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Introduction: The goal of this study is to determine factors associated with acceptance into Canadian plastic surgery (PS) residency programs by Saudi Arabian Medical Graduates. Methods: This is a cross-sectional study targeting eligible Saudi Arabian applicants to any Canadian PS residency program between 2017 and 2022. Collected data included demographics, education/licensure, electives in Canada, and letter of reference. The 2 main outcomes analyzed were "invited for an interview" and "offered a residency position." Results: We reviewed 52 applications. Of these, 18 applicants received an invitation for an interview and 8 were offered a residency training position. Significant variables associated with receiving an invitation for an interview were completing an elective in Canada ( P  = .016), having a master's degree ( P  = .012), and completion of an English test ( P  = .032). The variables most likely to influence receiving a residency position offer are completion of elective training in Canada ( P  = .004) and receiving a letter of reference from a Canadian plastic surgeon (95% CI: 0.77 to 76.69: OR: 8.90). Conclusion: Completion of an elective rotation in Canada and obtaining Canadian letters of reference were found to be the most important factors for Saudi Arabian physician applicants to be accepted into a Canadian PS residency program. Other factors that were less critical but improved their chances of being considered include completion of an English assessment test and having a master's degree. This study offers valuable guidance for any Saudi Arabian candidates interested in PS residency in Canada and may aid Canadian programs in their assessment of potential residents., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2023 The Author(s).)

Background: Postoperative fluid-related complications, such as hematoma and seroma formation, are common concerns in breast surgery, adversely affecting surgical outcomes and patient recovery. Topical tranexamic acid (TXA) has emerged as a promising intervention to minimize bleeding while reducing systemic adverse effects linked to intravenous administration. However, evidence on the efficacy of topical TXA in breast surgery remains sparse., Methods: This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language databases were searched through April 2024 to identify randomized controlled trials and cohort studies assessing the effects of topical TXA on postoperative outcomes in breast surgery, including hematoma, seroma, infection rates, and drain output/duration., Results: Six studies, encompassing 823 patients and 1477 breasts, were included. Subgroup meta-analysis demonstrated a statistically significant reduction in hematoma rates in patients who underwent mastectomy (risk ratio [RR] = 0.14; 95% confidence interval [CI], 0.03-0.78; P = 0.02), but not in patients who underwent breast reduction (RR = 0.76; 95% CI, 0.08-7.08; P = 0.24). No significant differences were found in overall hematoma rates (RR = 0.32; 95% CI, 0.08-1.195; P = 0.09), seroma formation (RR = 1.22; 95% CI, 0.99-1.51; P = 0.07), or infection rates (RR = 0.85; 95% CI, 0.46-1.56; P = 0.59)., Conclusions: Topical TXA significantly reduced hematoma rates in patients who underwent mastectomy but showed no significant effect on other outcomes. Larger studies with standardized methodologies are required to fully establish the role of topical TXA in optimizing breast surgery outcomes., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: Surgeons prioritize scar appearance after surgery, making suture choice crucial. Traditionally, non-absorbable sutures were standard but require removal, causing patient discomfort and extra visits. Absorbable sutures, while offering convenience, might raise concerns about scar quality. This study aims to provide an overview of the plastic surgery literature and clinically based evidence of the efficacy and outcome of absorbable and non-absorbable sutures., Methods: A systematic review of search databases in MEDLINE, EMBASE and the Cochrane Library was made to identify studies related to absorbable and non-absorbable sutures. The inclusion criteria for this study included RCTs comparing AS and NAS in plastic hand surgery, without any limitations of age or sex on recruited patients., Results: A total of 532 hands were treated with a combined sample size of 517 patients undergoing plastic hand surgery. Two hundred seventy-three (51%) of patients had their wound closed with non-absorbable sutures, and 259 (49%) had absorbable sutures. Overall patient satisfaction among the studies that reported number of patients satisfied with the wound closure