Abdul Rehman Zia Zaidi

Background: Pentalogy of Cantrell (POC) is a rare congenital malformation defined by five midline defects involving the sternum, anterior diaphragm, diaphragmatic pericardium, abdominal wall, and heart. Surgical strategies vary between staged and single-stage approaches, and optimal timing remains debated. We report a case of complete POC managed with a single-stage combined cardiac and abdominal wall reconstruction at six months of age, using a cemented sandwich mesh, previously used by our team after sternal tumor resection, for the lower sternal defect. Case presentation: A six-month-old Saudi male infant, born at 38 weeks by emergency cesarean section (birth weight 1.99 kg, Apgar 8/9), was diagnosed antenatally with ectopia cordis, ventricular septal defect (VSD), and epigastric omphalocele. Amniocentesis had excluded trisomy. Postnatal echocardiography confirmed a large perimembranous VSD with inlet extension, a mid-muscular VSD, a small atrial septal defect (ASD), and an ejection fraction of 57%. A multidisciplinary team elected to proceed with a single-stage combined operation once his weight exceeded 5 kg (6.2 kg at surgery). Cardiac surgery was performed first through sternotomy (bypass time 150 min; cross-clamp time 124 min), with patch repair of the VSD and ASD and excision of a left ventricular diverticulum. The pediatric surgery team then addressed the omphalocele via midline laparotomy extension, closed the anterior diaphragmatic defect primarily, and reconstructed the lower sternal defect using gentamicin-impregnated bone cement within doubled Gore-Tex mesh (a sandwich mesh configuration). Fascial closure reached the umbilicus without clinical signs of raised intra-abdominal pressure. The patient was extubated on postoperative day three and achieved full oral feeds by day five. Echocardiography before discharge showed no residual shunt and an ejection fraction of 54%. A small incisional hernia was repaired electively about one year later, and the child remained asymptomatic at two years. Conclusions: This case demonstrates that single-stage combined cardiac and abdominal wall repair in complete POC is feasible and can reduce the burden of repeated surgical interventions. The cemented sandwich mesh achieved stable reconstruction of the lower sternal defect in this patient, offering a potential alternative for centers managing similar complex congenital anomalies.

Bone tumors range from incidental benign lesions and locally aggressive intermediate tumors to primary sarcomas, and metastatic carcinoma is the most common malignant lesion of adult bone. This narrative review focuses on primary bone tumors, examining their classification, molecular pathobiology, diagnosis, staging, and treatment, and it addresses metastatic bone disease briefly from an orthopedic-oncology perspective. We synthesized literature identified through PubMed, Scopus, Web of Science, and the Cochrane Library, supplemented by targeted verification and updating of cited sources during revision in 2026. Classifications, clinical practice guidelines, clinical trials, cohort studies, and reviews informed the synthesis. Management depends on histological subtype, anatomical site, disease extent, symptoms, and the feasibility of preserving function. Suspected primary bone sarcomas should be imaged locally, staged with chest computed tomography, and referred to a sarcoma center before biopsy. Observation or intralesional treatment is appropriate for many benign lesions, whereas selected locally aggressive tumors require more extensive intervention. Osteosarcoma and Ewing sarcoma generally require systemic chemotherapy and local treatment. Surgery remains central to conventional chondrosarcoma management, and systemic treatment options differ across its subtypes. Molecular findings support, but do not replace, integrated radiological and histopathological diagnosis. Checkpoint inhibitors have shown limited activity in unselected bone sarcomas, and multikinase inhibitors have modest activity in relapsed osteosarcoma. Patient-specific implants, radiomics, liquid biopsy, and cellular therapies are promising, but each requires prospective evidence of improved patient outcomes before broad adoption. Accurate biopsy planning, specialist pathology review, and coordinated sarcoma care remain essential.

