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1.  Patterns of changes and diagnostic values of FEF50%, FEF25%–75% and FEF50%/FEF25%–75% ratio in patients with varying control of bronchial asthma 
Background
The pattern of change in FEF50%, FEF25%–75% and FEF50%/FEF25%–75% ratio depends on mechanics of forceful expiration, provided that non-homogenous lung emptying is faithfully recorded in the expiratory flow-volume loops.
Objective
To assess the potential clinical value of FEF50%, FEF25%–75% and FEF50%/FEF25%–75% ratio as an indicator of bronchial asthma (BA) control.
Methodology
The study involved 75 patients with BA matched for age and gender with 45 non-asthmatic subjects. Based on asthma control test (ACT) and spirometry, asthmatic patients were subdivided into controlled and poorly controlled/uncontrolled. The relationship between FEF50% and FEF25%–75% as well as FEF50%/FEF25%–75% ratio and ACT score were assessed using linear regression. ROC curves were used to assess reliability of FEF25%–75% and FEF50% to diagnose BA in patients with different degree of asthma control.
Results
FEF50% correlated strongly with FEF25%–75% (r = 0.989, P < 0.001) and the relationship between the two indices is governed by the formula FEF50% = 1.132* FEF25%–75% – 0.003. There was no significant correlation (r = − 0.159, P = 0.083) between FEF50%/FEF25–75% ratio and ACT score. The diagnostic capability of FEF25%–75% for spirometric diagnosis of BA is only marginally better compared to FEF50% (area under ROC curves were 0.88 and 0.89 respectively, P < 0.001); however, diagnostic power of both spirometric indices deceased with poor BA control.
Conclusion
FEF50%/FEF25%–75% has no clinical value as an indicator for BA control. Role of FEF25%–75% in evaluation of BA is marginally better than FEF50%; however, efficiency of both indices declined substantially as BA control worsened.
PMCID: PMC4791151  PMID: 27004052
Asthma control test; Bronchial Asthma; flow volume loop; FEF50%; FEF25%–75%
3.  Food intake, oral hygiene and gingival bleeding in pregnancy: does lifestyle make a difference? A cross sectional exploratory study 
Objectives
To investigate the association between lifestyle factors (food intake, sugary snacks consumption and oral health practices) and gingival bleeding during pregnancy.
Methods
A cross sectional exploratory study was conducted in the Maternity hospital, Dammam, Saudi Arabia. It included pregnant Saudi women selected using a convenience sample. Information was collected concerning participants’ background, oral hygiene practices and visits to dentists. They were asked about the amount of food they consumed and their use of sugary snacks. Logistic regression analysis assessed the association between lifestyle factors and gingival bleeding.
Results
Responses were obtained from 197 women (92.1% response rate). Most women brushed their teeth but had < the recommended intake in the various food groups. Brushing was associated with lower odd of gingival bleeding (odds ratio= 0.47, 95% confidence interval= 0.23, 0.93) whereas intake of fewer servings than the recommended amounts in all food groups was associated with higher odds (odds ratio = 3.64, 95% confidence interval = 1.12, 11.82)
Conclusion
Brushing and food intake during pregnancy are associated with gingival bleeding. Pregnant women can potentially improve their oral health by modifying their lifestyle and following healthier practices.
PMCID: PMC4791153  PMID: 27004053
Pregnancy; oral health; lifestyle; food
4.  Development of the Permanent Dentition and Validity of Demirjian and Goldstein Method for Dental Age Estimation in Sample of Saudi Arabian Children (Qassim Region) 
Objectives
To determine dental maturity (dental age) in cross-sectional sample of Saudi Arabian children by applying the standards established by Demirjian and Golstein and to examine the applicability of these standards in determination of dental maturity among Saudi Arabian children (Qassim region).
Materials & Methods
Dental maturity was assessed from panoramic radiographs of 400 Saudi Arabian children, 222 boys, and 198 girls ranging in age from 4 to 14 years by using these standards. The difference between the dental and chronological age in different age groups in both sexes was statistically compared using ANOVA testat 0.05 level of significance.
