Academic Medical Centers (AMCs) in Saudi Arabia are dedicated to providing high-quality patient care and promoting the health and wellbeing of its citizens. Additionally, they provide medical education and conduct research in a wide range of clinical disciplines. A recent global trend in academic hospitals with mandates similar to those in Saudi Arabia is that they have started utilizing digital health technology in a bid to increase efficiency and improve the quality of patient care. This paper takes the position that such digital health technologies should also be utilized in AMC settings in Saudi Arabia. Electronic health records (EHRs), smartphones, video-imaging technologies, virtual desktop infrastructures, mobile EHR access, and smart-beds can help AMCs serve patients more effectively. Rural people can be connected to consultants at AMCs using these technologies using virtual self-care tools. Validation of new digital health devices can be performed in collaboration with digital health partners and serve to enrich the knowledge of medical students in the area of digital health. This review aims to draw the attention of stakeholders to the need to implement digital health technology in AMCs in Saudi Arabia and help improve the quality of healthcare.

Objectives: Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods: We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results: In total, 57 patients (aged 23–95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions: Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.

Objectives: We sought to determine the diagnostic accuracy of ultrasound for benign and malignant breast lesions. Methods: This retrospective study was performed to evaluate the diagnostic accuracy of ultrasound in 203 patients with complete medical records who visited Mehr Medical Imaging Center for breast ultrasound between March 2014 and February 2016. The collected data comprised of demographic characteristics, ultrasound results (consisting of the anatomic area of the lesion, the involved side, and the ultrasound characteristics of the lesion), mammogram results, and pathology reports (if surgery or biopsy was performed). Results: For the diagnosis of malignant and benign lesions, ultrasound had a sensitivity of 93.9% and specificity of 86.5%; its positive and negative predictive values were 86.9% and 93.8%, respectively. Lesion type was significantly associated with a family history of breast cancer and fertility status (p < 0.005), but there was no significant association between the involved side and tumor type (p > 0.050). Conclusions: Mammography is the best technique for screening and identifying patients with non-mass-like breast lesions and microcalcifications. Considering the false positive and false-negative results, ultrasound is not a perfect screening modality. Future studies are recommended to study the value of ultrasound in the detection of high-risk breast cancer patients.

Objectives: Autoimmune diseases are known to occur in people with Down’s syndrome (DS), especially celiac disease, type 1 diabetes mellitus (DM), and hypothyroidism. Since there are common genetic risk factors involved in the occurrence of these autoimmune disorders, the risks would differ in different populations. We sought to determine the prevalence of type 1 DM, celiac disease, and hypothyroidism in Emirati patients with DS in Abu Dhabi, UAE. Methods: Ninety-two patients with DS were investigated for the presence of anti-thyroid antibodies, antithyroglobulin, and anti-thyroid peroxidase antibodies for hypothyroidism, anti-glutamic acid decarboxylase antibodies for type 1 DM, and anti-tissue transglutaminase immunoglobulin A antibodies for celiac disease. Results: Karyotyping was performed on 89 patients. Eighty-seven had non-disjunction of chromosome 21 (97.8%), one was a mosaic, and one had translocation. Of the patients studied, 19.6% had hypothyroidism, 4.3% had type 1 DM, and 1.1% had celiac disease. Out of the 92 patients studied, 66 (71.7%) did not have any autoimmune disease, 25 (27.2%) had one autoimmune disease, and one (1.1%) had two autoimmune diseases. Conclusions: Celiac disease was the least prevalent autoimmune disease in patients with DS patients, while type 1 DM and hypothyroidism were both significantly associated with DS.

