Cultural influence on generational gaps: A case for medical education in the Gulf region.

OBJECTIVE:  To explores cultural differences between generations of faculty and students in undergraduate medical education and to develop an educational framework for stakeholders involvement. METHODS:  This is a prospective cross-sectional mixed method study. A survey was administered on students and faculty members to measure generational differences using Hofstede's dimensions of cultural orientation. The study took place at King Abdulaziz University-Faculty of Medicine, Jeddah, Saudi Arabia, on February 2015. Quantitative methods, descriptive statistics, and correlations and regression analyses were used in data analysis. In addition, qualitative data from focus groups were used to explain findings obtained from the survey. RESULTS:  A total of 736 respondents were surveyed (129 faculty members and 607 medical students). Faculty members across all generations shared the same cultural values of low power distance and masculinity and high uncertainty avoidance, long-term orientation and collectivism. Advanced medical students showed higher power distance, collectivism, masculinity and long-term orientation than faculty members; junior medical students have higher masculinity and lower uncertainty avoidance and collectivism. CONCLUSION:  This study explains both the cultural gap between Saudi and Western medical students as well as between Saudi generations, demonstrating the need for customized curricular revisions.

The clinical utility of eye exam simulator in enhancing the competency of family physician residents in screening for diabetic retinopathy.

OBJECTIVES: To evaluate the utility of eye exam simulators in the training and assessment of family medicine residents for screening diabetic retinopathy (DR) utilizing direct ophthalmoscopy (DO). METHODS: This prospective, single arm, cross-sectional study was conducted at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia in April 2013, wherein the final year family medicine residents of the Saudi Board family medicine training program, underwent a practical session on DO using an eye exam simulator. The cognitive and motor skills of the participating family residents in performing DO, and their competency at diagnosing DR was assessed before, and after a practical session with the eye simulator. RESULTS: A total of 14 out of total 20 final year residents consented to join the study. Of these, 57.1% were females. A total of 42.9% (6/14) showed initial motor skill competency, and 35.7% showed cognitive skill competency to diagnose DR. Before the session on the eye simulator, merely 7.1% of the residents expressed confidence in performing DO. After the practical session, 78.6% (11/14) showed motor, and 64.3% (9/13) showed cognitive skill competency, in diagnosing DR. A total of 50% were adequately confident in performing DO. A total of 71.4% (10/14) of the residents preferred learning DO via simulation practical sessions than clinical rotation in ophthalmology clinics. CONCLUSION: Eye exam simulators are good tools in learning and assessment of DO skills leading to significant improvement in the efficiency and confidence of family physicians in screening for DR.

Botulinum neurotoxin type A versus punctal plug insertion in the management of dry eye disease.

PURPOSE: To compare the efficacies of punctal plug insertion and Botulinum toxin injection in dry eye disease not responding to topical medications. MATERIALS AND METHODS: A non-controlled randomized clinical trial of two parallel groups of 60 dry eye patients seen in the clinic not responding to topical medications were divided into two groups. One group received punctal plugs and the other group received Botulinum toxin injections to prevent lacrimal tear drainage. RESULTS: Of a total of 36 patients with a mean age of 44.5 years who received punctal plugs, 50% of them experienced improvements in the clinical manifestations of their disease. 12/36 (33.3%) developed plug extrusion, and 6/36 (16.7%) patients developed conjunctival erosions with irritation that necessitated plug removal within one week of insertion. A total of 24 patients with a mean age of 47.5 years received injections of Botulinum toxin. Of these, 83.3% had improvement in all of the clinical manifestations of dry eye. 4/24 (16.7%) had no improvement in the degrees to which they experienced foreign body sensations, 33.3% reported shampoo entering the eye while showering. All of the patients who received Botulinum toxin injections were satisfied with the results of their treatment, whereas only 72.3% of the patients who received punctal plugs were satisfied with their results. CONCLUSION: Botulinum neurotoxin A injections can be a very good alternative to punctal plugs in improving the clinical manifestations of dry eye disease They are associated with the development of fewer and milder complications and with higher levels of patient satisfaction.

Age, gender, and interracial variability of normal lacrimal gland volume using MRI.

PURPOSE: Aimed to evaluate normal volume of the lacrimal gland in patients of different age groups and race. METHODS: All MRI studies of the brain that were done between June 2012 and April 2013 were examined. Lacrimal glands were identified using fat-saturated fluid-attenuated inversion recovery (FLAIR) images, and the volumes were calculated using TeraRecon iNtuition viewer. Volumes for the right and left lacrimal glands were recorded for persons of different age groups and race, and the results were compared with those of a randomly selected group of patients who had undergone the same calculation method using CT of the brain, orbit, or paranasal sinuses. RESULTS: The authors included 998 lacrimal glands of 499 patients. The mean volumes for the right and left lacrimal glands were 0.770 and 0.684 cm, respectively. Lacrimal glands were larger in women; the largest volumes were observed during the second decade of life. Mean volumes also varied with race: 0.840 cm in Asians, 0.790 cm in Africans, 0.760 cm in Indians, and 0.710 cm in Middle Easterners. The consultant neuroradiologist and the intern showed excellent agreement for measurements of lacrimal gland volume. No significant difference was observed between lacrimal gland measurements method on MRI and CT. CONCLUSION: Lacrimal gland volume varies according to age, gender, race, and laterality. Measurements with MRI using fat-saturated FLAIR images and TeraRecon iNtuition viewer software are reliable, accurate, and can be used by junior staff with less radiation exposure to patients.