appearance was 64 (64%) in non-absorbable sutures cohort and 58 (59%) in absorbable sutures. Wound inflammation happened in 8 (3%) of wounds closed with non-absorbable sutures and in 9 (3.4%) of wounds closed with absorbable sutures., Conclusion: In both patients cohorts, the overall patient satisfaction and complication rates were not significantly different. Non-absorbable sutures appeared to have slightly higher patient satisfaction rates. However, absorbable sutures may offer some benefits in terms of convenience with lower risk of wound dehiscence., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: The authors do not have any conflict of interest. Ethical Approval: The need for ethical approval was waived because of the nature of the study. Funding : This study is supported via funding from Prince Sattam Bin Abdulaziz University project number (PSAU/2024/R/1446)., (© 2025. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique., Methods: We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate., Results: 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: None. Ethical Approval: This case report conforms to the Declaration of Helsinki, (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: The quality of reporting in randomized controlled trials (RCTs) is crucial for accurate interpretation and synthesis of evidence. The Consolidated Standards of Reporting Trials (CONSORT) guidelines provide a standardized framework for reporting RCT abstracts. This study aimed to evaluate the adherence of RCT abstracts published in three major plastic surgery journals to the CONSORT tool guideline for reporting abstracts, utilizing Generative Pre-trained Transformer 4 artificial intelligence (GPT-4 AI) technology., Methods: Abstracts of RCTs published between 2010 and 2023 were collected. The GPT-4 AI model was utilized to assess the abstracts based on the CONSORT criteria. Descriptive statistics were used to report the compliance scores and identify areas where abstracts lacked compliance., Results: Of the initially identified 500 abstracts, a total of 371 RCT abstracts met the inclusion criteria and were analyzed. The mean CONSORT score was 10.05 (±2.22), with a median score of 10.72. Specific areas where abstracts lacked compliance included trial design (39.6%), participant details (28.8%), intervention descriptions (15.6%), randomization process (25.3%), and the number of participants analyzed (33.4%). Trial registration (18.3%) and funding information (15.1%) were also frequently missing., Conclusions: Our study's innovative use of the GPT-4 AI model for analysis demonstrated the potential of AI technology in streamlining and enhancing the evaluation of research compliance. We advocate for heightened awareness and more rigorous application of CONSORT guidelines among authors, reviewers, and journal editors. Emphasizing the role of AI technology in the evaluative process can further improve the reporting quality of future RCTs in plastic surgery, contributing to more reliable and transparent research in the field., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Objectives: The current study aimed to evaluate the effectiveness of using a vibration device to ease pain during upper extremity injections. Specifically, the study aims to compare the pain levels of patients who receive the injection with and without the use of vibration therapy. The results of this study may have implications for improving patient outcomes and satisfaction during routine injection procedures., Material and Methods: This randomized controlled trial included patients aged 18 years or older who were scheduled to receive an injection in the upper extremity. A total of 60 patients were enrolled and randomized to either the intervention group or the control group using a computer-generated randomization sequence. The level of satisfaction and pain levels were assessed using a visual analog scale. The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board., Results: The mean pain score immediately after the injection was 4.03 ± 2.11 out of 10 in the vibration group (n = 30), compared to 7.4 ± 1.37 out of 10 in the control group (n = 30) ( P < 0.001). Patients in the vibration group also reported higher levels of satisfaction and comfort during the injection ( P < 0.001). No adverse events were reported in either group., Conclusion: Our study proves that using a vibration device during upper extremity injections can effectively reduce postinjection pain and improve patient satisfaction. Further research is needed to explore this intervention's long-term effects and feasibility in different clinical settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Anesthesia.)

