1,354,384 research outputs found
Upward migration of ureteric stone in a military trainer: a case report
No full textMoayid Fallatah,1 Sakher Tahaineh,2 Rawan Abu Mughli,3 Seddig M Fallatah1 1College of Medicine, Umm Al-Qura University, 2Urology Department, 3Radiology Department, Security Forces Hospital, Makkah, Saudi Arabia Abstract: Retrograde ureteric stone migration is an extremely rare phenomenon with only one previously reported case in the literature. We report on a case of upward spontaneous migration of a ureteric stone in a 39-year-old male military trainer in Saudi Arabia who was diagnosed with upper left ureteric stone based on non-contrast spiral computerized tomography kidney ureter bladder (CT-KUB) scan. The plan was to treat the patient conservatively with alpha blockers and oral hydration. Two weeks after treatment started, repeated CT-KUB scan revealed an upward migration of the stone to the left renal calyx. Accordingly, we highly recommend performing a prior stone localizing imaging test to avoid unnecessary procedures or operations. Keywords: ureteric stone, upward migration, reversed peristalsis, excessive exercise
Factors affecting external audit quality: the case of listed companies in Saudi Arabia
No full textThis study explores the factors affecting external audit quality in non-financial listed companies in Saudi Arabia (SA). In particular, it provides new insights by using an integrated research design framework. The study seeks to: (i) investigate the relationship between external audit quality and certain corporate governance characteristics in SA, namely, boards of directors, audit committees, and internal auditors, and (ii) find strategies that can be undertaken to enhance external audit quality in SA. Agency theory predicts that external auditors and corporate governance play a vital role in enhancing external audit quality. Ordinal Logistic regression was used to investigate the association between the variables. Semi-structured interviews and a questionnaire survey were implemented to attain a deeper understanding of the phenomena.To achieve the research goals, the researcher investigated the perceptions of boards of directors, audit committees, and internal auditors regarding external audit quality, using questionnaires, while the perceptions of external auditors were investigated by using interviews. Moreover, the ordinal logistic regression models were examined to test the hypotheses using a set of questionnaires. The decision to employ a mixed-methods research design was motivated by the recent calls for, and relative lack of, mixed-methods approaches in external audit quality research in general. Efforts were made to achieve integration between the two different research designs by applying the Convergent Parallel Design suggested by Creswell and Clark (2011). The researcher collected and analysed both quantitative (survey) and qualitative (interview) data separately, at the same time, and then combined the findings of the two approaches, which was achieved by merging the data and then comparing and contrasting the two sets of data and the results.The findings of the study showed that audit practice in SA was experiencing difficulties, because of the auditors’ lack of competence, their lack of training, lack of expertise and specialisation, lack of independence, and the length of tenure of the audit, all of which affected external audit quality. Regarding audit committees, there was a lack of knowledge and a lack of awareness of members’ responsibilities, a little time was taken to attend meetings and a lack of financial expertise. The findings relating to boards of directors showed that there were infrequent meetings, a lack of requesting speedy financial statements, and a low existence of personal relationships. With regard to internal auditors, the findings showed that there was a lack of education, and of independence. Additionally, corporate governance mechanisms in SA suffered from the absence of detailed regulations, non-implementation of the regulations, and a lack of control by regulators. Finally, the findings obtained from this study led to some suggestions to enhance the level of external audit quality and corporate governance practices in SA
Exploring Type Two Diabetes Mellitus in the Kingdom of Saudi Arabia: Studying the Socio-economic Environment
