Evaluation of Moral Reasoning Skills among Dental Students in the Makkah Region, Saudi Arabia.

Introduction: One of the main roles of healthcare educators is to prepare students to make the right ethical decisions. This study evaluated the moral reasoning levels of dental students according to Kohlberg's six-stage moral development system. Materials and Methods: This cross-sectional study was conducted in three dental schools in the Makkah region. Senior-year students completed the self-administered Socio-moral Reflection Objective Measure (SROM), which consists of hypothetical moral dilemmas and options that mirror individual reasoning possibilities. SROM results were matched to Kohlberg's six-stage moral development system and associations with demographic variables and perceptions of educational context variables assessed. Results: One hundred and eighty-eight senior students (mean age 23 ± 1.1 years) completed the SROM. Only 34.6% (n = 44) students reached stage four (morality of law and duty to the social order), while most students (63.8%; n = 81) were at stage three (morality of mutual interpersonal expectations); 1.6% (n = 2) were at stage two (the instrumental relativist orientation). No subject achieved stage 5. Attainment of moral reasoning was not associated with demographic or perception of educational context variables. Conclusion: Students demonstrated a relatively low level of moral reasoning. Healthcare educators must review curricula to provide focused training for students to cultivate their moral reasoning skills. Further studies are also needed to confirm and explain this low moral reasoning level in dental students.

Demographic features, clinical characteristics, and prognostic factors of non-epithelial ovarian tumors at Princess Noorah Oncology Center, National Guard Hospital, Jeddah, Saudi Arabia.

OBJECTIVES: To reveal the demographic features, prognostic factors, and tumor characteristics of patients with non-epithelial ovarian tumors (NEOTs). METHODS: This cross-sectional study was performed using data from all female patients diagnosed with NEOT (germ cell [GC], sex cord-stromal cells [SCSC], sarcoma, and small cell carcinoma) from 2002 to 2017 at Princess Noorah Oncology Center, National Guard Hospital Jeddah, Saudi Arabia. RESULTS: Forty patients with NEOTs were identified. There were equal percentages of GC (45%) and SCSC (45%) origin tumors, and these were the most common histological types. The remaining tumors were sarcomas. Germ cell tumors were more common in younger patients, while SCSC tumors were more frequent in the older age group. CONCLUSION: The findings for protective and risk factors were inconclusive. Patients with GC tumors had better survival outcomes than those with the other subtypes.

Epidemiological characteristics of cervical cancer in a tertiary care hospital, western Saudi Arabia: A retrospective record-based analysis from 2002-2018.

OBJECTIVES: To investigate the epidemiological characteristics of cervical cancer cases reported at a tertiary care teaching hospital in western Saudi Arabia. METHODS: A retrospective chart review was conducted on medical records of patients diagnosed with cervical cancer at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected on demographic characteristics, histological types and stage, treatment modalities, and disease outcomes. RESULTS: Cervical cancer was diagnosed among 89 patients from 2002 to 2018. History of pap smear was reported among 31 cases (34.8%). Squamous cell carcinoma was the most common reported histopathological subtype. Almost one third (29.2%) of the patients were at stage III or IV at the time of diagnosis. The most frequent treatment regimen was combined radio/chemotherapy. Kaplan-Meier analysis showed an overall survival rate of 81.5%. CONCLUSION: The lack of an effective screening program for cervical cancer increases the likelihood of a late diagnosis and higher rates of complications and mortality. Public health programs should focus on cancer screening, screening, and reporting HPV infections, and supporting HPV vaccination activities.

Common Complications of Cesarean Section During the Year 2017 in King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Cesarean section (CS) is one of the most well-known major obstetrics surgeries and one of the oldest operations in the area of abdominal surgery. It is used for the purpose of delivering the newborn and the placenta through the abdominal wall incision (laparotomy) as well as Uterine incision (hysterotomy), followed by suture of the uterus and abdominal wall layers. Most common maternal complications internationally, according to literature were bleeding and wound infection. Most common fetal complications according to the literature were depressed Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, low blood pH and ICU admissions. The aim of this study is to determine the most common CS complications among all the deliveries at King Abdulaziz Medical City (KAMC) in Jeddah in 2017 and to estimate maternal and fetal complication rates following CS. Comparing the rate of complication between residents and non-residents physicians performing a CS was tested as a secondary outcome. To the best of our knowledge, this is a novel research in this medical center at KAMC Jeddah that will aid in quality improvement in both clinical services and training activities of residents. The maternal and fetal complication rates were assessed in a cross-sectional chart review study. In order for this method to be achieved, a secondary data collection sheet was constructed to collect all eligible patient health records. This literature review was based on estimating the rate of CS complications for the mothers and their neonates that founded approximately 7% and 6%, respectively, where the procedure was either performed electively or emergently within the period of 1 January to 31 December 2017. Also, all patients with medical and surgical conditions were included while intrauterine fetal death was excluded. The most common maternal complications documented in our population were bleeding and wound extension, while the most common fetal complications were low APGAR score and NICU admissions. No statistical significance was found in either complications in terms of the correlation between demographical factors, maternal health conditions and gravida status. As for the secondary objective, the association between operator level of training and rate of complications revealed a higher percentage rate of maternal and fetal complications among consultants, which were 6.2% and 8.2%, respectively, mainly because the number and complexity of their cases in comparison to cases held by residents and others.