Background: Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care., Methods: A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data., Results: A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%., Conclusions: This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients' needs and promote patient-centered outcomes in plastic surgery., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Affecting the eccrine glands, granulosis rubra nasi (GRN) is an inherited disorder that manifests itself as redness, sweating, and papules distributed mainly in the center of the face. It is diagnosed clinically and the cornerstone of management is reassurance and education about the benign nature of the condition. A wide array of treatment modalities has been proposed, such as Botox and corticosteroids injections; however curative measures are yet to be discovered. In this paper, we present a case of a 26-year-old man complaining of chronic nose sweating. The case was successfully managed with Botox injections, though we suggested our theory of undercutting the glands through aggressive defatting as part of open rhinoplasty to the patient; he declined our suggested modality. It remains an untested option and caution should be exercised in high-risk patients to avoid compromising blood supply to the skin and risking skin necrosis., Competing Interests: The authors declare that they have no conflicts of interest to disclose., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

A 40-year-old female presented with right mandibular swelling. A panoramic radiograph showed a unilocular radiolucency from the mandibular angle to tooth #46. Biopsy confirmed a schwannoma. Surgical resection was performed via a submandibular approach with a reconstruction plate. Teeth 46 and 47 were extracted. Surgery was complication-free, and histopathology confirmed the tumor's benign nature. The patient was discharged on the second postoperative day. At the 1-year follow-up, she had no paresthesia, normal mouth opening, and full mandibular motion. The reconstruction plate was intact. This case adds to the limited literature on intraosseous schwannomas, emphasizing early detection, thorough radiological assessment, and meticulous surgical planning., Competing Interests: The authors declared no conflict of interest., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Background: Breast augmentation using silicone implants is common, with over 300,000 annual US surgeries. It was initially approved in 1962, there were safety concerns with the use of silicone implants, leading to a 1992-2006 FDA moratorium. Recently, Breast Implant Illness (BII) was described as a cluster of symptoms associated with silicone implants, with a lack of diagnostic criteria, which increased the likelihood of implant removal and a variety of treatment options. This comprehensive review aims to shed light on the extent, symptoms, management, and outcomes of BII., Methods: Multiple electronic databases were systematically searched in May 2023 for studies on Breast Implant Illness utilizing terms related to BII and its symptoms, diagnosis, and treatment. Out of 1204 studies, 20 met the inclusion criteria and were included in the systematic review. The Newcastle-Ottawa Scale for the included cohort prospective and retrospective studies, and the tool for evaluating the methodological quality of case reports and case series were utilized during quality assessment., Results: There were 20 papers on Breast Implant Illness published between 1995 and 2022, including a peak of papers published in 2020 and 2022. The majority of the studies came from the USA, with a variety of research methods, including case reports. Reports of arthralgia and fatigue were common findings. These symptoms were frequently alleviated by surgical procedures such as en bloc explantation and capsulectomy, highlighting the intricacy of the problem and the need for individualized treatment plans., Conclusion: The review underscores the critical need for further research into BII, advocating for a multidisciplinary strategy that prioritizes patient safety, informed decision-making, and comprehensive care. As the medical community progresses in understanding and managing BII, emphasizing evidence-based practices and patient-provider communication will be essential in addressing this complex condition effectively., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: Sociodemographic disparities in genitourinary cancer-related mortality have been insufficiently studied, particularly across multiple cancer types. This study aimed to investigate gender, racial, and geographic disparities in mortality rates for the most common genitourinary cancers in the United States., Methods: Mortality data for prostate, bladder, kidney, and testicular cancers were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database between 1999 and 2020. Age-adjusted mortality rates (AAMRs) were analyzed by year, gender, race, urban-rural status, and geographic region using a significance level of p < 0.05., Results: Overall, AAMRs for prostate, bladder, and kidney cancer declined significantly, while testicular cancer-related mortality remained stable. Bladder and kidney cancer AAMRs were 3-4 times higher in males than females. Prostate cancer mortality was highest in black individuals/African Americans and began increasing after 2015. Bladder cancer mortality decreased significantly in White individuals, Black individuals, African Americans, and Asians/Pacific Islanders but remained stable in American Indian/Alaska Natives. Kidney cancer-related mortality was highest in White individuals but declined significantly in other races. Testicular cancer mortality increased significantly in White individuals but remained stable in Black individuals and African Americans. Genitourinary cancer mortality decreased in metropolitan areas but either increased (bladder and testicular cancer) or remained stable (kidney cancer) in non-metropolitan areas. Prostate and kidney cancer mortality was highest in the Midwest, bladder cancer in the South, and testicular cancer in the West., Discussion: Significant sociodemographic disparities exist in the mortality trends of genitourinary cancers in the United States. These findings highlight the need for targeted interventions and further research to address these disparities and improve outcomes for all populations affected by genitourinary cancers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ghazwani, Alghafees, Suheb, Shafqat, Sabbah, Arabi, Razak, Sabbah, Alaswad, AlKattan, Ouban, Abdul Rab, Shawwaf, AlKhamees, Alasker, Al-Khayal, Alsaikhan, Addar, Aldosari, Al Qurashi and Musalli.)

Colorectal cancer (CRC) is a major health concern and a significant contributor to global oncological mortality, influenced by genetic predisposition and lifestyle factors. Hookah smoking, prevalent in the Middle East, has been associated with an increased risk of various cancers, including CRC. This case report discusses the incidental discovery of metastatic CRC in a 42-year-old habitual hookah smoker, shedding light on the potential association between hookah use and CRC pathogenesis. Additionally, it addresses the diagnostic complexities posed by the asymptomatic nature of CRC, often identified through non-specific indicators such as abnormal liver enzymes. Furthermore, the case illustrates the crucial role of family medicine in detecting diseases, highlights the significance of multidisciplinary care in managing advanced CRC, and emphasizes the importance of public health initiatives to raise awareness about the risks of hookah smoking and promote regular health screenings in at-risk populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Banamah et al.)

Background: Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi., Materials and Methods: After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR., Results: A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age ( P = 0.42), gender ( P = 0.275), BMI ( P = 0.672), comorbidity, grade of hydronephrosis ( P = 0.201), and stone location ( P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups ( P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049)., Conclusion: This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Urology Annals.)

