Khalid I. Khoshhal

The role of arthrography-guided closed reduction in minimizing the incidence of avascular necrosis in developmental dysplasia of the hip.

Avascular necrosis of the femoral head is the most serious complication after closed reduction in developmental dysplasia of the hip. Although arthrography has a well-established role in the treatment of developmental dysplasia of the hip, its use is not universal. A prospective study was conducted to compare the incidence of avascular necrosis after closed reduction in developmental dysplasia of the hip performed with and without arthrography in 85 patients, with a minimum of 5 years follow up. Arthrographic criteria were evaluated including lateralization of the femoral head and the type of limbus encountered. Hips treated by closed reduction based on arthrographic evaluation had significantly less incidence of avascular necrosis when compared with those treated by closed reduction without arthrographic guidance. Closed reduction with lateralization of more than 4 mm, and those hips with an inverted limbus were associated with an increased risk of avascular necrosis.

Learning styles of medical students at Taibah University: Trends and implications.

Background: Understanding the learning styles of medical students can drive the institutions to adapt instructional materials to enhance students’ learning of knowledge and skills. This study explored the learning styles of undergraduate medical students, comparing gender variations in terms of their significant preferences. Materials and Methods: A cross-sectional observational study was performed in 2012-2013, incorporating 1st-5th year undergraduate medical students of Taibah University. The instrument used was a Learning Style Questionnaire, with four learning styles (activist, reflector, theorist and pragmatist) and 40 items. Results: Of 450 students, 384 responded (response rate; 85%). No single learning style predominated; 96 (25%) reflectors, 78 (20%) theorists, 68 (17%) pragmatists, and 37 (9%) activists. Combined reflector and theorist was the predominant dual learning style in 27 (7%) students. Among genders, theorist style had a significant result (P = 0.071) indicating that theorists varied among genders due to their different opinions. Learning style preferences of theorists and pragmatists also showed a significant result (P = 0.000 each), depicting that both genders had unique preferences. Males had fewer variations of preferences, when compared with females who showed a significant difference of opinions (P < 0.05). Conclusion: The students in the study preferred diverse learning styles, which were unevenly distributed, reflectors being the most common and activists as the least common. The results reflect the need to promote self-directed learning and modifications of instructional strategies, with expectant tilt in the students’ learning styles towards activists and pragmatists.

Reassessment of the undergraduate educational environment in College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia.

Background: We reassessed the perception of all undergraduate students in Taibah medical college regarding the educational environment during the academic year 2010–2011 and compared it with the assessment carried out three years earlier in order to identify the change over time from previous assessment. Method: In the present prospective study, the validated 50-item Dundee Ready Education Environment Measure (DREEM) inventory was collected from medical students of basic phase (n = 302) and clinical phase (n = 222) and compared the scores of students’ responses with those of previous assessment 3years earlier. Results: In the year 2007/2008 DREEM inventory scored 109.1/200 and scored 120.70/200 (p ≤ 0.0001) in the year 2010/2011. There was an interesting inclination of female students towards a more positively perceived learning environment as compared to male students (26/48 versus 24/48, p < 0.03). There were statistically significant differences in all domain components of DREEM between the academic years 2007/2008 and 2010/2011. Conclusions: DREEM helped pinpoint areas of change in students’ perception regarding many aspects of the educational environment. It also helped to identify areas that are still in need of improvement by the colleges administration and staff. DREEM inventory can be used to monitor change over time in the educational environment.

Publish or Perish mantra in the medical field: A systematic review of the reasons, consequences and remedies.