Results
The Saudi Arabian children were generally somewhat advanced in dental maturity compared with the French Canadian reference sample with an overall mean difference between the dental and chronological age of 0.279 years in boys and 0.385 years in girls.
Conclusion
The applied standards appear to be adequate for studying dental age in groups of children among Saudi Arabian population.
PMCID: PMC4791154  PMID: 27004054
Dental age; chronological age; Demirjian & Goldstein method
5.  Cardiovascular disease risk profile among young Saudi women of Al-Qassim, Saudi Arabia: A cross-sectional study 
Study Objective
The aim of the study was to assess the level of risk for cardiovascular diseases (CVD) among young Saudi women living in Al-Qassim, Saudi Arabia.
Methods
As part of “The Heart Protection Campaign” in the Al-Qassim region, data were collected from Saudi women using questionnaires as well as objective measurement of height, weight, blood pressure, and blood glucose. Data were analyzed using descriptive statistics.
Results
Only 15% of the sample were free of risk factors, the majority had either one (57.5%) or two (20.8%) risk factors. Additionally, 6.7% were considered to be at high-risk with three or more risk factors. The most common risk factors were physical inactivity (74%) and overweight/obesity, (25%/29%). There was a significant increase in the number of risk factors across age groups. Women over the age of 30 were more likely to have a higher number of risk factors than the younger women (20–24 years).
Conclusions
Young women in Al-Qassim, Saudi Arabia have an unusually high risk for CVD. Since the number of risk factors increases substantially between the ages of 20 and 35, there is a need to develop prevention programs to lower the CVD risk through diet and exercise.
PMCID: PMC4791155  PMID: 27004055
cardiovascular risk factors; diabetes mellitus; hypertension; obesity; young women; Saudi Arabia
6.  Level of Physical Activity of Physicians Among Residency Training Program At Prince Sultan Military Medical City, Riyadh, KSA 2014 
Introduction
Physical exercise is a crucial component in maintaining a healthy life. Unfortunately, the prevalence of adequate physical activity among young physicians is low. Additionally, there was a few research estimating lifestyle habits and other preventive health measurements especially during their residency-training program despite the importance of this topic.
Objectives
The aim of this research is to determine the level of physical activity and the main barriers of being physically active among physicians at Prince Sultan Military Medical City (PSMMC).
Methods
An analytical cross-sectional study was adopted targeting the physicians of residency training program in different specialties at PSMMC, Riyadh, KSA.
Data was collected using of short form of the International Physical Activity Questionnaire (IPAQ).
Results
The study showed that 68.4% of the participants had low level of physical activity (≤600-MET min/week). High physical activity level was more reported among male physicians compared to female physicians (4.3% versus 1.3%). The most frequent barriers of practicing physical activities among males were limited exercise facilities at home (71.7%), not suitable weather (69%) and the first priority is not for exercise (67.2%) whereas among females were no enough time to exercise (69.3%), lack of suitable places to exercise nearby (68%), the first priority is not for exercise (66.7%)
Conclusion
Most of the physicians especially female residents reported low level of physical exercise due to many barriers. Overcoming these barriers may contribute to a further increase in the level of physical activity among them.
PMCID: PMC4791156  PMID: 27004056
7.  The Musculoskeletal Manifestations of Type 2 Diabetes Mellitus in a Kashmiri Population 
Objectives
Diabetes mellitus (DM), is affecting an ever increasing number of people worldwide. Diabetes is associated with several musculoskeletal manifestations. These may involve, the upper as well as the lower limb. We conducted this study to find out the prevalence of musculoskeletal problems in type 2 diabetics in the Kashmiri population.
Methodology
The study was conducted on 403 patients with diabetes and 300 controls. All patients underwent screening for any musculoskeletal abnormalities. The patients with musculoskeletal abnormalities were further assessed to find the exact diagnosis according to predefined criteria.