Low-Grade Endometrial Stromal Sarcoma Extending to The Right Atrium.

Endometrial Stromal Sarcoma (ESS) are very uncommon malignant tumors that make around 0.2% of the entire uterine related malignancies. They represent the endometrial stromal cells in the proliferative stage. The annual incidence of ESS is 1-2 per million women. We present an unusual case of ESS, which originates from the uterine artery through the Inferior Vena Cava (IVC) and extends to the right atrium. A 48 years old woman presented with menorrhagia and right flank pain for seven months. Physical examination was normal except for a palpable suprapubic mass. Computed tomography (CT) showed the right gonadal vein and IVC tumoral thrombus extending into the right atrium. An echocardiogram and Transesophygeal echocardiogram revealed a large non-mobile echogenic density in the right atrium. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Extensive myometrial and vascular invasion was noted along with the extensive lymphovascular invasion of the uterus. Eventually, distal IVC resections were done, and there was no chance to remove the tumor because it was too attached and invaded the IVC filter. Owing to the unresectability of the tumor, the patient was assigned for palliative chemotherapy. Keywords: Endometrial Stromal Sarcoma, Right Atrium, Inferior Vena Cava, Spindle Cell Sarcoma.

Aggressive Angiomyxoma of the Posterior Wall of the Uterus.

Aggressive angiomyxoma (AA) is a rare benign mesenchymal tumor that usually arises in the vulvovaginal and perineal regions of premenopausal females. The treatment of choice is surgical excision. Hormonal therapy or radiotherapy have emerged as alternative forms of treatment but are indefinite. In this article, we report a case of aggressive angiomyxoma in the posterior wall of the uterus of a 35-year-old Saudi female patient. The clinical data, imaging, histopathology, treatment, and prognosis were analyzed, and related literatures were reviewed. The frequency of recurrence in these tumors emphasizes the importance of long-term follow-ups.

The Rates of Cesarean Section Deliveries According to Robson Classification System During the Year of 2018 Among Patients in King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.

BACKGROUND: The rate of cesarean section (CS) births has been rapidly increasing in Saudi Arabia during the last two decades. Using the Robson Ten Group Classification System (TGCS) to classify and analyze the causes of the high CS rate. OBJECTIVE: To assess the increasing rates of CS by the implementation of the Robson TGCS on all CS births in our chosen population. STUDY DESIGN:  An observational, cross-sectional study conducted among all deliveries at the King Abdul-Aziz Medical City (KAMC), Jeddah, Saudi Arabia during most of 2018. Over the study period, 3168 births were enrolled in the study. RESULTS: The analysis of 3168 births, where 870 women gave birth through CS, resulted in a CS rate of 27.5%. The three major TGCS which contributed to the CS rate were group 5, 2 (divided into 2A and 2B), and 3. Class 5 (Previous CS, single cephalic, ≥37 weeks) contributed the most to the CS rate by 36.5%. Followed by Class 2 (divided into 2A; nulliparous, singleton, cephalic, ≥37 weeks, induced labor and 2B; nulliparous, singleton, ≥37, pre-labor CS) which contributed by 12.9%. Class 3 (multiparous (no previous CS), singleton, ≥37 weeks, spontaneous labor) was the third-highest contributing group by 9.2%. Women who gave birth spontaneously and vaginally were 1403 (44.3%) where women whose labor was induced were 1286 (40.6%). CONCLUSION:  The CS rate in KAMC was 27.5%. After classifying these patients according to the TGCS, Class 5 had the largest percentage of patients going for CS (36.2%). While they are individually low together, Robson classes from Class 1 to 4 (which are considered as low-risk classes) were responsible for 37.8% of the patients going for CS. Since the previously mentioned groups are considered low-risk they should be targeted by health institutions to reduce the CS rate. Improved education of nulliparous and multiparous women who never underwent a CS to prevent nonmedically indicated CS is in order, to preclude repeated CS births in the future and further increase the CS rate.

The Average Time Gap Between CA-125 Tumor Marker Elevation and Confirmation of Recurrence in Epithelial Ovarian Cancer Patients at Princess Noorah Oncology Center, Jeddah, Saudi Arabia.

