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1.  Lipoprotein (a) and atherogenic indices in Sudanese patients with type 2 diabetes 
Background & Aims
Type 2 diabetes is associated with significant cardiac morbidity and mortality with a more than threefold increased risk of coronary artery disease (CAD). We aimed to assess the serum concentrations of lipoprotein (a) and lipid profile indexes as predictors for CAD in Sudanese type 2 diabetics compared to healthy subjects.
Materials & Methods
This case-control study was conducted at Jabir Abu-Aliz Specialized Center, Khartoum State, Sudan. After overnight fasting, 4 ml blood samples were collected in plain vials through venous puncture from each subject. Lipid profile parameters were estimated by standard laboratory procedures. Serum lipoprotein (a) was measured by immunoturbidimetric method. Statistical analyses were performed using SPSS software (version 17).
Results
Compared to healthy controls, type 2 diabetics showed significantly higher serum lipids and lipoprotein fractions. The mean values of lipoprotein (a), TC: HDL-C (5.55±.8 vs. 3.89±.6) and LDL-C: HDL-C (3.80±0.7 vs. 2.32±0.5) were significantly increased in patients. Lipoprotein (a) was significantly correlated with TG (p=.025), HDL-C (inversely, p<.001), VLDL-C (p= .025), and TC: HDL-C ratio (p= 016). Moreover, LDL-C: HDL-C ratio and TC were the most common risk factors distributed among the study patients (80% and 71.4% respectively).
Conclusion
Diabetic patients characterized by higher ratios of TC: HDL –C and LDL: HDL and Lipoprotein (a) compared to healthy controls. The evaluation of these lipid indices in diabetics, beside the routine lipid profile analysis, may be a crucial helpful step in the prevention of coronary artery disease since these atherogenic factors can be reduced by lifestyle modifications.
PMCID: PMC4257359  PMID: 25505859
Sudan; type 2 diabetes; lipoprotein (a); TC: HDL-C ratio; LDL-C: HDL-C ratio; coronary artery disease
2.  Chronic Venous Insufficiency: prevalence and effect of compression stockings 
Introduction
Chronic venous insufficiency (CVI) is a common disease affecting mainly lower limbs and significantly influencing the quality of life. This study aims to estimate the prevalence of CVI in the Qassim Region and test the effectiveness of compression stockings as an intervention option.
Methods
A cross sectional study was conducted to assess the prevalence of CVI among patients visiting primary health care (PHC) centers in the Qassim Region. CVI patients were diagnosed and classified using the clinical, etiologic, anatomical, and pathophysiological (CEAP) scale. They were randomly divided into two groups, one using compression stockings and the other standard medical therapy. A clinical follow up was done using multiple scale system including CEAP scale. Data analysis was performed using SPSS.
Results
Among the 226 screened patients, 138 (61.1%) were diagnosed as having CVI (69% female and 45% male, p<0.001). Compared to the baseline, both the clinical and venous scores for CVI at the follow-up were significantly lower among patients using compression stockings, p=0.002 and p=0.003, respectively. Regression analysis suggested that, after controlling for age, sex and body mass index, compliance was the main factor responsible for a significant reduction in the clinical score among CVI patients.
Conclusions
Chronic venous insufficiency is very common in the Qassim Region. Compression stockings are highly effective in improving clinical symptoms and signs of CVI.
Trial registration
This study is registered at www.clinicaltrials.gov(NCT02050061).
PMCID: PMC4257358  PMID: 25505858
3.  Profile of Epilepsy in a Regional Hospital in Al Qassim, Saudi Arabia 
Introduction
Epilepsy is a diverse set of chronic neurological disorders characterized by seizures. It is one of the most common of the serious neurological disorders. About 3% of people will be diagnosed with epilepsy at some time in their lives.
Objectives
We aimed to address the commonest types of seizures, their aetiologies, EEG and neuroimaging results and prognosis of patients presented to neurology services of the King Fahad Specialist Hospital- AlQassim (KFSH).
Methodology
In this retrospective epidemiological study we investigated the medical records of patients with epilepsy, who attended the neurology services of KFSH, during the study period (26/10/2011–26/4/2012).
