A national competence framework has been developed by medical schools in the Kingdom of Saudi Arabia. The framework has seven domains - approach to daily Practice, Dr and patient, Dr and community, communication skills, professionalism, Dr and information technology, Dr and research. The framework will guide curriculum development and assessment in the Kingdom and ensure that medical education adapts to changing needs. The creation of a national framework promises the delivery of equivalent standards between medical schools while at the same time guaranteeing the schools' autonomy.

The widespread of multidrug-resistant bacteria, particularly carbapenem-resistant Enterobacterales (CRE) bacteria, constitutes a major public health threat worldwide, owing to the limited therapeutic options. This review will describe and uncover the Saudi experience in the challenge against carbapenem resistance (CR). The different carbapenem resistance prevalence and carbapenemase genes detected from various bacterial species were mapped for Saudi regional distribution, based on Saudi published data during a period extended from 2017 to 2021. However, VIM, IMP, and KPC enzymes were usually reported with the predominance of OXA and NDM among Enterobacterales. Although SIM and GIM carbapenemases were uncommonly detected in our country. Collaborative efforts and raising awareness of the threat of carbapenem resistance are required to minimize the spread of multidrug-resistant bacteria.

BackgroundThe Middle East is regarded as a secondary reservoir for OXA-48 and New Delhi metallo-β-lactamase (NDM) carbapenemases. One of the main challenges in clinical microbiology diagnostics is the detection of carbapenemases. For this reason simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. The present study aimed to evaluate the efficacy of the modified Hodge test (MHT) and a boronic acid-based combined disk test using carbapenems as substrates for the phenotypic determination of OXA-48 and NDM type carbapenemases in 45 epidemiologically unrelated carbapenem-resistant clinical isolates of Klebsiella pneumoniae (13 isolates), Acinetobacter baumanii (20 isolates), and Pseudomonas aeruginosa (12 isolates).ResultsBoronic acid disk test using meropenem as substrate and 600 µg of 3- aminophenylboronic acid (APB) was the most sensitive method (83.33 %) for detection of OXA-48, while the most specific method was MHT (100 %). As regards NDM carbapenemase, boronic acid disk tests using imipenem and 600 µg of APB per disk, and meropenem with 300 or 600 µg of APB were the most  sensitive methods (87.50 %), while the most specific method was the MHT (100 %).ConclusionsThe results of the present study indicate that phenotypic screening with the MHT and the boronic acid disk test may be used to detect OXA-48 and NDM carbapenemases in Gram-negative bacilli clinical isolates, and that these tests can be easily applied in tertiary care settings with minimal infrastructure.

Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children's Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.

BackgroundComputed tomography (CT) is used to evaluate the human tracheobronchial tree because of its unsurpassed ability to visualize the airway and surrounding structures. To establish an ideal animal model for studying subglottic stenosis, we assessed the size and morphology of the normal rabbit’s laryngotracheal airway by helical CT. We measured luminal dimensions at the levels of the arytenoid and cricoid cartilages and the first, third, and eighth tracheal rings. At all levels, the axial slices were used to calculate the maximum anteroposterior (AP) dimension, transverse dimension, and cross-sectional areas. We measured the tracheal length from the cricoid to the third and eighth tracheal rings on sagittal reformation. We assessed the hyoid, thyroid, cricoid, arytenoid, and tracheal rings for the presence of calcific or soft tissue densities. We also addressed the presence or absence of pre-epiglottic and paraglottic fat.ResultsThe mean AP tracheal dimension ± standard deviation (SD) was 8.6 ± 0.5 mm at the arytenoid level, 8.2 ± 0.7 mm at the cricoid level, and 7.7 ± 0.2 mm at the first tracheal ring level. The transverse tracheal dimension ±SD was 5.3 ± 0.1 mm at the arytenoid level, 5.5 ± 0.5 mm at the cricoid level, and 6.1 ± 0.6 mm at the first tracheal ring level. The mean tracheal area ±SD was 35.7 ± 2.2 mm2 at the arytenoid level, 35.8 ± 5.1 mm2 at the cricoid level, and 39.2 ± 4.3 mm2 at the first tracheal ring level. The tracheal length ±SD was 10.7 ± 2.3 mm from the cricoid to the third tracheal ring and 19.1 ± 1.14 mm to the eighth tracheal ring. There was complete calcification of the hyoid in all rabbits. Only two rabbits showed complete thyroid, arytenoid, or tracheal ring calcification. The remaining airway components were otherwise either uncalcified or partially calcified. The uvula, epiglottis, aryepiglottic fold, vallecula, piriform sinus, true/false vocal cords, and pre-epiglottic/paraglottic fat were not seen in any rabbit.ConclusionsHelical CT investigation provides good, highly definitive anatomic details of the larynx and trachea in rabbits. Such results may be used in further evaluation of the normal airway and in cases of subglottic stenosis.

