Financial and technical support and lesser administrative work load are some suggested remedies to foster the professors' research output.
In the recent past, dramatic advances in research have elucidated the prognosis of gallstone dise... more In the recent past, dramatic advances in research have elucidated the prognosis of gallstone disease and have permitted a more selective choice of persons for treatment based on symptom status and projected prognosis. Ultrasound - detected- incidental gallstones are infrequently clinically significant but this finding has prompted the surgeons to have a liberal attitude towards the operative indications for cholelithiasis particularly after the advent of laparoscopy. At the same time, the management of gallstones in the diabetics still remains controversial. Early retrospective studies reported an alarmingly high incidence of gallstones in diabetics as compared with general population and in view of profound morbidity and mortality rates observed in the diabetics, prophylactic cholecystectomy was generally recommended. However, recent evidence-based studies challenged this approach and have concluded that prophylactic cholecystectomy is not justified in diabetic patients with asympt...
Background: There are varying perceptions about professionalism and academic integrity, both bein... more Background: There are varying perceptions about professionalism and academic integrity, both being influenced by regional, cultural, contextual and religious factors worldwide. Very few studies have compared the variations in understanding about academic integrity among medical faculty and students. This study explored the existing understanding of academic integrity in a Saudi and a UK medical school. Methods: The validated Dundee Polyprofessionalism Inventory I: Academic Integrity was administered online to the students and staff of a Saudi and a UK medical school. The data was analysed by SPSS software and a p value of less than 0.05 was considered significant. Results: Of 1005 invitees, 411 completed the survey; response rate of 40.8%. The findings showed significant variations towards opinions of lapses of academic integrity. Mean rank scores showed that faculty of both schools were stricter than students and clinical staff were stricter than non-clinical staff (p < 0.05). The UK students were stricter for 16 and Saudi students were stricter for 10 lapses of academic integrity (p < 0.05). Yearly stratifications of students' recommendations identified a pattern of learning process as indicated by higher sanctions by senior students than their junior counterparts. Conclusion: This study identified some congruence as well as some significant dissimilarities in the sanctions for academic dishonesty. These data can be utilized for standard setting of professionalism that will facilitate the migration of International Medical Graduates by promoting their fitness to practise, especially probity and honesty, as defined by the General Medical Council of UK.
Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative ... more Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative surgery, some patients experience cancer recurrence. However, the pattern, stage, and time of recurrent disease (RD) remain unknown. We aimed to determine the pattern and stage of RD after curative open and laparoscopic surgery for CRC. Databases were searched using selected keywords for clinical studies that analyzed the pattern, stage, and time of RD from CRC. A systematic protocol was used for data extraction, data synthesis, and interpretation of results. Of 455 publications retrieved from databases, 9 clinical studies were selected for this systematic review. There is substantial evidence that pulmonary recurrence is most commonly associated with rectal tumors, and multisite RD appears more frequently with right-sided CRC. RD from colon cancers predominantly appears early in liver, while recurrences from rectal cancer appear late in lungs. Approximately 30% to 50% of RD after curative resection of CRC occurs within the first 2 years; however, median time to recurrence is gradually increasing, particularly for patients with rectal cancers. Advanced primary CRC is significantly correlated with more locoregional and distant RD, with worse disease-free survival. There is a decrease in the 5-year incidence of RD that is associated with prolongation of time of RD for both locoregional and metastatic disease. The duration and design of postoperative follow-up protocols for recurrences from CRC should be tailored to site and stage of primary tumor, as rectal cancers demand longer surveillance times than colon cancer.
BACKGROUND Although the use of social networking sites (SNSs) for fun is increasing, educational ... more BACKGROUND Although the use of social networking sites (SNSs) for fun is increasing, educational use of SNSs by students is low. Additionally, there is limited data about SNSs use by students from different faculties. OBJECTIVE This study compared patterns of SNSs use among medical and non-medical university students. METHODS It is a single-stage cross-sectional study conducted at university students (n=2350) from Saudi Arabia and China. A 21-statement questionnaire was administered to medical students of Taibah and Imam Abdulrahman AlFaisal University, Saudi Arabia, and non-medical students of the Beijing Institute of Technology and the University of International Business and Economics, China. The data about nature of SNSs use and strategies for sharing knowledge were analyzed. RESULTS Comparative data regarding use of SNSs between medical and non-medical students were obtained. Of 2350 respondents; 92% students did and 8% did not use SNSs for any reason. Overall, 624 (26.6%) stud...