Yemeni students in Saudi universities occupy an unusual position. They study abroad, yet in a country that shares their language, religion, and much of their culture, while their families remain in a state that has been at war since 2014. Depression and anxiety are common among international students generally, and recent national data from Yemen show that almost half of Yemeni medical students screen positive for depressive symptoms. What happens to this group once they cross the border into Saudi Arabia has not been described. This study examined the burden of depressive and anxiety symptoms among Yemeni students in Saudi universities, together with the demographic characteristics and levels of perceived social support associated with symptom severity. We conducted a cross-sectional online survey of 137 Yemeni students enrolled at Saudi universities, reported in accordance with the STROBE statement for cross-sectional studies. The questionnaire was offered in Arabic and English and comprised the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 scale (GAD-7), and the Multidimensional Scale of Perceived Social Support (MSPSS). Internal consistency in the present sample was good to excellent (Cronbach alpha 0.84 for the PHQ-9, 0.89 for the GAD-7, and 0.94 for the MSPSS). Crude and adjusted linear regression models were fitted in SPSS. Recruitment was by convenience sampling through student networks and social media, so the analysis is framed as exploratory throughout. Participants were predominantly male (122 of 137, 89.1%) and older than 24 years (95 of 137, 69.3%). Mean PHQ-9 and GAD-7 scores were 8.7 (SD 4.79) and 6.2 (SD 4.51). At the conventional cutoff of 10 or above, 37.2% screened positive for depressive symptoms and 19.0% for anxiety symptoms. Mild to moderate symptoms were reported by 69.3% of participants for depression and 52.6% for anxiety. In models adjusted for age, gender, marital status, family residence, family income, and social support ( n = 134), postgraduate enrollment was associated with higher depression (b = 2.381, SE 1.117, p = 0.035) and anxiety scores (b = 2.243, SE 1.073, p = 0.039), and perceived social support was inversely associated with both outcomes (depression b = -0.111, SE 0.023; anxiety b = -0.091, SE 0.022; both p < 0.001). Depressive and anxiety symptoms were common in this convenience sample of Yemeni students in Saudi universities, and lower perceived social support tracked with a heavier symptom burden. The regression coefficients are small on a per-point basis and the sample is not representative, so these findings are hypothesis-generating rather than population prevalence estimates. Universities hosting Yemeni students should consider brief routine screening, peer-mentoring networks, culturally and linguistically appropriate counseling, and targeted support for postgraduate students.

Background: Pre-clerkship Family Medicine teaching often covers content well but does too little with experiential immersion, structured reflection, and the open engagement with clinical uncertainty that defines generalist work in practice. We describe the partnership-based redesign of the COM353 Family Medicine and Primary Care block at Alfaisal University, Riyadh, with student-reported outcomes from the first delivered cohort. The paper is offered as a worked account of how academic-academic and academic-service partnerships can themselves become curriculum. Pedagogical framework: The redesign rests on three commitments developed in dialog with the Department of Family and Community Medicine at the University of Toronto: generalism as a clinical method that has to be taught deliberately, clinical courage as a disposition that can be cultivated, and community-based practice as a primary site of clinical learning. Teaching is built around an iterative concept-experience-reflection cycle, with didactic sessions, structured Primary Health Care Center placements, simulation, problem-based learning, and reflective writing. Learning environment and pedagogical format: COM353 is a four-week mandatory block for third-year medical students delivered through formal partnerships with Primary Health Care Centers in Riyadh and aligned with Saudi Arabia’s Vision 2030 health workforce priorities. Learning objectives target seven domains spanning generalist competencies, experiential learning, uncertainty tolerance, reflection, and systems thinking. Preliminary results from the first delivered cohort: A post-block survey of the January 2026 cohort produced 96 completed responses (response rate 76.2%). Domain means ranged from 3.90 to 4.27 on a five-point Likert scale, with Cohen’s d 0.92 to 1.58. Multiple linear regression identified Systems Thinking ( β = 0.727), Reflection ( β = 0.295), and Learning Environment ( β = 0.293) as significant predictors of overall block satisfaction, in a model explaining 78.2% of the variance. Discussion and implications: A pre-clerkship block built on explicit pedagogy and run through partnership was associated with coherent, favorable student-reported outcomes across the competencies it set out to develop. That systems thinking emerged as the dominant predictor matters for design: when students grasp healthcare as a system, the rest of the curriculum lands harder. The model has practical relevance for medical schools in Gulf and other LMIC settings working toward PHC-centered health system reform.