Objectives: Chronic fungal rhinosinusitis is a major health problem because of the large impact on quality of life and difficult medical treatment. Its prevalence is increasing. There is currently an opportunity to establish the diagnosis without invasive intervention by utilizing β-glucan, which is the largest component of fungal cell wall and neutrophil/eosinophil ratio (NER). We sought to discover the correlation between β-glucan level and the NER of paranasal sinuses mucosa and blood as a potential diagnostic marker for patients with chronic fungal rhinosinusitis. Methods: We conducted a cross-sectional study involving 20 subjects. Blood sampling and maxillary sinus surgery were performed, and fungal identification in the sinus mucosa was determined using the polymerase chain reaction. If a fungal species with β-glucan was found, then the examination was continued with the measurement of β-glucan by enzyme-linked immunosorbent assay, neutrophil, and eosinophil flow cytometry in sinus mucosa and blood. Results: Aspergillus flavus is the most commonly found fungus. All subjects passed the positive β-glucan limit (≥ 80 pg/mL) of the mucosal sample and only one subject had intermediate results (60–79 pg/mL) from their blood sample. Seventeen subjects had mucosal eosinophilic inflammation whereas the blood of 12 subjects revealed neutrophilic inflammation. There was no significant difference between the level of β-glucan in blood and mucosal sinus (p = 0.886), so that β-glucan examination of blood can describe β-glucan levels in paranasal sinuses. There was a significant difference between mucosal NER and blood (p < 0.001). β-glucan level with NER in both paranasal sinus mucosa and blood had no significant correlation (p > 0.050). Conclusions: β-glucan can be used to establish the diagnosis of chronic fungal rhinosinusitis. However, differential diagnosis of allergy or infection cannot be excluded by examination of blood NER. Still, it is hoped that the process of diagnosis can be obtained quickly and precisely without the need for invasive procedure although it requires more research, especially related to the diagnostic test.

Objectives: Obesity increases the risk of numerous chronic diseases. Obesity is classified clinically using body mass index (BMI), waist-to-hip ratio, and body fat percentage. The lipoprotein lipase (LPL) gene has been linked to lipoprotein metabolism and obesity. We performed a case-control study to determine the association between LPL gene polymorphisms and obesity-associated phenotypes such as insulin resistance (IR).
Methods: We examined the different LPL gene variants for association in 642 individuals segregated by BMI and IR. Genotyping of the LPL gene -93 and -53 promoter gene polymorphisms were analyzed using polymerase chain reaction-restriction fragment length polymorphism. Results: A substantial association was observed for -93 gene polymorphism of the LPL gene with obesity, while -53 promoter gene polymorphism showed association with IR. Conclusions: We found a significant association between -93 and -53 promoter gene polymorphisms of the LPL gene with obesity and associated phenotypes in the studied population.

Objectives: We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. Methods: We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. Results: We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. Conclusions: The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.

Objectives: Implemented in 2010, 1 Malaysia Clinic (1MC) is the latest innovation in public primary healthcare services in Malaysia to serve the urban population. This study aimed to assess the level of satisfaction and its associated factors using the SERVQUAL (SERV-service, QUAL-quality) instrument. We also sought to compare the difference of mean score between expectation and perception of SERVQUAL dimension among patients attending 1MC in Kota Bharu district, Malaysia. Methods: This cross-sectional study included all nine 1MCs in the Kota Bharu district, Malaysia, and used the validated SERVQUAL questionnaire from Ministry of Health, Malaysia. The primary data was collected in January 2017. The sample size was proportionate to the average daily patient attendance for each clinic, and a simple random sampling method was applied to reduced selection bias. Satisfaction level was determined by the mean gap score of expectation and perception of the SERVQUAL dimension. Results: A total of 386 patients were involved in this study (184 male and 202 female). Most were from the low socioeconomic group. Less than half of the patients were satisfied with the clinic services. The tangible dimension (service quality (SQ) gap: -0.25) was the most critical dimension among all five SQ dimensions assessed. The factors included low education level (adjusted odds ratio (adj. OR) 1.87; 95% confidence interval (CI): 1.06, 2.67; p = 0.024), monthly household income less than RM 3000 (adj. OR 2.97; 95% CI: 1.72, 5.51; p < 0.001), and frequency ≥ 3 visits (adj. OR 2.23; 95% CI: 1.44, 3.45; p < 0.001) had significant association with high level of satisfaction. Conclusion: 1MC has achieved its objective to increase the accessibility of health services among the low-income population in urban settings. However, most patients were not satisfied with certain parts of the services. Thus, proper evaluation of the service gap is required for improvement of the service.

