Khaled Alkattan

Antibiotic resistance and serotype distribution of invasive pneumococcal diseases before and after introduction of pneumococcal conjugate vaccine in the Kingdom of Saudi Arabia (KSA)

Streptococcus pneumoniae is one of the most common bacterial causes of morbidity and mortality worldwide, causing life threatening infections such as meningitis, pneumonia and febrile bacteremia, particular among young children. The severity and frequency of S. pneumoniae infection and emergence of drug-resistant isolates have highlighted the need for prevention of invasive pneumococcal disease (IPD) as the best method for controlling disease; to better achieve this, more information is needed about serotype distribution and patterns of antibiotic resistance in children in the Kingdom of Saudi Arabia (KSA). Cases of pneumococcal infections in children aged <5 years, recorded in hospitals throughout KSA from 2005 to 2010 were reviewed for serotyping and for antibiotic susceptibility. This covers the time period just before limited introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2006, to its introduction into the national immunization program in 2008, until right after a switch to PCV13 in 2010. Case definition required isolation of S. pneumoniae from blood, cerebrospinal fluid, or any sterile biological fluid. Isolates from 311 eligible cases were collected from different regions across KSA, 250 from blood and 61 from cerebrospinal fluid. The most frequently isolated IPD serotypes were 23F, 19F, 6B, 5 and 1. Over the course of the study, there was significant rise of serotype 19A (covered by PCV13 but not PCV7), which accounted for 20% of isolates of IPD in Western and 5% in Central regions in the last 2 years in KSA. There was a notable decrease in serotype 18C over this period, one of the PCV7 serotypes. Serotype coverage for PCV7, PCV10, PCV13 in children <5 years was 53%, 80%, and 91%, respectively across the Kingdom from 2005 to 2010. A total of 66% of IPD isolates were penicillin-resistant, and 62% were erythromycin-resistant. Continued surveillance is critical to measure the emerging of new serotypes and antibiotic resistance strain, and the potential impact of new PCVs. PCV13, recently introduced into the national immunization schedule in place of PCV7, provides the widest coverage among all IPD serotypes across KSA.

Integration of scientific research training into undergraduate medical education: a reminder call

There is an increasingly growing trend towards integrating scientific research training into undergraduate medical education. The importance and compulsoriness of this trend has been greatly highlighted at the Boyer Commission on Educating Undergraduates in the Research University. Despite the importance and benefits of undergraduate research, attempts of medical schools to encourage undergraduates to take part in formal research training during undergraduate medical education remain unsatisfactory. This article serves as a ‘reminder call’ highlighting the requisite to integrate scientific research training into undergraduate medical curricula.

Introducing medical humanities in the medical curriculum in Saudi Arabia: A pedagogical experiment

In a marked shift from the modern positivist materialist philosophy that influenced medical education for more than a century, Western medical educators are now beginning to realize the significance of the spiritual element of human nature. Consensus is currently building up in Europe and North America on the need to give more emphasis to the study of humanities disciplines such as history of medicine, ethics, religion, philosophy, medically related poetry, literature, arts and medical sociology in medical colleges with the aim of allowing graduates to reach to the heart of human learning about meaning of life and death and to become kinder, more reflective practitioners. The medicine taught and practiced during the Islamic civilization era was a vivid example of the unity of the two components of medical knowledge: natural sciences and humanities. It was also a brilliant illustration of medical ethics driven by a divine moral code. This historical fact formed the foundation for the three medical humanities courses presented in this article reporting a pedagogical experiment in preparation for starting a humanities program in Alfaisal University Medical College in Riyadh. In a series of lectures alternating with interactive sessions, active learning strategies were employed in teaching a course on history of medicine during the Islamic era and another on Islamic medical ethics. Furthermore, a third course on medically relevant Arabic poetry was designed and prepared in a similar way. The end-of-the-course feedback comments reflected effectiveness of the courses and highlighted the importance of employing student-centered learning techniques in order to motivate medical students to become critical thinkers, problem solvers, life-long learners and self-learners.