Beckwith-Wiedemann syndrome (BWS) is a complex congenital overgrowth disorder necessitating a multidisciplinary approach for effective management. A 5-year-old Saudi girl with BWS received comprehensive care involving various specialists, including a plastic surgeon who performed a keyhole technique tongue reduction to address macroglossia. The intervention resulted in significant improvements in speech and quality of life, with no postoperative complications. Intensive speech therapy further enhanced speech development. This case report emphasizes the importance of a multidisciplinary approach and the critical role of the plastic surgeon in managing BWS patients with macroglossia to achieve optimal outcomes., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: The internet serves as a vital health information resource, yet the quality of data on specific health conditions, especially in Arabic, is often overlooked. This research assesses the quality of Arabic online information about cleft lip and palate (CLP) and proposes avenues for enhancement., Methods: From July to August 2022, a systematic evaluation of Arabic articles on CLP was performed using the DISCERN tool for quality assessment. Searches on Google and Bing resulted in 119 articles that met the study's criteria., Results: The quality of available Arabic information on CLP displayed substantial gaps. Commercial sources dominated (49.6%), followed by private (32.8%) and nonprofit entities (17.6%). The average DISCERN score was 2.26 of 5 (SD = 1.06), indicating the need for enhanced content, particularly concerning treatment risks., Conclusions: The study underscores the subpar quality of Arabic CLP information online, which might mislead patients and impede access to accurate advice. Nonprofit organizations should bolster their online footprint, offering refined health content. A deep dive into DISCERN scores reveals pinpointed improvement areas. Clinicians should direct patients and their families to reliable information sources. Addressing these gaps promises improved CLP knowledge in Arabic, fostering superior patient education and outcomes for those with this condition., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023)., Methods: The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed., Results: The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author., Conclusion: Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: As artificial intelligence makes rapid inroads across various fields, its value in medical education is becoming increasingly evident. This study evaluates the performance of the GPT-4.0 large language model in responding to plastic surgery board examination questions and explores its potential as a learning tool., Methods: We used a selection of 50 questions from 19 different chapters of a widely-used plastic surgery reference. Responses generated by the GPT-4.0 model were assessed based on four parameters: accuracy, clarity, completeness, and conciseness. Correlation analyses were conducted to ascertain the relationship between these parameters and the overall performance of the model., Results: GPT-4.0 showed a strong performance with high mean scores for accuracy (2.88), clarity (3.00), completeness (2.88), and conciseness (2.92) on a three-point scale. Completeness of the model's responses was significantly correlated with accuracy ( P < 0.0001), whereas no significant correlation was found between accuracy and clarity or conciseness. Performance variability across different chapters indicates potential limitations of the model in dealing with certain complex topics in plastic surgery., Conclusions: The GPT-4.0 model exhibits considerable potential as an auxiliary tool for preparation for plastic surgery board examinations. Despite a few identified limitations, the generally high scores on key parameters suggest the model's ability to provide responses that are accurate, clear, complete, and concise. Future research should focus on enhancing the performance of artificial intelligence models in complex medical topics, further improving their applicability in medical education., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nassar et al.)

Background The application of artificial intelligence (AI) in education is undergoing rapid advancements, with models such as ChatGPT-4 showing potential in medical education. This study aims to evaluate the proficiency of ChatGPT-4 in answering Saudi Medical Licensing Exam (SMLE) questions. Methodology A dataset of 220 questions across four medical disciplines was used. The model was trained using a specific code to answer the questions accurately, and its performance was assessed using key performance indicators, difficulty level, and exam sections. Results ChatGPT-4 demonstrated an overall accuracy of 88.6%. It showed high proficiency with Easy and Average questions, but accuracy decreased for Hard questions. Performance was consistent across all disciplines, indicating a broad knowledge base. However, an error analysis revealed areas for further refinement, particularly with category (Option) A questions across all sections. Conclusions This study underscores the potential of ChatGPT-4 as an AI-assisted tool in medical education, demonstrating high proficiency in answering SMLE questions. Future research is recommended to expand the scope of training and evaluation as well as to enhance the model's performance on complex clinical questions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Aljindan et al.)

Minoxidil is a widely utilized medication androgenic alopecia. An original investigation on its potential to cause hair darkening in treated people is lacking. We conducted an observational study using two face-validated questionnaires that dermatologists altered to assess minoxidil's hair discolouration risk. This Saudi Arabian survey collected data in October and November 2022. One questionnaire targeted the population, while the other targeted dermatologists. Survey 1 included 453 patients, 56.7% of whom were 18-24 and mostly female. It's interesting that 26% (n=118) detected hair greying and 14.8% (n=67) noticed other color changes. With P-values of 0.0001, longer-term minoxidil users and those with a family history of hair greying had higher hair discolouration. Dermatologists completed Survey 2 (57 participants). Nearly 60% of dermatologists have ten years of experience. 42.1% of dermatologists saw grey hair after minoxidil use. 17.5% of doctors blame minoxidil for hair graying. This observational study examined the data of over 400 patients to determine if minoxidil could cause hair discoloration. Based on the data, we hypothesize that this drug may cause hair discoloration with prolonged use and in people with a family history of hair greying., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (Copyright © 2024, the Author(s).)

