Variation in annual volume at a university hospital does not predict mortality for pancreatic resections.

Annual volume of pancreatic resections has been shown to affect mortality rates, prompting recommendations to regionalize these procedures to high-volume hospitals. Implementation has been difficult, given the paucity of high-volume centers and the logistical hardships facing patients. Some studies have shown that low-volume hospitals achieve good outcomes as well, suggesting that other factors are involved. We sought to determine whether variations in annual volume affected patient outcomes in 511 patients who underwent pancreatic resections at the University of California, San Francisco between 1990 and 2005. We compared postoperative mortality and complication rates between low, medium, or high volume years, designated by the number of resections performed, adjusting for patient characteristics. Postoperative mortality rates did not differ between high volume years and medium/low volume years. As annual hospital volume of pancreatic resections may not predict outcome, identification of actual predictive factors may allow low-volume centers to achieve excellent outcomes

Facial analysis using a new clinical device : The Kattan Facio-meter

The aim of the study was to attempt to set average faciometric standards for Egyptians using the Kattan Facio-meter. The sample consisted of 180 faculty students with age range 17-25 years. It was divided into three groups; Angle Class I, II and III. Class II was further subdivided into divisions 1 and 2. Linear and angular facial measurements in relation to K plane were taken using the Kattan facio-meter. The measurements were correlated to Angle?s classification and between genders. On comparing the different classes, Class II division 1 showed the statistically highest mean value for Orbitale-soft tissue A; p=0.042, Class II divisions 1 and 2 for Orbitale- Labrale superius; p=0.002 and soft tissue ANB; p<0.001. Females showed significantly higher mean value than males for the upper incisor/K plane; p=0.031. Males showed significantly higher mean value for the inter-incisal angle than females; p=0.001. Within the limitations of the current study, it was found that both linear and angular soft tissue measurements conformed to the antroposterior skeletal relation of the jaws and that Class II division 1 was due to protruded maxilla. Males had more prominent lips and deeper mentolabial sulcus. Egyptians had less prominent noses than Caucasians. The Kattan Facio-meter was a valuable tool for clinical analysis without the hazards of irradiation

Middle East respiratory syndrome coronavirus disease is rare in children: An update from Saudi Arabia

AIM: To summarize the reported Middle East respiratory syndrome-coronavirus (MERS-CoV) cases, the associated clinical presentations and the outcomes. METHODS: We searched the Saudi Ministry of Health website, the World Health Organization website, and the Flutracker website. We also searched MEDLINE and PubMed for the keywords: Middle East respiratory syndrome-coronavirus, MERS-CoV in combination with pediatric, children, childhood, infancy and pregnancy from the initial discovery of the virus in 2012 to 2016. The retrieved articles were also read to further find other articles. Relevant data were placed into an excel sheet and analyzed accordingly. Descriptive analytic statistics were used in the final analysis as deemed necessary. RESULTS: From June 2012 to April 19, 2016, there were a total of 31 pediatric MERS-CoV cases. Of these cases 13 (42%) were asymptomatic and the male to female ratio was 1.7:1. The mean age of patients was 9.8 ± 5.4 years. Twenty-five (80.6%) of the cases were reported from the Kingdom of Saudi Arabia. The most common source of infection was household contact (10 of 15 with reported source) and 5 patients acquired infection within a health care facility. Using real time reverse transcriptase polymerase chain reaction of pediatric patients revealed that 9 out of 552 (1.6%) was positive in the Kingdom of Saudi Arabia. CONCLUSION: Utilizing serology for MERS-CoV infection in Jordan and Saudi Arabia did not reveal any positive patients. Thus, the number of the pediatric MERS-CoV is low; the exact reason for the low prevalence of the disease in children is not known

