Showing papers in "International journal of health sciences in 2012"

Epidemiology of Road Traffic Injuries in Qassim Region, Saudi Arabia: Consistency of Police and Health Data

Abstract: INTRODUCTION: In Saudi Arabia, road traffic accidents (RTA) are becoming a serious public health problem. Police reports are designed for legal purposes with very little information on the health consequences. Also, health system data include detailed health information, but not related or linked to the data obtained police reports. Examining the consistency of these sources is vital to build an accurate surveillance system that can track the risk factors and the health consequences, as well as establishing and evaluating prevention interventions. OBJECTIVES: This study is intended to: ▪ Examine the consistency of health -registration data with the data gathered by the traffic police department.▪ Elucidate the magnitude, risk factors and outcome of RTI in Qassim region of Saudi Arabia,▪ Compare the pattern of accidents in Qassim with those at different regions of the Kingdom. METHODOLOGY: Health care information was collected on visits of victims of road traffic accidents to emergency and outpatients' departments of the major hospitals in Qassim region during the year 2010. The information included the patients' demographics, and clinical characteristics. Traffic Police Department information was also collected on all accidents that occurred in the study region. A Questionnaire was also developed and pilot tested to collect data from a random sample of population attending hospital outpatient and Primary Health Care clinics. Data included previous involvement in road traffic accident, and information about any injury; fatality or disability due to these RTI. RESULTS: During the study period, road traffic death rate based on death registration data was almost twice as high as the rate reported by the police (P 7 days is more than twice in females.. Also a total of 12 deaths due to RTI were reported in 5-49 years age group in the last 3 years, representing an estimated annual RTI mortality rate of 35.4/100,000 (95% CI 16.6 - 57.8). A total of 11 participants reported RTI related disability in the last 3 years representing an estimated annual RTI disability rate of 34.1/100,000 population (95% CI 11.4 - 55.7). Reports of the Traffic Police Department showed that 18623 accidents occurred throughout the year 2010. These accidents involved 23178 persons, and resulted in the injury of 2025 people and the deaths of 369. In contrast, the health system reports showed that 4232 people had been injured and 1054 had died. Comparison with local & Arab Rates showed that Qassim is among the highest 5 regions in the kingdom regarding the number of RTA Saudi Arabia is also having a very high level of road traffic accidents and fatalities compared to other Arab countries. CONCLUSION: RTI are responsible for significant loss of life, disability and injury in Qassim population and in Saudi Arabia. The inconsistency between police-reported data and health system data strongly suggests that active efforts to audit and monitor data quality are clearly necessary. Language: en

Anal cancer - a review.

Abstract: Anal cancer accounts for only 1.5% of gastrointestinal malignancies but this disease has shown a steady increase in incidence particularly in HIV positive males. The understanding of pathophysiology and treatment of anal cancer has changed radically over last thirty years. Risk factors have been identified and organ preservation by chemoradiotherapy has become a standard. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for anal cancer in the light of current literature.

Vitamin D status among Adult Saudi Females visiting Primary Health Care Clinics

Abstract: Background : Vitamin D plays an important role in diverse physiological functions in addition to its role in bone health. Vitamin D deficiency is very common in elderly people, but there are few reports on its prevalence in young adults. Method: A cross-sectional study was carried out on a total of 465 young adult Saudi females aged 19 to 40 years old who were selected from primary health care centers of King Abdulaziz medical city, Riyadh, KSA. A questionnaire was used to identify socio-demographic characteristics and risk factors such as sunlight exposure and dietary intake. 25-hydroxy vitamin D [25(OH)D], Parathyroid hormone (PTH) and bone biochemical parameter were measured. The cutoff values for Vitamin D were defined as follows: deficient (<25nmol/L), insufficient (25-75 nmol/L) and normal (≥ 75 nmol/L). Result : Overall, hypovitaminosis D were identified in all participants, with a mean level of 18.34 ±8.2 nmol/L. Of all the participants, 79.1% exhibited severe vitamin D deficiency (serum 25(OH) D < 25 nmol/L), while 20.9% exhibited vitamin D insufficiency (serum 25(OH) D between 25-50 nmol/L). There was a significant inverse correlation between serum 25 (OH) D concentrations and PTH, where secondary hyperparathyroidism was evident in 61.4% of participants with deficient vitamin D compared to 39.2% of participants with insufficient vitamin D. Conclusion: Despite the abundant sunlight in Saudi Arabia, the prevalence of hypovitaminosis D among young healthy Saudi females is 100%. This finding should be considered a public health problem. Case identification, health education and prevention should be encouraged. Keywords: Vitamin D, prevalence, women, Saudi, secondary hyperparathyroidism, sunlight, dietary supplement.