Background: Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction., Methods: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes., Results: A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03)., Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events., Prospero Registration Number: CRD42021271580., Competing Interests: Declaration of competing interest Each author certifies that there are no funding or commercial associations that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members., (Copyright © 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objective: We conduct a secondary analysis on the demographics, tumor characteristics, survival, and risk factors for mortality among patients with prostatic ductal adenocarcinoma (PDA) in the Kingdom of Saudi Arabia (KSA)., Methods: This is a registry-based retrospective study that included all patients diagnosed with prostate cancer in the KSA. The data were collected from the Saudi Cancer Registry, which collects tumor data from all private, military, and health ministry hospitals in Saudi Arabia through five regional offices., Results: Among 3607 prostate cancer patients detected during the specified period, 209 (5.8%) had ductal adenocarcinoma. The median interquartile range age of patients was 72.0 years (64.0-78.0). Adenocarcinoma lesions were malignant among all the patients. Grade III tumors were most frequently apparent lesions (61.2%), followed by Grade II tumors (26.3%), Grade I tumors (7.2%), and Grade VI tumors (5.3%). A total of 33 patients died, representing 15.8% of the whole sample. The 1-year survival rate was 78.1%. More than a third of patients who were residing in the Western region deceased (38.0%), whereas no deaths were reported in other regions with a statistically significant difference based on regions ( P < 0.001)., Conclusion: To the best of our knowledge, this is the first registry-based study to investigate PDA in the KSA; these efforts were done to further understand this deadly condition and to further enhance patient care in the KSA., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Urology Annals.)

Although many published studies have investigated the benefits of tranexamic acid (TXA) in reducing perioperative bleeding, no large meta-analysis has been conducted to demonstrate its overall benefit., Methods: A systematic review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Cochrane, Ovid, Embase, Web of Science, ClinicalTraisl.Gov, and Scopus databases were searched for articles reporting the benefit of TXA in reducing perioperative bleeding in craniosynostosis surgery from establishment through October 2022. The results of our meta-analysis were pooled across the studies using a random-effects model, and presented as a weighted mean difference with 95% confidence interval (95% CI)., Results: The database search yielded 3207 articles, of which 27 studies with a corresponding number of 9696 operations were eligible. The meta-analysis included only 18 studies, accounting for 1564 operations. Of those operations, 882 patients received systemic TXA, whereas 682 patients received placebo (normal saline), no intervention, low dose TXA, or other control substances. This meta-analysis demonstrated a significant beneficial effect of TXA in reducing perioperative bleeding, particularly when compared with other controlled substances, with a weighted mean difference of -3.97 (95% CI = -5.29 to -2.28)., Conclusions: To our knowledge, this is the largest meta-analysis in the literature investigating the benefit of TXA in reducing perioperative blood loss in craniosynostosis surgery. We encourage implementing TXA-protocol systems in hospitals after the appraisal of the data presented in this study., Competing Interests: The authors have no financial interests to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

The purpose of this article is to share our first-year outcomes and the overall impact of the plastic surgery interest club (PSIC) since its establishment, and to discuss the future directions that any interested club may follow and benefit from., Methods: This cross-sectional study utilized a self-developed questionnaire that experts in the field revised. The authors recruited active PSIC members during the year 2021-2022 to assess the overall impact of the club in their various interests of the field as well as to have an overview of their opinions of this newly done initiative in Saudi Arabia. The data collection spanned from October 2021 to September 2022., Results: The authors analyzed the responses from 66 active members with a response rate of 78%. We found various significant positive impacts of the PSIC in the community of plastic surgery in Saudi Arabia. There was a significant difference in the interest in pursuing a career in plastic surgery before and after being a member of PSIC, with a P value of 0.0001. The members became noticeably more interested in pursuing an academic career and publishing field data after enrolling in PSIC research activities., Conclusions: The authors provided an analysis of 1-year outcomes of the PSIC in Saudi Arabia; there were many positive impacts of such an initiative in enhancing the local community of plastic and reconstructive surgery. The authors strongly encourage the adaption of such initiatives in various parts of the globe to develop the field of plastic surgery further., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Atrial Fibrillation (AF) is a major risk factor for stroke, which is the second leading cause of death worldwide. It remains uncertain whether insertable cardiac monitors (ICMs) enhance the ability to recognize AF over external cardiac monitoring in patients who have experienced a stroke., Aim: We conducted a systematic review and meta-analysis to determine whether ICM devices are more effective than external cardiac monitoring for the detection of AF in stroke patients., Methods: We included studies that reported an AF detection rate in stroke patients with a follow-up of at least 12 months. We analyzed the data of 1233 patients from 3 randomized control trials (RCTs)., Results: When compared to external cardiac monitoring, ICM devices (Medtronic Reveal LINQ and Reveal XT) showed a significantly higher detection rate of AF (RR = 5.04, 95% CI = 2.93-8.68; p < 0.05; ARR = 10.47%, NNT = 10). The ICM arm had significantly higher usage of oral anticoagulants (OAC) as compared to the control arm. (RR = 2.76, 95% CI = 1.89-4.02, p < 0.05). Additionally, ICM usage was associated with a higher incidence of mild to moderate adverse events (RR = 10.52, 95% CI =1.35-82.14; p = 0.02) and a higher number of severe adverse events as compared to the control arm (RR = 7.61, 95% CI = 1.36-42.51; p = 0.02)., Conclusion: ICM devices are associated with better detection rates of AF and higher usage of OAC as compared to external cardiac monitoring in post-stroke patients. However, ICM insertion is associated with a higher incidence of mild/moderate and severe adverse effects., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature., Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational., Results: A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%)., Conclusion: Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