Objectives: Generally, academic promotions, job retention, job mobility, and professional development of a medical faculty members are judged primarily by the growth in publication outputs. Universities and research institutions are more likely to recruit and promote those academics carrying voluminous résumés with larger number of published articles. This review elaborates the causes and consequences of the pressure to publish and the ways and means to cope with this paradigm. Methods: In 2015, database of Abstracts of Reviews of Effects, LISTA (EBSCO), Medline and Oxford University Library were searched for the English language full-text articles published during 2000-2015, by using MeSH terms “pressure to publish”, “urge to publish”, “research ethics”, “plagiarism”, “article retraction”, “medical field”. This search was further refined by selecting the articles in terms of relevancy and contents. Results: This research showed that some universities offer generous grants to researchers with a high h-index and with more publications in elite journals, which promise an enhanced prospect of citations and elevation in the scientific rankings of the funding institutions. This generates an involuntary obsession to publish with the primary intention to obtain promotions, high scientific rankings, and improved job security. This compelling pressure to publish results in widespread publication of non-significant research with a high index of plagiarism that eventually leads to an increased frequency of retractions. Conclusion: Research centers and academic institutions have an obligation to train their academics in sound scientific writing and to apprise them of the publication ethics and the grave consequences of plagiarism and research misconduct.

Developmental dysplasia of the hip: usefulness of next generation genomic tools for characterizing the underlying genes - a mini review.

Developmental dysplasia of the hip (DDH) is one of the most common skeletal anomalies. DDH encompasses a spectrum of the disorder ranging from minor acetabular dysplasia to irreducible dislocation, which may lead to premature arthritis in later life. Involvement of genetic factors underlying DDH became evident when several studies reported chromosomal loci linked to DDH in families with multiple affected individuals. Moreover, using association studies, variants in genes involved in chondrogenesis and joint formation have been shown to be associated with DDH. At least, one study identified a pathogenic variant in the chemokine receptor gene in DDH. No genetic analysis has been reported or carried out in DDH patients from the Middle East. Here, we review the literature related to genetics of DDH and emphasized the usefulness of new generation technologies in identifying genetic variants underlying DDH in consanguineous families.

Primary obturator internus and obturator externus pyomyositis

Background Pyomyositis is a rare condition in immune competent patients and is usually seen in tropical countries. Pyomyositis of obturator muscles in particular is an extremely rare condition, which causes hip pain and mimics septic arthritis. Case Report: This is a case report of a 9-year-old boy without an underlying disease or a compromised immune system, who presented with knee pain that progressed to hip pain and inability to bear weight. He was diagnosed initially with septic arthritis of the hip and underwent unnecessary hip exploration surgery. Magnetic resonance imaging scan was performed postoperatively and showed pyomyositis of obturator internus and obturator externus muscles. He was managed medically and had a good outcome. Conclusions: A greater awareness of this emergency condition is necessary to prevent misdiagnosis, unnecessary surgical intervention, and to avoid the devastating possible complications of delayed diagnosis.

Congenital trigger thumb in children: electron microscopy and immunohistochemical analysis of the first annular pulley

Although numerous studies have been performed on congenital trigger thumb (CTT), the pathogenesis is still unknown. Cytocontractile proteins and myofibroblasts are present during soft-tissue contraction, and they may have a role in CTT. The aim of the study is to clarify the immunohistochemical and the electron microscopy characteristics of the first annular (A-1) pulley in CTT. The specimens from the A-1 pulleys were collected from 22 children with CTT. Electron microscopy was used to study the last five specimens. Immunohistochemistry staining demonstrated that all specimens stained positively for vimentin and for &agr;-smooth muscle actin, and stained negatively for desmin. Electron microscopy showed fibroblasts in collagenous matrix, which contain vimentin-like material and associated at the surface with elastin-like tubular matrix filaments and elastin fibers. In two specimens, a few cells showed markers of myofibroblastic differentiation. The presence of the cytocontractile proteins and myofibroblasts suggests proliferation of fibrous tissues during either the intrauterine or extrauterine phase of development and may account for the presence of congenital stenosis at the level of the A-1 pulley. We believe that CTT may be developmental; if the process started in the intrauterine phase it might present as a fixed flexion contracture and will show mature fibroblasts. If the process started in the extrauterine phase, it might present as triggering first and will show myofibroblastic changes, then with the maturation of the fibrous tissue, result in a fixed flexion contracture.