The Bethesda System for Reporting Thyroid Cytopathology: A Five-Year Retrospective Review of One Center Experience

Abstract: Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. Objective: The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. Materials and methods : A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005- Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. Results: Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. Conclusion : Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs. Â

Surgical site infections: A one year prospective study in a tertiary care center.

Abstract: Background: Surgical Site Infections (SSI) is the third most commonly reported nosocomial infection which has an adverse impact on the hospital as well as on the patient. A continuous surveillance is called for, to keep a check on the occurrence of SSI. Objectives : a) to study the incidence of SSI in our hospital. b) to study the risk factors of SSI in our hospital. c) to identify the areas in our hospital, which need to be strengthened and dealt with proactive measures to curb the incidence of SSI, which is an indicator of health care system in a given set up. Methodology : We conducted a one year study of SSI in our hospital. 300 cases of Surgery and Obstetrics and Gynaecology were included in the study. A few host factors, wound factors and surgery related factors that cause SSI were studied. Swabs were collected from the infected surgical wounds and processed by the conventional microbiological methods. Antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method. Results : Prolonged surgery (>2hours) and insertion of drain were found to be significantly associated with occurrence of SSI and the clean surgeries showed minimum risk of infection. Escherichia coli (31.25%) was the commonest pathogen, followed by Pseudomonas aeruginosa (25 %) and Staphylococcus aureus 22% . The incidence of SSI in our set up is 6%. Conclusions : The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) decrease the duration of the surgeries performed b) focus on regular and intensive drain care c) identify poor risk patients and ensure their proper management d) conduct periodic surveillance to keep a check on SSI. Key words : SSI, incidence, risk factors, clean surgery, pathogen

Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting

Abstract: Background: DPN is an important complication and contributes to the morbidity of diabetes mellitus. Evidence indicates early detection of DPN results in fewer foot ulcers and amputations. Objective: The purpose of this study was to compare different screening tests in the detection of DPN in primary care setting. Methodology: It is a cross-sectional study in a random sample (N = 242) of type 2 diabetes mellitus participants at primary care setting. Different screening tests for detecting DPN such as Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein Monofilament (SWM), vibration sensation and ankle reflex were performed for each patient and compare between them. Results: 45% of the participant had DPN based on MNSI, The detection rate using the 128-Hz tuning fork and 10-g SWM was nearly same (32.6 & 31.4%) respectively and significantly higher than ankle reflexes (23.1%). Although, the prevalence of DPN determined by the combined two tests (38.79%) was higher than that through the single test. Conclusion: this study showed different results of DPN screening tests, even in the same group of patients. However there was a significant correlation between them. 128-Hz tuning fork and 10-g SWM monofilament would appear to be an appropriate, cheap and easy to use tool for identifying patients at risk of having neuropathy in primary care setting.

Antimicrobial Irrigants in the Endodontic Therapy

Abstract: This paper highlights the importance of root canal disinfection. It discusses the different endodontic irrigants available and comments on how these can be used most effectively. Eliminating bacteria from the root canal system is an essential stage in endodontic therapy. An objective of endodontic treatment is removal of diseased tissue, elimination of bacteria from the canal system and prevention of recontamination. (1) Disinfection of the root canal system, as part of endodontic therapy, by preparation and irrigation is a key in reducing the number of bacteria within the root canal and helping to control periapical disease.

Otomycosis with Perforated Tympanic Membrane: Self medication with Topical Antifungal Solution versus Medicated Ear Wick

Abstract: Objectives: In otomycosis with tympanic membrane perforation, many physicians prefer to insert an ear wick medicated with antimycotic cream. This needs multiple visits to the clinic and keeps the ear blocked for several days. Direct instillation of alcohol based antimycotic solution causes severe burning if it reaches the middle ear. In this work we compare patient’s self medication with clotrimazole antimycotic solution used on Q-tips with physician–inserted ear wicks; in terms of safety, efficacy and patient satisfaction. Study Design & Setting: Prospective controlled study in ambulatory setting. Methodology: Forty consecutive patients with otomycosis with tympanic membrane perforation were included in the study. Diagnosis of otomycosis was both clinical and with mycological culture. Mean pure tone average (PTA) in the involved ear was measured after cleaning fungal debris. Patients were then, randomized into two groups; Q-tip group patients (n=20) were taught to self-medicate their ears two times daily with the clotrimazole solution on suitable Q-tips for three weeks. In ear wick group (n=20), a gauze wick impregnated with clotrimazole cream was inserted in the ear. Wick was changed every third day for two more visits (one week overall). Patients were followed up for 3 months. Results: After three weeks all patients in Q-tip group and ear wick group had relief of their ear itching and complete disappearance of fungal growth in the deep meatus and on the tympanic membrane. PTA was 22+11dB in Q-tip group and 25 +. 12 dB in ear wick group; the difference was not statistically significant (p= 0.11). Patients in ear wick group had sense of ear blocking and wetness during period of treatment. Transient burning sensation was reported by 2 patients in Q-tip group. During three months, there was recurrence of otomycosis in 5 patients from ear wick group and no recurrence in Q-tip group (p=0.04). Conclusion: Self medication with clotrimazole solution on Q-tips and physician inserted medicated wicks are equally safe in treating otomycosis with perforated tympanic membrane. However, self medication with antimycotic solution on Q-tips gives more patient satisfaction and less rate of otomycosis recurrence.

