Fabrication, Structural Characterization, and Photon Attenuation Efficiency Investigation of Polymer-Based Composites.

Experiments have assessed various polymer composites for radiation shielding in diverse applications. These composites are lighter and non-toxic when compared to lead (Pb), making them particularly effective in diagnostic imaging for shielding against low-energy photons. This study demonstrates the fabrication of four composites by combining a base material, specifically a high-density polyethylene (HDPE) polymer, with 10% and 20% silicon (Si) and silicon carbide (SiC), respectively. Additionally, 5% molybdenum (Mo) was incorporated into the composites as a heavy metal element. The composites obtained were fabricated into 20 disks with a uniform thickness of 2 mm each. Discs were exposed to radiation from a low-energy X-ray source (32.5-64.5 keV). The chemical and physical properties of composites were assessed. The shielding ability of samples was evaluated by determining the linear and mass attenuation coefficients (µ and µm), radiation protection efficiency (RPE), half-value layer (HVL), and mean free path (MFP). According to our findings, supplementing HDPE with additives improved the attenuation of beams. The µm values showed that composite X-ray shielding characteristics were enhanced with filler concentration for both Si and SiC. Polymer composites with micro-molecule fillers shelter X-rays better than polymers, especially at low energy. The HVL and MFB values of the filler are lower than those of the pure HDPE sample, indicating that less thickness is needed to shield at the appropriate energy. HC-20 blocked 92% of the incident beam at 32.5 keV. This study found that increasing the composite sample thickness or polymer filler percentage could shield against low-energy radiation.

Implementation of Enhanced Recovery After Surgery protocols for gastrostomy tube insertion in patients younger than 14 years of age: a retrospective cohort study.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have improved treatment outcomes and have standardized patient care. OBJECTIVES: Identify the benefit of introducing the ERAS protocol for feeding after gastrostomy insertion with or without Nissen fundoplication, the effects on the time of reaching the full feeds the length of stay single-center experience, and complications associated with early feeding protocols. DESIGN: Retrospective cohort study SETTING: Tertiary hospital METHODS: The study review included cases performed between 2015 and 2021 by four surgeons, and cases performed in 2022 by all surgeons using ERAS feeding protocol (P) in a tertiary hospital. MAIN OUTCOME MEASURES: Comparison the mean and mode of the length of stay (LOS) and the time until the patient reached full feed (TFF). SAMPLE SIZE: 224 patients; 181 by the four surgeons and 43 cases by the ERAS protocol group. RESULTS: The difference in the ERAS protocol from the four surgeons in TFF and LOS was statistically significant (P<.001). There was no noticeable difference in postoperative complications after introducing the ERAS protocol. CONCLUSION: ERAS improved the TFF and decreased the LOS without any increase in procedure complications. Increasing bed utilization and reducing costs were two benefits of reducing LOS at our hospital. LIMITATIONS: Single-center study, which may not be generalizable. Multiple comorbidities. Travel time from different parts of the country could impact LOS. Retrospective and thus dependent on the accuracy of the information in file notes. CONFLICT OF INTEREST: None.

Consensus Recommendations for the Diagnosis, Biomarker Testing, and Clinical Management of Advanced or Metastatic Non-small Cell Lung Cancer With Mesenchymal-Epithelial Transition Exon 14 Skipping Mutations in the Middle East, Africa, and Russia.

Mesenchymal-epithelial transition exon 14 (METex14) skipping mutations occur in about 3%-4% of patients with non-small cell lung cancer (NSCLC). This is an aggressive subtype associated with poor prognosis. METex14 skipping is a potentially targetable mutation. Targeted therapy is a promising treatment modality for patients with advanced/metastatic METex14-mutant NSCLC. Performing systematic molecular testing to detect the driver mutation is essential for initiating targeted therapy. However, there is a lack of guidelines on molecular testing for assessing the eligibility of patients for targeted therapy. Therefore, a multidisciplinary panel consisting of experts from the Middle East, Africa, and Russia convened via a virtual advisory board meeting to provide their insights on various molecular testing techniques for the diagnosis of METex14 skipping mutation, management of patients with targeted therapies, and developing consensus recommendations for improving the processes. The expert panel emphasized performing molecular testing and liquid biopsy before treatment initiation and tissue re-biopsy for patients with failed molecular testing. Liquid biopsy was recommended as complementary to tissue biopsy for disease monitoring and prognosis. Selective MET inhibitors were recommended as the first and subsequent lines of therapy. These consensus recommendations will facilitate the management of METex14 skipping NSCLC in routine practice and warrant optimum outcomes for these patients.