The predictive capability of various risk assessment models (RAMs) in evaluating the risk of mortality in burn patients is not well established. It is also unclear which RAM provides the highest discriminative ability and presents the highest clinical utility. We pooled all available studies to establish this validity and compare the predictive capability of the various RAMs., Methods: We reviewed PubMed, MEDLINE, and Embase from their inception up until December 2021 for studies evaluating risk of mortality in burn patients as stratified by RAMs. Data were pooled using random-effect models and presented as area under the receiver operating characteristic (AUROC) curve., Results: Thirty-four studies, comprising of a total of 98,610 patients, were included in our analysis. Most studies were found to have a low risk of bias and a good measure of applicability. Nine RAMs were evaluated. We discovered that the classic Baux; the revised Baux; and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES) scores presented with the highest discriminative power with there being no significant difference between the results presented by them [AUROCs (95% CI), 0.92 (0.90-0.95), 0.92 (0.90-0.93), 0.94 (0.91-0.97), respectively, with P < 0.00001 for all]., Conclusions: Many RAMs exist with no consensus on the optimal model to utilize and assess risk of mortality for burn patients. This study is the first systematic review and meta-analysis to compare the current RAMs' discriminative ability to predict mortality in patients with burn injuries. This meta-analysis demonstrated that RAMs designed for assessing mortality in individuals with burns have acceptable to great discriminative capacity, with the classic Baux, revised Baux, and FLAMES demonstrating superior discriminative performance in predicting death. FLAMES exhibited the highest discriminative ability among the RAMs studied., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Breast reconstruction (BR) is a unique surgical procedure that provides patients undergoing mastectomy with significant psychosocial and aesthetic benefits and has also become a crucial part of the treatment pathway for women with breast cancer. Due to methodological inadequacies and the absence of substantial risk factor analysis, no conclusion can be drawn about the correlation between risk variables and post-surgical complications in BR surgery. We aim to identify the potential risk factors associated with postoperative complications., Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to March 2022, for published randomized controlled trials and observational studies that assessed complications post-reconstruction procedure in breast cancer patients following mastectomy or evaluated at least one of the following outcomes of major or reoperative complications. The results from the studies were presented as odds ratios with 95% confidence intervals and were pooled using a random-effects model., Results: Our pooled analysis demonstrated a significant correlation with BR postoperative complications and risk factors such as diabetes, hypertension, and obesity. Diabetes and the development of seroma were found to have a significant relationship. Risk variables such as age, radiotherapy, COPD, and smoking had no significant connection with 0-to-30-day readmission and 30-to-90-day readmission., Conclusion: This meta-analysis shows that risk factors like age, smoking history, high blood pressure, and body mass index (BMI) have a big effect on complications after BR, and patients with risk factors have a high rate of developing infection., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE., Methods: MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model., Results: The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26-6.78], medium-risk (OR, 5.29; 95% CI, 2.38-11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32-43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10-6.72)., Conclusions: Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background and Aim: Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions., Methods: PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model., Results: 9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036)., Conclusion: Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Large numbers of people infected with COVID-19 developed acute symptoms. Post-COVID-19 conditions have been reported after recovery or discharge from the hospital. However, little is known about the prevalence and possible risk factors of post-COVID-19 conditions in the Saudi community. Here, we describe the incidence of post-COVID-19 conditions among the general population of Saudi Arabia. Methods: We conducted a cross-sectional, nationwide study using an online survey in Saudi Arabia from 1 September 2021 to 28 February 2022. The survey was distributed using social media platforms, such as Twitter, WhatsApp, and Facebook. Patients with SARS-CoV-2 infection were included in the questionnaire adapted from published studies. Result: The study enrolled 7520 individuals who were previously infected with SARS-CoV-2. Most patients in our study were symptomatic and their acute symptoms may persist for more than six days. On the other hand, long-term complications may develop and continue for an extended period (post-COVID-19 conditions). Most of these complications are respiratory, neurological, psychological, or skin related. The proportion of long-term complications reported in this study is 36% among SARS-CoV-2-infected individuals. In addition, being female, old age, number of chronic complications, long-term medication, length of stay in hospital and intensive care unit, and duration of acute symptoms may be significant predictors of post-COVID-19 symptoms. Conclusion: In conclusion, the incidence of post-COVID-19 conditions among the Saudi population was high, which urges further investigation into the risk factors associated with post-COVID-19 symptoms.

