The minimally invasive laparoscopic surgery has gained popularity among various surgical specialties. However, unique skills are required to perform it. These skills are not transferable from open approach and are associated with a steep learning curve. Therefore, they need to be obtained in a safe-simulated environment. Fundamental laparoscopic surgery program is currently considered the gold standard for assessing laparoscopic skills and a mandatory requirement for board certification in the United States and for promotional advancement of residents in different surgical residency programs. Despite its proven benefits and its superiority when compared to other training models, challenges exist related to its implementation outside North America. The lack of sufficient eligible examiners is the major obstacle. Once overcome, one can aspire to achieve the remaining standards required for full implementation.

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnostic applications in treatment of neurological and psychiatric diseases. Epilepsy is a major problem with devastating effects on patients and their caregivers and has a tremendous socioeconomic impact on families and health-care systems in the Saudi Arabia and worldwide. tDCS is a low-cost, noninvasive portable neuromodulation technique which can transiently decrease or increase cortical excitability in humans and which was invasively demonstrated to reduce epileptiform discharges in animals. This article reviews the tDCS as tools of neuromodulation for epilepsy and discusses the opportunities and challenges available for clinicians and researchers interested in advancing neuromodulation therapy. The aim of this review is to highlight the usefulness of tDCS and to generate an interest that will lead to appropriate studies that assess the true clinical value of tDCS for epilepsy among local clinician and scientist.

Vulvovaginitis is one of the most common gynecologic complaints in prepubertal girls. It accounts for 40%–80% of visits to pediatric gynecology services. It arouses parental anxiety because of the perceived rarity of vulvovaginitis in children, the fear of sexual abuse or concerns over lack of appropriate supervision, and hygiene in daycare or school. The majority of cases are due to nonspecific vulvovaginitis in which vaginal cultures will grow organisms considered to be part of the normal flora. The condition is easily managed with good perineal hygiene. In reluctant cases, oral antibiotics or local estrogen cream may be helpful. A small percentage will have a specific etiology and vaginal cultures will identify the pathogen. Most of these pathogens will be intestinal organisms, respiratory organisms, or sexually transmitted diseases. The isolation of sexually transmitted organisms should alert the physician to investigate for child sexual abuse. Other causes of prepubertal vulvovaginitis include systemic illness and foreign bodies which will result in foul-smelling bloody discharge most commonly toilet paper which can be removed by in-office vaginal irrigation but requires a cooperative child otherwise we may have to do vaginoscopy under general anesthesia.

Celiac disease (CD) is a chronic enteropathy due to ingestion of gluten and related products leading to villous injury and its various manifestations. It has a strong genetic tendency with the presence of human leukocyte antigen (HLA-DQ 2, DQ 8) in more than 98% of these patients with CD. Western studies documented 0.5%–1% prevalence of CD but it is not an uncommon condition in the Arabic peninsula. Classical gastrointestinal (GI) manifestations are common in the toddler's age group while non-GI manifestations predominate in the adolescents and older children. High-risk groups and associated conditions need special considerations for screening CD. European and Americans guidelines are available for diagnosing these children and recommend to screen with anti-tissue transglutaminase antibodies which have got very high sensitivity and specificity. North American guidelines recommend to do small bowel biopsies and interpreted by Marsh grading. Gluten-free diet for the rest of life is still a recognized therapy for these children under the supervision of an expert dietician dealing with CD. National awareness programs and seminars may help in identifying this underdiagnosed condition to avoid morbidity and mortality related to this lifelong disorder.

Objectives: The purpose of this study was to determine whether physicians' gender has any influence on patients' choice of their treating physician. Methods: A survey was conducted in different public places in Riyadh, Saudi Arabia, to determine preferences for the gender of a physician under various health-care aspects. Results: Three thousand and fifteen people participated in this cross-sectional survey. The majority of participants had no gender preference regarding their physician's attitude and professional competence. However, 49.8% of the female participants preferred a female physician and 37.4% of the male participants preferred a male physician when discussing family and psychological problems. Regarding general and genital examination, 65.8% and 86.4% of women and 53% and 67.5% of men, respectively, preferred to be examined by a physician of their same gender. The majority of women preferred a female physician during breast examination (90.1%) and delivery (71.4%). With regard to medical specialties, men preferred a male general surgeon (48.6%), male urologist (65.1%), and male orthopedic surgeon (54.4%). On the other hand, women preferred a female urologist (58.1%) and had no gender preference regarding their general surgeon (48.1%) and orthopedic surgeon (51.4%). Conclusion: Findings of this study highlight the difference in participants' choice for the gender of their treating physician in different medical specialties. Women participants preferred a female physician for psychosocial counseling and when visiting a gynecologist, obstetrician, or urologist. In addition, women of childbearing age favored a female physician during delivery. Men preferred a physician of the same gender when being treated by a urologist, general surgeon, or orthopedic surgeon.