Results
The hand was involved in 80 patients [19.8%] in the diabetic group and 15 (5%) patients of the control group. The elbow was affected in 56 patients [14%] in the diabetic group and 24 patients [5.9%] in the non-diabetic group. The shoulder involvement was diagnosed in 61 patients [15%] on the diabetic cohort and 15 patients in the non-diabetic cohort. All the upper limb figures showed a statistically significant difference i.e. P value <0.05.
Conclusion
The prevalence of musculoskeletal complications in type 2 diabetics in Kashmir is quite high.
PMCID: PMC4791158  PMID: 27004058
8.  Assessment of Mental Health among Iranian Medical Students: A Cross-Sectional Study 
Objectives
More mental morbidities were reported in medical students than their nonmedical peers, which may negatively influence their lives and future career. The aim of this study was to assess the mental health status among medical students of Shiraz University of Medical Sciences.
Method
Two hundred and eight 1st to 4th year Medical students took part in this cross-sectional study. General Health Questionnaire with 28 items (GHQ-28) was used for data collection. We performed descriptive statistics, Mann Whitney U test, one way ANOVA and Tukey’s post hoc and Kruskal Wallis H and Chi square test for statistical analysis.
Results
The mean age of participants was 20.70 ± 1.14 (mean ± SD) years. More than half of them (54.4%) had total GHQ score above the cut-off point considered as probably abnormal mental health status. Years of education, positive family history and low satisfaction of the medicine discipline affected their mental health. Third and fourth year students had significantly higher mean scores of total GHQ (p-value = 0.009) and anxiety, somatic and social subscales (p-value = 0.001, 0.004 and 0.026). Students with positive family history of mental illness and low satisfaction of field of the study significantly had higher GHQ scores (p-value = 0.012 and < 0.001 respectively).
Conclusion
Poor mental health prevalence is high among medical students in Shiraz. Proper changes in educational programs and other effective interventions to raise the students’ satisfaction may reduce the effect of other stress reasons and improve their mental health status.
PMCID: PMC4791157  PMID: 27004057
Medical students; Mental health; Depression; Iran
9.  Anti-inflammatory activity of Euphorbia aegyptiaca extract in rats 
Background
There were no studies on the anti-inflammatory activity of Euphorbia aegyptiaca, though it is commonly used by Sudanese herbalists in the treatment of rheumatoid arthritis.
Objectives
To determine phytochemical constituents of Euphorbia aegyptiaca
To investigate the anti-inflammatory activity of Euphorbia aegyptiaca in rats.
Methodology
Plant material was extracted by ethanol and phytochemical screening was done according to standard methods. The thickness of Albino rats’ paws were measured before injection of 0.1 ml of 1% formalin in the sub planter region and then, 1, 2, 3, 4 and 24 hours after oral dose of ethanolic extract of Euphorbia aegyptiaca at a rate of 400mg/kg, 800mg/kg, indomethacin (5mg/kg) and normal saline (5ml/kg). Edema inhibition percentage (EI%) and mean paw thickness (MPT) were measured in the different groups and compared using appropriate statistical methods.
Results
The phytochemical screening revealed the presence of saponins, cumarins, flavonoids, tannins, sterols, triterpenes, and absence of alkaloids, anthraquinones glycosides and cyanogenic glycosides. The mean of EI% of rats treated with indomethacin at a dose of 5 mg/kg over different time intervals (64.0%) was significantly lower compared to those treated with Euphorbia aegyptiaca at a dose of 800 mg/kg (75.0%, P< 0.001), but higher compared to rats treated at higher dose of 400 mg/kg (57.4%, P< 0.001). In contrast, MPT of rats treated with indomethacin at a dose of 5 mg/kg (6.5±1.1 mm) was significantly higher compared to those treated with Euphorbia aegyptiaca at a dose of 800 mg/kg (6.1±.7 mm, P< 0.001) as well as 400 mg/kg (5.9±.5, P< 0.001).
Conclusion
Euphorbia aegyptiaca ethanolic extract has a sustained dose-dependent anti-inflammatory activity.