Exam anxiety in the undergraduate medical students of Taibah University

Abstract Background and objectives: Assessment is perceived to create highly stressful environment among medical students. Several studies have reported exam-related anxiety symptoms but the contributing factors seem to differ across institutions. This study aimed to determine the prevalence of exam anxiety, gender differences and the variables that moderate exam anxiety among students of a Saudi medical school. Methods: A cross-section study was done on 5th year medical students by administering a 12-statement self-administered questionnaire. The degree of exam anxiety was gauged by a visual analog scale. Results: Of 125 students, 111 responded (response rate 89%). About 65% students experienced exam anxiety due to various reasons. Studying all night before exam (28 students; 25.2%) and extensive course load (26 students; 23.4%) were the major confounding factors. Female students experienced more stress due to extensive course load as compared with male students (p = .00). Conclusions: The data about the identified risk factors for exam anxiety can help medical educators to deeply understand the reasons for exam anxiety. There is a need to reassess the amount of study material in undergraduate medical curricula and students need to organize their time management skills to cope with exam anxiety.

Genetics of clubfoot; recent progress and future perspectives

Clubfoot or talipes equinovarus (TEV) is an inborn three-dimensional deformity of leg, ankle and foot. It results from structural defects of several tissues of foot and lower leg leading to abnormal positioning of foot and ankle joints. TEV can lead to long-lasting functional disability, malformation and discomfort if left untreated. Substantial progress has been achieved in the management and diagnosis of limb defects; however, not much is known about the molecular players and signalling pathways underlying TEV disorder. The homeostasis and development of the limb depends on the complex interactions between the lateral plate mesoderm cells and outer ectoderm. These complex interactions include HOX signalling and PITX1-TBX4 pathways. The susceptibility to develop TEV is determined by a number of environmental and genetic factors, although the nature and level of interplay between them remains unclear. Familial occurrence and inter and intra phenotypic variability of TEV is well documented. Variants in genes that code for contractile proteins of skeletal myofibers might play a role in the aetiology of TEV but, to date, no strong candidate genes conferring increased risk have emerged, although variants in TBX4, PITX1, HOXA, HOXC and HOXD clusters genes, NAT2 and others have been shown to be associated with TEV. The mechanisms by which variants in these genes confer risk and the nature of the physical and genetic interaction between them remains to be determined. Elucidation of genetic players and cellular pathways underlying TEV will certainly increase our understanding of the pathophysiology of this deformity.

Leaders produce leaders and managers produce followers. A systematic review of the desired competencies and standard settings for physicians’ leadership

Objectives: To elaborate the desired qualities, traits, and styles of physician’s leadership with a deep insight into the recommended measures to inculcate leadership skills in physicians. Methods: The databases of MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for the full-text English-language articles published during the period 2000-2015. Further search, including manual search of grey literature, was conducted from the bibliographic list of all included articles. Medical Subject Headings (MeSH) keywords “Leadership” AND “Leadership traits” AND “Leadership styles” AND “Physicians’ leadership” AND “Tomorrow’s doctors” were used for the literature search. This search followed a step-wise approach defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The retrieved bibliographic list was analyzed and non-relevant material such as abstracts, conference proceedings, letters to editor, and short communications were excluded. Finally, 21 articles were selected for this review. Results: The literature search showed a number of leadership courses and formal training programs that can transform doctors to physician leaders. Leaders can inculcate confidence by integrating diverse views and listening; supporting skillful conversations through dialogue and helping others assess their influence and expertise. In addition to their clinical competence, physician leaders need to acquire the industry knowledge (clinical processes, health-care trends, budget), problem-solving skills, and emotional intelligence. Conclusion: This review emphasizes the need for embedding formal leadership courses in the medical curricula for fostering tomorrow doctors’ leadership and organizational skills. The in-house and off-campus training programs and workshops should be arranged for grooming the potential candidates for effective leadership.