Association of MTHFR C677T and A1298C gene polymorphisms with hypertension.

Abstract: Objectives. To check for the association of genetic polymorphisms related to the methylenetetrahydrofolate reductase (MTHFR) gene namely C677T and A1298C with hypertension in Saudi affected subjects from Qassim region. Subjects and methods: Participants included 123 Saudi hypertensive cases (83 males and 40 females) in addition to 250 (142 males and 108 females) unrelated healthy controls from the same locality. Their age mean ±SD was 50.93 ± 15.43 years. For all subjects, DNA was extracted followed by real-time PCR amplifications for characterization of genotypes and alleles related to MTHFR C677T and A1298C gene polymorphisms Results: Total cases showed significantly higher carriage rate for the mutant allele 677T compared to controls (40.7% vs. 26%, OR=1.9, 95% CI= 1.2-3.1) with a lower frequency of the wild type 677CC genotype (59.3% vs. 74%, p=0.004). The same was observed among cases-subgroups of hypertension associated with obesity with a notably higher odds ratio (OR=2.6, 95% CI=1.3-5.01, p=0.004). Total cases showed also significantly higher frequency of mutant 1298 C allele carriage rate compared to controls (59.3% vs. 42.4%, OR=1.98, 95% CI= 1.3-3.1) with a lower frequency of the normal AA genotype (40.7% vs. 57.6%, p=0.003). The same was observed among cases-subgroups of hypertension associated with both diabetes and obesity and among cases of hypertension with obesity, also with higher odds ratio (OR=2.6 and 2.2 respectively). Conclusion. This work showed that genetic polymorphisms related to the MTHFR gene are associated with the risk of hypertension particularly when accompanied with obesity and diabetes among Saudi subjects.

Academic Accreditation Process: Experience of a Medical College in Saudi Arabia

Abstract: Objective: This study aims to describe effects of the accreditation process of the National Commission for Academic Assessment and Accreditation (NCAAA) and its impact on the quality of medical education in one medical college in Saudi Arabia, and determines the extent to which the tools used for this purpose (the NCAAA Standards) are applicable to medical colleges. Methodology: We conducted a semi-qualitative study in Qassim University College of Medicine, where an accreditation exercise led by NCAAA was recently completed. Data pertaining to applicability and impact of the accreditation process were collected through semi-structured interviews, focus-group discussions and structured questionnaires. Data were aggregated and analyzed and compared with information prior to accreditation, where available. Results: The accreditation process lasted about two years, culminating in the preparation of a self-evaluation report and a visit of external reviewers. The process itself brought significant changes in the educational processes and administration and implementation of the curriculum. Our analysis also indicated significant improvements in the quality of medical education in the College. However, there were questions about the applicability of the NCAAA accreditation process on medical education. The process can be modified to suit the special requirements of medical colleges in Saudi Arabia. Conclusions: NCAAA accreditation process was successful in improving the quality of medical education, without imposing radical changes in curriculum philosophy or orientation. Better measurement of students learning outcomes, regular review and updating of the quality standards and continuous quality improvement are anticipated to deliver better medical education in the college.