PMCID: PMC4791159  PMID: 27004059
anti-inflammatory; edema; Euphorbia aegyptiaca; indomethacin
10.  Awareness, utilization, and determinants of using oral diseases prevention methods among Saudi adults – a clinic-based pilot study 
Objectives
The present study was conducted to assess the level of awareness and utilization of methods to prevent oral diseases among a group of adult Saudis.
Methodology
An anonymous, self-administered questionnaire was distributed to patients visiting the clinics of the College of Dentistry, University of Dammam in 2015. The questionnaire assessed the background of the respondents, their dental history, awareness and use of a number of methods available to prevent oral diseases, sources of information about these methods and barriers against their use. Regression analysis was used to assess the factors affecting the use of these practices.
Results
Brushing was reported to be used by about 60% of respondents whereas fluoride and sealant were less prevalent (≤30%). Dentist was the most frequently reported source of information about preventive methods (60%) and about 40% cited cost and time as the main reasons why they did not use these preventive methods. Awareness and age were associated with using a greater number of the various preventive methods (odds regression coefficient ratio= 0.27 and 0.04).
Conclusions
Use of preventive methods is not prevalent among Saudi adults and it can be improved by more intensive efforts to increase the awareness of these methods, primarily through dentists.
PMCID: PMC4791160  PMID: 27004060
11.  Teachers’ knowledge about oral health and their interest in oral health education in Hail, Saudi Arabia 
Objectives
To assess the dental health knowledge and the interest of secondary school teachers in imparting oral health education in Hail, Saudi Arabia
Methods
It was a questionnaire based cross-sectional survey of secondary school teachers in Hail, Saudi Arabia, carried out from November 2014 to January 2015. A validated self-administered questionnaire was used to determine teachers’ oral health knowledge and their interest in participating in oral health education of school children. Data analysis was performed using SPSS version 20 statistical software.
Results
Two hundred and twenty three secondary school teachers responded to the survey. Results showed that about 80 to 90 % of teachers had sufficient knowledge of causes and prevention of dental caries and gingivitis. About 94% of teachers agreed that they can play an effective role in oral health promotion while 96% were found to be interested in performing additional duty as oral health promoter. A large majority (91.9 %) had the opinion that oral health education must be included in school curriculum.
Conclusion
Teachers in Hail region had adequate amount of knowledge regarding oral health, and they were interested to play their role in promoting oral health education. Based on the findings of this study, it is recommended to include dental health education in curriculum at secondary school level and to provide sufficient training to teachers to enable them to participate actively in oral health promotion activities.
PMCID: PMC4791161  PMID: 27004061
Dental; Oral health education; Oral health promotion; Saudi Arabia; School teachers
12.  Molecular Genetic of Atopic dermatitis: An Update 
Atopic dermatitis (AD) is a chronic multifactorial inflammatory skin disease. The pathogenesis of AD remains unclear, but the disease results from dysfunctions of skin barrier and immune response, where both genetic and environmental factors play a key role. Recent studies demonstrate the substantial evidences that show a strong genetic association with AD. As for example, AD patients have a positive family history and have a concordance rate in twins. Moreover, several candidate genes have now been suspected that play a central role in the genetic background of AD. In last decade advanced procedures similar to genome-wide association (GWA) and single nucleotide polymorphism (SNP) have been applied on different population and now it has been clarified that AD is significantly associated with genes of innate/adaptive immune systems, human leukocyte antigens (HLA), cytokines, chemokines, drug-metabolizing genes or various other genes. In this review, we will highlight the recent advancements in the molecular genetics of AD, especially on possible functional relevance of genetic variants discovered to date.