Knowing what attracts cosmetic patients to a specific surgeon can help current cosmetic surgeons and aspiring ones improve themselves and better market their practice. Hence, this study aimed to investigate the influential factors when selecting an aesthetic surgeon for a cosmetic procedure in Saudi Arabia., Methods: This is a cross-sectional, nationwide study targeting the public from all regions of Saudi Arabia. The study was conducted between September 21 and October 29, 2021. The self-structured electronic survey was based on previously published studies and was revised by two academic plastic surgeons., Results: This study included a total of 7190 participants from all regions of Saudi Arabia. The most influential factor for choosing an aesthetic surgeon was the surgeon's qualifications (39.9%), followed by friends and relatives' advice (24%) and hospital/clinic environment (10.2%), while the number of social media followers was the least favorable factor (0.8%). Additionally, the most preferred aesthetic surgeon was a surgeon with international board certification (mean score, 4.17)., Conclusions: This study showed that the most common factor for choosing an aesthetic surgeon was the surgeons' qualifications. Thus, Saudi aesthetic surgeons and aspiring Saudi aesthetic surgeons must focus on obtaining high qualifications to attract more patients. Furthermore, an internationally board-certified surgeon is the most preferred surgeon for Saudi Arabian patients; thus, traveling abroad to world-renowned institutions is recommended., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Nomophobia is a psychological condition caused by a fear of disconnecting from others through mobile phones., Aim: This study aims to determine the prevalence of and predictors of nomophobia and anxiety symptoms among the general population in Saudi Arabia and Jordan., Methods: This study was an observational cross-sectional study using a web-based online survey distributed in two middle eastern countries (Saudi Arabia and Jordan) between Jun 24 and Jul 20, 2021. A convenience sample was used to recruit the study participants. Categorical variables were identified as frequencies and percentages. In addition, a binary logistic regression analysis was used to determine the factors associated with nomophobia symptoms. The Statistical Package for Social Science (SPSS) software, version 27 (IBM Corp, Armonk, NY, USA), analyzed the data., Results: A total of 5,191 responded to the online survey. Around (26.5%) reported that they suffer from an anxiety problem or use a treatment for anxiety. The median daily time spent using a mobile phone (IQR) (minutes) was around 210 min per day. About half of the study sample (51.2%) are diagnosed with dependence syndrome. The binary logistic regression analysis revealed that those within the age group of 30-49 years and 50 years and above) are less likely to have mobile phone dependence compared to those less than 30 years old. Females were 16% at lower risk of developing mobile phone dependence compared to males Married participants were less likely to have mobile phone dependence compared to single participants (OR: 0.62 (95% CI 0.56-0.70)), while divorced participants were at a 46% higher risk of developing mobile phone dependence., Conclusion: Nomophobia prevalence among Saudi Arabia and Jordon's population is 51.2%. Several factors may predict mobile phone dependence including age, gender, marital status, and previous history of anxiety., (© 2022. The Author(s).)

Competing Interests: None declared.

•Currently natural lifestyle modification is recommended over bariatric surgery in the management of infertility in obese men and women, despite natural weight loss often being an ineffective method to both lose and maintain weight loss in these individuals.•Through this meta-analysis and systematic review, we provide evidence that bariatric surgery effectively improves fertility outcomes for men and women by measurements of hormone levels and improvements in sexual function index scores.•This study demonstrates the importance and even cruciality of bariatric surgery in obese men and women who struggle with reproductive health, especially when finding it difficult to lose and maintain weight. It also proves that it is vital to continue to create and expand our knowledge with evidence-based medicine to help this cohort of patients., Competing Interests: None of the authors have any conflicts of interest in this study., (© 2022 The Authors.)

Objective: We aimed to assess the quality of life (QoL) and its predictors in colorectal cancer (CRC) patients at King Abdulaziz Medical City, Jeddah., Methods: A total of 118 CRC patients at King Abdulaziz Medical City, a tertiary hospital in Jeddah, participated in this study. The participants were provided with the online questionnaire via WhatsApp by trained researchers and data collectors in February 2021. All participants were required to answer the three-section questionnaire comprising of (a) demographic data and a validated Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires, (b) a general version (QLQ-30), and (c) a CRC-specific version (QLQ-CR29)., Results: Statistical analysis revealed that the most common comorbidity among the participants was diabetes mellitus (42.4%). In addition, the mean global health status was 63.91 ± 24.75. For the global health tool QLQ-C30, results exhibited that physical functioning [62.94 (30.04)] and social functioning [63.56 (31.95)] scored below the threshold, while the cognitive functioning scale scored the highest [74.86 (25.11)]. In addition, on the QLQ-C30 scales, fatigue and insomnia were distressing, with fatigue scoring the highest. For the disease-specific tool QLQ-CR29, it was found that for the symptom scale, urinary frequency and embarrassment scored the highest. Conclusion. The participants reported high global quality of life on both the EORTC QLQ-30 and QLQ-CR29 scales. This study identifies the factors and predictors that affect the quality of life of CRC patients in Saudi Arabia. Recognizing these factors and predictors may empower those patients to maintain positive perception towards the impact of colorectal cancer and improve their survival., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Jumanah T. Qedair et al.)