Objective: This study was aimed to compare the results of immunophenotyping by flow cytometry (FC) and immunohistochemistry (IHC) in the diagnosis of B-cell lymphomas and classic Hodgkin's lymphoma (cHL). Methods: This was a retrospective cohort study of 280 patients with chronic B-cell neoplasms and cHL performed between 2008 and 2013. Percentages of B- and T-cell markers detected by FC and IHC were compared regardless of the final diagnosis. Results: FC and IHC results were obtained from 280 patient medical records. There were 155 (55.4%) patients with non-Hodgkin's lymphoma (NHL), 110 (39.3%) with cHL, and 15 (5.4%) with chronic lymphocytic leukemia (CLL). Disparity between FC and IHC was observed for CD19 expression in cHL group where 73.6% (n = 81) CD19 expression was detected by FC and 59.1% (n = 65) detected by IHC (P < 0.02). In NHL group, a higher percentage (81.3%; n = 126) of CD19 was detected by FC as opposed to 61.3% (n = 95) detected by IHC (P < 0.0001). CD19 expression was no different between the two groups. CD20 expression assessed by FC (61.3%; n = 95) was lower than 85.2% (n = 132) detected by IHC in NHL group (P < 0.0001). Whereas no differences were observed in cHL, IHC performed better (100%; n = 15) than FC (66.7%; n = 10) for CD20 detection in CLL group (P < 0.01). In cHL and NHL groups, flow cytometric detections of CD21 of 61.8% and 56.1% were higher than 46.4% (P < 0.02) and 41.9% (P < 0.01) detection rates by IHC. No disparities were observed between FC and IHC detection rates for CD5, CD10, CD23, and CD30 expressions. Conclusion: There was a considerable amount of disparity between FC and IHC results, warranting further evaluation.

Background: Hepatitis C infection is considered one of the most common hepatological infections. Many papers have been published, but none have listed the most influential work in the field of hepatitis C. Objectives: The aim of this study is to produce a bibliometric historical review on hepatitis C and its management. Methods: We underwent a title-specific search using Scopus database in 2017; using hepatitis C as our search term. The top 100 most cited articles were obtained and analyzed. Results: The top 100 articles received an average of 1273 citation per paper. The most productive years of publication ranged between 1999 and 2003 which accounted for 33 articles in our list. The top two journals in our list were New England Journal and Hepatology Journal with a contribution to 21 and 20 articles in our list, respectively. Research study category was accounted as the most common study category (60%). The top two specialties of contribution were Medicine (26 articles) and Hepatology (25 articles). Albrecht, J and Mchutchison have produced 9 and 8 articles, respectively, from our 160 authors list. The majority of the papers were created in the United States of America (62%). Conclusions: The identification and clustering of the top 100 most impactful work in hepatitis C serve as an excellent overview of the current trends of publication in the field of hepatitis C to identify areas of research inadequacy and to serves as an efficient guide to achieving evidence-based clinical practice.

Objectives: Public awareness of palliative care (PC) is satisfactory in only twenty countries in 2013, which does not include Saudi Arabia in spite of the global efforts done to enhance the public awareness of PC. This study was conducted to evaluate the awareness, knowledge, and beliefs of the Saudi adult population about PC. Methods: A cross-sectional design study was conducted in December 2017 using a self-administered questionnaire survey that was sent through Google Docs to assess the Saudi general public on the awareness of PC. Results: There were 1987 (out of 3164, 62.8% response rate) Saudi adults who responded to the survey, in which 60.3% were males (mean age: 39.50 years, median: 39.0 years, and range: 15–77 years). There were 321 (16.2%) respondents who reported that they know PC and 454 (22.8%) answered that they have heard or were aware of PC. A total of 755 (38.2%) believe that PC improves the quality of life of sick people and 684 (34.4%) believe that PC can reduce the physical suffering of patients. Knowledge of PC was not statistically significantly affected by gender, place of residence, and marital status. On the other hand, employment and having higher levels of education led to better knowledge and more awareness of PC. Conclusion: The current study demonstrated that the knowledge and awareness of PC is still low among surveyed Saudis. There is a need for the government to advocate institutions to functionally devote programs and initiatives and promote literacy of PC in the general population. Nongovernmental sectors should also participate in programs to improve the knowledge and awareness of PC.