Clinical use of combined positron emission tomography and computed tomography in thymoma recurrence

The aim of this study is to evaluate the efficacy of hybrid fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) for surveillance and follow-up of thymoma patients to detect recurrent disease. A retrospective chart review was performed on 37 thymoma patients who underwent FDG-PET/CT-scans during postoperative follow-up. The following information was obtained: clinical indication for FDG-PET/CT, the results of the FDG-PET/CT, particularly with regard to the additional diagnostic imaging information, the localization of the disease and subsequent clinical patient management. A total of 51 CT-scans were performed on 37 patients providing sensitivity and specificity for thymoma recurrence of 71% and 85%, respectively. Forty-five FDG-PET/CT-scans were performed on the same group of patients with an overall sensitivity and specificity of 82% and 95%, respectively. Notably, FDG-PET/CT sensitivity when employed for diagnosis of thymoma recurrence in the anterior mediastinum has reached 100% (CT has shown only 55% sensitivity for the detection of anterior mediastinal thymoma recurrence). Our preliminary study demonstrates that during follow-up after thymoma excision, FDG-PET/CT is superior to computed tomography alone in the detection and localization of mediastinal recurrence. In particular, the combined structural and metabolic information of FDG-PET/CT enhances the diagnostic confidence in lesion characterization.

The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

This is the first guideline developed by the Saudi Thoracic Society for the diagnosis and management of noncystic fibrosis bronchiectasis. Local experts including pulmonologists, infectious disease specialists, thoracic surgeons, respiratory therapists, and others from adult and pediatric departments provided the best practice evidence recommendations based on the available international and local literature. The main objective of this guideline is to utilize the current published evidence to develop recommendations about management of bronchiectasis suitable to our local health-care system and available resources. We aim to provide clinicians with tools to standardize the diagnosis and management of bronchiectasis. This guideline targets primary care physicians, family medicine practitioners, practicing internists and respiratory physicians, and all other health-care providers involved in the care of the patients with bronchiectasis.

Perspectives of students and mentors on a formal mentorship program in Saudi Arabia

Student mentorship is a dynamic reciprocal relationship between an advanced career incumbent (mentor) and a beginner (protege), aimed at promoting the development of both.1 The main goals of any mentorship program include career counselling and development alongside professional enhancement.2-4 While numerous studies highlight the importance of a formal mentorship program at the undergraduate level, no significant reports have emerged from the Kingdom of Saudi Arabia regarding such structured programs. There remains a need to identify and evaluate gaps in the efficacy of mentorship programs to establish and measure the effectiveness of such programs in undergraduate medical education. The aim of this perspective is to describe the strengths, weaknesses and challenges of the mentorship program among preclinical medical students at Alfaisal University, Riyadh. Program organization At Alfaisal University a formal mentorship program was introduced in 2012 whereby students were assigned a mentor at the beginning of his/her first year. The same mentor was maintained through the student’s tenure at the University. The program aimed to cover academics, career plans and personal growth. Students were provided with the name, email, office location, contact extension, and office hours. The student mentors were also notified about the program. In a separate email, mentors were advised regarding their responsibilities, and are asked to contact their mentees to arrange an initial meeting. Mentees had the option to change their mentors if they were not satisfied and had to provide a reasonable rationale for this change.

Dual-degree MBBS–PhD programs in Saudi Arabia: A call for implementation

Abstract Engaging medical students in scholarly research activities and producing clinically competent and research-oriented medical workforces are essential demands, particularly in developing countries. Dual-degree MD–PhD programs offer simultaneous rigorous education in medicine and research, and train its graduates (physician–scientists) to successfully catalyze translational research evolutions. Literature fundamentally identifies dual-degree MD–PhD programs as the single most important, well-established, popular and influential programs toward commencing physician–scientist professions. While the physician–scientist population is alarmingly vanishing in the West with ongoing efforts to reverse this undesired trend, such population is largely nonexisting, unfortunately to start with, in Saudi Arabia. This is simply because no single dual-degree MBBS–PhD program is yet established in Saudi Arabia. Herein, we call on the Saudi Higher Education bodies to implement dual-degree MBBS–PhD programs with anticipated generation of competent physician-scientists in Saudi Arabia. To the best of our knowledge, this is the first ever report to call for such innovative implementation.