PMCID: PMC4791162  PMID: 27004062
Atopic dermatitis; molecular genetics; immune genes; cytokine; chemokine; drug-metabolizing genes
13.  An update of biochemical markers of hepatocellular carcinoma 
The definition of a tumor marker is broad, which covers a wide spectrum of biomacromolecules synthesized in excess concentration by a wide variety of neoplastic cells. Tumor markers can be normal endogenous products that are produced at a greater rate in cancer cells or the products of newly switched on genes that remained inactive in the normal cells. These markers consist of any products of either tumor itself or the host in reaction to tumor’s presence that distinguishes malignant tissues from benign and is measurable in body fluids or tissues. They increase with progressive or recurrent disease, decrease with response to treatment, and normalize with remission. Clinical applications include screening in asymptomatic individuals, confirming a suspected diagnosis, assisting in tumor classification and staging, prognosis, monitoring treatment response, surveillance for residual disease, and early detection of recurrent disease.
PMCID: PMC4791163  PMID: 27004063
HCC; Alpha-fetoprotein; AFP; Glypican-3; SCCA; GEP; Enzymes and isoenzymes
14.  Gigantobilharzia, possible cause of cercarial dermatitis: Case report 
Cercarial dermatitis (swimmer’s itch) is a worldwide, often neglected parasitic skin disease characterized by strong maculopapular skin eruption accompanied by intensive itching. A fisherman suffered from forearm dermatitis. Clinical history associated with the recovery of the avian schistosome; Gigantobilharzia from little green bee-eater (Merops orientalis najdanus) and collected Lymnaea snails supported the authors’ opinion that patient clinical signs are most likely due to the invasion of avian schistosome cercariae.
PMCID: PMC4791165  PMID: 27004065
Cercarial dermatitis; Swimmer’s itch; Gigantobilharzia
15.  Human papillomavirus related cervical cancer and anticipated vaccination challenges in Ethiopia 
Cervical cancer is the leading cause of cancer deaths among women in Ethiopia. This may be due to the high prevalence of high-risk human papillomavirus (HR-HPV) genotypes in the population. So far, few studies have been done that showed the presence of HR-HPV genotypes. The HR-HPV-16, -18, -52, -56, -31 and -58 were the most common genotypes reported in Ethiopia. The introduction of HPV vaccines in Ethiopia is likely to go a long way in reducing cervical cancer deaths. However, there are few challenges to the introduction of the vaccines. The target population for HPV vaccination is at the moment not well-defined. Besides, the current HPV vaccines confer only type-specific (HPV-16 and -18) immunity, leaving a small proportion of Ethiopian women unprotected against other HR-HPV genotypes such as 52, 56, 31 and 58. Thus, future HPV vaccines such as the nanovalent vaccine may be more useful to Ethiopia as they will protect women against more genotypes.
PMCID: PMC4791164  PMID: 27004064
Cervical cancer; Human papillomavirus; Vaccination challenges; Ethiopia
17.  Knowledge, attitudes, and breast feeding practices of postnatal mothers: A cross sectional survey 
Background
Breast feeding has several benefits for both the infants and mothers. However, despite strong evidences in support of breast feeding its prevalence has remained low worldwide. The objective of the present study was to examine the knowledge and attitude towards breast feeding and infant feeding practices among Indian postnatal mothers.
Methodology
A cross sectional descriptive study was carried out among randomly selected postnatal mothers at Pediatric outpatient department at a tertiary care center. Data was collected through face-to-face interview using a structured questionnaire.
Results
Our findings revealed that a majority (88.5%) of the mothers were breast feeders. However, merely 27% of the mothers were exclusive breast feeders and only 36.9% initiated breast feeding within an hour. While mothers have good knowledge on breast feeding (12.05±1.74, M±SD), the average score of the Iowa Infant Feeding Scale (IIFAS) (58.77±4.74, M ±SD) indicate neutral attitudes toward breast feeding. Mothers those who were currently breast feeding (58.83 ± 4.74) had more positive attitudes than non- breastfeed mothers (45.21±5.22).
Conclusion
Our findings also show that the level of exclusive breast-feeding was low. Thus, it is important to provide prenatal education to mothers and fathers on breast-feeding. We also recommend strengthening the public health education campaigns to promote breast-feeding.
PMCID: PMC4682591  PMID: 26715916
Attitudes; Breast feeding; India; Infant feeding practices; Knowledge; Mothers
18.  Evaluation of Potential Oxidative Stress in Egyptian Patients with Acute Zinc Phosphide Poisoning and the Role of Vitamin C 
Objective
To evaluate potential oxidative stress in patients with acute phosphide poisoning and the effect of vitamin C.