Increasing trend of Junk food use in Saudi Arabia and health implications

Abstract: In Saudi Arabia there is increasing trend of junk food use. Combined with sedentary life style, high prevalence of obesity, diabetes mellitus, hypertension and coronary heart disease, it is detrimental to health and will aggravate existing life style diseases in the country. People here eat more consuming more quantity with less quality. The fast food market in Saudi Arabia is expected to reach $4.5 billion in gross sales by 2015, driven by growing demand from its population. (1) Fast food is a major enterprise in Saudi Arabia. The major chains like Mc-Donald’s, Pizza Hut, Burger King, Hardees, Little Caesars, Subway, Dunkin Donuts to name a few. Most meal packages with fries and coke run around 15–20 SAR. Beside multinational food chains some national brands are Al-Baik, Shawerma Joha and Kudu are available. (2) Junk food, fast food and trash food are all definitions of a quick, unhealthy, hunger satisfying food, which are easy to make and easy to consume. They are low in nutritional value with a high caloric value. The term ‘Junk food’ was coined by Michael Jacobson, director of Center for Science in 1972. Junk food contains high level of refined sugar, white flour, polyunsaturated fats, salts and numerous food additives but lacking in protein, vitamin and fibers. Junk food is popular because of their simplicity of manufacture, consumption and good taste. (3) Junk foods as burgers, pizza, fried chicken and chips usually has high amount of saturated fats. Fats cause people to put on weight and being overweight is a risk to heart and causes other disease as obesity and diabetes. Junk food often has too much salt which may make hypertension worse. Similarly soft drinks, cordials, biscuits, cakes have huge amount of sugars which makes people fat and has bad effect on the teeth. Various types of junk food is available in market out of which the most popular junk food are soft drink, pizza, hamburgers, potato chips, ice-creams, hot dog, French fries, cheese chili, etc. Junk food addiction is high as it’s easy to prepare and are tasty. Peoples prefer to eat them while watching TV, they save themselves from lot of hassles and time when they are in a hurry as they are served at their door step hot and ready to eat. (4) If time constraint is one reason that pushes peoples to eating junk food, great taste also, to an extent influences them to opt for junk food. But junk foods get their taste owing to lavish usage of oils, salts and sugar. Junk food advertising has a major role in its promotion. There is also concern about the targeting to children and adolescents because they are easy and potential target for junk food. Similarly transportation of junk food is easy due to its packaging and cost is less as compared to healthy food. The nutritional value of junk food is least, the nutritional value is lost in the process of making the junk food so synthetic vitamins and minerals are added to it, but they are not good compared to natural vitamins and minerals. Junk food has lots of chemical additives which are not useful to body like artificial coloring and preservatives.

Perceived Sources of Stress among Junior & Mid-Senior Egyptian Dental Students.

Abstract: Objectives: The purpose of this study was to identify the sources of stress among dental students enrolled at Pharos University in Alexandria (PUA) - Egypt, and to explore the role of gender, level of undergraduate study and residence with parents on perceived stressors. Materials and Methods: A thirty-item self-reported modified version of the Dental Environment Stress (DES) questionnaire was administered to 537 junior and mid-senior undergraduate dental students during the academic fall semester 2010, with a response rate of 79.89%. Results: Workload, performance pressure, and self-efficacy beliefs constituted the most stress-provoking factors. Female students experienced greater stress than males for all stressor items except for “Self-Efficacy Beliefs” and “Faculty & Administration” with no statistically significant difference by gender. Mid-senior dental students registered higher levels of perceived stress for “Workload”, “Self-Efficacy Beliefs”, and “Personal Factors” stressors in comparison to their junior peers. Those students who lived away of their parents were at higher risk of perceived stress than those students who lived with their parents. “Uncertainty about future dental career” was the first best predictor variable by gender. Whereas, “Difficulty of classwork” was the first predictor variable by both level of undergraduate study and residence with parents. Conclusion: Female dental students had higher mean overall problem scores compared to their male counterparts, mid-senior students showed some higher perceived problems compared to junior students, and students who lived away from their parents revealed higher levels of perceived stress.

Water Pipe & Cigarette Smoking among Qassim University Male Students: Prevalence and Beliefs.

Abstract: OBJECTIVE The main objective of this study was to investigate the prevalence and beliefs of water pipe & cigarette smoking among Qassim University male students. METHODOLOGY A cross-sectional survey was conducted among the students of Literature Colleges, Health Colleges of Qassim University and a self-administered, anonymous, pre-structured, designed proforma was distributed among randomly selected group of 500 male university students during January 2011. The questionnaire was designed to ask specific questions that are related to cigarette smoking and water pipe smoking in general and their belief regarding smoking. Statistical analysis was done using SPSS software. RESULTS The total prevalence rate of waterpipe smoking was found to be 40% and Cigarette smoking was 41%. The major prevalence was found among the students of Health College (50%) then Science College (38%) and Literature College (12%). Cigarette smoking, smoking among relatives and friends has significant association (P<0.05) with prevalence of waterpipe among university students, while residence, income and marital status do not have any significant effect on water pipe smoking. CONCLUSIONS Approximately more than one-third of the students currently smoke waterpipe. Smoking of both cigarette and waterpipe was frequently found and it is precipitated with the same habits in family and friends.