In search of hedges and safe havens during the COVID-19 pandemic: Gold versus Bitcoin, oil, and oil uncertainty.

This paper investigates the potential hedging and safe-haven properties of several alternative investment assets, including gold, Bitcoin, oil, and the oil price volatility index (OVX), against the risks of the Saudi stock market and its constituent sectors in different phases of the COVID-19 pandemic. Using daily data, we employ the bivariate dynamic conditional correlation-generalized autoregressive conditional heteroskedasticity (DCC-GARCH) technique to model volatilities and conditional correlations. Our findings show that all investigated alternative investment assets had a time-varying hedging role in the Saudi stock market, which became expensive during the early stages of the COVID-19 pandemic. Our results also show that the optimal weights for gold were substantially higher than those of other assets, reaching a peak during the pandemic, implying that investors consider gold a flight-to-safety asset. Additionally, we find that gold and OVX were strong hedges and could have served as weak safe havens for investors during the early stages of the COVID-19 pandemic, while the remaining assets generally lacked these properties and could be merely used as diversifiers. Our empirical findings offer several key implications for policymakers and portfolio managers in Saudi Arabia that may be applicable to similar markets. In particular, we show that OVX-based products can serve as a promising hedging asset for stock markets in oil-exporting countries.

Potential predictors of length of study for finance and accounting degrees: evidence from a public business school in Saudi Arabia.

The accumulated evidence from developed countries indicates that a large proportion of undergraduates exceed the normal time to obtain their degrees before completing their baccalaureate studies, which has attracted the attention of academics and policy-makers. However, the evidence on degree completion in developing countries is scant to nonexistent. The present study aims to fill this gap by developing a predictive model to explore the impact of the student's preadmission criteria and academic performance indicators on the study length for graduates of the bachelor of business administration (BBA) degree in finance and accounting in a Saudi public university. We used deidentified demographic and academic data from the 2018/2019 cohort of students at the College of Business and Economics (CBE), Qassim University. The dataset is assembled from official administrative student records. Using multinomial logistic regression (MLR), we find that students with a higher college entry age, higher secondary school score percentage, higher General Achievement Test (GAT) score, and higher academic performance in "gatekeeper" quantitative courses, including mathematics, statistics and economics, are more likely to graduate within the normal time to degree. The implications of the findings and future research directions are discussed.

Pharmacokinetics Parameters of Diagoxin among Saudi Patients in Qassim Region, Saudi Arabia.

BACKGROUND: The pharmacodynamic effects of digoxin are susceptible to multiple factors, most notably, heart uptake of the digoxin dose and its concentration in the serum. Another important factor to mention is the renal function state of an individual. OBJECTIVE: In this study, we aimed to develop a simple algorithm based on subsets of clinically relevant information, which will help to personalize digoxin based on pharmacokinetic (PK) approach which can help in marketing the appropriate utilization of this medication. METHODS: This was a retrospective chart review and analysis of 48 patients who were admitted to the Drug and Poison Information center in Buraidah, Saudi Arabia, between January 2016 and April 2019. All pharmacokinetic parameters were added according to the C-peaks and C-troughs. MONOLiX® was used for data pharmacokinetic analysis. RESULTS: Twenty-seven (56%) were males and twenty-one (44%) were females with an average age of 63.6 years across both genders. The mean volume of distribution was 496.6 litres with an average clearance of 6.6 L/h. For females, their average volume of distribution was slightly higher than that for males (526 litres compared to 473 litres). In addition, the clearance rate between both genders showed a 2.1 litre/hour discrepancy (7.8 L/h for females compared to 5.7 L/h for males). CONCLUSION: In order to individualize the digoxin dosage regimens, this model can be used to predict digoxin serum concentration. Further studies are needed to clarify the effects of nutritional status and co-administration of medications on digoxin pharmacokinetics.

