The well-known 3-hydroxyl 3-methyl glutaryl-Coenzyme A reductase inhibitors, called statins, have been the main medication used in the treatment of hypercholesterolemia and some cases of cardiovascular diseases. The effectiveness of this drug in controlling cholesterol production is impeccable, however, patients often complain of a variety of side effects, such as myalgia, muscle atrophy, and in some cases, rhabdomyolysis. Not only has the use of statins caused the aforementioned side effects, but they are also shown to cause testicular discomfort, erectile dysfunction, altered semen parameters, and modified steroid hormone production. These reported adverse effects on male fertility are not generally agreed upon, as some have shown the use to be beneficial. Hence, this makes the aftermath effect of statin use on male fertility debatable and controversial. The negative effects have been associated with imbalanced or reduced steroid hormones, which are necessary for proper spermatogenesis and other sexual functions. Meanwhile, the beneficial effects are related to statin’s anti-inflammatory and cardioprotective properties. These contradictory findings are in part due to the different age of users, concentrations of statins, the type and duration of treatment, and the underlying disease and/or comorbidities. Therefore, the current study aims to analyze the literature and gather evidence as to the effects of statin on male sexual health and reproductive parameters, and subsequently give recommendations for the direction of future studies.

Male infertility is attributable to 60% of total infertility cases and about 30-50% of these cases remain idiopathic. In the Middle East and North Africa region (MENA), male infertility affects about 22.6% of men of reproductive age. Male infertility is caused by a variety of factors, including endocrine disruption, exposure to toxins, lifestyle, genetic and epigenetic modifications. Genetic modifications, including chromosomal abnormalities, chromosomal rearrangements, Y chromosome microdeletions and single-gene mutations, explain for about 10-15% of infertility cases. Since genetic aberration is a key player in the pathogenesis of male infertility, it is important to explore the impact in the MENA region due to the high incidence of male infertility. Therefore, the current study aims to systematically analyse the literature regarding the impact and common causes of male infertility in the MENA region. To achieve this aim, a comprehensive literature search was performed on PubMed, Google Scholar, and Science Direct databases. Following the search, a total of 126 articles was retrieved, of which 12 were duplicates and another 69 articles did not meet the inclusion criteria, totaling the exclusion of 81 articles. Studies excluded were those that had patient populations originating outside the MENA region, review articles, non-English written articles, or studies where the patient population was under 18 years of age. Findings showed that the frequent genetic aberration leading to male infertility in these regions include Y chromosome microdeletions, gene polymorphisms or copy number variations, mitochondrial microdeletions and other genetic deletions or mutations. In lieu of this, diverse clinical genetic tests should be made available for the proper diagnosis of male infertility.