BRCA 1 & 2 mutations in Sudanese secondary school girls with known breast cancer in their families

Abstract: Objective: Breast cancer is a major cause of morbidity and mortality as the commonest cancer in women worldwide. In Sudan, it is the most commonly diagnosed cancer. This study  assesses the prevalence of BRCA1 and BRCA2 mutations among female students with a family history of breast cancer, in secondary schools of Marawi Locality, Northern State, Sudan. Methods: From a survey of 2370 students, 67 cases were analyzed for BRCA1 and BRCA2 mutations with a single-stranded conformation polymorphism (SSCP) mutation detection method applied to peripheral blood. Eighteen subjects knew of first degree female relatives with breast cancer, 23 with second degree female family members affected and 6 with related male sufferers. Tenty randomly selected girls from the remainder of the survey population with no known family history were also tested. Results: The breast cancer susceptibility genes BRCA1 and BRCA2 accounted, respectively, for 1.21% of responders or 51% of those claiming a family history. Mutations were found in 20% of the group selected with no family history. Only 2 BRCA 2 mutations were found, both in girls with no known afflicted relatives. Six girls knew of male relatives with breast cancer; five of these girls carried mutant BRCA 1. Most of the BRCA1- mutations located to exon 11 fragment 11.9 and 11.1. Conclusion: The study indicates a high prevalence of genetically associated breast cancer in the Marawi locality suggesting a need to focus on the two mutation sites in developing screening protocols for at least this area of Sudan. Â

Emergence of Potential Superbug Mycobacterium Tuberculosis , Lessons from New Delhi Mutant-1 Bacterial Strains

Abstract: Recent reports have shown that certain bacterial strains attain the New Delhi Metallo-beta-lactamase-1 (NDM-1) enzyme and become resistant to a broad range of antibiotics. Similarly, more dangerous "superbugs" of multi-drug resistant (MDR) and extensive drug resistant (XDR) Mycobacterium tuberculosis strains are gradually emerging through rapid genetic mutation caused by prescription non-compliance or unsupervised indiscriminate use of anti-tubercular drugs or other antibiotics. Mycobacterium tuberculosis cases have been reported in highly susceptible population groups including the aboriginal communities of US and Canada. In Canada alone, the total number of reported tuberculosis cases has decreased over the past decade. However, there is a steady increase in HIV cases in certain communities including the aboriginal communities. Reintroduction of MDR/XDR strains of tuberculosis is possible in these susceptible communities, which in turn may pose serious public health situation. MDR/XDR strains of tuberculosis are virtually untreatable using current anti-tubercular medication protocols. Thus, MDR/XDR tuberculosis presents a grave global public health threat. The unpredictable genetic mechanism involved in generating MDR/XDR resistant strains of Mycobacterium tuberculosis may pose greater challenges in developing appropriate treatment strategies. In this article, we briefly review potential genetic mechanism of emerging NDM-1 bacterial strains and draw a rationale parallel to the underlying genetic mechanism of MDR/XDR Mycobacterium tuberculosis strain development.

Impact of Allergic Rhinitis on Quality of Life in Patients with Bronchial Asthma

Abstract: Allergy and asthma can reduce HRQOL as a result of profound physical and psychosocial complications. Most patients with asthma also suffer from rhinitis, which also impairs quality of life. However, the impact of allergic rhinitis on asthmatic patients has not been investigated. Objective: To assess Quality of life (QOL) in asthmatic patients and assess relative burden of allergic rhinitis on asthmatics’ QOL. Patients and Methods: we analysed HRQOL questionnaire (SF-36) answers of 219 patients (118 allergic rhinitis, 79 asthma and 22 asthma with allergic rhinitis) and controls (30 healthy individuals), in addition to analysis of questionnaire scores according to patients’ characteristic including gender, BMI and duration of symptoms. Moreover, pulmonary function test were done for all patients and control. Results: HRQOL parameters were significantly lower in females more than males and in patients with BMI>25 if compared with those with BMI<25. Moreover, HRQOL was significantly lower in all 3 patients’ groups if compared with control group (P<0.001) in all parameters except mental health and role emotional. Significantly higher scores (SF-36 sub-scales for physical functioning, role-physical, bodily pain) were found among allergic rhinitis patients compared with asthmatics with or without allergic rhinitis. Although, quality of life was worse in asthmatic patients compared to patients with rhinitis alone, no significant difference was found between asthmatics and those with both diseases. Both PCS and MCS scores are significantly lower in patients’ groups compared with the control (p<0.05). Asthmatic patients with or without rhinitis tended to have lower PCS and MCS scores than subjects with isolated allergic rhinitis, the difference between the groups was statistically significant only for PCS scores. Moreover, highly significant positive correlation between PCS score and FEV1 in asthmatics with or without allergic rhinitis was detected denoting that PCS score is markedly affected by severity of asthma. (r=0.949, P<0.001). Conclusions: Allergic rhinitis has a limited role in reduction of HRQOL. HRQOL is markedly reduced in patients with asthma with or without rhinitis than in those with allergic rhinitis only; this could be related to the severity of asthma more than the presence of associated allergic rhinitis. These findings indicated that allergic rhinitis does not seem to further impair quality of life in subjects with asthma. We recommend that patients with bronchial asthma with or without allergic rhinitis in need of great help from physicians and social workers to improve their physical and mental health. Moreover, further studies with larger populations and longer duration are needed in order to determine the extent to which asthma and rhinitis comorbidities are associated in HRQOL.  Key words: asthma, allergic rhinitis, HRQOL, SF-36 questionnaire