No full textType two diabetes mellitus (T2DM) is a global public health challenge, yet the socio-economic factors that contribute to this remain largely unexplored. This high burden of T2DM has profound economic and societal impact, particularly in the Gulf Cooperation Council (GCC) countries, where the oil-boom in the Arabic Gulf region has led to unprecedented growth and urbanisation. Saudi Arabia stands out as one of the countries with the highest prevalence of T2DM worldwide. Rapid socio-economic development in the Kingdom has resulted in lifestyle changes and concomitant changes in non-communicable disease epidemiology. Despite this, there are few national studies exploring the relationship between socio-economic factors and T2DM in Saudi Arabia. In this thesis I address this deficit by investigating the association between education level and the prevalence, diagnosis, and control of T2DM in Saudi Arabia. I explore and evaluate the impact of demography and geographical location together with socio-economic, lifestyle, healthcare access and behavioural factors such as self-care on T2DM outcomes.I first explore the association between education level and T2DM prevalence in Saudi Arabia and show an inverse association. The prevalence of T2DM is elevated among groups with low education level, together with those who are older, obese, and lived in Southern region. Additionally, the findings support projections in which the prevalence of T2DM continues to increase up to 2030. I then investigate individuals with diagnosed T2DM and analyse the association between education level and other risk factors on the diagnosis of T2DM. These analyses confirm that age and low household income are highly associated with achieving diagnosis of T2DM. Based on these findings, I then develop two prediction models for undiagnosed diabetes and pre-diabetes by considering education level and socio-economic factors. Development of the prediction models established that age, administrative region, and body mass index are the three main predictors of undiagnosed diabetes, although gender and hypertension also emerged as predictors for the compound outcome of undiagnosed diabetes or pre-diabetes.In the final analysis, I investigate whether education level is associated with achieving control of diabetes through interaction with health-care access and self-care factors. Administrative region, prescribed diet and adherence to medication emerged as key predictors of controlled diabetes. The association with administrative region reflected differences in patterns of T2DM management relating to medication and behavioural modification interventions. My findings indicate that T2DM management forms vary between regions and that the success of lifestyle management approaches is influenced by patients' socio-economic characteristics. The work described in this thesis establishes that education level is associated with the prevalence of diagnosed T2DM.However, among other socio-economic factors, administrative region stands out as a significant predictor of diagnosed T2DM, undiagnosed T2DM and achieving effective control of T2DM. These findings have important implications for primary prevention of T2DM in Saudi Arabia through population approaches, especially in poorer or more deprived groups. They inform strategies to improve the early diagnosis of T2DM in such groups and suggest approaches to gain better glycaemic control in individuals with diagnosed disease. A combination of these two approaches will prevent complications and improve the quality of life for patients with T2DM
Combination of immune stimulatory strategies to promote anti-tumour immunity
No full textCD8+ T cells can kill cancer cells but are tightly regulated by receptors that confer positive or negative signals. Members of the tumour necrosis factor receptor superfamily (TNFRSF) can improve the responses of antigen-specific CD8+ T cells by enhancing their survival, proliferation and differentiation into effector and memory T cells. However, the roles of different members of the TNFR superfamily on CD8+ T cell function has not been fully explored. The aims of this thesis were therefore to investigate the effects of stimulation through different TNFRSF members on augmenting CD8+ T cell responses, controlling tumour growth and CD8+ T cell differentiation into memory cells. Initially I compared the efficacy of agonist antibodies to TNFRSF members CD27, GITR, 4-1BB and OX40 for their ability to expand adoptively transferred gp100-specific pmel-1 tumour-reactive CD8+ T cells in vivo. Anti-CD27 was the most potent agonist and further combined with the TLR ligands PolyI:C and LPS and with inhibitors of the check-point receptor PD-1 to enhance the accumulation of T cells. For anti-tumour immunity, adoptive T cell transfer and anti-CD27 as a monotherapy was ineffective against a lethal dose of melanoma. However anti-CD27 synergised with PD-1/L1 blockade to confer long term protection dependent on co-transfer of tumour-reactive CD8+ T cells. This combination treatment increased the frequency of adoptively transferred cells, and their expression of effector molecules such as granzyme B, IFN-훾 and TNF-훼 and the transcription factor T-bet, which is associated with T cell effector function. Interestingly in a colon carcinoma model, while anti-CD27 as a monotherapy conferred protection to a minority of mice, this did not synergise with PD-1 blockade. I found that colon carcinoma cells express less PD-L1 