Background: Family Medicine and Primary Health Care anchor effective health systems, yet undergraduate curricula have given them limited dedicated space. The COM353 Family Medicine and Primary Care block at Alfaisal University was created to give these areas more dedicated curricular space, combining didactic teaching, Primary Health Care Center (PHCC) visits, structured reflection, and explicit engagement with clinical uncertainty. Methods: We conducted a single-institution, cross-sectional quantitative evaluation of third-year medical students who completed the block in January 2026. A 42-item Likert instrument, adapted from the Dundee Ready Education Environment Measure (DREEM) and the Groningen Reflection Ability Scale (GRAS) with block-specific items, captured perceptions across seven domains. Of 126 enrolled students, 96 responded (76.2%). Analyses included descriptive statistics, internal-consistency reliability, inter-domain correlations, and multiple linear regression. Reporting follows the STROBE guideline. Results: Domain means ranged from 3.90 to 4.27 (of 5), with all domains exceeding the scale midpoint by large margins (Cohen’s d, 0.92 to 1.58). Agreement rates ran from 63.7 to 80.7%. Internal consistency was excellent (Cronbach’s alpha = 0.988 overall; 0.940 to 0.974 across domains). Family Medicine and PHC Competencies achieved the highest mean (4.27) and reflective practice the lowest (3.90). On a single global rating, 87.5% of students rated the block positively (mean 3.80, SD 1.13). Multiple regression with six domains predicting perceived block value explained 78.2% of variance; F (6, 89) = 53.25, p < 0.001. Three domains independently predicted overall evaluation: Systems Thinking (beta = 0.727, p < 0.001), Reflection (beta = 0.295, p = 0.002), and Learning Environment (beta = 0.293, p = 0.013). Despite producing the highest absolute scores, Family Medicine Competencies did not independently predict overall evaluation, likely reflecting shared variance with Systems Thinking (r = 0.874). Conclusion: A purposefully integrated Family Medicine block joining community-based experience, reflective practice, and explicit work with uncertainty appears to produce favorable educational outcomes across multiple domains. Of these, perceiving healthcare as an interconnected system most strongly predicted students’ overall evaluation, suggesting that systems thinking acts as the integrative thread giving other curricular elements coherence.

The 2018 Declaration of Astana reaffirmed Primary Health Care (PHC) as the foundation for universal health coverage and the health-related Sustainable Development Goals, yet the workforce, curricula, and research infrastructure required to deliver that vision remain unevenly developed across regions. This narrative review, prepared in line with the SANRA reporting standard, examines the global field of academic partnerships for family medicine (FM) and PHC education during the 7 years that followed Astana. We synthesize peer-reviewed and gray literature from 2010 to April 2026 across PubMed, Semantic Scholar, ERIC, and the principal FM and global health journals, and we map the evidence to the World Health Organization three-component PHC framework and Starfield’s 4Cs of primary care. We propose a five-modality typology, the AP-PHC Typology, that distinguishes bilateral North-South capacity-building partnerships, multi-institutional North-South networks, South-South peer-learning networks, triangular partnerships, and multilateral convening platforms. Each modality is mapped to its distinctive contribution across the 4Cs and to the WHO components of integrated services, multisectoral action, and community empowerment. The evidence shows that South-South networks such as PRIMAFAMED, the Iberoamerican Confederation of Family Medicine, AfriWon Renaissance, and the South Asian primary care research community have produced contextually grounded curricula, faculty development pathways, and emerging research traditions. North-South initiatives, in turn, have made measurable but uneven contributions to faculty capacity, often constrained by short donor cycles and asymmetric authorship, with cultural translation rarely fully achieved. Academia is the engine room of post-Astana implementation, but only when partnerships are governed by explicit ethical principles, equitable authorship norms, and sustained financing aligned to country priorities. We close with a falsifiable proposition: where academic FM partnerships explicitly embed the Besrour ten ethical principles and demonstrate equitable LMIC-led authorship, program sustainability beyond donor cycles is significantly more likely than where these conditions are absent. Testing this claim should anchor the next decade’s research agenda.