Meta-analysis of the effect of posterior mucosal flap anastomosis in primary external dacryocystorhinostomy.

PURPOSE: We aimed to compare the outcomes of primary external dacryocystorhinostomy and silicone tube with anterior and posterior mucosal flap anastomosis, versus dacryocystorhinostomy and silicone intubation with anterior mucosal flap anastomosis. METHODS: We utilized the electronic databases PubMed, EMBASE, Ovid, Cochrane Central Register of Controlled Trials, and MEDLINE® to find articles related to external dacryocystorhinostomy. For inclusion in this meta-analysis, we isolated prospective and retrospective comparative studies of adult patients with acquired nasolacrimal duct obstruction, or chronic dacryocystitis, who had undergone primary external dacryocystorhinostomy and silicone intubation with anterior and posterior flap anastomosis; versus primary dacryocystorhinostomy and silicone intubation with anterior flap anastomosis. The minimum follow-up period for each study was 4 months. RESULTS: We identified and analyzed seven studies. Overall, dacryocystorhinostomy with anterior and posterior flap anastomosis was performed on 368 eyes, while primary external dacryocystorhinostomy with anterior flap anastomosis was performed on 397 eyes. There was no significant difference in the success rates of both techniques (risk ratio: 0.987; 95% confidence interval 0.946-1.030). CONCLUSION: For patients with acquired nasolacrimal duct obstruction or chronic dacryocystitis, there was no significant difference in the resolution of epiphora, and patency of the lacrimal system, between those who underwent external dacryocystorhinostomy with anterior and posterior mucosal flap anastomosis, and those who had dacryocystorhinostomy with anterior flap anastomosis.

Management options of acquired punctal stenosis.

Punctal stenosis is a frequent source of patients referral to the otoplasty clinic and the search for a procedure that can permanently eliminate epiphora without disturbing the normal lacrimal system anatomy and physiology started centuries ago and continues today. The following article summarizes the reported procedures in the English literature in the acquired punctal stenosis with a description of techniques, success rates, and potential complications with the goal of identifying the most effective treatment strategy based on the current knowledge available.

Associations between the grade of meibomian gland dysfunction and dyslipidemia.

PURPOSE: To examine the relationship between dyslipidemia and the severity of meibomian gland dysfunction (MGD). METHODS: A prospective cohort study of 132 subjects with and 104 without MGD were recruited. A correlation between serum fasting lipids and MGD severity was performed. RESULTS: Mean age for all candidates was 49.4 years; and 57% were women. In all, 42.9% had no MGD, 14.8% had grade 1 MGD, 17.4% had grade 2 MGD, and 23.7% had grade 3 MGD. High cholesterol was found in 37.1% of grade 1 MGD, 43.9% of grade 2 MGD, and 50% of grade 3 MGD. High triglyceride was found in 5.7% of grade 1, 14.6% of grade 2, and 39.3% of grade 3 patients. High low-density lipoprotein was found in 17.1% of grade 1, 29.3% of grade 2, and 35.7% of grade 3 patients. The mean age of the control group was 41.2 years; and 55.4% were women. High cholesterol was found in 42.3%, triglyceride in 7.7%, low-density lipoprotein in 23.1%, low high-density lipoprotein in 3.8%, and high high-density lipoprotein in 3.8%. CONCLUSIONS: Although the presence of MGD does not have any correlation with dyslipidemia, the prevalence of high triglyceride and low-density lipoprotein levels increases with the increasing severity of MGD. This might highlight the significance of monitoring fasting serum lipids due to its association with the potential correlation with the progression of MGD.

The distinguishing anthropometric features of the Saudi Arabian eyes.

PURPOSE: Identifying the peri-ocular anthropometric measurements characteristic of Saudi Arabian eyes. METHODS: A prospective, cohort, hospital-based study. RESULTS: Measurements were made on 668 subjects (mean age 33.8 years; 58.7% female). The horizontal palpebral aperture was 30.1 ± 2.9 mm (mean ± SD), vertical palpebral aperture was 10.1 ± 0.85 mm, upper lid skin fold height was 3.6 ± 1.9 mm, upper lid crease height was 9.6 ± 0.8 mm, eyebrow height was 10.2 ± 2.7 mm, and intercanthal distance was 32 ± 2.7 mm. There was a statistically significant correlation between gender and eyebrow height (P = 0.001) and gender and horizontal palpebral aperture (P = 0.016), but no significant correlations were noted between any measurement and age. CONCLUSIONS: Saudi Arabian eyes are unique in exhibiting a higher upper lid skin fold, higher lid crease.