Results
The study included 341 patients; 189 (55.4%) males and 152 (44.6%) females. Their ages ranged between 12 and 85 years (mean ± SD = 31±16.9). The majority of patients had Generalised Tonic Clonic Seizures (76.2%), followed by Complex Partial Seizures (7.6%). 73% of our patients had idiopathic epilepsy. The commonest causes for symptomatic epilepsy were Cerebro Vascular Accidents and Head trauma. Hemiplegia, mental retardation and psychiatric illness were the commonest comorbidity. 69.3% of patients had controlled seizures. Patients with idiopathic epilepsy were significantly controlled than patients with symptomatic epilepsy (P=0.01), and those using one Anti Epileptic Drug were significantly controlled compared to patients using polytherapy (P=0.0001) there was no significant relation between controlled seizure and duration of illness or hospitalization or EEG changes.
Conclusion
Seizure types, aetiology, drug therapy, Comorbidities and outcome in a tertiary care hospital in Saudi Arabia are similar to previous local and international studies. 35.3% of patients were hospitalized, higher rates than previous studies. Seizure control was better in generalized seizures and idiopathic epilepsy compared to complex partial seizures or partial seizures with secondary generalization and symptomatic epilepsy.
PMCID: PMC4257360  PMID: 25505860
seizures; epilepsy; epidemiology; Saudi Arabia
4.  Histopathological Studies on Rabbits Infected by Bacteria Causing Infectious Keratitis in Human through Eye Inoculation 
Aim
This study aimed to investigate the pathogenic effect of bacteria causing infectious keratitis among patients through experimental study conducted on rabbits’ eyes with the aid of histopathology as eye infection is a common disease in developing countries that may complicate to loss of vision.
Methodology
100 swab samples were collected from human infected eyes, at Qassim region during 2012, for the isolation of Pseudomonas aeruginosa and Staphylococcus aureus. The isolated pathogenic bacteria were tested to various antibiotics using some selected antibiotics discs through agar-well diffusion method. Then, experimental study conducted on 27 rabbits. The rabbits were divided randomly into three equal groups, each containing 9 rabbits. Rabbits of group (1) served as control group (Negative Control) and their eyes were inoculated with the buffer only. Rabbits of group (2) were inoculated through eyes with the isolated Pseudomonas aeruginosa. Rabbits of group (3) were inoculated through eyes with the isolated Staphylococcus aureus.
Results
Out of 100 collected swab samples from human infected eyes, Pseudomonas aeruginosa and Staphylococcus aureus were isolated with a total percentage of 25.21% and 15.65%; respectively and used in this study. Both bacterial isolates were sensitive to Gentamicin and Cefuroxime.
Clinically, experimentally infected rabbits by Pseudomonas aeruginosa, revealed varying degree corneal abrasions, corneal abscess and dense corneal opacity. Histopathologically, at 3rd day post-infection (PI), the cornea revealed polymorpho-nuclear cells infiltration with loss of the outer epithelial lining. At 7th day PI, neutrophils were seen in the stroma. At 15th day PI, proliferation of fibroblasts and new vascularisation were seen in the stroma.
Clinically, rabbits experimentally infected with Staphylococcus aureus, revealed corneal ulcers and focal abscesses. Histopathologically, at 3rd and 7th day PI, the cornea revealed edema and infiltration of leukocytes. At 15th day PI, hyperplasia of corneal epithelium and proliferation of keratocytes were evident. The liver and kidneys of experimented rabbits revealed no remarkable histopathological alterations along the period of experiment.
Conclusion
Pseudomonas aeruginosa and Staphylococcus aureus are common eye infection in human, both induced severe lesions in the eyes of rabbits that could interfere with vision, therefore, strict measures to control these infections in human is recommended.
PMCID: PMC4257361  PMID: 25505861
5.  Extrinsic stain removal with a toothpowder: A randomized controlled trial 
Objectives
The efficacy of a commercially available toothpowder was compared with toothpaste in removing extrinsic dental stains.