Oral lipoma in elderly saudi patient: a case report.

Abstract: Lipomas are relatively uncommon benign tumor occurring in the oral cavity with a prevalence rate of 1% to 4% of all oral lesions. They present as a slow growing, painless, asymptomatic submucosal mass and surgical excision is the treatment of choice. Oral lipomas have been known to grow to large sizes causing interference with speech, mastication and construction of denture. A case of 77 years old male patient with lipoma of buccal mucosa in oral cavity which exhibited a sudden growth after a lag time of 3 years with mastication and speech difficulties. The tumor excised in total with restoration of normal speech and mastication. Keywords: Oral Lipoma, Benign Tumor, Case Report

Organizing Evidence Based Medicine (EBM) Journal Clubs in Department of Neurosurgery, Tabriz University of Medical Sciences.

Abstract: Introduction: A journal club is a group of individuals who meet regularly to evaluate critically the clinical application of latest medical literature. Evidence-based medicine (EBM) is ‘the use of current best evidence, in making decisions about the care of individual patients’. For this purpose, we organized journal clubs using standard EBM method, to substitute for traditional ones, evaluating efficacy of evidence based meetings in improvement of medical education in department of Neurosurgery. Methods and Materials: After six traditional journal clubs two validated questionnaires (evaluating organizing method and degree of satisfaction), were filled out by the residents. After an instructing workshop and six evidence based journal sessions, the same questionnaires were completed by the attendees. The collected data were analyzed using SPSS 17. Results: The mean score of the first questionnaires (Evaluating the method of organizing sessions) 16.72±7.86 (median=14) for traditional journal clubs and 40.18±6.38 (median=40) for evidence based forms (P=0.003).The mean grade of the second questionnaires (degree of satisfaction) was 13.18±4.6 (median=14) and 21.90±4.27 (median=22), for traditional and evidence based ones, respectively. (P=0.006). Conclusion: The aim of evidence based journal club is to help individuals to evaluate the current literature critically. The best way to decide if any adjustments are necessary is to ask the participants whether they are satisfied with the conference. As improvement of critical judgment is the goal of the journal clubs, the response of the resident according to the knowledge of methodology and biostatistics, is a principle. In present study, significant improvement in critical appraisal skills was seen after holding evidence based journal clubs. Key Words: Journal Club, EBM, Neurosurgery

Challenges facing smokers in Saudi Arabia.

Abstract: Tobacco smoking causes nearly one fifth of cancer deaths worldwide. The International Agency for Research on Cancer predicts 10 million tobacco-related deaths annually by 2020, of which nearly three forth will be in developing countries. (1) Although Kingdom of Saudi Arabia has a population of about 20 millions, it is the fourth in the world in terms of tobacco sales. (2, 3) The prevalence of smoking for males ranges between 13 to 38% (average 26.5%), while for females it ranges from 1 to 16% (average 9%). (4) Smoking prevalence among students was estimated to be at 14.5%, among those 32.7% males and 5.9% females. The risk factors predispose for smoking among males were age, father’s smoking habits and friends’ smoking habits; while among females were sister’s smoking habits and friends smoking habits. (5) Young adult smokers from Saudi Arabian University exhibited lower levels of fractional exhaled nitric oxide compared to nonsmokers. This could be an early indicator of effects of smoking on lungs. (6) Toxic effects of tobacco smoking are widely known but the shocking data about its health injuring effect are frequently ignored and less disseminated. It causes between 80–90% of all lung cancer deaths and increases the risk of other cancers (e.g., bladder, oral cavity and esophagus), cardiovascular disease (e.g., myocardial infarction, stroke), lung diseases (e.g., emphysema, bronchitis), and infectious diseases. In addition, the economic burden caused by tobacco smoking is also eating precious resources of the young government. (7) It is one of the most common forms of nicotine dependence (ND) and, is defined as an addictive disorder by Diagnostic and Statistical Manual of Mental Disorder or International Classification of Diseases. Moreover, ND is one of the most prevalent and, most fatal psychiatric disorders where 30–50% of current smokers will die of tobacco-related disorders. Consequently, smoking is still a leading major public health world concern wide. The World Health Organization recently estimated over 1 billion smokers in the world with tobacco use rapidly rising in the developing countries. (8) The secondhand smoke (SHS) contains at least 250 known toxicants generated by the burning of tobacco. The ozone can react with chemicals in SHS to produce ultrafine particles less than 100 nm in diameter. The American Heart Association determined that SHS is a cause of fatal cardiovascular diseases. The third hand smoke (THS) is generally considered to be residual nicotine and other chemicals left on a variety of indoor surfaces by tobacco smoke. This residue is thought to react with common indoor pollutants to create a toxic mixture. This toxic mixture of THS contains cancer-causing substances and poses a potential health hazard to nonsmokers who are unwillingly exposing to it, especially children. (9) The important fact is that no level of smoking or exposure to SHS is safe, even at the lowest detectable levels of exposure, some changes in gene expression within the cells lining the respiratory airways have been reported. (10)