The Integrated Clinical Anatomy Program at Alfaisal University: An Innovative Model of Teaching Clinically Applied Functional Anatomy in a Hybrid Curriculum.

Anatomy has historically been a cornerstone in medical education regardless of specialty. It is essential for physicians to be able to perform a variety of tasks, including performing invasive procedures, examining radiological images, performing a physical examination of a patient, etc. Medical students have to be prepared for such tasks, and we can assist this by changing the way that we educate students in medical schools. Thus, newer medical curricula need to be designed according to needs of future physicians. In this report, we describe a unique program called the Integrated Clinical Anatomy Program (ICAP). The ICAP was developed at the College of Medicine of Alfaisal University in the Kingdom of Saudi Arabia. Here, we describe the unique features of this program, including the structure and facilities of the Anatomy Resource Center. The Anatomy Resource Center plays a pivotal role in engaging the students for faculty-directed structured laboratory sessions as well as peer-assisted uniform student-centered learning. The ICAP has shown great promise, as reflected by early results from a nationwide progress test. Students from all years of the Alfaisal University medical school scored significantly higher than the national average on the anatomy and physiology component of the nationwide progress test examination, with P values of 0.0179 and 0.0015, respectively. We believe that the ICAP can be used as a model for teaching clinically applied functional anatomy to medical students in a hybrid curriculum around the world.

Interest and perceived barriers toward careers in academic medicine among medical students at Alfaisal University – College of Medicine: A Saudi Arabian perspective

Abstract Aims: [1] Identify the percentage of undergraduate students who are interested in academic medicine (AM) careers, [2] Explore the relationship between students’ characteristics, previous experiences and interest in AM careers and [3] Determine students’ perceived barriers toward AM careers at Alfaisal University – College of Medicine. Methods: An online, anonymous, random, self-rating survey was administered during spring 2013–2014 to second-year and third-year students (n = 302). Chi-square test was used to correlate between interest in AM careers and students’ characteristics. Mann–Whitney U-test was used to compare the mean 5-point Likert scale responses between male and female students. Results: A total of 231 students participated in the survey (response rate: 76.5%). A total of 32 students (13.9%) expressed interest in AM careers, and this percentage significantly differed by gender, academic year, interest in teaching and research and previous research experiences (p < 0.05). The top three barriers were “lower income” (77.5%), “competing pressures to fulfill clinical-teaching-research duties” (73.6%) and “lack of career advising” (69.7%). As opposed to males, females achieved higher statistically significant differences of means regarding: “competing pressures to fulfill clinical-teaching-research duties” (p < 0.001) and “lack of same-gender role models in AM careers” (p < 0.000). Conclusions: AM careers were unpopular by students. Curricular, extracurricular and institutional measures should be implemented to rectify this dilemma.

Huge primary mediastinal synovial sarcoma fully occupying the right hemithorax

Primary mediastinal synovial sarcomas are exceedingly uncommon tumors. Herein, we present the case of primary mediastinal synovial sarcoma (monophasic spindle cell-shaped variant) fully occupying the right hemithorax in a 37-year-old woman who presented to clinic with a 2-month history of right-sided chest pain and shortness of breath. Although extremely rare, however, synovial sarcoma should be considered in the differential diagnosis of all monophasic and biphasic spindle cell neoplasms of the mediastinum. Despite molecular testing for (t[x; 18] [p11.2; q11.2]) is characteristically positive in 90% of synovial sarcoma cases, it is not routinely done. Histopathological and immunohistochemical analyses can greatly confirm the diagnosis. Optimal surgical resection is the standard of care. Adjuvant therapy (radiotherapy and/or chemotherapy) is indicated in inoperable advanced disease or unachieved surgical tumor-free surgical margins. Prognosis is poor with a 5-year overall survival (OS) rate of 35.7%. Early diagnosis and prompt appropriate management yield better disease-free and OS rates.