Methods
In this single-blind, randomized controlled trial, 77 volunteers were included from a residential professional college. All study subjects (control toothpaste users and test toothpowder users) plaque control measures. All study subjects were instructed to rinse with 5 ml 0.12% chlorhexidine mouthwash for 1 minute, twice and one cup of double tea bag solution three times daily for three weeks. Subjects were randomized into test (n=36) and control (n=36) groups. Toothpaste (control) and toothpowder (test) was used for two weeks to see the effects on removing stains on the labial surfaces of 12 anterior teeth. For measuring dental extrinsic stains Lobene Stain Index (SI) was used.
Results
The amount of stain following the use of toothpaste and toothpowder was more controlled with the experimental toothpowder. For all sites combined, there was evidence that the experimental toothpowder was significantly superior to toothpaste in reducing stain area (p<.001), stain intensity (p<.001) and composite/product (area × intensity) (p<.001).
Conclusion
Stain removing efficacy of toothpowder was significantly higher as compared with toothpaste. A toothpowder may be expected to be of benefit in controlling and removing extrinsic dental staining.
PMCID: PMC4257362  PMID: 25505862
Essential Oil; Toothpowder; Toothpaste; Dental Extrinsic Stains; Lobene Stain Index (SI)
6.  The Effect of Systemic Delivery of Aminoguanidine versus Doxycycline on the Resorptive Phase of Alveolar Bone Following modified Widman Flap in Diabetic Rats: A Histopathological and Scanning Electron Microscope (SEM) study 
Objectives
Aminoguanidine (guanylhydrazinehydrochloride) is a drug that prevents many of the classical systemic complications of diabetes including diabetic osteopenia through its inhibitory activity on the accumulation of advanced glycation end –products (AGEs). The aim of the present study was to evaluate the effectiveness of aminoguanidine versus doxycycline in reducing alveolar bone resorption following mucoperiosteal flap in diabetic rats, using the conventional histopathology and scanning electron microscope (SEM).
Methods
Twenty-seven male albino rats were used in this study. Periodontal defects were induced experimentally on lower anterior teeth. All rats were subjected to induction of diabetes, by IV injection of the pancreatic B-cells toxin alloxan monohydrate. After eight weeks following the establishment of periodontal defects in all rats, the ligation was removed and 3 rats were scarified as negative control (group 1). The remaining animals were divided into three group based on treatment applied following mucoperiosteal flap surgery. Group 2 received saline treatment only, group 3 received doxycycline periostat (1.5 mg/kg/day) for 3 weeks, and group 4 received aminoguanidine (7.3 mmol/kg) for 3 weeks. The fasting glucose level was measured weekly post operatively. After 21 days all rats were sacrificed. Three anterior parts of the mandible of each group was prepared for histopathological examination and two parts were prepared for SEM.
Results
Aminoguanidine treated group (group 4) showed statistically significant increased new bone formation, higher number of osteoblasts and decrease osteoclasts number, resorptive lacunae and existing inflammatory cell infiltration as compared to positive control group (group 2) (P<0.05). Doxycycline was also effective in reducing bone loss as documental by histopathological study.
Conclusion
The present study showed that aminoguanidine was significantly effective in reducing alveolar bone loss and can modify the detrimental effects of diabetes in alveolar bone resorption.
PMCID: PMC4257363  PMID: 25505863
7.  Pain Assessment and Management in Critically ill Intubated Patients in Jordan: A Prospective Study 
Objectives
The purpose of this study was to describe: (1) pain indicators used by nurses and physicians to assess pain, (2) pain management interventions (pharmacological and non-pharmacological) used by nurses, and (3) indicators used by nurses to verify pain intervention effectiveness.
Methodology
A total of 301 medical records of currently admitted patients from six different ICUs in Jordan were reviewed using a data collection instrument developed by Gélinas et al. (2004) Pain-related indicators were classified into non-observable (patient’s self-reports of pain) and observable (physiological and behavioral) categories.
Results
Only 105 (35%) of a total 301 reviewed medical records contained pain assessment data. From these medical records, 15 pain episodes were collected altogether. Observable indicators documented 98% of the 115 pain episodes. Patients’ self-reports of pain were documented only 1.7% of the time. In 78% and 46% of the 115 pain episodes, pharmacological and nonpharmacological interventions for pain management were documented, respectively. Only 37% of the pain episodes were reassessed with self- report (1%) and observable indicators (36%) to determine the effectiveness of the interventions.
Conclusion
Pain documentation for assessment, management, and reassessment was lacking and needs improvement.