Histological evaluation of the jejunum and ileum of rats after administration of high dose garlic aqueous extract.

Abstract: Objectives This study investigated the adverse effects of excessive consumption of garlic on the small intestine (jejunum and ileum) of adult male Wistar rats Methodology Sixteen (16) Wistar rats with average weight of 181.5 g were grouped into two: Control Group A which received distilled water, and Treatment Group B which received 1000 mg/kg/ml aqueous extract of garlic, orally for 28 weeks. The aqueous extraction of raw garlic was done to obtain a concentration of 1000 mg/kg/ml. The animals were sacrificed by cervical dislocation after the last day of administration, and tissues for histological studies were fixed in buffered formalin, while those for enzyme studies were homogenised, and appropriate biochemical kits used to study the activities of acid phosphatase (ACP), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). Results The histological sections of the jejunum of animals that received the high dose of aqueous garlic extract revealed the presence of vacuolations, cell death and loss of epithelium, and intact muscle layer; the Periodic-Acid Schiff (PAS) positivity also reduced, while the ileum also showed degeneration of the brush borders, loss of epithelial cells, reduction in the number of goblet cells, vacuolations, and a reduced intensity of PAS positivity. Activities of ACP, ALP and LDH in the jejunum and ileum were increased. Conclusion Consumption of excessive amount of garlic could cause structural changes to the intestinal tract, which are capable of affecting intestinal functions, such as decrease in glycogen activity in the small intestine, and impairment of the absorptive activities.

Patterns and Obstacles of Provision of Minor Orthopedic Procedures among Primary Care Physicians in Saudi Arabia.

Abstract: Introduction: Musculoskeletal disorders are common reasons for consultation with the primary care provider (PCP). For many of these disorders, treatment with minor procedures can bring about rapid and effective response with a very low complication rate. In reality, not many of these procedures are carried out in the primary care facilities in Saudi Arabia and in many other countries around. Materials and Methods: A cross sectional study design was chosen. The questionnaire aimed to quantify the number and different types of injections performed by PCPs; to evaluate the level of training and to identify barriers to PCPs performing joint and soft tissue injections in the primary care facilities. This questionnaire was distributed on 298 physicians working in primary care setting in Riyadh. The absolute frequency and percentages were calculated, and Chi square and ANOVA analyses were calculated and correlation test was done to procedures obstacles and their patterns. Results: One hundred and thirty physicians (43.6%) of the respondents have taken orthopedic training during their residency program . Among the respondents who have taken a training period during their residency 115 (88.5%) had orthopedic training for 4 weeks . Only 69 (53.1%) of them -who had training- had performed joint and soft tissue injections during their family medicine residency program . The top reasons cited for not performing the procedures were "Lack of up to date skills" and "limited consultation time” because of work overload. Conclusion: Many physicians working in primary care settings in Saudi Arabia refer patients requiring minor office procedures for specialist consultation. Treating patients at the primary care level can be more time and cost effective. These results uncover that there is a big need for improvement in orthopedic and rheumatology training during undergraduate medical vocational training and family medicine residency program . Key words: Minor orthopedic procedures , joint and soft tissue injection, Family medicine program , Primary care physician, Training program.

Inflammatory bowel disease register: Steps towards Crohn's & colitis foundation of Saudi Arabia (CCFSA).

