The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.

ConclusionThree-quarters of the participants reported side effects after the COVID-19 vaccination, which affected the work performance of 41% of participating general surgeons. There was no significant relationship between the appearance of symptoms and age, gender, blood group, number of doses, and past history of COVID-19 infection. However, there was a significant relationship between the severity of side effects and gender and type of vaccination. Future large-scale studies are recommended to further evaluate the implication of ABO blood type on COVID-19.

AimsThis paper aims to describe the procedures and current status regarding the pursuit of postgraduate pharmacy training in the United States for international pharmacy graduates. Also, it highlights some of the challenges those individuals may face throughout their journey and provides future perspectives.MethodsTo describe the procedures regarding the pursuit of postgraduate pharmacy training in the United States, we searched and summarized the information in public online platforms, such as the National Matching System, National Association of Boards of Pharmacy, and many others. To describe the current status, we searched the publicly available American Society of Health‐System Pharmacists residency online directory and the American College of Clinical Pharmacy fellowship online directory for programs offered to international pharmacy graduates.ResultsTwo main pathways were identified to pursue postgraduate pharmacy training in the United States for international pharmacy graduates. Of the currently available residency training programs, we identified 16 programs that offer postgraduate year one and eight programs that offer postgraduate year two positions for international pharmacy graduates. We identified 64 fellowship programs in the American College of Clinical Pharmacy fellowship directory. However, the directory does not provide information on whether or not these fellowship programs will accept international pharmacy graduates.ConclusionIn order to pursue postgraduate training in the United States, international pharmacy graduates face several logistical, administrative, and immigration obstacles. This is the first article to describe the current status, provide guidance on the approaches to pursue postgraduate pharmacy training in the United States, address some of the challenges, and provide several recommendations to be considered in the future.

Background: Previous studies showed organ donation to be less common in Arabic countries, and since there are not many studies exploring the perception toward organ donation, especially in the Eastern region of Saudi Arabia, this study aimed to assess the knowledge, attitude, and influence of social media campaigns on the willingness of organ donation. Methods: A cross-sectional study was conducted between September 2021 and April 2022 among social media users through an Arabic online survey exploring the population’s knowledge and attitude regarding organ donation and their willingness to donate. A total of 443 Saudi residents participated in the survey, with 376 of them meeting the required criteria. Results: In all, 85% of participants of the study’s calculated response rate were eligible to be included. One hundred ninety-eight of them (52.7%) were female, with age ranges between 18 and 29 years old (76.9%). The majority of the participants (63%) showed unwillingness to donate organs, with the highest rate among males (70.2%), aged above 30 (78.1%), and employees/students out of the healthcare sectors (69.5%). Inadequate knowledge was reported as the most common reason behind their rejection. Next to fears of operation and losing life, and the desire to donate to relatives only. Almost half of the participants (51.6%) agreed on the effect of social media on their behavior toward organ donation, with 187 of them (96.4%) referring to it as a positive effect which was significantly associated with the willingness to donate organs (P=0.006). Conclusion: The study results showed that most of the participants have neither proper knowledge nor willingness toward organ donation. Therefore, more strategies could be developed to increase the rate of donation in the Eastern region.

Erythrodermic psoriasis (EP) is a severe, often refractory, variant of psoriasis. Due to the high morbidity and mortality rate associated with EP and other causes of erythroderma, they are often classified as dermatologic emergencies. EP is usually a therapeutic challenge, where topical and conventional systemic therapies have yielded a less than satisfactory result in several patients. Furthermore, there are a limited number of studies evaluating other therapeutic modalities, such as biologic agents, with no clear treatment guidelines. In this case report, we present a patient who was diagnosed as a case of EP and showed an impressive response to risankizumab.

Locally advanced rectal cancer (LARC) is managed by Chemo-radiotherapy (CRT), followed by surgery. Herein we reported patients with metastases during or after CRT. Methods: Data of patients with LARC who received CRT from 2008 to 2017 were reviewed. Patients with metastases after CRT were included. Those with metastatic tumors at the initial diagnosis were excluded. Results: Fourteen (1.3%) patients of 1092 received CRT presented with metastases. Magnetic resonance circumferential resection margin (mrCRM) and mesorectal lymph nodes (LNs) were positive in 12 (85.7%) patients. Meanwhile, magnetic resonance extramural vascular invasion (mrEMVI) was positive in 10 (71.4%) patients. Magnetic resonance tumor regression grade 4 (mrTRG4) and mrTRG5 was detected in 5 and one patient respectively. Ten (71.4%) patients underwent combined surgery and 3 (21.4%) received palliative chemotherapy. Conclusion: Patients with metastases after CRT showed higher rate of positive mrCRM, mrEMVI, mesorectal LNs, and poor tumor response. Further studies with large number of patients are necessary for better survival outcomes in LARC.

Background. Zika virus (ZIKV) has become a major concern across the world. It is highly necessary for healthcare providers (HCPs) to have sufficient knowledge about such a disease. The purpose of this study is to assess the knowledge regarding ZIKV among HCPs in Riyadh, Saudi Arabia. Materials and Methods. A cross-sectional survey study was conducted at a tertiary care center in Riyadh, KSA, during a two-month period from September 19, 2016 to November 19, 2016. Descriptive statistics were performed on data collected. For continuous variables, data were expressed as means ± standard deviations (SDs), medians, and ranges. Proportions were used to describe categorical variables. Knowledge scores were evaluated and compared by demographic characteristics including age, designation, years of practice, and gender, using the t-test/Mann–Whitney U test or the Kruskal–Wallis test, as appropriate. Results. A total of 336 HCPs from different specialties (physicians, dentists, nurses, pharmacists, and nutritionists) completed the questionnaire. Significant differences in knowledge about ZIKV were observed by participant’s age. Significantly higher knowledge levels were observed among older participants (45 years or more; p=0.011). A substantial difference in the knowledge level was observed by department, with pairwise comparisons showing significant differences in knowledge scores between all departments except for Pharmacy vs. Nutrition and Nursing vs. Internal Medicine. Knowledge scores were not significantly different by years of practice. Conclusion. Our study showed inadequate knowledge of HCPs from different specialties about ZIKV infection which needs to be improved in terms of infection prevention and control. Awareness about ZIKV infection should be ensured and maintained among HCPs to face any possible emergence in the region.

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