Background: Hormonal contraceptives are widely used worldwide, yet the relationship between contraceptive use and mental health outcomes remains an area of active clinical inquiry, with mixed evidence regarding potential risks and benefits. Family physicians require clear guidance on screening, monitoring, and counseling. Objective: To provide a narrative review of current evidence on the association between hormonal contraceptive use and mental health outcomes, and to offer practical, expert-informed recommendations for family physicians. Methods: We conducted a narrative review of literature published between 2000 and 2025 in PubMed, Cochrane Library, EMBASE, and PsycINFO, examining studies on hormonal contraceptive methods and mental health outcomes (depression, anxiety, and mood disorders) in women of reproductive age. A narrative design was selected because of marked heterogeneity in study designs, formulations, populations, and outcome measures. Methodological quality was self-assessed using the Scale for the Assessment of Narrative Review Articles (SANRA), and the strength of the evidence underlying each conclusion is indicated throughout. Results: Evidence on hormonal contraception and mental health was mixed. Some studies reported associations with increased depression and anxiety; others reported neutral or even protective associations. Individual variability was notable, influenced by age, pre-existing psychiatric history, and formulation. Progestin-only methods and initiation during adolescence were more consistently associated with higher mood-related risks, whereas certain combined oral contraceptives, particularly those with anti-androgenic progestins, were associated with better outcomes or mood stabilization. Because most evidence is observational, these associations cannot establish causation and are susceptible to confounding by indication, reverse causation, and selection effects including the healthy-user phenomenon. Conclusion: Given this variability, clinicians should prioritize individualized risk assessment, informed counseling, and close monitoring. Tailoring contraceptive choices to each woman’s mental health history is likely to support both reproductive autonomy and emotional well-being. The screening, risk-stratification, and monitoring approaches proposed here represent expert-informed clinical guidance rather than formal practice standards, and their feasibility will vary across primary care settings. Future research should focus on longitudinal designs, standardized outcomes, and diverse populations.

Gastrointestinal basidiobolomycosis (GIB) is a rare invasive fungal infection of immunocompetent hosts that is endemic to Saudi Arabia and the wider Gulf region. Its presentation overlaps with inflammatory bowel disease (IBD), intestinal tuberculosis and malignancy, and many patients reach a definitive diagnosis only after surgery. We report a 39-year-old Saudi woman who presented with a 7-day history of right lower quadrant pain and non-bloody watery diarrhea. Initial bloods showed an elevated C-reactive protein of 21.5 mg/L, an erythrocyte sedimentation rate of 44 mm/hour and an absolute eosinophil count of 0.54 × 10³/µL. Contrast-enhanced computed tomography (CT) demonstrated segmental wall thickening of the terminal ileum, cecum and proximal transverse colon, with a 3×5 cm intramural cecal collection. Colonoscopy revealed ulcerated congested mucosa and an ileocecal stricture; targeted biopsies showed an eosinophil-rich granulomatous inflammation with broad, sparsely septate fungal hyphae demonstrating the Splendore-Hoeppli phenomenon, positive on Grocott methenamine silver and periodic acid-Schiff stains; and tissue culture grew Basidiobolus spp. Interventional radiology and surgical drainage were considered but were technically not feasible because of the intramural location, so the patient was managed medically with oral itraconazole at 200 mg every 8 hours for 3 days followed by 200 mg once daily, with monthly liver enzyme monitoring. Surgery was avoided. A repeat CT scan at 2 months showed near complete resolution of wall thickening, and follow-up colonoscopy at 5 months was normal. The patient self-discontinued itraconazole at 9 months because of symptom resolution and remained asymptomatic at follow-up 2 months later. Clinicians working in endemic regions should consider GIB in any patient with an ileocecal mass or abscess, eosinophilia and an IBD-like presentation, because early biopsy with fungal stains and prompt azole therapy can avert surgery.