compared with melanoma cells suggesting that the efficacy of PD-1 blockade may depend on local concentrations of PD-L1. I then investigated whether the rat anti-mouse CD27 mAb was still effective when converted to a syngeneic isoform to move towards clinical therapy. I found that anti-CD27 of the mouse IgG1 isotype was an effective agonist whereas, when converted to a mouse IgG2a form, CD27 positive cells were depleted. Finally, across all experiments I noted that adoptively transferred pmel1 CD8+ T cells did not persist after contraction and, in contrast to previous work, IL-2 and the mTORC inhibitor rapamycin did not lead to their increased maintenance. The affinity of pmel-1 cells for gp100 peptide is relatively low. To gain insight into whether the affinity of the TCR/peptide interaction influences memory CD8+ T cell generation, I made use of OT-1 TCR transgenic mice for which a range of altered peptide ligands of different affinities have been described. These data revealed that the magnitude of the primary CD8+ T cell response is dependent on both peptide affinity and density. However OT-1 CD8+ T cells differentiated into memory T cells and expanded equally after secondary stimulation following priming with either the low or high affinity peptide in the presence of anti-CD27. Moreover, the combination of anti-CD27 plus PD-1/PD-L1 delivered with either the low or high affinity peptide synergised for increased OT-1 CD8+ T cell expansion and anti-tumour immunity. Together my data show that anti-CD27 and PD-1/L1 blockade may be a particularly potent combination for enhancing low affinity CD8+ T cells specific for cancer cells<br/
Pain knowledge and attitude survey among health-care professionals at a university hospital in Saudi Arabia
No full textBackground: There is growing awareness in the hospital setting toward pain management to decrease patients' suffering, improve postsurgical outcomes and to decrease cost.
Objective: The aim of this study was to get an overview of the knowledge and attitude among health-care professionals toward pain management in the King Fahd Hospital of the University, and the need for an educational plan to improve pain service in hospitals.
Materials and Methods: We conducted a survey over a 3-month period based on a 30-question questionnaire to test pain knowledge and attitude among nurses and physicians of different specialties, the level of education and years of experience.
Results: The results of the data showed that knowledge and attitude of pain were deficient and unsatisfactory.
Conclusion: We concluded that efforts to spread knowledge and education of proper pain management among health-care professionals are required. Further surveys involving more hospitals are warranted
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Successful management of complex regional pain syndrome type 1 using single injection interscalene brachial plexus block
No full textComplex regional pain syndrome (CRPS) type 1 of the upper limb is a painful and debilitating condition. Interscalene brachial plexus block (ISB) in conjugation with other modalities was shown to be a feasible therapy with variable success. We reported a case of CRPS type 1 as diagnosed by International Association for the Study of Pain criteria in which pharmacological approaches failed to achieve adequate pain relief and even were associated with progressive dysfunction of the upper extremity. Single injection ISB, in combination with physical therapy and botulinum toxin injection, was successful to alleviate pain with functional restoration
Variations on the Author
No full text“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Xanthogranulomatous Pyelonephritis: A Retrospective Study of 10 Cases and Review of the Literature
No full textWe herewith report 10 patients with xanthogranulomatous pyelonephritis (XGP) who were treated in our department between the years 1988 and 2000. The patients′ age ranged from 20 to 60 years (mean 45 years); there were seven males and three females giving a male-female ratio of 2.3:1. Sixty percent of the patients were over 50 years old. The lesion was unilateral in all cases and pyonephrosis was found in seven patients. Nine cases had associated renal stones (90%), which led to non-functioning kidney in all these cases. Two cases had associated fistulae (one uretero-colonic fistula and one reno-cutaneous fistula). One case of focal XGP was found to be associated with renal cell carcinoma while a second patient with diffuse obstructive type of XGP and renal stone had associated transitional cell carcinoma of the renal pelvis. In all patients, the urine culture was negative. Pus culture revealed Escherechia coli in four cases (40%), Salmonella Para B in one, and no organism could be grown in four other cases. One case did not have any pus. All patients were treated with nephrectomy
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