Methods
Participants were females and divided into three groups; group I: healthy volunteers group II: healthy volunteers received vitamin C, group III: patients with acute phosphide poisoning received the supportive and symptomatic treatment and group IV: patients with acute phosphide poisoning received the supportive and symptomatic treatment in addition to vitamin C. All the participants were subjected to thorough history, clinical examination, ECG and laboratory investigations were carried on collected blood and gastric lavage samples on admission. Blood samples were divided into two parts, one for measurement of routine investigations and the second part was used for evaluation of malondialdehyde and total thiol levels before and after receiving the treatment regimen.
Results
Most of the cases in this study were among the age group of 15–25 years, females, single, secondary school education, from rural areas and suicidal. All vital signs were within normal range and the most common complaint was vomiting and abdominal pain. All cases in this study showed normal routine investigations. The mean MDA levels after receiving treatment decreased significantly in groups II and IV. The mean total thiol levels increased significantly after receiving treatment in groups II and IV.
Conclusion
It can be concluded that vitamin C has a potential benefit due to its antioxidant property on zinc phosphide induced-oxidative stress in acute zinc phosphide poisoned patients.
PMCID: PMC4682592  PMID: 26715917
Oxidative Stress; Zinc Phosphide; Vitamin C
19.  Barriers and Facilitators of Compliance with Universal Precautions at First Level Health Facilities in Northern Rural Pakistan 
Aim
We assessed the compliance at first level care facilities (FLCF) with universal precautions (UP) and its behavioral predictors using Health Belief Model (HBM).
Methods
A sample of FLCF from public clinic (PC), privately owned licensed practitioners’ clinic (LPC) and non-licensed practitioners’ clinic (NLPC) was obtained. Health Care Workers (HCW) who diagnose and prescribe medication was termed as Prescriber and that carries out prescriber’s order was defined Assistant. Compliance to UP was measured on 11 items Likert scale. HCW responded “always” or “often” to all items of UP were added to compute a binary variable of overall compliance. We used linear regression to assess association between HBM and UP score.
Results
We interviewed 485 HCW (75% prescribers) from 365 clinics; mean age 38±10.4 years. Overall, compliance to UP was 6.6%; 11.6% LPC, 5.3% PC, and 4.4% NLPC. Prescribers were less compliant than Assistants. Compliance with not recapping contaminated needle was poor (PC=32%, LPC=33%, NLPC=15%). Compliance with wearing gloves during blood or body fluid exposure was lowest (30%) at PC. Modes of transmission knowledge, self-efficacy and perceived benefits of safe practice, and susceptibility to blood borne infections were positively associated with UP score.
Conclusion
Higher perception of barriers and severity of blood borne infection result in lower compliance.
PMCID: PMC4682593  PMID: 26715918
Universal Precautions; Health Care workers; HBM; blood borne pathogens
20.  Physical Activity Behavior Predictors, Reasons and Barriers among Male Adolescents in Riyadh, Saudi Arabia: Evidence for Obesogenic Environment 
Objective
This study aimed to assess physical activity, socio-demographic predictors and to determine reasons for practicing and/or not practicing physical activities.
Methods
Cross-sectional study was conducted among male high school students in Riyadh, Saudi Arabia. A self-administered questionnaire was used to collect the data using stratified cluster sampling technique (N= 453 students).
Results
Although 36.4% of the student reported that they practiced enough exercise during their usual week days, only 15.5% of the students were found to be practicing physical activity at a recommended level (≥5 days/week). On the other hand, 20.1% of the students were found to be inactive and not practicing physical activity at any day. Among the factors that associated with adolescents physical activity, logistic regression showed that students age was associated negatively with physical activity behaviour (OR= 0.6, P <0.001). Also, logistic regression showed that students physical activity behaviour was independently associated with students perceived body weight (OR= 27, P <0.001). The main reasons for practicing physical activity were: to enhance muscle and strength (70.9%), to have fun with friend and entertainment (66%), and to improve physical appearance (53.6%), respectively. The main reported barriers inhibiting adolescents from practicing physical activity were: lack of sports facilities in the community (74%), lack of friends and peer support (59.4%) and lack of suitable public sport club in the community (54.6%).