BACKGROUND Literature has shown that aberrantly expressed microRNAs may have implications in cert... more BACKGROUND Literature has shown that aberrantly expressed microRNAs may have implications in certain cancers. A wealth of studies signal potential prognostic role of microRNA-21 in GIT cancers. This meta-analysis quantitatively determines prognostic significance of circulating microRNA-21 in esophageal squamous cell carcinoma (ESCC), pancreatic ductal adenocarcinoma (PDAC) and colorectal carcinoma (CRC). METHODS Databases of Medline, Wiley online library, Cochrane library, Taylor and Francis Online, CINAHL, Springer, Proquest, ISI Web of knowledge, ScienceDirect, and Emerald were searched using MeSH terms serum/tissue microRNA-21, prognosis, esophagus squamous cell carcinoma, pancreatic ductal adenocarcinoma, colorectal cancer. A systematic algorithm was used that selected 15 relevant studies. Meta-analysis was conducted using forest plot and a summary effect model was employed. RESULTS This meta-analysis reports significant prognostic value of miR-21 in predicting worse overall survival (OS) in ESCC, PDAC, and CRC with pooled hazard ratio (HR) of 3.49 (95% CI 2.58-4.71, p-value < 0.01). Subgroup analysis for ESCC showed a pooled HR of 3.46 (95% CI 1.88-635, p value of <0.01), worse overall survival (OS) with the pooled HR of 3.14 (95% CI 2.22-4.43, p value < 0.01) for CRC and a pooled HR of 3.77 (95% CI 1.63-8.73, p value < 0.01) for PDAC. CONCLUSION This research infers that microRNA-21 expression is a powerful prognostic tool. Expression of micro-RNA-21 is associated with poor OS and poorer disease-free survival in ESCC, PDAC and CRC.
ynchronous bilateral breast cancer is uncommon (1-2.6% of all patients with breast cancer) but it... more ynchronous bilateral breast cancer is uncommon (1-2.6% of all patients with breast cancer) but its incidence is likely to rise due to earlier detection by mammography and longer survival rates of patients with unilateral breast cancer. The striking feature of the disease is reflected by the worse histological grade which necessitates an urgent risk-reduction multi disciplinary approach for such patients. The incidence of synchronous bilateral breast cancer (SBBC) ranges from 0.8-3%.1 Patients with an index breast cancer have an increased risk of the development of a second breast cancer. The calculated average risk of development of a second breast cancer is approximately 0.7% per year and the cumulative incidence of bilateral breast cancer (BBC), synchronous and metachronous, has been reported to be 4-26%.2 There is no general consensus of the optimal treatment for SBBC which is defined as cancer diagnosed in both breasts simultaneously or within 3 months of the diagnosis of the first tumor.3 The patients are often treated with bilateral mastectomy rather than breast conservation and the prognosis is worse than a unilateral breast cancer. We managed a 42-year-old Filipino lady at King Khalid University Hospital Riyadh, Kingdom of Saudi Arabia, admitted with the history of a palpable lump in her left breast found accidentally at approximately 3 months back. The patient had 3 children and she breast-fed all of them. Her family history was unremarkable of breast cancer, and she did not take contraceptive pills in the past. Examination of the left breast revealed a 5x6 cm firm; non-tender mass in upper and inner quadrants of the breast with ill defined edges. At the same time, on physician’s examination, the patient’s right breast also demonstrated a 4x3 cm hard lump with irregular borders in upper and outer quadrants. There was no associated nipple retraction, skin tethering, muscular attachment or axillary lymphadenopathy on both sides. The mammographic findings of both breasts are illustrated in Figures 1 and 2. Fine needle aspiration cytology (FNAC) reported infiltrating ductal carcinoma of the left breast and suspicious dysplastic cells in the right breast. Radionuclide bone scan, computerized tomography scan of the chest and abdomen were unremarkable and her serum CA 153 was found to be 34.6 (normal is 0-22). The patient underwent left mastectomy with
To explore the usefulness of an online inventory for tracking medical students&amp;amp;amp;am... more To explore the usefulness of an online inventory for tracking medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; understanding of the importance of lapses in academic integrity. Respondents were asked to recommend sanctions for lapses as a proxy of their understanding of the importance of the 34 types of poor professionalism. The data suggest that while there is congruence, there are also substantial differences between ratings of the importance of poor professionalism, particularly in relation to data integrity, between a cohort in Saudi Arabia and one in the UK. This resource may be useful both for teaching and learning in individual schools, and particularly for the induction of doctors into organisational environments different from the one they were trained in.
The decision whether to operate for diverticular disease and the appropriate selection of right c... more The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated episode of acute diverticulitis remains controversial. Although both the impact of symptomatic disease and occurrence of its complications are extensively studied, there is no consensus about the role of elective colonic resection in the management of symptomatic recurrent diverticulitis. In this study, the database of ERIC, the Web of Science, EMBASE, and MEDLINE were searched for the English-language published articles about the functional outcomes and symptomatic improvement in patients after elective surgery for diverticular disease. A majority of clinical trials showed that elective surgery following a successful conservative treatment of acute diverticulitis resulted in significantly better social and functional well-being. In addition, elective surgery greatly reduces the potential events of disease recurrence, thus decreasing financial burden on the national health services. However, to obtain the best functional outcome surgical intervention must be individualized and tailored to meet every single patient&amp;amp;#39;s specific indigenous symptomatology.