PMCID: PMC4257364  PMID: 25505864
Pain assessment; Pain management; critically ill; intubated patients
8.  The Effect of Chemical Disinfectants on the Color of a Porcelain Shade Guide 
Objective
To evaluate the effect of long term utilization of chemical disinfectants on the color of porcelain shade guides.
Methodology
three chemical disinfectants were used in this study: Minuten spray, Lysol ICQuaternary Disinfectant Cleaner (QDC), and Lysol IC Ready to Use Disinfectant Cleaner (RDC). Simulation of disinfecting cycles for one year, two years, and three years were done on Vita 3D master shade guide. Color differences were determined by visual inspection and analyzing ΔE.
Results
ΔE values were significantly below the perceptible (ΔE=1) and the clinically acceptable (ΔE=3.7) thresholds.
Conclusions
Simulated utilization of Minuten Spray, Lysol IC (QDC), and Lysol (RDC) disinfectants for up to three years didn’t cause a clinically significant difference in the color of VITA Toothguide 3D-Master Shade Guide.
PMCID: PMC4257365  PMID: 25505865
9.  Umbilical Pilonidal Sinus 
Pilonidal sinuses are commonly encountered, but their occurrence in the umbilical area is rare. The author presents one such case of an umbilical pilonidal sinus in an obese male patient that presented with recurrent episodes of umbilical discharge. The condition was treated with sinus excision and umbilical reconstruction. There was no recurrence of the disease until one year of follow up.
PMCID: PMC4257366  PMID: 25505866
Umbilical pilonidal sinus; hair; granulation tissue; excision; recurrence
13.  Learning Outcomes and Tutoring in Problem Based-Learning: How do Undergraduate Medical Students Perceive Them? 
Objectives
To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views were sought about the role of tutors and qualities of effective tutors.
Method
This was a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, Central region, Saudi Arabia during the period of 1st of April to 30th June 2012.
Results
One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors’ role in PBL tutorials, majority of the participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred a member role in the PBL tutorials and 80 percent of participants preferred both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase.
Conclusion
Majority of the participants believed that PBL had a positive impact on the development of their cognitive, personal and teamwork skills. The view of the students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials.
PMCID: PMC4166984  PMID: 25246879
Problem Based Learning; Teaching; Undergraduate Medical Education
14.  The Use of Soft Tissue Diode Laser in the Treatment of Oral Hyper Pigmentation 
Objective
To evaluate the clinical effectiveness and patients’ acceptance of soft tissue diode laser, for the elimination of hyper pigmented areas of the gingivae and buccal mucosa.
Subjects and methods
Twenty patients complaining of dark localized areas in their gingivae of upper and lower jaws, or in cheek mucosa were included in this study. All are females ages ranged from 18–37 with average of 27.5 years. The patients were all not pregnant, and free from any systemic diseases, and had no other areas of hyperpigmentation.
Results
Most of the patients (18 Pts.) required two treatment sessions to remove the melanotic lesions satisfactorily. The patients were seen after one, two, and three weeks respectively. Eight patients (40%) had a good response after one week, Ten patients (50%) had a very good response after two weeks, while only two patients (10%) had a bad result and required a third treatment session after two weeks. At the third week postoperatively in the successful cases, restoration of the normal gingival and mucosal texture and color was achieved with optimal esthetic results. Most of the patients had no postoperative discomfort including: pain, edema and disfigurement.
Conclusion
The soft tissue diode laser can be considered as a reliable mean for elimination of melanotic lesions of the gingivae or buccal mucosa, and is well tolerated by the patients.
PMCID: PMC4166985  PMID: 25246880
hyperpigmentation; soft tissue diode laser; patient response
15.  Basic life support knowledge of healthcare students and professionals in the Qassim University 
Objective
To evaluate the knowledge of basic life support (BLS) among students and health providers in Medicine, Pharmacy, Dentistry, and Allied Health Science Colleges at Qassim University.
Methodology
A cross sectional study was performed using an online BLS survey that was completed by 139 individuals.