Conclusion
This study revealed low prevalence of physical activity among adolescents. National strategies to increase levels of physical activity and minimize obesogenic environmental factors are required.
PMCID: PMC4682594  PMID: 26715919
Saudi Arabia; Physical activity; Obesogenic environment; Adolescents; School Health; Public Health
21.  A study of the clinical profile of acute pancreatitis and its correlation with severity indices 
Background
Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis.
Aim and objectives
The present study was aimed to assess the clinical profile of acute pancreatitis and to assess the efficacy of various severity indices in predicting the outcome of patients.
Methodology
This was a prospective study done in Sri Ramachandra Medical College and Hospital from April 2012–September 2014. All patients with a diagnosis of acute pancreatitis were included in this study. Along with routine lab parameters, serum amylase, lipase, lipid profile, calcium, CRP, LDH, CT abdomen, CXR and 2D Echo was done for all patients.
Results
A total of 110 patients were analysed. 50 patients required Intensive care, among them 9 patients (18%) died. 20 patients (18.2%) had MODS, 15 patients (13.6%) had pleural effusion, 9 patients (8.2%) had pseudocyst, 2 patients(1.8%) had hypotension, 2 patients(1.8%) had ARDS and 2 patients(1.8%) had DKA. In relation to various severity indices, high score of CRP, LDH and CT severity index was associated with increased morbidity and mortality. 15 patients (13.6%) underwent open necrosectomy surgery, 3 patients (2.7%) underwent laparoscopic necrosectomy and 7 patients (6.4%) were tried step up approach but could not avoid surgery. Step up approach and surgery did not have a significant reduction in the mortality.
Conclusion
Initial assessment of severity by CRP, LDH and lipase could be reliable indicators of outcome in acute pancreatitis
PMCID: PMC4682595  PMID: 26715920
Acute pancreatitis; C-Reactive Protein; LDH; Severity index; Step up approach
22.  Patient Safety Competence of Nursing Students in Saudi Arabia: A Self-Reported Survey 
Objective
With the growing recognition of the significance of patient safety (PS) in educational institutions and health organizations, it is essential to understand the perspective of nursing students on their own PS competence. This study analyzed the self-reported PS competence of nursing students at a government university in Saudi Arabia.
Methodology
A cross-sectional self-reported survey of 191 respondents, using the Health Professional Education in Patient Safety Survey (H-PEPSS) was conducted. The survey tool reflected 6 key socio-cultural dimensions assessing competence in classroom and clinical setting.
Results
Female nursing students reported higher PS competence in both the classroom and clinical settings along the dimensions ‘working in teams’ and ‘communicating effectively’ while males reported higher competence in both settings as to the ‘managing safety risks’ and ‘understanding human and environmental factors’ dimensions. The respondents’ academic level and self–reported PS competence have weak negative correlation in the classroom while a strong negative correlation between the 2 variables existed in the clinical setting. Self-reported PS competence for the dimensions ‘working in teams’, ‘recognize and respond to remove immediate risks of harm’, and ‘culture of safety’ is significantly higher in classroom than in the clinical setting.
Conclusion
Generally, the Saudi nursing students reported varying levels of competence in the six dimensions of patient safety. Significant gap between the perceived PS competence was observed between learning settings. Educational and training interventions are suggested for implementation to bridge this gap.
PMCID: PMC4682596  PMID: 26715921
Patient safety; Patient safety competence; Nursing students; Saudi Arabia
23.  Video-Assisted Thoracoscopic Surgery for the Treatment of First-Time Spontaneous Pneumothorax versus Conservative Treatment 
Background and aim of the work
Recent studies have shown that video-assisted thoracoscopy (VATS) is safe and beneficial as first time treatment for patients presenting with primary spontaneous pneumothorax (PSP). In this study we will compare the outcome of patients presenting with first time PSP treated by VATS with those treated conservatively.