To report the incidence of cholesterolosis in the surgically removed gallbladders, its associatio... more To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment. This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy. The study group was comprised of 549 patients and out of which, 74 (13.4%) had cholesterolosis of the gallbladder. There were 59 (79.9%) female and 15 (20.1%) male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three (85.1%) cases were reported to have abnormally high fasting serum cholesterol levels (&amp;amp;amp;amp;amp;amp;gt;=5.5 mmol/L), whereas 11 (14.9%) had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 (63.3%) patients while 27 (36.5%) subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 (95.9%) individuals, whereas 3 patients ended up with open cholecystectomy (conversion rate of 4.2%). There were no postoperative complications. Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis.
Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer du... more Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer due to their rapid nutritional disturbances and difficult surgical management. This case report details a 23-year-old female who presented with diarrhea, anorexia, weight loss, anemia and abdominal pain. A series of examinations showed a transverse colon carcinoma with a malignant duodenocolic fistula and direct infiltration of the right lobe of the liver. The patient underwent extended right hemicolectomy with wide local excision of the duodenum and segmental hepatic resection. Postoperative recovery was uneventful. The analysis of other similar cases from the literature treated with this procedure or less frequently, with right hemicolectomy and pancreaticoduodenectomy, allows us to discuss the indications and results of radical surgery. Whenever feasible, resection offers the best treatment as lesser techniques such as bypass and exclusion result only in minimal palliation. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long term survival are realistic goals and prognostically justifiable.
Dear Sir, Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neop... more Dear Sir, Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neoplasms with the age-adjusted incidence of 0.12 case per 1,000,000 people per year [1]. Owing to its vague and bizarre presentations, primary appendiceal cancer cannot be diagnosed preoperatively and is diagnosed in only 0.9%–1.4% of appendectomy specimens. Carcinoid tumours have been reported to be the most frequent primary tumours of appendix, accounting for 32%-85% of all appendiceal tumours, followed by adenocarcinomas that comprise further 4%-6% of tumours [2]. Appendiceal adenocarcinomas are extremely aggressive tumours behaving similar to that of colonic adenocarcinomas, requiring right hemicolectomy for curative intent. A retrospective study showed 10 cases of adenocarcinoma of the appendix from a total of 9323 appendectomies [Table/Fig-1] (0.1%: 8 men and 2 women with a mean age of 53.1 years) [3]. Akbulut et al., reported unusual histological findings in 54 of 5462 (1%) appendectomy specimens; 37 enterobiasis, 6 carcinoids, 4 mucinous cystadenomas, 2 eosinophilic infiltrations, 2 mucoceles, 2 tuberculosis, and 1 neurogenic hyperplasia [4]. An examination of 4545 appendectomy specimens, performed for acute appendicitis, showed 44 (0.97%) unexpected tumours of appendix including an adenocarcinoma and a primary lymphoma of the appendix [5]. Another series analysed histological reports of 324 appendectomy specimens and reported 8 unexpected lesions [6]. The study concluded that surgeons should bear in mind the possibility of unusual pathologies justifying the need for the routine histopathological examination of appendices. Meticulous attention to the gross operative findings such as abnormally hard part of appendix, grossly visible/palpable lymph nodes in peri-appendiceal region, and the arrangements for frozen-section during surgery can help identify the tumours at an earlier stage. [Table/Fig-1]: A well-differentiated adenocarcinoma of the appendix showing the glands with severe hyperchromatism and the stroma surrounded by lymphocytes Although fecoliths and lymphoid hyperplasia are the common aetiologies of acute appendicitis, some rare but vitally fatal lesions may also cause appendicitis. On the same note, intraoperative observations alone are not enough to identify the unexpected disease. The most frequent unusual findings in appendectomy specimens are parasites and benign or malignant tumours. Although the routine histological examination of appendectomy specimens poses a burden on the financial and technical resources, current research strongly justifies this practice. There is a need for routine histopathologic examination of the appendectomy specimens. The histologic examination is valuable in identifying unexpected conditions which may require further management depending on the nature of the disease process. Specimens from patients with suspected acute appendicitis may exhibit a myriad of histological variations including cancerous growths [7]. With increasing emphasis on cost-effectiveness in surgery, routine pathological examination of appendectomy specimens, although expensive and labourintensive, still holds a valuable promise in diagnosing unexpected appendiceal lesions.
World journal of gastrointestinal surgery, Jan 27, 2012
To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pan... more To evaluate the efficacy of computed tomography scan in diagnosing and grading the pattern of pancreatic injuries in children. We conducted a retrospective study to review medical files of children admitted with blunt pancreatic injuries to the Maternity and Children Hospital Al-Madina Al-Munawwarah, Kingdom of Saudi Arabia. The demographic details and mechanisms of injury were recorded. From the database of the Picture Archiving and Communication System of the radiology department, multidetector computed tomography (MDCT) images of the pancreatic injuries, severity, type of injuries and grading of pancreatic injuries were established. Seven patients were recruited in this study over a period of 5 years; 5 males and 2 females with a mean age of 7 years (age range 5-12 years). Fall from height was the most frequent mechanism of injury, reported in 5 (71%), followed by road traffic accident (1 patient, 14%) and cycle handlebar (1 patient, 14%) injuries. According to the American Assoc...
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Papers by Salman Guraya