Chest Trauma Experience: Incidence, associated factors, and outcomes among patients in Saudi Arabia.

BACKGROUND AND OBJECTIVE: Worldwide chest trauma is considered one of the leading causes of morbidity and mortality. There is a lack of sufficient information on the etiology, pattern, and management of these injuries in Saudi Arabia. Therefore, the current study was conducted to determine the spectrum of chest trauma and its associated factors among patients admitted to King Khalid University Hospital, Riyadh, Saudi Arabia. METHODS: A quantitative observational cross-sectional analysis was performed, data obtained from the medical records of the chest trauma patients which were admitted in the thoracic surgery unit, King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia from January 2013 to Jan 2019. The records of all these patients were reviewed and data were collected and analyzed prospectively. RESULTS: A total of 236 patients (male: 87.3%; mean age: 32.4 years) were included in the analyses. The majority of these chest trauma cases (n=205; 86.9%) were caused by road traffic accidents (RTA). Blunt trauma predominated the cases n=225 (95.3%). Ribs fracture had the highest prevalence among the chest injuries with a number of 150 (63.5%) followed by lung contusion 140 (59.3%). Pneumothorax occurred in 131 (55.5%) and hemothorax occurred in 80 (33.8%) with most common indication for emergency thoracotomy. Extra-thoracic injuries involving the head/brain, limbs, and abdominal organs occurred in 189 (80%). 130 (55%) were intubated and ventilated, and almost half of the patients 115 (48.7%) were required a chest tube insertion. CONCLUSIONS: Chest trauma is a major health issue particularly in young male adults and road traffic accidents are the leading cause of chest trauma in Saudi Arabia. Early recognition of the patterns, etiology and appropriate management of trauma reduce the incidence of chest trauma related injuries.

Benign Broncho-esophageal Fistula Presenting as Unresolved Pneumonia.

Benign acquired broncho-esophageal fistula (BEF) in adults is a very rare entity and has not been reported properly in the literature, compared to malignant BEF. Nonetheless, infection has predisposed most of the reported benign acquired BEF cases. We report here a case of tuberculous BEF, in a patient with a history of pulmonary tuberculosis (TB). He presented with recurrent chest infections, and choking. Upper gastrointestinal (GI) endoscopy showed BEF due to tuberculous mediastinal lymphadenopathy, and the patient was managed by surgery successfully. He was prepared for surgery for one month by nutritional support and anti-tuberculous treatment.

The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy.

BACKGROUND: Hyperhidrosis is a functional disorder identified by excessive sweating. Its incidence is approximately 1% in any population. Bilateral endoscopic thoracic sympathectomy (BETS) intervention is the definitive treatment of choice for palmar and axillary hyperhidrosis. AIMS AND OBJECTIVES: The purpose of this study is to evaluate and compare the quality of life (QOL) and satisfaction rate of patients with upper limb hyperhidrosis before and after BETS surgery and the influence of compensatory hyperhidrosis (CH) on patients' QOL after surgery. SETTINGS AND DESIGN: This study is a cross-sectional study designed to generate longitudinal data. SUBJECTS AND METHODS: This study is a cross-sectional study designed to generate longitudinal data pre- and postbilateral BETS prospectively. This study was conducted in the surgery department of University Hospital in Riyadh, Saudi Arabia. Hundred patients with upper limb hyperhidrosis who underwent BETS from 2014 to 2017 were included. A modified and validated QOL questionnaire for hyperhidrosis was completed by the patients themselves in order to compare the QOL for patients both before and after BETS. Patients' satisfaction and the occurrence of CH were obtained postoperatively. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS® statistical package for social studies, version 22.0 (SPSS 22; IBM Corp., New York, NY, USA) for Windows®. RESULTS: A total of 100 patients completed the questionnaire; 94% of patients had a positive QOL outcome after the surgery. The mean decrease in QOL scores was -42.0 points toward better QOL. The site of sweating had a significant effect on the patients' QOL before and after the surgery (P value < 0.001). Moreover, 76% of patients reported a high satisfaction rate. CONCLUSION: Primary hyperhidrosis can negatively impair patients' QOL in different domains. BETS showed to be an effective option for improving the QOL of patients and it provided both short- and long-term effectiveness in treating upper limb hyperhidrosis. CH did not interfere with the rate of patient satisfaction or their QOL postoperatively.