Results
Ninety-three responders were medical students, 7 were medical interns, 6 were dental students, 7 were pharmacy students, 11 were medical science students and 15 were clinical practitioners. No responder scored 100% on the BLS survey. Only two out of the 139 responders (1.4%) scored 90–99%. Both of these individuals were fifth year medical students. Six responders (4.3%) scored 80–89%. Of these, 5 were fifth year medical students, and one was fourth-year medical student. Eleven responders (7.9%) scored 70–79%. Of these, eight were fifth year medical students, two were medical interns and one was a pharmacist. Twenty-three responders (16.5%) scored 60–69%. Of these, 11 were fifth year medical students, 1 was a fourth-year medical student, 3 were medical interns, 2 were medical science students, 1 was a dentistry student, and 5 were pharmacists. Twenty-eight responders (20.1%) scored 50–59%. Of these, 11 were fifth year medical students, 3 were fourth-year medical students, 1 was a third-year medical student, 1 was a second-year medical student, 2 were first-year medical students, 1 was a pharmacy student, 3 were dental students, 1 was a allied health science student, 2 were doctors, and 3 were pharmacists. The remaining 69 responders (49.6%) scored less than 50%.
Conclusion
Knowledge of BLS among medicine, pharmacy, dentistry, and allied health science students and health providers at Qassim University is poor and needs to be improved. We suggest that inclusion of a BLS course in the undergraduate curriculum with regular reassessment would increase awareness and application of this valuable life-saving skill set.
PMCID: PMC4166986  PMID: 25246881
16.  Relation between HLA typing and clinical presentations in Systemic Lupus Erythematosus patients in Al-Qassim region, Saudi Arabia 
Background
Systemic lupus erythematosus (SLE) is a disease with diverse clinical presentations due to interaction between genetic and environmental factors. SLE is associated worldwide with polymorphisms at various loci, including the major histocompatibility complex (MHC), although inconsistencies exist among these studies.
Aims
This study was carried out to investigate, the association of HLA-DRB1, DRB3, DRB4, DRB5, and DQB1 alleles in SLE patients and clinical presentations at Qassim, Saudi Arabia.
Methods
Fifty one patients with SLE—84.3% of whom had kidney involvement were studied in a case control study for HLA-DRB1, DRB3, DRB4, DRB5, and DQB1.
Results
It was found that DRB3 is a protective gene among Saudi’s against SLE, HLA DRB3, HLA DRB1*11 frequency was increased in patients with serositis with a p value of (0.004), (0.047) respectively, increased frequency of HLA DQB1*3 among SLE patients with skin manifestations with a p value of (0.041), the frequency of HLA DRB1*15 alleles was increased among SLE patients with nephritis with a p value of (0.029), the frequency of HLA DRB1*11 among those with hematological manifestations with a p value of (0.03) and the frequency DRB1*10 was found to be increased among SLE patients with neurological manifestations with a p value of (0.002)
Conclusion
In contradistinction to what have been found among other populations DRB3 is a protective gene among Saudi’s against SLE. No evidence for a role of the HLA-DRB1, DRB4, DRB5, DQB1 alleles. There was an increased HLA DRB3 frequency with serositis, DQB1*3 skin manifestations, HLA DRB1*15 with nephritis, DRB1*10 with hematological manifestations and DRB1*11 with neurological manifestations.
PMCID: PMC4166988  PMID: 25246883
SLE; HLA; Saudi; disease clinical expression; lupus
17.  Newborn care knowledge and practices among mothers attending pediatric outpatient clinic of a hospital in Karachi, Pakistan 
Objectives
To assess newborn care knowledge and practices among mothers.
Methodology
A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 170 mothers accompanying their infants attending the Paediatric Out Patient Department were interviewed through a structured questionnaire. Areas of inquiry included Antenatal care seeking, delivery care, cord care, eye care, bathing and breastfeeding practices.
Results
Ninety-two percent mothers reported at least one antenatal care visit. Tetanus Toxoid coverage was 88%. Home deliveries were 18%. Seventy-four percent reported applying various substances like coconut oil, mustard oil, purified butter and turmeric to the cord stump. Kohl application to newborn’s eyes was 68%, while 86% reported first bath within 24 hrs of birth. 48% mothers initiated breastfeeding within 2 hours of delivery. Colostrum was discarded by 43% and prelacteal feeds given by 73%. Exclusive Breast Feeding rate was 26%.