A New Horizontal Plane of the Head

AIM: This study aimed to attempt to introduce a new extracranial horizontal plane of the head (K plane that extends from SN to SAE bilaterally) that could act as a substitute to the Frankfurt horizontal intracranial reference plane; both clinically and radiographically.MATERIAL AND METHODS: The new K plane depended on three points of the head. The first was the soft tissue nasion (NS) on the interpupillary line when the subject looked forward at a distant point at eye level. The other two points were the superior attachments of the ears (SAE).RESULTS: The student “t†test comparing mean values of K/V and FH/V was not significant; -0.21.  The coefficient of correlation between different variables was highly positively significant (r = 0.98 with probability = 0.001).CONCLUSION: Within the limitations of this prospective study, the new K plane was found to be both reliable and reproducible. It can be used as a reliable reference plane instead of Frankfort horizontal plane both clinically and radiographically; as it is an accurate tool for head orientation in the natural head position

EXPLORING THE VALIDITY OF MULTIMEDIA WRITTEN ASSESSMENT IN SAUDI ARABIA

Introduction: Multiple choice questions are widely used in high-stakes written examinations and are continuously being challenged for testing recall facts rather than higher cognition. Innovative MCQ formats (Multimedia-enhanced) can test such skills. To evaluate this format a recent validity framework “The Cambridge Framework” was used to assess and explore this intervention. Aim: Explore the validity of multimedia MCQs for testing higher cognition in Emergency Medicine (EM) in Saudi Arabia using the Cambridge framework, and evaluate the use of this framework. Methods: A total of 164 EM residents (seniors and juniors) from three regions of Saudi Arabia took a total of 80 multimedia-text matched items in an end of year exam. A mixed-methods approach triangulating quantitative (pilot test, parallel forms of multimedia and text items, item psychometrics and characteristics, questionnaires) and qualitative methods (semi-systematic literature review, focus-group discussions, Cambridge validity framework implementation and research legitimation), were applied using systematic guidelines for each method to explore multimedia items. Results: Discrimination was significantly higher for multimedia than text items (DI= 0.19 +18, 0.14 +17, p= .03), and took significantly longer to answer (p=.01). Both formats had a moderate difficulty level (Diff = 0.75,0.74). Multimedia-items had a higher reliability and G-coefficient than text items. Focus group results revealed seven main themes of multimedia that effect item characteristics. Review of the Cambridge Framework demonstrated areas of gaps in sources of validity evidence and external-related factors not covered in other frameworks that have implications on validity. Conclusion: Multimedia questions were more discriminating and took longer time to answer than the text questions. They test higher cognition and have certain characteristics that effect difficulty level and how they are perceived by the examinees altering their thinking process towards the answer. Gap areas identified in the Cambridge framework and external factors that were contextual, may give room to explore the issue of international validity in assessment.Saudi Commission for Health Specialtie

7. Long term results of quadrangular autologous pericardial patch reconstruction of the pulmonary artery during arterial switch operation on post-

The aim of this retrospective study is to evaluate the technique of Quadrangular Fresh Autologous Pericardial Patch for the reconstruction of the pulmonary artery in Arterial Switch Operation (ASO) to prevent the post-operative pulmonary artery stenosis (PAS). A total of 287 consecutive infants with transposition of great arteries were treated with ASO in our center between January 2000 and September 2014. The mean age was (7.76days) and mean weight was (3.67kg). The new pulmonary arterial root was reconstructed with a fresh quadrangular autologous patch. The technique includes extensive mobilization of both pulmonary artery branches and direct suturing of the parch to 2/3 of the annulus of the new pulmonary artery trunk first, and then reconstruction finish by the re-suspension of the posterior commissure of the new pulmonary valve inside the patch. Patients were examined using trans-thoracic echocardiography consecutively at discharge form the hospital, and at 3–6 months and yearly after discharge. The mean follow up time was 78 months. The early mortality was 5.19% (17 patients), and there were no late mortality. The highest mortality was reported during the beginning of the pediatric surgical program. The mortality for the last 100 patients was 1%. The pressure gradient across the pulmonary valve in 249 patients (87%, was less than 20mmHg. Mild pulmonary stenosis (pressure gradient of 20–40mmHg) was present in 32 patients (11.14%) and moderate pulmonary stenosis with gradient 40–60mmHg was manifested in 4 patients (1.39%). Reconstruction of the new Pulmonary artery during the ASO, using the quadrangular autologous fresh pericardial patch, is effective and reproducible in reducing the incidence of post-operative pulmonary stenosis