Objectives: We sought to assess the impact of educational intervention on female junior high school students’ perceived susceptibility and self-efficacy regarding oral and dental health. Methods: We recruited 100 female junior high school students (50 in intervention and 50 in control group) from Falavarjan city using multistage random sampling. A self-administered questionnaire was used to gather data about study variables. Students in the intervention group attended five 90-minute sessions designed to teach the students about dental hygiene. Results: We found no significant difference between the two groups with respect to the preintervention mean scores of knowledge, perceived susceptibility, and self-efficacy (p > 0.050). The postintervention mean scores in the intervention group were significantly higher than those in the control group (p < 0.050). Conclusions: Training plans with particular behavioral goals and good instructional strategies can be useful in empowering students toward dental health.

The autosomal dominant polycystic kidney disease (ADPKD) accounts for one out of 400–1000 live births, being a hereditary disorder with cystic and noncystic manifestations as well as extrarenal involvement. The pericardial effusion (PE) in the context of a patient with ADPKD is complex, and it is not entirely defined. Several theories have been proposed. The most accepted, so far, is linked to mutations in the PKD1 gene which can entail an abnormal production of matrix components, matrix-degrading enzymes, and inhibitors of metalloproteinases, and defects in connective tissue which would lead to an abnormal distensibility of the connective tissue. We report the case of a 35-year-old female Moroccan patient with the diagnosis of ADPKD associated with arterial hypertension who came into the Emergency Department with lower abdominal pain lasting for five days being diagnosed as salpingitis. Abdominal computed tomography scan with contrast showed both kidneys with several cystic images with a thin wall. A transthoracic echocardiogram revealed the presence of moderate PE more in the anterior aspect. A greater set of standard tests to rule out collagen vascular disease, rheumatoid diseases, autoimmune disorders, and malignancies was ordered. These tests yielded no abnormality. The association of ADPKD with PE is rare. The awareness of this connection by the emergency physicians is key to prevent
misplaced concern.

Nodulocystic acne is a severe form of acne which can result in significant damage to the skin with great impact on quality of life. Oral isotretinoin considered to be the best treatment for such cases. Although it has a high rate of success and its efficacy is well established in the treatment of nodulocystic acne, it may occasionally fail to control the disease. We report a case of a patient who presented to our skin clinic with severe facial nodulocystic acne in which treatment with isotretinoin failed to achieve disease control and caused worsening of his baseline condition. Therefore, oral dapsone was administered as an alternative treatment, and we reached a complete remission of acne lesions within six months. Oral dapsone could be an adequate and safe drug in severe acne, and it might also be a promising and hopeful alternative treatment for nodulocystic acne when isotretinoin fails.

Maternally inherited diabetes and deafness (MIDD) is not only a disorder of the pancreas and ears but a multisystem mitochondrial disorder syndrome. Hypogonadism, however, has not been reported as a phenotypic feature of MIDD. We report a single case of a patient with MIDD which manifested clinically at 41 years old. In addition to diabetes and deafness, he manifested with seizures, ataxia, myopathy, and hypogonadism. We used established methods for the routine workup of this patient. MIDD is indeed a multisystem condition. A previously undescribed phenotypic feature of MIDD may be hypogonadism.

Round ligament fibroids are rare tumors and can present as inguinal, adnexal, or vulvar masses. Preoperative diagnosis can be made by ultrasonography or magnetic resonance imaging (MRI). A 28-year-old virgin female presented with pelvic pain that persisted for a few days. Her sonographic evaluation detected a well-defined hyperechoic 45 × 40 mm right adnexal mass interfering endometrioma. A contrast-enhanced pelvic MRI showed a 43 × 39 × 32 mm solid mass located in the right adnexa. Laparoscopic exploration revealed a well-defined double torsion around the peduncle pinky solid mass arising from the right round ligament. The mass was resected with the final histopathological diagnosis being leiomyoma. The diagnosis of round ligament fibroids can be challenging, and laparoscopy is one of the first options where surgical facilities are available.