Abstract: Inflammatory bowel diseases (IBD) are among the leading cause of financial burden ,morbidity and employee absenteeism in developed countries because of their chronic remitting and relapsing courses. IBD is estimated to affect the Canadian economy to the tune of 100 million dollars per year. The data regarding exact prevalence in Asian countries, including Saudi Arabia, is still incomplete as there is underreporting and lack of proper registry of the diagnosed cases. The prevalence of inflammatory bowel disease (Ulcerative colitis, Crohn , s disease) has increased over the last decade in Saudi Arabia due to increased IBD awareness among population, as more patients seek medical help and also due to unknown reasons .There is a need of proper registration of IBD patients and establishment of Crohn’s & colitis foundation of Saudi Arabia (CCFSA) as in other parts of the world. The Crohn’s & colitis foundation of Saudi Arabia will be a forum which will co ordinate IBD treatment and research in the country in addition to health education among IBD population.

Water Pipe Smoking among Qassim University Male Students: Prevalence and Beliefs

Abstract: Objective: The main objective of this study was to investigate the prevalence and beliefs of water pipe & cigarette smoking among Qassim University male students. Methodology: A cross-sectional survey was conducted among the students of Literature Colleges, Health Colleges of Qassim University and a self-administered, anonymous, pre-structured, designed proforma was distributed among randomly selected group of 500 male university students during January 2011. The questionnaire was designed to ask specific questions that are related to cigarette smoking and water pipe smoking in general and their belief regarding smoking. Statistical analysis was done using SPSS software. Results: The total prevalence rate of waterpipe smoking was found to be 40% and Cigarette smoking was 41%. The major prevalence was found among the students of Health College (50%) then Science College (38%) and Literature College (12%). Cigarette smoking, smoking among relatives and friends has significant association (P<0.05) with prevalence of waterpipe among university students, while residence, income and marital status do not have any significant effect on water pipe smoking. Conclusions: Approximately more than one-third of the students currently smoke waterpipe. Smoking of both cigarette and waterpipe was frequently found and it is precipitated with the same habits in family and friends.

Steel minus Salter (SMS) osteotomy in recurrent bladder exstrophy repair: a case report

Abstract: Bladder exstrophy is a very rare congenital disorder, in which the first stage of reconstruction is usually performed within the first 72 hours of life. The most feared form of failure of the reconstruction is postoperative dehiscence of the bladder and abdominal wall. We present an 11-year-old girl with bladder exstrophy. She underwent three iliac bone supra-acetabular osteotomies with repair of the bladder exstrophy. Unfortunately the diastasis of the symphysis recurred widely open with dehiscence of bladder and abdominal wall. Bilateral pubic and ischial rami osteotomies with adequate soft tissue release were carried out, which allowed the urology team to perform a tension-free repair of the bladder and the abdominal wall. Here we report an osteotomy with the soft tissue release that succesfully allowed the closure of the pelvis, bladder and anterior abdominal wall in a recurrent case with more than three years follow up. Keywords : Bladder exstrophy, Ischail osteotomy, Pelvic osteotomy, Pubic osteotomy, Recurrent repair, SMS osteotomy, Steel osteotomy.

Oral hygiene assessment by school teachers and peer leaders using simplified method.

Abstract: Background: A significant proportion of children in developing countries are having plaque-induced gingivitis. A public health strategy may involve teachers and peer leaders to motivate and train school children for regular and thorough removal of dental plaque. The monitoring and evaluation of such a strategy may require teachers and peer leaders to assess oral hygiene status of children at periodic intervals. Objective: To validate the simplified dental examination performed by teachers and peer leaders to detect dental plaque and calculus. Methodology: This longitudinal study involved 632 adolescents studying in sixteen schools of Karachi, Pakistan. Eight schools each were randomly allocated to the peer-led and teacher-led strategies of examination. One section of class six was selected at random in each school to be included in the study. In each selected section of class six the trained teacher-in-charge or a peer-leader undertook dental examinations at baseline, 6-month and 18-month intervals and their findings were compared with those of a dentist. The outcome measures included the Kappa values for examiner agreement as well as the sensitivity, specificity, positive and negative predictive values. Results: All teachers and peer leaders showed a substantial degree of agreement (Kappa ≥ 0.8) with the dentist in detecting plaque and calculus at all three examinations. The values of validity measures for teachers’ and peer leaders’ examination were in the range of 87-90%. Conclusions: The examinations performed by teachers and peer leaders were reasonably valid to detect plaque and calculus. However, booster training sessions are needed to maintain their performance as dental examiners. Key words: Validity, teachers, peers, oral examination, dental examination, plaque, calculus.