Background Cardiovascular disease (CVD) remains the leading cause of death in the United Arab Emirates (UAE). One of the common CVDs is hypertrophic cardiomyopathy (HCM). Recent studies conducted in heart cells of mice have shown that this condition involves a chemical modification called hydroxymethylation of the DNA of heart cells. Objective Objectives of the proposed research are to profile the distribution of 5-hydroxymethylation in the cardiomyocyte (CMC) genome of cadaveric cardiac tissue and cardiac biopsy specimens; to compare the hydroxymethylome of cadaveric CMCs with that of cardiac biopsy specimens from HCM patients and/or cardiac transplant patients (control) undergoing cardiac catheterization; to histologically appraise sarcomere distribution and mitochondrial morphology of CMCs in the presence of HCM; to correlate the mitochondrial genome with the HCM phenotype; and to integrate anatomy with biochemistry and genetics into the instructional design of HCM in the core medical curriculum at Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU). Methods Normal and hypertrophic heart specimens will be obtained from 8 whole-body cadavers (2/8, 25% control and 6/8, 75% HCM). Myocardial biopsy specimens will be obtained from cardiothoracic and transplant units at the Cleveland Clinic in Abu Dhabi, UAE. As this is a proof-of-concept study, we plan to recruit 5 patients with HCM, where HCM has been diagnosed according to the guidelines of the 2014 European Society of Cardiology Guidelines. Patients with valvular heart disease, history of myocarditis, regular alcohol consumption, or cardiotoxic chemotherapy will be excluded. The control biopsy specimens will be obtained from patients who had received heart transplants. Three investigational approaches will then be employed: (1) gross anatomical evaluation, (2) histological analysis, and (3) profiling and analysis of the hydroxymethylome. These investigations will be pursued with minor modifications, if required, to the standard protocols and in accordance with institutional policy. The objective associated with the education of health professionals will be addressed through a strategy based on Graham’s knowledge translation model. Results This study is at the protocol-development stage. The validated questionnaires have been identified in relation to the objectives. The MBRU and the Cleveland Clinic Abu Dhabi Institutional Review Board (IRB) are reviewing this study. Further clarification and information can be obtained from the MBRU IRB. There is funding in place for this study (MBRU-CM-RG2019-08). Currently, we are in the process of standardizing the protocols with respect to the various molecular techniques to be employed during the course of the study. The total duration of the proposed research is 24 months, with a provision for 6 months of a no-cost extension. Conclusions The spectrum of CVDs has recently received significant focus from the public health sector in the UAE. HCM is a common familial heart disease, contributing to the sudden increase in the mortality rate of young Emiratis in the UAE. Incorporating artificial intelligence into the identification of epigenetic risk factors associated with HCM will promote accurate diagnosis and lead to the development of improved management plans, hence, positive patient outcomes. Furthermore, integration of these findings into the instructional design of undergraduate, postgraduate, and continuous professional development medical curricula will further contribute to the body of knowledge regarding HCM. International Registered Report Identifier (IRRID) PRR1-10.2196/17241

Gastrointestinal stromal tumors (GISTs) are uncommon GI tract cancers that develop from immature mesenchymal cells. It might be difficult to get an early diagnosis of people with small bowel GISTs, which can cause delays in therapy. We present here a case of a 62-year-old male with an incidental finding of a small intestine GIST during the workup for umbilical hernia. He presented with swelling above the umbilicus for the past six months that was progressive in nature and not associated with pain. Computer tomography (CT) of the abdomen with intravenous contrast revealed a heterogeneously enhancing mass lesion in the left paraumbilical intraperitoneal region, and immunohistochemistry results of the CT-guided biopsy showed a GIST. The patient underwent excision of the tumor with segmental resection and anastomosis, and supraumbilical hernia repair. Chemotherapy (imatinib for three years) after suture removal was planned for him.

Background: Robotic surgery comprises surgical procedures performed via robotic assistance. Recently, 75% more surgical robotic systems were installed in the United States’ hospitals. Saudi Arabia was the first regionally to introduce robotic surgery in 2003. Our study aims to compare and assess medical students’ knowledge and attitude on robotic surgery in the Gulf Region. Methods: This descriptive cross-sectional study assessed medical students across Kingdom of Saudi Arabia (KSA), United Arab Emirates (UAE) and Qatar. Our questionnaire evaluated demographical background, knowledge on robotic surgery, and lastly attitude towards robotic surgery. Results: The 278 participants (UAE: 144, KSA: 99, and Qatar: 35) were mostly female (66.9%), preclinical students (56.1%) and local (53.2%). Most UAE participants (86.8%) were aware of local robotic surgery applications, while most KSA (62.6%) and Qatar (82.9%) participants were not sure. Most KSA (60.6%), UAE (89.6%) and Qatar (68.6%) students correctly defined robotic surgery. Most participants from KSA felt neutral (36.3%) or agreed (33.3%) to use robotic surgery in clinical practice, while majority of UAE participants (57.6%) strongly agreed, and Qatar participants (51.4%) agreed. In addition, KSA respondents were more neutral (42.4%) on investing into robotic surgeries than UAE and Qatar participants. Conclusion: Most UAE participants were aware of local robotic surgery applications, while most KSA and Qatar participants were not sure. Mostmedical students in the Middle East had high level of knowledge on robotic surgery and its characteristics. However, attitudes on applicability of robotic surgery varied between positive and neutral outlooks depending on the country.