The monitoring of the tumor marker cancer antigen 125 (CA-125) is commonly used as a part of epithelial ovarian cancer monitoring for recurrence. This study seeks to calculate the average time between CA-125 elevation above 35 IU/mL and evidence of recurrence through any currently accepted modality (positive clinical findings, biopsy, imaging, or PET [positron emission tomography] findings) in a patient population in Jeddah, Saudi Arabia. We studied patients who were diagnosed between January 2006 and December 2016, underwent successful primary therapy, and were then followed up at Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. We adopted a cross-sectional chart review study design. We used inclusive (consecutive) sampling. A total of 13 patients were included, of whom 76.9% (10 patients) developed CA-125 elevations above 35 IU/mL prior to the confirmation of recurrence. If all 13 patients are included in the mean average calculation, the mean average time elapsed between CA-125 elevation and confirmation of recurrence was 161.5 days (standard deviation ± 230.6). If only the 10 patients who did exhibit a CA-125 elevation above 35 IU/mL were included, the mean average was 210 days (standard deviation ± 244.2).

Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western Saudi Arabia: 11-year experience.

Background A wide range of reports on the incidence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes mellitus (T1DM) in children have been published worldwide. Reports from Saudi Arabia are limited. The aim of this study was to assess the incidence, clinical pattern and severity of DKA in children with newly diagnosed T1DM and the association of autoimmune conditions with initial DKA occurrence at King Abdulaziz Medical City - Jeddah. Methods This retrospective chart review was conducted during the period 2005-2015. All newly diagnosed T1DM children during the study period were investigated (n = 390). Data were collected on the demographic characteristics, body mass index (BMI), DKA severity, length of hospital stay and follow-up data on the type of diabetes therapy. Results The incidence of DKA among newly diagnosed T1DM pediatric patients was 37.7% (n = 147). Moderate and severe DKA cases were significantly higher among female children (p = 0.04). Patients diagnosed with DKA had lower BMI (20.87 ± 5.21) than their counterparts (p = 0.03). The median length of hospital stay was higher among severe DKA compared to moderate and mild cases (5.0, 4.5 and 4.0 days, respectively). Conclusions The incidence of DKA among newly diagnosed T1DM is still high compared to developed countries; however, it is relatively lower than previous reports in Saudi Arabia. Immediate interventions, such as awareness campaigns, are vital to reduce the burden of this preventable health sequela among children with DM.

Awareness of risk factors and preventive measures for neural tube defects: Perception towards pregnancy termination in the Saudi population.

BACKGROUND: Neural tube defects (NTDs) are among the most common congenital anomalies worldwide with an incidence of 300,000/year. Spina bifida, which is the most prevalent NTD, has an incidence of 1.2/1000 live births in Saudi Arabia. Our study aimed to assess the awareness of NTDs and the implementation of preventative measures against them. In addition, to gauge public opinion regarding abortion following early diagnosis of NTDs. METHODS: This was a cross-sectional study in which questionnaires were distributed using non-probability convenient sampling technique and data was collected in a face-to-face interview. Subjects were approached in an outpatient clinic and in a shopping mall in Jeddah city, Saudi Arabia. RESULTS: Out of 353 subjects, 35.7% were males, 64.3% females (33% pregnant), and the median age was 34 (IQR = 14) years. Of subjects, 66.3% were not aware of NTDs, and regarding folic acid 54% believed that it helps in preventing NTDs, and only 25% agreed on starting it before pregnancy. However, only 19% agreed on all points, which even dropped to 9% after considering planned pregnancies. Gender differences were extremely significant (p-value <0.001) as females were more aware. Interestingly, 62% would abort in early-diagnosed NTD cases. Of pregnant women, only 20% started taking folic acid before pregnancy. CONCLUSIONS: The data shows that the majority of the study's population are in favor of terminating the pregnancy in justified NTD cases. There is a need for increasing public awareness, especially to males, and should be provided through all channels of knowledge.

Malignant transformation of persistent endometriosis after hysterectomy.

The malignant transformation of persistent endometriotic implants into endometrioid adenocarcinoma is rare, especially after remote hysterectomy and salpingo-oophorectomy (TAH-BSO), and there are few cases reported in the English language literature. Patients receiving estrogen replacement therapy are common among the reported cases. We present a case that demonstrates the possibility of malignant transformation in a 53-year-old female, known case of endometriosis, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no evidence of malignancy in the final pathology report. After 9 years, she presented with lower abdominal mass, and histopathological studies confirmed the diagnosis of well-differentiated endometrioid adenocarcinoma. The possibility of malignant transformation and possible risk factors are discussed with a brief literature review.