Efficacy and safety of crizotinib in patients with anaplastic lymphoma kinase-positive advanced-stage non-small-cell lung cancer.

INTRODUCTION: Lung cancer is the leading cause of cancer mortality worldwide, despite advances in management, especially with targeted agents and immunotherapy. Numerous oncogenes have been identified that control the growth of these malignancies. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase that develops distorted functioning as a result of chromosomal rearrangement. Crizotinib, a tyrosine kinase inhibitor (TKI), was approved by the Food and Drug Administration (FDA) in 2011 for the treatment of advanced ALK-positive non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: In this chart review, we compiled data from two cancer hospitals in Kuwait and Saudi Arabia which were collected from patients with advanced NSCLC treated between January 2013 and September 2017 with crizotinib after diagnosed with ALK-positive disease. Crizotinib 250 mg BID was given orally with/without food intake. We assessed overall survival (OS), objective response rate (ORR), progression-free survival (PFS), duration of the response, and dose reduction/cessation. RESULTS: De-identified data from 38 subjects were compiled. Their median age was 53 years, 65.8% were male, the 1-year OS was 88%, and the PFS was 16.5 months. Two cases (5.3%) had a complete response (CR), while 17 (44.7%) had a partial response (PR). Side effects of grade III/IV occurred, including elevated transaminase levels, diarrhea, and prolonged QT intervals, in 8% patients, with dose reduction in six patients (15.8%). CONCLUSION: In NSCLC, crizotinib is a viable treatment option with good response and tolerable toxicity for patients with ALK-positive advanced disease.

Squamous Cell Carcinoma Arising in Zenker's Diverticulum: A Case Report and Review of the Literature.

The occurrence of squamous cell carcinoma (SCC) arising in a Zenker's diverticulum is a very rare incident. Complete excision of the diverticulum is considered as the procedure of choice for SCC in the pharyngeal pouch. Histopathological assessment of the pouch is the only modality to rule out SCC. Here, we report a case of a 71-year-old male with 20 years of history of Zenker's diverticulum, who recently presented with a history of weight and appetite loss. A barium swallow confirmed Zenker's pouch, the patient underwent diver-ticulectomy and cricopharyngeal myotomy; a histopathological examination of the specimen revealed a fungating mass of SCC within the pouch. This report highlights the suggestion of considering SCC not only in patients with a long history of Zenker's diverticulum but also when there is a clinical suspicion with new symptoms for a more aggressive management for diagnosis and complete excision of the pouch.

Near-fatal presentation of bilateral pneumothorax in cutis laxa patient: Case report, and review of the literature.

Cutis laxa (CL) is a rare connective tissue disease characterized by a loose, wrinkled, and inelastic skin. Here, we report an unusual presentation in a 15-year-old male patient who is a known patient of CL who presented with bilateral pneumothorax. He was successfully managed initially by chest tube insertion and then he was treated surgically with bilateral staged thoracoscopy, apical bullectomy, and pleurodesis with full uneventful recovery.

Pulmonary Nodular Amyloidosis Mimicking Metastatic Lung Lesion in a Patient with Colon Cancer.

Amyloidosis is defined as abnormal aggregation of amyloid proteins. Amyloidosis can be localised or systemic affecting the lung, heart, spleen, liver and kidneys. The most common form of pulmonary amyloidosis is the nodular type. The disease is idiopathic and linked to many systemic diseases. The clinical manifestations and prognosis of respiratory tract amyloidosis depends on its etiology and anatomical location. Radiologically, the nodular pulmonary amyloidosis may appear as single or multiple nodules in any lobe, and, therefore, may mimic as primary pulmonary or metastatic neoplasms. Here, we report a case of 70-year female who was diagnosed with colon cancer, which was treated by surgery. During metastatic follow-up, her CT chest showed right lung nodule highly suspicious for metastatic lesion from the colon. Thoracoscopic wedge resection of the lung nodule done after micro-coil localisation technique under CT guidance. The histopathology report showed pulmonary nodular amyloidosis. This case indicates that histological examination is necessary to differentiate a benign pulmonary nodule from a metastatic lung nodule, especially in a patient with underlying malignancy.