Family income of Rs. 10, 000 (USD120) or less/month and maternal education level of primary or less were significantly associated with home delivery, unhygienic cord care and kohl application to the newborn’s eyes.
Home delivery was a risk factor for poor cord care (OR=4.07) and discarding colostrum (OR= 3.18).
Conclusion
Antenatal care coverage was good, but knowledge regarding newborn care was poor. Harmful practices regarding newborn care were prevalent among mothers. Institutional deliveries did not guarantee optimal practices. Tradition and culture played a significant role. Health education can improve the mothers’ knowledge regarding newborn care practices.
PMCID: PMC4166989  PMID: 25246884
Newborn; Home Delivery; Cord Care; Exclusive Breastfeeding; Prelacteals
18.  The Role of Educational Level in Glycemic Control among Patients with Type II Diabetes Mellitus 
Objectives
To evaluate the impact of the educational level on glycemic control among patients with type II diabetes mellitus.
Methods
A disproportional systematic stratified sample of 384 patients, based on educational level, was selected from patients of type II diabetes attending the Primary Care Clinic of King Khalid University Hospital, over a period of 6 months in 2012–2013. A questionnaire sought information about socio-demographic factors, clinical characteristics, awareness of diabetic complications and self-care management behaviors. Weight and height were measured. Poor glycemic control was defined as HbA1c ≥7%.
Result
The rate of patients who had poor glycemic control is 67.7%. The educational level had no impact on glycemic control, but the patients of high educational level had better awareness of the complications and a high rate of adherence to diet. About 70.5% of patients were aware of two or more diabetic complications. The factors associated with poor control included increased duration of diabetes, use of insulin and oral hypoglycemic agents combination, being obese or overweight, poor adherence to diet, poor adherence to exercise and poor compliance with follow up. This study found a high rate of poor adherence to diet (68%) and poor adherence to exercise (79.4%).
Conclusion
The proportion of patients with poor glycemic control was high in this study. This study showed that educational level may not be a good predictor of better therapeutic compliance. In-spite of the significant importance of appropriate diet and exercise in the control of diabetes, there was a high rate of poor adherence to diet and to exercise, especially among females. Educational programs that emphasize adherence to treatment regimens as a whole, especially to diet, to exercise and to regular follow up are of greater benefit in glycemic control as compared to compliance of medications alone.
PMCID: PMC4166990  PMID: 25246885
Primary care clinic; diabetes mellitus type 2; educational level; awareness of diabetic complications; glycemic control
19.  False positive Hepatitis B Surface Antigen due to recent vaccination 
Objective
Hepatitis B is the most common viral hepatitis, potentially life threatening, with long term complications. Currently, vaccine is the most effective tool against hepatitis B infection. It is worthwhile mentioning that due to rampant use of hepatitis B vaccine (HBV), there have been concerns about hepatitis B surface antigen (HBsAg) reactivity. This article aims to report the false positive results of HBsAg due to recent HBV among healthy male adults.
Subjects and Methods
The subjects were selected from a Community Health Center, under the umbrella of a tertiary care hospital, Saudi Arabia. The data was retrieved from electronic medical records maintained at the clinic.
Results
A total of 130 employees were recruited, only 117 records could be retrieved from the system. The mean age of participants was 31.34 ± 12.73 years. The administration of HBV and HBsAg test was performed simultaneously. The lab reported three cases of HBsAg positivity, a false positive result of 2.56%. Repeat testing after one week for HBsAg was negative for the three cases.
Conclusion
This study confirmed that HBsAg reactivity might be seen in regular screening programs for healthy adults.
PMCID: PMC4166991  PMID: 25246886
20.  Turner Syndrome Genotype and phenotype and their effect on presenting features and timing of Diagnosis 
Background
Turner syndrome (TS) is a common genetic disorder caused by abnormalities of the X chromosome. We aimed to describe the phenotypic characteristics of TS patients and evaluate their association with presenting clinical characteristics and time at diagnosis.
Methods
We studied females diagnosed with TS at King Abdul Aziz Medical City (KAMC), Riyadh between 1983 and 2010. Patients were classified based upon karyotype into females with classical monosomy 45,X (group A) and females with other X chromosome abnormalities (mosaic 45,X/46,XX, Xqisochromosomes, Xp or Xq deletion) (group B). Clinical features of the two groups were analyzed.