Introduction: Plastic surgery is a unique field' and its scope is beyond a specific demographic group or anatomic part. The poor understanding and misconception about plastic surgeons' scope of practice has been well-established among the public, especially in Saudi Arabia; but the question is, do healthcare physicians share the same misconception? This study aims to answer this question., Methods: This study was conducted between September 11, 2021 and November 1, 2021. This is a cross-sectional, survey-based study utilizing a self-structured questionnaire targeting physicians in Saudi Arabia., Results: A total of 261 medical and surgical physicians participated in this study. Nearly 45% of them demonstrated a poor understanding of plastic surgery and its scope of practice, whereas only 16.1% were sufficiently knowledgeable. Male physicians were more likely to understand the field of plastic surgery when compared with female physicians. More than 80% of the physicians knew that cosmetic operations are done by plastic surgeons, whereas 50% or less knew that reconstructive operations are conducted by plastic surgeons., Conclusion: This study shows that 44.1% of the participating physicians demonstrate poor knowledge regarding plastic surgery as a field, in addition to a lack of understanding about the scope of practice of plastic surgeons. We recommend enhancing promotional efforts that raise awareness about the nature of plastic surgery as a specialty among healthcare physicians., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: It is well established in the literature that the satisfaction of trainees correlates with higher productivity and efficiency during training years. The satisfaction rate of Saudi Board of Plastic Surgery trainees has not been investigated since its establishment in 2001. Therefore, we aimed to measure the satisfaction rate of local trainees and detail the predictors of satisfaction., Methods: This study was conducted on September 9-13, 2021. The study is a cross-sectional, nation-wide study utilizing a self-structured questionnaire targeting all plastic surgery residents in Saudi Arabia. IRB approval and approval from the governing body of residency programs in Saudi Arabia were obtained., Results: The study included 100% of western region residents (N = 9) and 72.7% of central region residents (N = 24), yielding a total of 33 participants with 78.6% response rate. Of all the residents, only 39.4% were satisfied with their training in the Saudi Board of Plastic Surgery program, 45.5% were neutral regarding their opinion, and 15.2% expressed their dissatisfaction with the program. The area most in need of improvement was mentorship (30.3%), followed by the quality of teaching (12.1%) and workplace climate (12.1%), whereas the least was administrative components (6.1%)., Conclusions: The mild level of dissatisfaction toward the local training in plastic surgery should alarm the governing body in the Saudi Commission for Health Specialties and the program directors to take certain interventions toward the improvement of local training. Considering the areas most in need of improvement is necessary to achieve a suitable training environment for the residents., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Breast cancer occurs when abnormal breast cells grow rapidly and uncontrollably. Early detection and intervention have been established to significantly decrease mortality rates., Objective: There is a lack of focused research investigating the degree of breast cancer awareness among Saudi women. Thus, this study aimed to fill this gap by conducting a nationwide survey on a large pool of women., Design: A cross-sectional web-based nationwide study., Methods: This study targeted Saudi women from all regions of the country and was conducted from 20 August to 3 September 2021. The study used the Breast Cancer Awareness Measure questionnaire to measure breast cancer awareness. This study was approved by the King Abdullah International Medical Research Center institutional review board., Results: Overall, poor breast cancer awareness scores were demonstrated by 71% of the participants. Unemployed women were more likely to have poor breast cancer awareness., Conclusion: Our study reports an alarmingly high level of poor overall breast cancer awareness in Saudi women. Interventions should be implemented to combat this lack of awareness.

Graduates of medical school must choose a specific specialty as a life-long practice from a large pool of medical specialties. This decision stands out as one of the most memorable and critical in their lifetimes. To reach such a decision with satisfaction, medical school graduates consider a variety of factors. This is the first study to explore the influential factors on pursuing plastic surgery as a career in Saudi Arabia., Methods: This is a cross-sectional, unicentral study based on an electronic questionnaire that has been constructed with an assistance of field experts to ensure a sufficient coverage of the influential factors. Only those with an established interest in plastic surgery were included. Institutional review board approval was obtained for this study., Results: Of the 695 questionnaires fully completed by third-year medical students up to intern doctors, only 32 (4.6%) expressed an interest in the pursuit of plastic surgery as a future career, with a female predominance of 62.5% ( N = 20). The factors that influenced their decision of specialty choice were the geographic advantage (81.3%), predominance of nonurgent cases (71.9%), the reward associated with immediate outcome (71.9%), and prior significant events (71.9%)., Conclusions: Certain factors, as explored by this study, strongly influence the choice of plastic surgery as a future specialty, among Saudi medical graduates. Cultivating more knowledge about plastic surgery as a specialty may help consider scientific research as an impactful factor in the future for further development in the field., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)