Evaluation of safety and efficacy of regional anesthesia compared with general anesthesia in thoracoscopic lung biopsy procedure on patient with idiopathic pulmonary fibrosis.

BACKGROUND: Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF). SUBJECTS AND METHODS: This is a retrospective qualitative study based on adult cases of video-assisted thoracoscopy (VAT) lung biopsy on patients with IPF admitted in the division of Thoracic Surgery, Department of General Surgery, King Khalid University Hospital, Riyadh, KSA. We included 67 patients with IPF, 26 with RA, and 41 with GA, who underwent this procedure from January 2008 to December 2015. Procedures performed under RA were done using three different approaches, intercostal nerve blocks, extrapleural infusion, and paravertebral block while GA was performed using double-lumen endotracheal tube placement. For statistical analysis, SPSS program, version 21.0. Software used to analyze the obtained data. The statistical significance was defined as P < 0.05. RESULTS: Sixty-seven patients underwent the procedure of thoracoscopic lung biopsy. Twenty-six of them (38.8%) underwent the procedure under RA and 41 (61.2%) under GA. The cross tabulation of the intercostal chest tube duration showed that it was significantly longer in GA group (6.23 ± 5.1 days) compared to RA group (3.12 ± 1.5 days), P = 0.004. Furthermore, for the Intensive Care Unit (ICU) stay, it was significantly longer in GA group (3.38 ± 2.1 days) compared to RA group (1.09 ± 0.7 days), P = 0.019. Regarding the relation between the number of biopsies taken and type of anesthesia performed, the probability values for GA group as well as RA group come out to be >0.05 (statistically independent) and the results of risk estimate also show that there was no significant association found between them. The cross tabulation of the representation of biopsies taken by the two methods showed that all biopsies taken under both settings were representative of the disease. Of 41 procedures done under GA, 16 of the total showed a number of complications. Likewise, of 26 procedures under RA, five cases showed complications. The significant (two-sided) value was (P = 0.110), there was no statistical significance between the risks of complications and the two types of anesthesia. CONCLUSION: There was a significant decrease in chest tube duration and ICU stay in RA group compared to the GA group. There was no statistical difference between both types of anesthesia in the number of biopsy, representation, and postoperative complications although the rate of these complications was much less in the RA group. Based on this outcome, we can conclude that VAT lung biopsy procedure on patients with IPF under RA is safe, representative, and effective operation. In addition, high-risk patients for GA can go through this procedure under RA as an alternative and safe option with no added complications.

Late Presentation of Aggressive Fibromatosis Involving Head, Neck and Chest Wall.

Fibromatosis is a rare, benign, slow-growing and locally infiltrative tumour, caused by uncontrolled proliferation of fibrous tissue arising from muscles, connective tissue, fasciae and aponeurosis. It is also called desmoid tumour, which is very rare pathology representing only 0.03% of all neoplasms in human and around 3% of all soft tissue tumours. It is locally aggressive and usually invades the surrounding structures and has a high recurrence rate, even after surgical complete resection, which should be the first line of treatment. Here, we report a very rare case of extensive and disabling fibromatosis tumour in a 38-year male, involving three compartments of the right side of the head, neck and chest wall, which was completely excised surgically and had excellent postoperative results with no morbidity.

Thoracoscopic resection of suspected metastatic pulmonary nodules after microcoil localization technique: a prospective study.