Results
Of the 52 patients included in the study, 16(30.8%) were diagnosed with classical monosomy 45,X and the rest with other X chromosome abnormalities. Only 19(36.5%) patients were diagnosed in infancy and the remaining during childhood or later (odds ratio (OR) = 4.5,95%CI 1.27–15.90, p=0.02). Short stature was universal in group A versus 77.8% in group B. All patients in group A had primary amenorrhea compared with 63.2% of those in group B (P = 0.04); the rest of group B had secondary amenorrhea. Cardiovascular abnormalities were higher in group A (OR=3.50, 95%CI 0.99–12.29, p-value =0.05). Renal defects and recurrent otitis media were similar in both groups.
Conclusion
This study suggests that karyotype variations might affect the phenotype of TS; however, it may not reliably predict the clinical presentation. Chromosomal analysis for all suspected cases of TS should be promptly done at childhood in order to design an appropriate management plan early in life.
PMCID: PMC4166992  PMID: 25246887
Turner Syndrome; phenotype; genotype; Saudi Arabia
21.  Attitudes and Practices of Primary Care Physicians in the Management of Overweight and Obesity in Eastern Saudi Arabia 
Background
Obesity is a global world-wide health problem in both developing and developed countries. In Saudi Arabia, this problem becomes an alarming disease both during childhood and adulthood among males and females. Primary health care physicians are identified as the first line of defense and contributor to cost-effective for the management and prevention of the disease; they are expected to normalize the weights in the community.
Objective
The aim of this study was to determine attitudes and practice by physician working in primary health care centers regarding management of obesity in the cities of Dammam and Al-Khobar in the Eastern Province of Saudi Arabia.
Methods
This study is a cross-sectional study that took place from December 2009 to March 2010. A specially made questionnaire with a Cronbach alpha reliability of 0.86 and content validity by 5 experts was used to measure the attitudes and practices from several different aspects of care provided at primary health care centers to obesity were distributed and collected from 76 physicians working in primary health centers in Dammam and 73 in Al-Khobar in Saudi Arabia. One hundred thirty physicians responded (12.8% non-response rate) and became the sample.
Results
Eighty-three per cent of physicians has negative attitude toward the concept of obesity, and more than two-thirds of primary care physicians see themselves play a key role in the management of obesity; The mean attitude scores of studied nurses was ranged from 2.95±1.06 to 4.34 ±0.82 with an agreement that obesity is considered as a disease and the role of the primary health care physician is not only to refer obese patients to other specialized care as well as difficulties in counseling for weight reduction. However, the majority of physicians gave their obese patients advice on dietary habits and physical activities and also they are sometimes referred obese people to dieticians. Moreover, half of physicians provide educational materials as part of the management and above two third of the studied physicians never use medications in weight reduction. Only one third of them believe that they are well prepared for the treatment of obesity.
Conclusion
There exist gaps in attitudes contradictory for the management of obesity which indicates Physicians in Eastern Saudi Arabia showed a reasonable level of interest in participating in obesity prevention and management. Accordingly, they need for more education and training in management and prevention of obesity, and should continue education from medical school till post-graduate.
PMCID: PMC4166987  PMID: 25246882
obesity; attitude; primary health care; and practices
22.  Biological Functionalization of Dental Implants with Fibronectin: A Scanning Electron Microscopic Study 
Objectives
Early stages of peri-implant bone formation play an essential role in the osseointegration and long-term success of dental implants. Biological implant surface coatings are an emerging technology to enhance the attachment of the implant to the surrounding bone and stimulate bone regeneration. The purpose of this study was to determine the effect of coating the implant surface with fibronectin on osseointegration.
Material and methods
The experiment was conducted on a total of twelve New Zealand white mature male rabbits, weight between 2.5–4 kg. Twenty four pure titanium implants were used in this study. Each rabbits received two implants, one implant in each tibia; the implant in the right limb was coated with fibronectin (experimental group), whilst on the contralateral side the implants were placed without coating (control group). Six rabbits were sacrificed for Scanning Electron Microscopic evaluation after 4 and 8 week healing periods.