We report usefulness of ultrasound used as an adjunct diagnostic tool to mammogram in routine annual checkup for women breasts of certain ages and breast mass. The purpose of breast imaging is to detect areas of tissue distortion and breast cancers. A mammogram is the common diagnostic imaging modality used to find breast diseases but sometimes the mammogram might not give the doctor enough information especially in women with dense breasts. As a result, the patient may be asked to undergo ultrasound or magnetic resonance imaging as a better mean of judgment to the case. Because ultrasound is widely used, simple and safe to patients we were encouraged to emphasis on exploring its role adjunct to mammogram. A retrospective observation study was done at the diagnostic radiology department at King Abdulaziz University Hospital (KAUH) in the period from January 2012 to June 2012; we covered all women with dense breasts in mammography and ultrasound units. The study group was 40 patients. All patients were imaged with both mammography and ultrasound. The statistical measures of accuracy, sensitivity and specificity were calculated using the SPSS program. The results we obtained suggest that age and the physical density of breast potentially affect mammogram images of women with 41 years or smaller with sensitivity 66% and specificity 68%. Therefore, we recommend using ultrasound alongside the mammogram in women with dense breast for better diagnosis of small cancers that were not identified on mammography or clinical breast examination alone.

In recent years, widespread use of mobile phones has led to a public debate about possible harmful effects on human health. A lot of researchers studied the possible effect of radiofrequency energy (RFE) emitted from cell phones on the human body. Up to our knowledge no one studied the effect of these waves on the thyroid gland by Ultrasonography (US). Our aim was to investigate the possible effects of EMR arising from cell phones on the thyroid gland using US. A prospective study was done on 180 participants, 110 females and 70 males, ranging in age from 15 to 65. A constructed questionnaire was distributed among them before performing US of the neck. Demographic data along with US findings were collected and statistically analyzed. A total of 46.7% of our participants had abnormal findings of the thyroid gland more in non smart phone users and more in females. The commonest abnormality was multinodular goiter (54%). Expanded researches are still needed to answer the question about the hazards of RFE on human health. All efforts should be made to encourage users of cellular phone to follow mobile device recommendations of manufacturers and avoid its possible hazards as possible.

Type 2 diabetes mellitus (type 2 DM) is one of the common epidemics worldwide. The prevalence of type 2 DM is high among Saudi population. Renal affection by DM is in the form of nephropathy that may end in the end stage of renal disease (ESRD) and renal failure warrants chronic dialysis or renal transplantation. Renal Ultrasonography (US) is a simple, accurate, affordable and non-invasive test that can help in management of type 2 DM patients who have renal affection. Four hundred patients, aged from 13-93 years with type 2 DM were recruited from the outpatient internal and family medicine clinics at KAUH. Renal US was requested for 202 patients, and was done at the diagnostic radiology department using digital iU22 Philips machine with 3.5-5 MHz convex array transducer. The renal size, parenchymal echogenicity and associated renal pathologies e.g. stones, cysts or masses were evaluated. Statistical analysis was performed using SPSS program version 16. Most cases showed normal renal size and echogenicity. Grade one nephropathy was more than grade two or three. Nephropathy was non-significantly correlated to the patients' gender, but to their age. Increased patients' age was associated with increased renal echogenicity. Non-diabetes-related renal abnormalities were detected in 39% of patients. The most common of non-diabetes-related renal abnormalities was simple renal cyst followed by renal stones (25% and 23%) respectively. Renal US for patients with type 2 DM has a great role in diagnosing and grading diabetic nephropathy, selecting cases with non-diabetic nephropathy for renal biopsy, and detecting associated renal abnormalities. Due to the high prevalence of DM in Saudi Arabia, we recommend future expanding study of the underlying possible genetic relation between DM and renal cysts and also the relation between renal stones and type 2 DM.