BACKGROUND: Newly developed pulmonary nodules less than 20 mm in diameter in patients with a previous history of malignancy is highly suspicious to be metastatic. In this study we evaluate a new technique of computed tomography guided microcoils localization to facilitate thoracoscopic resection of deep pulmonary nodules. METHODS: Seventy-four patients, who were discovered to have lung nodules (less than 20 mm) during follow up and were referred to the thoracic surgical unit in our institute from Sept. 2008 till Sept 2013, underwent CT-scan guided Microcoil localization followed by video-assisted thoracoscopic surgery (VATS) where the nodule along with microcoil was excised completely using endostaplers guided by fluoroscopy. RESULTS: CT-scan guided microcoil placement was successful in all cases; however, two coils were displaced at the time of lung isolation. There was no mortality, no bleeding or hemothorax, or massive pneumothorax, no air emboli or any other post procedural complications, but a small pneumothorax occurred in 3 patients, who were managed conservatively. Mean operative time was 52.5±24.5 minutes, microcoil localization time was 43±13 minutes, and fluoroscopy time was 3±1.2 minutes. The resected nodules were inflammatory or granulomatous disease in 17 patients (23%), benign lung lesions in12 patients (16.2%), metastatic in origin in 43 patients (58.1%), and 2 patients (2.7%) primary lung cancer. CONCLUSIONS: This study demonstrates that CT-guided microcoil localization is feasible, safe, and effective. It increases the success rate of VATS resection of pulmonary nodules to 100% compared with the reported 37% success rate with the non-guided approach.

Unusual cause of bilateral vocal cord paralysis.

The most common cause of vocal cord paralysis (VCP) as a result of recurrent laryngeal nerve compression is malignant tumors. A benign and inflammatory causes of VCP is rarely reported in the literature, and in almost all reported cases it was a unilateral paralysis. We report a rare case of tuberculous mediastinal lymphadenopathy causing bilateral VCP in a young female patient.

Unusual case of inhaled metallic dental bur during dental procedure in a healthy adult.

Bronchial foreign body aspiration (BFBA) is not a rare incident in children. It can be managed successfully with flexible bronchoscopy in most of the cases, except for some cases, which require rigid bronchoscopy or even surgical intervention such as thoracotomy. Here, we report an unusual case of BFBA of metallic dental bur in a healthy 24-year-old dental nurse assistant, who was herself undergoing a dental procedure to remove dental caries, and suddenly the foreign body which was "diamond metallic dental bur" has slipped into her mouth and was aspirated to the bronchial tree. It was successfully removed 5 days after the incident using rigid and fiberoptic bronchoscopy with full recovery.

Is it safe to use frova airway intubating device during tracheal intubation in difficult airway patient with multiple and chest trauma?

Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.

Behavior, knowledge, and attitude of surgeons and patients toward preoperative smoking cessation.

INTRODUCTION: Tobacco smoking is a well-known risk factor for postoperative complications. Quitting smoking prior to surgery helps overcome those complications. PROBLEM: Surgeons' attention for educating their patients about the importance of smoking cessation prior to surgery is one of the most effective ways to reduce smoking-related surgical complications. The extent of advised patients by their surgeons has not been identified. METHODS: A descriptive, comparative cross-sectional study using a survey was conducted in 2013 including eligible patients in King Khalid University Hospital. Simultaneously, 69 surgeons were included. All participant data were randomly collected and analyzed using Chi-square analysis. RESULTS: The frequency of smokers is more in surgical patients (37.5%) when compared to ex-smokers (12.5%) and passive smokers (8.3%), which were ex- and passive smokers, and it demonstrated an increased risk (P = 0.001) for surgery group compared to the nonsurgery group (P = 0.001). When comparing with nonsurgery group, most surgical patients agreed to quit smoking before surgery (95.3%). More than half (58.8%) of the patients said that they have been advised by their treating surgeons to quit smoking before surgery. Concerning the surgeons, 66 nonvascular and nonpediatric surgeons responded to the questionnaire (response rate: 22.83%). The majority of the surgeons (60.9%) were interacting with smoker patients. With regard to smoking cessation, 69.6% surgeons have advised smoker patients to stop smoking for more than 2 weeks before surgery. More than half of the surgeons (53.6%) believed that patients quit smoking after preoperative smoking cessation advice. CONCLUSION: The surgeons and patients who participated in this study were aware that smoking cessation improves outcomes, but most of the surgeons did not provide brief advice about time duration to stop smoking.