Background: Lower urinary tract symptoms (LUTSs) are among the most common urological complaints in older men, frequently arising from benign prostatic hyperplasia (BPH) or prostate cancer (PCa). While both conditions share overlapping symptomatology, the way each condition progresses and is managed differs considerably. In sub-Saharan Africa, data on the relative burden of BPH and PCa among men presenting with LUTSs are scarce. This study aimed to determine the prevalence of histologically confirmed BPH and PCa among men presenting with LUTSs at a major tertiary referral center in Tanzania and to explore the association between specific urinary symptoms and histopathological diagnoses. Methods: A retrospective cross-sectional study was conducted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania, reviewing medical records of adult male patients aged ≥50 years who presented with LUTSs and underwent prostatic biopsy between January and December 2023. A total of 133 patients were included through simple random sampling from an eligible population of 260. Data on demographics, comorbidities, International Prostate Symptom Score (IPSS), serum prostate-specific antigen (PSA), prostate volume, and histopathological biopsy outcomes were extracted using a purpose-built digital form. This study was conducted in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Most patients (39.8%) were aged 70 to 79 years. Hypertension was the most frequent comorbidity among those with chronic disease (31.65%), followed by diabetes mellitus (12.03%). The mean serum PSA was 465.1 ng/mL (SD = 1610.1), and the mean prostate volume was 80.6 cm³ (SD = 75.6). Histopathologically, 57.9% of biopsies were benign and 40.6% were malignant. The most commonly reported IPSS symptoms were urinary frequency (78.2%), weak stream (78.2%), and incomplete emptying (64.7%). Most patients (59.4%) had severe IPSSs. Statistically significant associations were observed between biopsy outcomes and incomplete emptying (p = 0.011), frequency (p = 0.014), weak stream (p = 0.022), nocturia (p = 0.001), urge incontinence (p = 0.004), and post-void dribbling (p < 0.001). IPSS severity was significantly associated with biopsy diagnosis (p < 0.001), with 63% of malignant cases presenting with moderate symptom scores. Conclusions: BPH was the predominant histopathological diagnosis among men presenting with LUTSs at this tertiary center, while prostate cancer accounted for a substantial minority of cases. Certain individual LUTSs, particularly nocturia, urge incontinence, and post-void dribbling, demonstrated significant associations with malignant histopathology. These findings underscore the necessity for systematic histopathological evaluation in all men presenting with LUTSs in resource-limited settings, irrespective of symptom severity.

Background: Human papillomavirus (HPV) vaccination represents a critical public health intervention for preventing HPV-related cancers, yet global uptake remains suboptimal due to cultural beliefs and misconceptions. This narrative review examines the multifaceted barriers to HPV vaccination acceptance across diverse populations. Methods: We conducted a comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar for articles published between January 2010 and December 2025. Search terms included combinations of HPV vaccination, cultural beliefs, misconceptions, barriers, and vaccine hesitancy. Articles were screened for relevance to cultural and social determinants of HPV vaccine uptake. Results: Cultural and religious beliefs significantly influence HPV vaccination decisions across global populations. Common misconceptions include concerns about vaccine safety, fears regarding sexual promiscuity, and misinformation about vaccine efficacy. Structural barriers such as healthcare access, cost, and provider recommendation practices compound these challenges. Successful intervention strategies incorporate community engagement, culturally tailored education, and healthcare provider training. Conclusion: Addressing HPV vaccination barriers requires multifaceted approaches that respect cultural contexts while providing evidence-based education. Future research should focus on developing and evaluating culturally sensitive interventions across diverse populations.