Results
The results of the present study demonstrating the mean gap distance between the bone and implant was greater in the control group compared to fibronection group at both observation periods however, the difference between these two groups was not statistically significant.
Conclusion
Thus, it could be suggested that the biological functionalization of dental implants with fibronectin, may influence the integration or biocompatibility and bonding of the implant to the surrounding bone.
PMCID: PMC4039585  PMID: 24899880
Dental implant; Osseointegration; Biofunctionalization; Extracellular matrix; Fibronectin
23.  Surveillance of antimicrobial resistance among clinical isolates recovered from a tertiary care hospital in Al Qassim, Saudi Arabia 
Background
The emergences of antimicrobial-resistances have become an important issue in global healthcares. Limitations in surveying hinder the actual estimates of resistance in many countries.
The aim
the present study was designed to retrospectically survey antimicrobial susceptibility for resistance profiling of dominant pathogens in a tertiary-care center in Buraidah, Saudi Arabia from January-2011 to December-2011.
Materials and Methods
the design was cross-sectional and spanned records of a 1000 bacterial non-related isolates. Antibiograms were based on the 2012 Clinical and Laboratory Standards Institute guidelines.
Results
showed that Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Escherichia coli, were the most resistant. All isolates of S. aureus, S. epidermidis, and Staphylococcus haemolyticus, were resistant to penicillin (100%), and oxacillin with 52%, 75%, and 82%, respectively. Interestingly, an increasing trend of resistance-pattern was seen for the three species against gentamicin 26%, 50%, 68% ciprofloxacin 22%, 50%, 68%, tetracycline 30%, 44%, 27%, erythromycin 26%, 64%, 73%, and clindamycin 20%, 47%, 50% suggesting potential between-species transfer of resistances. Acinetobacter baumannii was resistances to all antibiotics tested including ciprofloxacin (90%), ceftazidime (89%), cefepime (67%), Trimethoprim/sulfamethoxazole (66%), amikacin (63%), gentamicin (51%), tetracycline (43%), piperacillin-tazobactam (42%), and imipenem (9%). A similar pattern was seen by P. aeruginosa. Furthermore, a typical pattern of resistance in K. pneumoniae carbapenemase–producing organisms was observed.
Conclusion
we have shown staphylococci, Acinetobacter baumannii, Pseudomonas aeruginosa, and enteric bacteria were the most resistant species in this region.
PMCID: PMC4039578  PMID: 24899874
Antimicrobial-Resistance; nosocomial-pathogens; AST-surveillance program; infection control
25.  Fever of Unknown Origin in Children: A 6 year- Experience in a Tertiary Pediatric Egyptian Hospital 
Background
Fever of unknown origin (FUO) is among the most conditions which poses challenge in diagnosis. The presence of information on regional patterns of FUO will shorten the time for diagnosis and reduces health services costs. There are almost no previous studies describing the etiology of FUO in children of Egypt or nearby countries.
Aim of the Study
To determine different causes of FUO and the possible diagnostic procedures.
Methods
Data of patients with FUO, presented to the Infectious Diseases Unit of Mansoura University Children Hospital, were retrospectively collected in a 6 year-period from May 2006 to May 2011. The study included children with a fever of 38.3° C or more documented by a health care provider and for which the cause could not be identified after 3 weeks of evaluation as an outpatient or after a week of evaluation in hospital. Patients were then categorized into 5 groups.
Results
127 patients met the diagnostic criteria. Infectious diseases were the commonest causes of FUO in 46 cases (36.22%) followed by the miscellaneous causes in 38 cases (29.9%). Meanwhile, collagen vascular diseases and malignancy were diagnosed in 13 cases (10.2%) and 10 cases (7.87%) respectively. While, 20 cases (15.75%) remained undiagnosed.
Conclusions
Infectious diseases are the commonest cause of FUO. The delay in diagnosis was due to atypical presentations or inappropriate use of antibiotic prior to the referral. Non infectious causes, malignancy and collagen or vascular disorders were diagnosed in rest of the patients. However, about 15% of our patients remained undiagnosed. The diagnosis was established by non-invasive means in more than two-third of the cases.
PMCID: PMC4039580  PMID: 24899875

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