Material and methods
This was a prospective double-blind, randomized clinical trial conducted at our hospital, Forty one patients, presented to the hospital with first attack PSP from January 2010 to January 2013, were randomized to be treated by chest tube drainage (conservative group, group 1) or by primary video-assisted thoracoscopy (VATS group, group 2). Outcomes were; duration of intercostal tube drainage, mean hospital stay, and recurrence rates of pneumothorax during the period of follow up.
Results
There was no significant difference in both groups regarding demographic data. The mean durations of removal of intercostal tube and hospital stay were significantly higher in conservative group than in VATS group. The recurrence rate in conservative group was 40.9% versus 0% in VATS group (highly significant).
Conclusions
Initial VATS is considered an efficient treatment modality for PSP as it has a shorter hospital stay and lower recurrence than conservative treatment, which if occurs, requires re-hospitalization with needs for VATS or surgery.
PMCID: PMC4682597  PMID: 26715922
Primary spontaneous pneumothorax; VATS; Conservative treatment
24.  Bone marrow aspiration in north Sudan: the procedure, indications and the diagnostic value 
Introduction
Bone marrow aspiration (BMA) is a common and useful investigation tool in clinical practice to obtain information about both hematological and non-hematological disorders. The aim of the work was to identify the main indications for BMA in Atbara city, north Sudan and to determine the common diagnoses encountered.
Methods
All reports of BMA carried out during a 6-year period from 2009 to 2014, in the Modern Specialized Laboratory (the only site where BMA is conducted in Atbara) were reviewed. The information extracted included the main indications for performing this procedure, age groups involved, and the most common diagnoses established. A specially designed form was used for this purpose and the data were analyzed using SPSS computer program.
Results
A total number of 112 cases were subjected to bone marrow aspiration. The most frequent indications were: pancytopenia 43(38.4%), anemia 39 (34.8%), and suspected leukemia 13 (11.6%). In 86(76.8%) cases, BMA provided either the diagnosis or diagnostic clues to the disease process, while 26 (23.2%) of the aspirates revealed a normally functioning marrow.
Conclusion
Bone marrow aspiration is an important investigation for establishing the diagnosis in many medical conditions. The most common indication for this procedure in our study was pancytopenia and the most common finding was aplastic anemia.
PMCID: PMC4682598  PMID: 26715923
Bone marrow aspiration; Atbara; Sudan
25.  Detection of integrons and Staphylococcal Cassette Chromosome (SCCmec) types in Staphylococcus aureus isolated from burn and non-burn patients 
Background
Methicillin Resistant Staphylococcus aureus (MRSA) strains have been recognized as an important reason of infections in health care units. Integrons role in antibiotic resistance box gene transfer has been well recognized which are found in Gram positive bacteria.
Objective
The aim of this study was analyzed of SCCmec typing and determine of integron classes in burn and non-burn specimens.
Methodology
A total of 110 S. aureus strains were isolated from burn and non-burn patients. Antimicrobial susceptibility testing, detection of mecA gene, various SCCmec types and integrons classes were analyzed.
Results
In antimicrobial susceptibility test in burn patients, resistant to both gentamicin and oxacilin and in non-burn patients resistance to oxacilin and cefepime showed the highest ratio In PCR molecular test (80%) and (52.7%) of strains harbored the mecA gene. Therefore five different SCCmec types were recognized among our studied strains. Subsequently, integron class I was evaluated as (94.5%) in burn and (12.7%) in non-burn isolates by the multiplex PCR method.
Conclusion
Albeit MRSA strains have the hospital reservoir so may cause serious treats for hospitalized and non-hospitalized patients, hence clinical decision for prevention and treatment may develop due to, mecA gene, SCCmec elements and integrons detection in health care units.
PMCID: PMC4682599  PMID: 26715924
MRSA; Integron; mecA gene; SCCmec types

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